This document summarizes information about Zika virus infection in pregnancy from several sources:
- Zika virus is transmitted by Aedes mosquitoes and was first isolated in Uganda in 1947. Recent outbreaks have occurred in French Polynesia, Brazil and other parts of the Americas.
- Brazil reported an increase in infants born with microcephaly in 2015 which was linked to Zika virus infection during pregnancy after the virus was detected in amniotic fluid and brain tissue of affected fetuses and infants.
- The CDC provides testing and screening guidelines for pregnant women with travel history or residence in areas with Zika virus transmission to monitor infections and potential fetal impact.
Zika virus disease is a mosquito-borne viral infection that primarily occurs in tropical and subtropical areas of the world.
It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: mosquitoes (gut, blood, saliva )
human ( blood, prostate, semen and testes )
Data Integrity in Decentralized Clinical Trials (DCTs)InsideScientific
Experts expand on the need for a comprehensive understanding of all sources of data in DCTs, and the need to evaluate those data centrally in real time to mitigate the risks associated with their capture (including data capture at the edge of the network (wearables)).
Every disruptive innovation must be complemented by adapted procedures, and this also applies to decentralized clinical trials (DCTs). Traditionally, sites entered clinical trial data in an Electronic Data Capture (EDC) system and these source data were verified at the site to confirm accuracy. Risk based monitoring focused on site level metrics such as screen failure rates, query rates, Serious Adverse Events (SAEs) reported, missed/late visits, etc. With DCTs, as source data are collected directly from participants this is no longer an option and a different approach is required to ensure the quality and integrity of the data. As a rule, a comprehensive understanding of all sources for data capture in a clinical trial and the process for centralization is essential. Also, it is important to evaluate the data collected in real time to allow early interventions that will ensure data integrity for regulatory submission.
In this webinar, Chitra Lele describes how centralized monitoring strategies can help aggregate and analyze data in real time and provide insights to a variety of functional teams across the trial continuum. Daniel Gutierrez describes how the Clinerion platform can boost data integrity in DCTs. The technology transforms global data sources to one query-able data model for structured medical data, while ensuring that the data keep its full resolution and integrity during aggregated queries.
Pierre Etienne talks about the expanding role of mobile Health Care Professionals (HCPs) and their crucial role in protecting data integrity. Clifton Chow finishes with a comparison of several artificial intelligence (AI) based binary classifiers for detecting the integrity of data obtained from Internet of Things (IoT) enabled wearable sensors.
Introduction to Oracle Clinical Overview in Clinical Data Management in Clinical Trials of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Zika virus disease is a mosquito-borne viral infection that primarily occurs in tropical and subtropical areas of the world.
It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: mosquitoes (gut, blood, saliva )
human ( blood, prostate, semen and testes )
Data Integrity in Decentralized Clinical Trials (DCTs)InsideScientific
Experts expand on the need for a comprehensive understanding of all sources of data in DCTs, and the need to evaluate those data centrally in real time to mitigate the risks associated with their capture (including data capture at the edge of the network (wearables)).
Every disruptive innovation must be complemented by adapted procedures, and this also applies to decentralized clinical trials (DCTs). Traditionally, sites entered clinical trial data in an Electronic Data Capture (EDC) system and these source data were verified at the site to confirm accuracy. Risk based monitoring focused on site level metrics such as screen failure rates, query rates, Serious Adverse Events (SAEs) reported, missed/late visits, etc. With DCTs, as source data are collected directly from participants this is no longer an option and a different approach is required to ensure the quality and integrity of the data. As a rule, a comprehensive understanding of all sources for data capture in a clinical trial and the process for centralization is essential. Also, it is important to evaluate the data collected in real time to allow early interventions that will ensure data integrity for regulatory submission.
In this webinar, Chitra Lele describes how centralized monitoring strategies can help aggregate and analyze data in real time and provide insights to a variety of functional teams across the trial continuum. Daniel Gutierrez describes how the Clinerion platform can boost data integrity in DCTs. The technology transforms global data sources to one query-able data model for structured medical data, while ensuring that the data keep its full resolution and integrity during aggregated queries.
Pierre Etienne talks about the expanding role of mobile Health Care Professionals (HCPs) and their crucial role in protecting data integrity. Clifton Chow finishes with a comparison of several artificial intelligence (AI) based binary classifiers for detecting the integrity of data obtained from Internet of Things (IoT) enabled wearable sensors.
Introduction to Oracle Clinical Overview in Clinical Data Management in Clinical Trials of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Database Designing in Clinical Data ManagementClinosolIndia
When designing a Clinical Data Management (CDM) database, several key considerations should be taken into account to ensure efficient data capture, storage, and retrieval. Here are some important aspects to consider in CDM database design:
Define Study Requirements:
Understand the specific requirements of the study and the data to be collected. This includes variables, data types, formats, and any specific rules or calculations required for data validation and derivation. Consult with the study team and stakeholders to determine the necessary data elements.
Data Model Design:
Develop a data model that represents the structure and relationships of the data. Use standard data models, such as CDISC (Clinical Data Interchange Standards Consortium) standards, as a foundation. Define entities (e.g., patients, visits, assessments) and attributes (e.g., demographics, lab results) and establish relationships between them.
Data Dictionary:
Create a comprehensive data dictionary that provides a detailed description of each data element, including its name, definition, data type, length, format, allowable values, and any validation or derivation rules. The data dictionary serves as a reference for data entry and validation checks.
Database Schema:
Design the database schema based on the data model and data dictionary. Identify the tables, fields, and relationships needed to store the data. Determine primary and foreign keys to establish relationships between tables. Normalize the schema to reduce redundancy and improve data integrity.
Data Capture Forms:
Design user-friendly data capture forms to facilitate efficient and accurate data entry. Align the form layout with the data model and data dictionary. Include necessary data validation checks and provide clear instructions or prompts for data entry.
Data Validation and Quality Checks:
Incorporate data validation checks to ensure data accuracy and completeness. Implement range checks, format checks, consistency checks, and logic checks to identify and prevent data entry errors. Include data quality control processes to identify and resolve data discrepancies or anomalies.
Security and Access Controls:
Implement appropriate security measures to protect the confidentiality, integrity, and availability of the data. Define user roles and access levels to control data access and modification. Employ encryption, authentication, and audit trails to ensure data security and compliance with regulatory requirements.
Data Extraction and Reporting:
Consider the need for data extraction and reporting capabilities. Design mechanisms to extract data from the database for analysis or reporting purposes. Implement data export functionalities in commonly used formats, such as CSV or Excel, or integrate with reporting tools or systems.
Introduction to Clinical Research RegulationsClinosolIndia
Clinical research plays a vital role in advancing medical knowledge, developing new treatments, and improving patient care. However, conducting clinical trials involves numerous ethical and regulatory considerations to ensure participant safety, data integrity, and compliance with applicable laws and guidelines.
Appalla Venkataprabhakar and I presented this at the Oracle\'s Annual Clinical Development and Safety Conference 2010 at Hyderabad, India on 6th October 2010.
• As defined by the ICH E6 GCP, an inspection is the act by a regulatory authority
of conducting an official review of documents, facilities, records, and any other
resources that are deemed by the authority to be related to the clinical trial and
that may be located at the trial site, at the sponsors and/or CRO’s facilities, or at
other establishments deemed appropriate by the regulatory authority.
• All clinical trials including bioavailability and bioequivalence studies, be
designed, conducted, recorded and reported in accordance with the ethical
principles that have their origin in the Declaration of Helsinki, and that are
consistent with ICH GCP and the applicable regulatory requirements.
Three years ago, the Zika virus was nowhere to be found in the Western Hemisphere. But in 2015, Brazil suddenly found itself in the throes of an unprecedented Zika outbreak — with more than a million people infected by the mosquito-transmitted disease
Social Media Prescription for PhysiciansHelen Madamba
A non-me dical topic given as a lecture to physicians in Zamboanga City. We encourage healthcare professionals to have a presence on social media. We need to be where our patients are, and as of today, they are on social media. Patients turn to social media for information. It is the responsibility of healthcare professionals to ensure that the health information on social media is accurate, reliable and ethical.
Database Designing in Clinical Data ManagementClinosolIndia
When designing a Clinical Data Management (CDM) database, several key considerations should be taken into account to ensure efficient data capture, storage, and retrieval. Here are some important aspects to consider in CDM database design:
Define Study Requirements:
Understand the specific requirements of the study and the data to be collected. This includes variables, data types, formats, and any specific rules or calculations required for data validation and derivation. Consult with the study team and stakeholders to determine the necessary data elements.
Data Model Design:
Develop a data model that represents the structure and relationships of the data. Use standard data models, such as CDISC (Clinical Data Interchange Standards Consortium) standards, as a foundation. Define entities (e.g., patients, visits, assessments) and attributes (e.g., demographics, lab results) and establish relationships between them.
Data Dictionary:
Create a comprehensive data dictionary that provides a detailed description of each data element, including its name, definition, data type, length, format, allowable values, and any validation or derivation rules. The data dictionary serves as a reference for data entry and validation checks.
Database Schema:
Design the database schema based on the data model and data dictionary. Identify the tables, fields, and relationships needed to store the data. Determine primary and foreign keys to establish relationships between tables. Normalize the schema to reduce redundancy and improve data integrity.
Data Capture Forms:
Design user-friendly data capture forms to facilitate efficient and accurate data entry. Align the form layout with the data model and data dictionary. Include necessary data validation checks and provide clear instructions or prompts for data entry.
Data Validation and Quality Checks:
Incorporate data validation checks to ensure data accuracy and completeness. Implement range checks, format checks, consistency checks, and logic checks to identify and prevent data entry errors. Include data quality control processes to identify and resolve data discrepancies or anomalies.
Security and Access Controls:
Implement appropriate security measures to protect the confidentiality, integrity, and availability of the data. Define user roles and access levels to control data access and modification. Employ encryption, authentication, and audit trails to ensure data security and compliance with regulatory requirements.
Data Extraction and Reporting:
Consider the need for data extraction and reporting capabilities. Design mechanisms to extract data from the database for analysis or reporting purposes. Implement data export functionalities in commonly used formats, such as CSV or Excel, or integrate with reporting tools or systems.
Introduction to Clinical Research RegulationsClinosolIndia
Clinical research plays a vital role in advancing medical knowledge, developing new treatments, and improving patient care. However, conducting clinical trials involves numerous ethical and regulatory considerations to ensure participant safety, data integrity, and compliance with applicable laws and guidelines.
Appalla Venkataprabhakar and I presented this at the Oracle\'s Annual Clinical Development and Safety Conference 2010 at Hyderabad, India on 6th October 2010.
• As defined by the ICH E6 GCP, an inspection is the act by a regulatory authority
of conducting an official review of documents, facilities, records, and any other
resources that are deemed by the authority to be related to the clinical trial and
that may be located at the trial site, at the sponsors and/or CRO’s facilities, or at
other establishments deemed appropriate by the regulatory authority.
• All clinical trials including bioavailability and bioequivalence studies, be
designed, conducted, recorded and reported in accordance with the ethical
principles that have their origin in the Declaration of Helsinki, and that are
consistent with ICH GCP and the applicable regulatory requirements.
Three years ago, the Zika virus was nowhere to be found in the Western Hemisphere. But in 2015, Brazil suddenly found itself in the throes of an unprecedented Zika outbreak — with more than a million people infected by the mosquito-transmitted disease
Social Media Prescription for PhysiciansHelen Madamba
A non-me dical topic given as a lecture to physicians in Zamboanga City. We encourage healthcare professionals to have a presence on social media. We need to be where our patients are, and as of today, they are on social media. Patients turn to social media for information. It is the responsibility of healthcare professionals to ensure that the health information on social media is accurate, reliable and ethical.
I was fortunate to be accepted as an Arthur Ashe fellow to observe HIV Care in New York City, USA for a whole month last October 2016. Here I share my observations on how HIV+ patients are managed, and how our own HACT in Cebu has a long way to go to stop the Philippine HIV/AIDS epidemic.
11th CIM Medical World Congress Zika, Sick ka?Helen Madamba
This is a lecture given during the 11th Cebu Institute of Medicine Medical World Congress at the Radisson Blu entitled "ZIKA, Sick ka?" as updates on the zika virus epidemic in the Philippines.
Superbug infections are resistant to most antibiotics, and are therefore difficult to treat. Symptoms of superbug infections vary by infection type, and should be treated by a physician immediately. This article explores three of the most common superbugs, their symptoms, and explains the precautions you should take to protect yourself from potential infection.
Shaping the Caribbean's response to Zika, UWI’s Zika Task Force (www.uwi.edu/zika) is gathering and providing expert advice to develop a strategic, scientific approach for tackling the Zika virus.
Advisor Live: Zika virus disease – What you need to knowPremier Inc.
Presented as part of Premier’s AdvisorLive® series and co-sponsored by the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC)
This webinar covers:
* Updates and late breaking information on Zika virus outbreak, lab diagnosis and travel,
* Issues for reproductive age and pregnant women, including evaluation, management, counseling, and congenital findings, and
* Implications and risks for healthcare personnel.
EXPERT PRESENTERS:
* Joanne Cono, MD, ScM, Director, Office of Science Quality, Office of the Director, Centers for Disease Control and Prevention (CDC)
* Jeanne S. Sheffield, MD, Director of Maternal-Fetal Medicine and Professor, Johns Hopkins Medicine
* Moderator: Gina Pugliese, RN, MS, Vice President, Premier Safety Institute
This is a lecture given to medical students of Cebu Institute of Medicine under the reproductive module. It contains a discussion of principles of HIV infection screening, diagnosis, staging and management, especially during pregnancy.
Zika and Dengue: Creating Partnerships to Interrupt Transmission (Honein)Rotary International
Zika, a mosquito-borne virus, can be passed from a pregnant
woman to her fetus, potentially causing microcephaly and
other devastating defects. Environmental factors may
contribute to the spread of the viruses that cause Zika,
dengue, and other tropical diseases, as a changing climate
may allow their mosquito carriers to flourish. Though
no vaccines exist for Zika or dengue, Rotary clubs can
implement service projects to provide education, clean up
mosquito habitats, promote prevention, and implement
an exciting new method to interrupt mosquitoes’ ability to
transmit these viruses.
The meaning of meningococcal carriage - Slideset by Professor Adam FinnWAidid
Professor Finn on the risks of meningococcal
disease. The slideset face the effects of vaccines, the speculation about meningococcal infection and respiratory viruses, so as the epidemiology & evolving vaccine
strategies in Europe and Africa.
The world’s biggest multi-sport event summer Olympics Games 2016 officially known as the Games of the XXXI Olympiad, and commonly known as Rio 2016 due to take place Rio de Janeiro, Brazil, from 5th to 21st August, 2016. More than 10,500 athletes from 206 National Olympic committees (NOCs) will take part.[1] These sporting events will take place at 33 venues in the host city Rio de Janeiro and at least 5 venues in the cities of Säo Paulo, Belo Horizonte, Salvador, Manaus and Brazil’s capital Brasilia. International Olympic Committee (IOC) have predicted around 4,80,000 tourists will arrive at Rio de Janeiro for this mega event.[2] Similar to the other tropical countries the tourists will be at risk of acquiring gastrointestinal illnesses and vector-borne infections.
Neurological and Autoimmune Complications of Zika Virus infection - Slideset ...WAidid
The slideset by Professor Safadi analyses the case control study providing evidence for Zika virus infection causing Guillain-Barré syndrome.
In addition to Zika Virus association with Guillain-Barré syndrome, the slides show new data from endemic areas suggesting that ZIKV may be linked to other neurological outcomes.
The Role of Maternal Immunization in Reducing Infections in InfantsHelen Madamba
A lecture provided for the Immunization for Filipino Women committee of the Philippine Obstetrical and Gynecological Society, Inc (POGS) and the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) to encourage vaccination for pregnant women in the Philippines
COVID-19 and COVID-19 Vaccination in PregnancyHelen Madamba
As an update to the management of COVID-19 in Pregnancy based on the PIDSOG Handbook, we have the POGS Practice Bulletin on COVID19 Vaccination for Pregnant and Breastfeeding Women. Vaccines work!
A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
This is a lecture for medical students of the Cebu Institute of Medicine as an orientation on the prevalence of HIV infection in the Philippines, the basic knowledge on HIV and the program on prevention of mother to child transmission of HIV.
During the time of COVID-19 use of social media in medicine is as relevant than ever and should be maximized by healthcare professionals as a public health tool for health education and promotion to ensure the impact on healthcare is a positive one.
Use of social media for public health promotionHelen Madamba
A short talk with medical technology students of the Velez College for the seminar on "Cyber Etiquette: A Social Responsibility on Health Promotion for the Society" February 15, 2020 from 1pm to 5pm.
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
As part of the 5th Philippine Healthcare Social Media Summit 2019 #HCSMPH2019 at the Waterfront Hotel in Cebu City, Track B involved choosing platforms for social media depending on one's purpose and based on the target audience.
This is one of the lectures for the POGS Research Forum in Bacolod, mostly based on the chapter on Clinical Practice Guidelines for Ethics Review from the POGS Research Handbook: The Essentials. I hope this can be a guide for residents who are preparing their research proposal for ethical review.
This is a plenary lecture given during the CVCHRD Research and Innovation Conference at CIT-U in Cebu City with the theme "Research innovations for Improved Health and Wellness"
Emerging Issues for Social Workers in dealing with PLHIVsHelen Madamba
This was a talk for ALSWDOPI 2019 at Waterfront Hotel where LGU social workers are challenged to become the government employees who are catalysts of change that the Philippine society needs to address the Philippine HIV epidemic.
These were slides I was not able to use during the lecture I gave for the weekend POGS research workshop because of a mix up in assigned topics. Nevertheless, I think OBGYN residents may find these slides useful in crafting their research proposals.
As a speech during the Public Health Forum 2018, this is a collection of inspirational post from my facebook newsfeed. Talking about how to be a clinical specialist involved in public health, the emphasis is in finding your passion, something you would be willing to do even if you were not paid for it.
This focuses on the Consensus Recommendations on the Prevention and Management of Surgical Site Infections in the Philippine Setting by Saguil, Bermudez, Antonio and Cochon, PJSS 2017.
Public Health Forum - Social Media in Medicine: Etiquettes for the Modern DoctorHelen Madamba
This lecture introduces reasons why healthcare providers should be on social media and the limits of what we should and shouldn't post on social media, remembering that people are on the other end of the public health conversation.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
3. Zika virus
• Zika virus, a flavivirus
transmitted by Aedes
mosquitoes.
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
4. CLINICAL ILLNESS
CONSISTENT WITH ZIKA
VIRUS DISEASE
• Two or more of the following
signs or symptoms:
– Acute onset of fever
– Maculopapular rash
– Arthralgia
– Conjunctivitis
@helenvmadamba POGS CEBU 2016
5. • Zika virus (ZIKV), a mosquito-borne
flavivirus, was first isolated from a rhesus
monkey in Uganda in 1947.
Hayes EB 2009 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
6. • ZIKV was isolated from humans in Nigeria
during studies conducted in 1968 and during
1971-1975.
Hayes EB 2009 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
7. • From 1951 through 1981, serologic
evidence of human ZIKV infection reported
• African countries such as Uganda,
Tanzania, Egypt, Central African Republic,
Sierra Leone, and Gabon
• Parts of Asia including India, Malaysia,
Philippines, Thailand, Vietnam, and
Indonesia
Hayes EB 2009 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016@helenvmadamba POGS CEBU 2016
8. • Discovery of ZIKV on the
physically isolated community
of Yap island is testimony to
the potential for travel or
commerce to spread the virus
across large distances.
Hayes EB 2009 at http://wwwnc.cdc.gov/eid
• The outbreak on Yap island, Micronesia in
2007 shows that ZIKV illness has been
detected outside of Africa and Asia.
@helenvmadamba POGS CEBU 2016
9. Since January 2012, the Pacific Region has
experienced 28 new documented outbreaks and
circulation of dengue, chikungunya and Zika virus.
Roth A et.al. 2016 at http://www.eurosurveillance.org
@helenvmadamba POGS CEBU 2016
10. Map of newly reported dengue, chikungunya and Zika virus infection
outbreaks or new virus circulation, Pacific Region,
January 2012–17 September 2014 (n=28)
Roth A et.al. 2016 at http://www.eurosurveillance.org
@helenvmadamba POGS CEBU 2016
11. Map of the known distribution of Aedes (Stegomyia) mosquitoes, vectors
of dengue and possible vectors of chikungunya and
Zika viruses, Pacific Region as of beginning October 2014
Roth A et.al. 2016 at http://www.eurosurveillance.org
@helenvmadamba POGS CEBU 2016
12. • Largest ZIKV outbreak occurred in French
Polynesia during 2013-2014.
Musso 2016 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
13. Brazil strain = French Polynesia
• Imported cases from French
Polynesia
• Occurred among attendees of the
annual Tapati festival
• World Cup Soccer competition in
2014
• Va’a World Sprint Championship
canoe race in Rio de Janeiro
Musso 2016 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
15. MARCH 2012
• A prospective longitudinal cohort
study, which included active
surveillance for acute febrile
illness, was initiated in Cebu
City, Philippines.
– 270 acute febrile illnesses
– 267 samples for serologic testing
for evidence of influenza, dengue,
chikungunya, Japanese
encephalitis, and Zika virus
infections
Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
16. MAY 2012
• A 15-year old boy in Cebu City
• subjective fever, headache,
conjunctivitis, sore throat,
myalgias, stomach pain,
anorexia, nausea and vomiting,
but no rash
• The boy recovered fully by the 3-
week study follow up visit.
• ZIKV RNA was detected in the
patient’s serum sample
Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
17. • It is possible that the ZIKV strain
was introduced into the
Philippines before 2012 and
remained undetected.
Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
18. Why the fuss now?
• Rapid spread since its first detection
in May 2015 in Brazil to 22 other
countries and other territories in the
Americas
• Possible association with a significant
rise in the number of babies born with
microcephaly and neurological
disorders
• “Global Emergency” by the WHO
Petersen E et.al. 2016 at http://wwwnc.cdc.gov/eid
@helenvmadamba POGS CEBU 2016
20. In Brazil November 2014: great outbreak of a
new exanthematic disease characterized by
early onset exanthema, no or little fever,
arthraligia, articular edema and conjunctivitis
Zika virus confirmed through PCR in April 2015.
@helenvmadamba POGS CEBU 2016
21. On January 22, this report was posted as an MMWR
Early Release on the MMWR website
@helenvmadamba POGS CEBU 2016
22. September 2015
• Increase in the number of infants
born with microcephaly in Zika
virus-affected areas began to
emerge.
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
23. Microcephaly
• Head circumference ≥ 2
standard deviations [SD] below
the mean for sex and gestational
age at birth
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
24. October 2015
• The Ministry of Health (MoH) confirmed
an increase in birth prevalence of
microcephaly in northeast Brazil,
compared with previously reported
estimates (approx 0.5/10,000 LB)
• 58 cases in a single month from different
cities
• MICROCEPHALY REGISTRY in Brazil
established
Brito C. 2015 at http://www.actamedicaportuguesa.com
@helenvmadamba POGS CEBU 2016
25. Brazilian Society of
Medical Genetics
• Zika Embryopathy Task Force
(SBGM-ZETF) includes clinical
geneticists, obstetricians,
pediatricians, neurologists and
radiologists
• Objective: to review all incident cases
of microcephaly as well as infants
born to mothers with suspected Zika
virus infections during pregnancy
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
26. Brazil Ministry of Health
• Cohort of 35 infants with
microcephaly born August to
October 2015
– 35 mothers lived in or visited Zika
virus-affected areas during pregnancy
– 25 infants had severe micrcephaly
– 17 had at least one neurologic
abnormality
– 27 infants who had neuroimaging
studies, all had abnormalities
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
27. Brazil Ministry of Health
• Pregnant women should protect
themselves from mosquito bites:
– By using airconditioning, screens, or
nets when indoors
– Wearing long sleeves and pants
– Using permethrin-treated clothing and
gear
– Using insect repellants when
outdoors
r
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
28. Increase in microcephaly
associated with ZIKV
• Outbreak of many cases in short
space of time in different cities
high attack rates and rapid
dispersion transmitted by
arthropods
Brito C. 2015 at http://www.actamedicaportuguesa.com
@helenvmadamba POGS CEBU 2016
29. Increase in microcephaly
associated with ZIKV
• Microcephaly, periventricular and
cortical microcalcifications, vernix
cerebellar hypoplasia and
lisencephaly compatible with
congenital infections
Brito C. 2015 at http://www.actamedicaportuguesa.com
@helenvmadamba POGS CEBU 2016
30. Increase in microcephaly
associated with ZIKV
• Diseases associated with TORCH not
associated with large outbreaks
• Negative for TORCH infections
• 70% mothers reported compatible
features of Zika disease in first
trimester of pregnancy (during
outbreak)
Brito C. 2015 at http://www.actamedicaportuguesa.com
@helenvmadamba POGS CEBU 2016
31. Zika virus genome was detected in amniotic fluid
samples from two pregnant women in Brazil whose
fetuses had been diagnosed with microcephaly.
Calvet et al 2016 at http://www.thelancet.com
@helenvmadamba POGS CEBU 2016
32. Zika Viral RNA and antigens were detected in
brain tissues from infants with microcephaly and
placental tissues from early miscarriages.
Martines et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
35. On January 19, 2016 this report was posted as an MMWR
Early Release on the MMWR website
@helenvmadamba POGS CEBU 2016
36. Health care providers should ask
all pregnant women about recent
travel.
• (+) symptoms consistent with
Zika virus transmission with
ultrasound findings of fetal
microcephaly or intracranial
calcifications test for Zika
Petersen et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
37. • Testing is not indicated for
women without travel history to
an area with Zika virus
transmission.
Petersen et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
38. Pregnant women with laboratory
evidence of Zika virus infection
• serial ultrasound examination to
monitor fetal growth and
anatomy
• referral to maternal-fetal
medicine or infectious disease
specialist.
– There is no specific antiviral
treatment for Zika virus, supportive
care is recommended
Petersen et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
39. On January 26, 2016, this report was posted as an MMWR
Early Release on the MMWR website
@helenvmadamba POGS CEBU 2016
40. Zika virus testing
• Infants with microcephaly or
intracranial calcifications born to
women who traveled to or resided
in an area with Zika virus
transmission while pregnant
• Infants born to mothers with
positive or inconclusive test
results for Zika virus infection
Staples JE et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
41. Zika virus testing
• Molecular
• serologic
Staples JE et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
42. Zika virus testing
• As an arboviral disease, Zika
virus disease is a nationally
notifiable condition.
Staples JE et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
43. Staples JE et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
44. Staples JE et.al. 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
45. On February 5, 2015, this report was posted as an MMWR
Early Release on the MMWR website
@helenvmadamba POGS CEBU 2016
47. With clinical illness consistent
with Zika virus disease
• Reverse transcription-PCR
testing (RT-PCR)
• Immunoglobulin M (IgM)
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
48. Asymptomatic pregnant women
• Serologic testing for Zika virus
– Consider cross-reactivity among
dengue, yellow fever and West
Nile viruses
– Negative IgM obtained 2-12 weeks
after travel would suggest a recent
infection did not occur and could
obviate need for serial ultrasounds.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
50. Recommendation
• Includes recommendations for
screening, testing, and
management of pregnant
women and recommendations
for counseling women of
reproductive age (15–44 years)
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
52. • Pregnant women who reside in
areas with ongoing Zika virus
transmission have an ongoing
risk for infection throughout their
pregnancy and should be
evaluated for symptoms of Zika
virus disease.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
54. (+) clinical illness
• Testing by RT-
PCR on serum
collected
within 7 days
of symptom
onset
@helenvmadamba POGS CEBU 2016
55. Women who report clinical
illness consistent with Zika
virus disease
• A negative RT-PCR result from
serum collected 5-7 days after
symptom onset does not exclude
Zika virus infection
• Serologic testing should be
performed.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
56. • A false positive IgM result is
more likely among women
residing in areas with ongoing
Zika virus transmission than
among travelers because of a
higher likelihood of previous
exposure to a related flavivirus.
Serologic testing
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
57. (-) clinical illness
• Testing
recommended at
the initiation of
prenatal care with
follow-up testing
mid-second
trimester
– Local levels of Zika
virus transmission
– Laboratory
capacity
@helenvmadamba POGS CEBU 2016
58. Pregnant women with
negative Zika virus IgM
• Routine prenatal care
• Ultrasound should include
careful evaluation of the fetus for
brain anomalies, including
microcephaly and intracranial
calcifications (late second and
early third trimesters of
pregnancy)
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
59. Pregnant women with
positive or inconclusive
Zika virus IgM
• Referral to maternal-fetal
medicine specialist
• Serial fetal ultrasounds to
monitor fetal anatomy and
growth every 3-4 weeks
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
60. At the time of delivery
• histopathologic examination of
the placenta and umbilical cord,
• testing of frozen placental tissue
and cord tissue for Zika virus
RNA, and
• testing of cord serum
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
61. • To prevent human-to-mosquito-
to-human transmission, persons
infected with Zika, dengue, or
chikungunya virus should protect
themselves from mosquito
exposure during the first week of
illness.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
63. • Health care providers should
discuss reproductive life plans,
including pregnancy intention
and timing, with women of
reproductive age in the context
of the potential risks associated
with Zika virus infection.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
64. Pregnancy intentions
and timing
• Patient age
• Fertility
• Reproductive and medical history
• Values and preferences of the woman and
her partner
• Discussion of the signs and symptoms and
potential risks associated with Zika virus
infection
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
65. Strategies to prevent
unintended pregnancy
• Counseling on family planning
• Safety, effectiveness, availability,
acceptability considered when
selecting a contraceptive method
• Correct and consistent use of
condoms reduces the risk for
sexually transmitted infections
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
66. • Women of reproductive age with
current or previous laboratory-
confirmed Zika virus infection
should be counseled that there
is no evidence that prior Zika
virus infection poses a risk for
birth defects in future
pregnancies.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
67. • Viremia is expected to last
approximately one week in
patients with clinical illness.
• There is no current evidence to
suggest that a fetus conceived
after maternal viremia has
resolved would be at risk for fetal
infection.
Oduyebo et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
68. On February 5, 2015, this report was posted as an MMWR
Early Release on the MMWR website
@helenvmadamba POGS CEBU 2016
69. Sexual transmission of Zika
virus is possible
• From man to woman in
Colorado, USA
• From man to woman in Dallas
County Health and Human
Services
• Replication-competent Zika virus
isolated from semen
Oster AM et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
70. • Clinical and serologic evidence indicate that 2
American scientists contracted Zika virus
infections while working in Senegal in 2008.
• One of the scientists transmitted this
arbovirus to his wife after his return home.
• Direct contact is implicated as the
transmission route, most likely as a sexually
transmitted infection.
Foy et.al. 2011 at http://www.ncbi.nlm.nih.gov
@helenvmadamba POGS CEBU 2016
71. On February 2, 2016 News reports
of a Dallas County case of
sexually transmitted Zika virus
https://www.youtube.com/watch?v=ubEfwHM0mlA
@helenvmadamba POGS CEBU 2016
72. • In December 2013, during a Zika virus (ZIKV)
outbreak in French Polynesia, a patient in
Tahiti sought treatment for hematospermia,
and ZIKV was isolated from his semen.
• ZIKV transmission by sexual intercourse has
been previously suspected.
• This observation supports the possibility that
ZIKV could be transmitted sexually.
Musso et.al. 2015 at http://www.ncbi.nlm.nih.gov
@helenvmadamba POGS CEBU 2016
73. • Men who reside in or have traveled to
an area of active Zika virus
transmission who have a pregnant
partner should abstain from sexual
activity (i.e. vaginal intercourse, anal
intercourse, or fellatio) for the duration
of the pregnancy.
Oster AM et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba POGS CEBU 2016
74. • Pope Francis says contraception
is the lesser of two evils.
https://www.youtube.com/watch?v=64ZhdDd6FH4
@helenvmadamba POGS CEBU 2016
76. Mode of Transmission of ZIKV
• Mosquito-borne ZIKV transmission
• Sexual transmission
• Blood transfusion and
transmission of ZIKV
Peterson et.al. 2016 at http://ac.els-cdn.com
@helenvmadamba POGS CEBU 2016
77. Brazil reports Zika infection
from blood transfusions
http://www.reuters.com/article/us-health-zika-brazil-blood-idUSKCN0VD22N
@helenvmadamba POGS CEBU 2016
78. Reduce risk of acquiring ZIKV
• Measures to avoid mosquito bites include
wearing long-sleeved shirts, use of insect
repellant and staying in screened or air-
conditioned accomodations.
• Any travelers who are pregnant or planning
to become pregnant, should avoid travelling
to areas with ZIKV outbreaks.
Peterson et.al. 2016 at http://ac.els-cdn.com
@helenvmadamba POGS CEBU 2016
79. Reduce risk of acquiring ZIKV
• Pregnant women should wear protective
clothing, apply a U.S. Environmental
Protection Agency (EPA)-approved insect
repellant, and sleep in a screened room or
under a mosquito net.
Peterson et.al. 2016 at http://ac.els-cdn.com
@helenvmadamba POGS CEBU 2016
81. WHO Emergency Committee on Zika virus
• A coordinated international response is
needed to improve surveillance, the
detection of infections, congential
malformations, and neurological
complications, to intensify the control of
mosquito populations, and to expedite the
development of diagnostic tests and
vaccines to protect people at risk,
especially during pregnancy
Peterson et.al. 2016 at http://ac.els-cdn.com
@helenvmadamba POGS CEBU 2016
82. DOH, Philippines
• Metro Manila (CNN Philippines):
The Department of Health (DOH)
said it is ready to handle cases of
Zika virus, which is "relatively milder
compared to dengue."
"Yes we are ready," said DOH
spokesman Dr. Lyndon Lee-Suy.
@helenvmadamba POGS CEBU 2016
83. DOH, Philippines
• He added: "But let us clear that not
all pregnant women naman with Zika
would really have babies with
microcephaly.”
• The last recorded Zika virus victim in
the Philippines was in 2012, and he
survived the disease.
@helenvmadamba POGS CEBU 2016
89. References
• Hayes EB. Zika Virus Outside Africa.
Emerging Infectious Diseases Vol. 15, No.
9, September 2009. page 1347-1350.
Accessed on February 23, 2016 at
http://wwwnc.cdc.gov/eid/pdfs/vol15no9_pdf
-version.pdf
90. References
• Roth A, Mercier A, Lepers C, Hoy D,
Duituturaga S, Benyon E, Guillaumot L,
Souarès Y. Concurrent outbreaks of
dengue, chikungunya and Zika virus
infections – an unprecedented epidemic
wave of mosquito-borne viruses in the
Pacific 2012–2014. Euro Surveill.
2014;19(41):pii=20929. Accessed on
February 23, 2016 at
http://www.eurosurveillance.org/ViewArticle.
aspx?ArticleId=20929
91. References
• Musso. Zika Virus Transmission from
French Polynesia to Brazil. Emerging
Infectious Diseases Vol. 21, No. 10,
October 2015, page 1887. Accessed on
February 23, 2016 at
http://wwwnc.cdc.gov/eid/article/21/10/15-
1125_article
92. References
• Alera MT, Hermann L, Tac-An IA,
Klungthong C, Rutvisuttinunt W,
Manasatienkij W, Villa D, Thisomboonsuk
B, Velasco JM, Chinnawirotpisan P, Lago
CB, Roque VG Jr, Macareo LR,
Srikiatkhachorn A, Fernandez S, Yoon I.
Zika Virus Infection, Philippines, 2012.
Emerging Infectious Diseases Vol. 21, No.
4, April 2015 accessed on February 23,
2016 at
http://www.ncbi.nlm.nih.gov/pmc/articles/PM
C4378478/
93. References
• Petersen E, et al. Unexpected and Rapid
Spread of Zika Virus in The Americas -
Implications for Public Health Preparedness
for Mass Gatherings at the 2016 Brazil
Olympic Games. Int J Infect Dis (2016).
Accessed on February 23, 2016 at
http://ac.els-
cdn.com/S1201971216000217/1-s2.0-
S1201971216000217-
main.pdf?_tid=a142cdc6-dc19-11e5-8574-
00000aacb361&acdnat=1456444014_f7624
2858baeb56d6bb8ee290f6ec1da
94. References
• Brito C. Zika Virus: a New Chapter in the
History of Medicine. Acta Med Port 2015
Nov-Dec; 28 (6):679-680. Accessed on
February 23, 2016 at
http://www.actamedicaportuguesa.com/revi
sta/index.php/amp/article/view/7341/4565
95. References
• Schuler-Faccini L, Ribeiro EM, Feitosa IM,
et al. Possible Association Between Zika
Virus Infection and Microcephaly — Brazil,
2015. MMWR Morb Mortal Wkly Rep
2016;65:59–62. Accessed on February 20,
2016 at
http://www.cdc.gov/mmwr/volumes/65/wr/m
m6503e2.htm
96. References
• Petersen EE, Staples JE, Meaney-Delman,
D, et al. Interim Guidelines for Pregnant
Women During a Zika Virus Outbreak —
United States, 2016. MMWR Morb Mortal
Wkly Rep 2016;65:30–33.accessed on
February 23, 2016 at
http://www.cdc.gov/mmwr/volumes/65/wr/m
m6505e2.htm?s_cid=mm6505e2.htm_w
97. References
• Oduyebo T, Petersen EE, Rasmussen SA,
et al. Update: Interim Guidelines for Health
Care Providers Caring for Pregnant Women
and Women of Reproductive Age with
Possible Zika Virus Exposure — United
States, 2016. MMWR Morb Mortal Wkly
Rep 2016;65:122–127 accessed on
February 23, 2016 at
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m6505e2.htm?s_cid=mm6505e2.htm_w
98. References
• Staples JE, Dziuban EJ, Fischer M, et al.
Interim Guidelines for the Evaluation and
Testing of Infants with Possible Congenital
Zika Virus Infection — United States, 2016.
MMWR Morb Mortal Wkly Rep 2016;65:63–
67. Accessed on February 23, 2016 at
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m6503e3.htm
99. References
• Foy BD, Kobylinski KC, Foy JLC, Blitvich
BJ, Travassos da Rosa A, Haddow AD, et
al. Probable non–vector-borne transmission
of Zika virus, Colorado, USA. Emerg Infect
Dis. 2011 May. Accessed February 26,
2016 at
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C3321795/pdf/10-1939_finalD.pdf
100. References
• Musso D, Roche C, Robin E, Nhan
T, Teissier A, Cao-Lormeau VM. 2015
Potential sexual transmission of Zika virus.
Emerg Infect Dis. 2015 Feb;21(2):359-61.
Accessed February 26, 2016 at
http://www.ncbi.nlm.nih.gov/pmc/articles/PM
C4313657/
101. References
• DOH ready for Zika virus, February 2, 2016
on CNN Philippines accessed on February
23, 2016 at
http://cnnphilippines.com/news/2016/02/01/
doh-ready-zika-virus.html
102. Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
February 26, 2016
POGS Cebu Chapter
INFECTION IN PREGNANCY
@helenvmadamba POGS CEBU 2016
103. #HealthXPH tweetchat
Let’s talk about ZIKA!
Saturday, February 27, 2016
9:00 p.m. to 10:00 p.m. MLA
@helenvmadamba
https://www.facebook.com/Helen-V-Madamba
http://www.slideshare.net/HelenMadamba
INFECTION IN PREGNANCY
@helenvmadamba POGS CEBU 2016
Editor's Notes
Reverse transcription-PCR testing for symptomatic patients with onset of symptoms during the previous week
Immunoglobulin M (IgM) and plaque-reduction neutralizing antibody testing should be performed on specimens ≥4 days after onset of symptoms
FIGURE 1. Updated Interim guidance: testing algorithm*,†,§,¶,** for a pregnant woman with history of travel to an area with ongoing Zika virus transmission
* Testing is recommended for pregnant women with clinical illness consistent with Zika virus disease, which includes two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis during or within 2 weeks of travel. Testing includes Zika virus reverse transcription-polymerase chain reaction (RT-PCR), and Zika virus immunoglobulin M (IgM) and neutralizing antibodies on serum specimens (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluation for dengue or chikungunya virus infection is also recommended.
† Testing can be offered to pregnant women without clinical illness consistent with Zika virus disease. If performed, testing should include Zika virus IgM, and if IgM test result is positive or indeterminate, neutralizing antibodies on serum specimens. Testing should be performed 2–12 weeks after travel.
§ Laboratory evidence of maternal Zika virus infection: 1) Zika virus RNA detected by RT-PCR in any clinical specimen; or 2) positive Zika virus IgM with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in serum. Testing is considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibody titers.
¶ Fetal ultrasounds might not detect microcephaly or intracranial calcifications until the late second or early third trimester of pregnancy.
** Amniocentesis is not recommended until after 15 weeks of gestation. Amniotic fluid should be tested for Zika virus RNA by RT-PCR. The sensitivity and specificity of RT-PCR testing on amniotic fluid are not known.
FIGURE 2. Interim guidance: testing algorithm*,†,§,¶,** for a pregnant woman residing in an area with ongoing Zika virus transmission,†† with or without clinical illness consistent with Zika virus disease§§
* Tests for pregnant women with clinical illness consistent with Zika virus disease include Zika virus reverse transcription-polymerase chain reaction (RT-PCR), and Zika virus immunoglobulin M (IgM) and neutralizing antibodies on serum specimens (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluation for dengue or chikungunya virus infection is also recommended. If chikungunya or dengue virus RNA is detected, treat in accordance with existing guidelines. Timely recognition and supportive treatment for dengue virus infections can substantially lower the risk of medical complications and death. Repeat Zika virus testing during pregnancy is warranted if clinical illness consistent with Zika virus disease develops later in pregnancy.
† Testing can be offered to pregnant women without clinical illness consistent with Zika virus disease. If performed, testing should include Zika virus IgM, and if IgM test result is positive or indeterminate, neutralizing antibodies on serum specimens. Results from serologic testing are challenging to interpret in areas where residents have had previous exposure to other flaviviruses (e.g., dengue, yellow fever).
§ Laboratory evidence of maternal Zika virus infection: 1) Zika virus RNA detected by RT-PCR in any clinical specimen; or 2) positive Zika virus IgM with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in serum. Testing is considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibody titer.
¶ Amniocentesis is not recommended until after 15 weeks gestation. Amniotic fluid should be tested for Zika virus RNA by RT-PCR. The sensitivity and specificity of RT-PCR testing on amniotic fluid are not known.
** Fetal ultrasounds might not detect microcephaly or intracranial calcifications until the late second or early third trimester of pregnancy.
†† Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity.
§§ Clinical illness consistent with Zika virus disease is defined as two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis.
FIGURE 2. Interim guidance: testing algorithm*,†,§,¶,** for a pregnant woman residing in an area with ongoing Zika virus transmission,†† with or without clinical illness consistent with Zika virus disease§§
* Tests for pregnant women with clinical illness consistent with Zika virus disease include Zika virus reverse transcription-polymerase chain reaction (RT-PCR), and Zika virus immunoglobulin M (IgM) and neutralizing antibodies on serum specimens (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluation for dengue or chikungunya virus infection is also recommended. If chikungunya or dengue virus RNA is detected, treat in accordance with existing guidelines. Timely recognition and supportive treatment for dengue virus infections can substantially lower the risk of medical complications and death. Repeat Zika virus testing during pregnancy is warranted if clinical illness consistent with Zika virus disease develops later in pregnancy.
† Testing can be offered to pregnant women without clinical illness consistent with Zika virus disease. If performed, testing should include Zika virus IgM, and if IgM test result is positive or indeterminate, neutralizing antibodies on serum specimens. Results from serologic testing are challenging to interpret in areas where residents have had previous exposure to other flaviviruses (e.g., dengue, yellow fever).
§ Laboratory evidence of maternal Zika virus infection: 1) Zika virus RNA detected by RT-PCR in any clinical specimen; or 2) positive Zika virus IgM with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in serum. Testing is considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibody titer.
¶ Amniocentesis is not recommended until after 15 weeks gestation. Amniotic fluid should be tested for Zika virus RNA by RT-PCR. The sensitivity and specificity of RT-PCR testing on amniotic fluid are not known.
** Fetal ultrasounds might not detect microcephaly or intracranial calcifications until the late second or early third trimester of pregnancy.
†† Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity.
§§ Clinical illness consistent with Zika virus disease is defined as two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis.
FIGURE 2. Interim guidance: testing algorithm*,†,§,¶,** for a pregnant woman residing in an area with ongoing Zika virus transmission,†† with or without clinical illness consistent with Zika virus disease§§
* Tests for pregnant women with clinical illness consistent with Zika virus disease include Zika virus reverse transcription-polymerase chain reaction (RT-PCR), and Zika virus immunoglobulin M (IgM) and neutralizing antibodies on serum specimens (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluation for dengue or chikungunya virus infection is also recommended. If chikungunya or dengue virus RNA is detected, treat in accordance with existing guidelines. Timely recognition and supportive treatment for dengue virus infections can substantially lower the risk of medical complications and death. Repeat Zika virus testing during pregnancy is warranted if clinical illness consistent with Zika virus disease develops later in pregnancy.
† Testing can be offered to pregnant women without clinical illness consistent with Zika virus disease. If performed, testing should include Zika virus IgM, and if IgM test result is positive or indeterminate, neutralizing antibodies on serum specimens. Results from serologic testing are challenging to interpret in areas where residents have had previous exposure to other flaviviruses (e.g., dengue, yellow fever).
§ Laboratory evidence of maternal Zika virus infection: 1) Zika virus RNA detected by RT-PCR in any clinical specimen; or 2) positive Zika virus IgM with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in serum. Testing is considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibody titer.
¶ Amniocentesis is not recommended until after 15 weeks gestation. Amniotic fluid should be tested for Zika virus RNA by RT-PCR. The sensitivity and specificity of RT-PCR testing on amniotic fluid are not known.
** Fetal ultrasounds might not detect microcephaly or intracranial calcifications until the late second or early third trimester of pregnancy.
†† Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity.
§§ Clinical illness consistent with Zika virus disease is defined as two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis.