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Zika.pptx
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- 2. ZIKA VIRUS EPIDEMIOLOGY ANDCONTROL 09-12-2021 2 Dr Lakshmi Rajeev Assistant Professor Department Of Community Medicine
- 3. Introduction •Mosquito borne Flavivirus •Firstidentified from Uganda in 1947 •Till 1952- disease specific to monkeys •First in humans- Uganda and United Republic of Tanzania,1952 09-12-2021 3
- 4. Introduction (continued) •Largest outbreak– 2015 -201633 countries •Worst – Brazil -1.4 million cases •WHO- Public Health Emergency of International Concern (PHEIC) -1stFeb 2016 •86 countries/territories –till date 09-12-2021 4
- 5. Problem statement –India •2016 – First 3 cases reported from Gujarat- routine surveillance •Sep-Oct 2018- Biggest outbreak(157 cases)- Rajasthan •Other states- Madhya Pradesh, Maharashtra, Uttar Pradesh •2021- Kerala 09-12-2021 5
- 6. Problem Statement -Kerala 24 year old pregnant ,third trimester- Parassala, Thiruvanathapuram Fever ,headache and generalized rash -28/06/2021 ZIKV confirmed (RT-PCR)-08/07/21 13 hospital staffs/patients positive -10/07/21 Active and passive surveillance – 70 positives/590 samples All resided/travelled to Thiruvanathapuram 09-12-2021 6
- 7. Agent •Zika Virus •Arbovirus- Flavivirusgenus •Single stranded RNA virus •One serotype 09-12-2021 7
- 8. Vector •Aedes aegypti (mostcommon) A.albopictus 09-12-2021 8
- 9. Aedes aegypti Day timebiter Highest bite rate- dawn and dusk Highly domestic Nervous feeder Flight range -100m(short fliers) Multiple cases & clustering of cases Breeds- artificial water collections Same vector responsible for ? 09-12-2021 9
- 10. Host factors •Lack ofherd immunity •Pregnancy- Complications 09-12-2021 10
- 11. •Rain fall andhumidity •Frequency of bites increases with temperature •Wide geographical distribution of vector •High vector density •International travel 09-12-2021 11 Environmental factors
- 12. Modes of transmission •Biteof Aedes mosquito- most common •Human to human -Pregnant mother to foetus- intra uterine and perinatal -Sexual contact -Blood transfusion -Organ transplantation 09-12-2021 12
- 13. Clinical features •Incubation period-3 to 14 days •Only 1 in 4 infected people develop symptoms •Symptoms- Fever, maculo-papular rash, conjunctivitis, muscle and joint pain, malaise, headache •Lasts for 2 to 7 days •Viremia –3rd and 5th day of onset •Severe forms of disease and fatalities are rare 09-12-2021 13
- 14. 1. Pregnancy related–trans placental transmission symptomatic/asymptomatic mothers •Congenital Zika Syndrome -Microcephaly -Limb contractures -Eye abnormalities -Hearing loss •Abortion/Still birth •Preterm birth Complications 9-12-2021 14
- 15. Complications (continued) 2. Neurologicalcomplications(rare)- older children and adults • Guillain-Barre Syndrome(GBS) • Neuropathy • Myelitis 09-12-2021 15
- 16. Zika virus disease-Case definitions •Suspected Zika virus disease Acute onset of fever, maculo-papular rash, arthralgia in those with history of travel to areas with ongoing transmission during 2 weeks preceding onset of illness •Confirmed Zika virus disease Suspected case with positive laboratory results (RT-PCR) 09-12-2021 16
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- 18. Clinical features- Zika,Dengue and Chikungunya Features Zika Dengue Chikungunya Fever ++ +++ +++ Rash +++ + ++ Conjunctivitis ++ - - Arthralgia ++ + +++ Myalgia + ++ + Headache + ++ ++ Hemorrhage - ++ - Shock - + - 09-12-2021 18
- 19. Diagnosis Samples- Blood,urine, semen • Nucleic acid testing- RT-PCR- <7 days (serum) 7-20 days (urine) • Serology 09-12-2021 19
- 20. Prevention and Control I.Individual level 1. Management of general case • Self limiting • No specific antiviral or vaccine • Symptomatic management -Rest -Plenty of oral fluids -Management of fever and pain • Isolation of cases under bed net 09-12-2021 20
- 21. Prevention and Control(continued) 2. Management in pregnant women •Ongoing transmission- Lab testing •Symptomatic pregnant females -Early medical care -Regular follow up ultrasound scan- microcephaly, developmental abnormality -Counselling – possible adverse effects, option for termination 09-12-2021 21
- 22. Prevention and Control(continued) II. Family level 1. Source reduction 2. Use mosquito repellents 3. Wear light coloured full sleeve dress 4. Household screens- windows/doors 5. Bed nets-daytime - infants and children 09-12-2021 22
- 23. Prevention and Control(continued) III. Community level 1. Source reduction- DRY DAY 09-12-2021 23 Day Place Thursday JHI visits 50 houses – Vector survey Friday Schools Saturday Offices, shops, other establishments Sunday Houses
- 24. Prevention and Control(continued) 2. Vector surveillance Larval surveys • House index • Container index • Breteau index 09-12-2021 24
- 25. Prevention and Control(continued) 3. Chemical control a) Larvicide –Temephos b) Adulticide –Only during outbreak Integrated vector management 09-12-2021 25
- 26. Prevention and Control(continued) IV. International airports and seaports 1. Quarantine and isolation facilities 2. Aircraft disinfection 3. WHO- IHR- Aedes aegypti index=0 (400 m) 09-12-2021 26
- 27. SUMMARY •Arboviral disease- transmittedby Aedes mosquito •1 in 4 symptomatic •Symptoms include- Fever, rash, conjunctivitis, arthralgia, headache •Mild- 2 to 7 days; few- complications •Pregnant females and fetus at risk •Symptomatic management •Prevention- mosquito control 09-12-2021 27
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Editor's Notes
- #4 Infection rate-73%, all age group affected, no severe dz/hospitalization/death
- #5 PHEIC explain
- #10 Dengue, JE, Yellow fever
- #13 Breast feeding?
- #14 Viremia can last upto a week, remains longer in semen than in blood But still we are very concerned about ----complications
- #20 Zika IgM followed by Plaque Reduction Neutralization Test (PRNT)