Post on 10-May-2020
transcript
ZIKA VIRUS
OUTBREAK
JANET B. EDDY M.D.
KU-WICHITA PGY2
OBSTETRICS AND GYNECOLOGY RESIDENCY Dominican Republic 2016
Zika time line
1947: 1st isolated in rhesus monkey in Zika forest of Uganda1
12/2013: Outbreak in French Polynesia1
2015 1ST reported case in South America
1/8/16: 1ST reported US case of Zika infected mother with microcephaly. 2
Detected in Hawaii but thought to have acquired in Brazil
2/1/16: World Health Organization declared the Zika virus outbreak a
Public Health Emergency of International Concern
2/12/16: 120,256 total cumulative cases reported3
Zika Virus
It is a single stranded RNA virus that spreads primarily
through infected Aedes aegypti mosquitoes infecting both
humans and nonhuman primates4
Perinatal transmission
“Possible sexual and transfusion transmission”4
Can spread from infected human up to a week
Incubation period: 3-12 days
http://ais.paho.org/phip/viz/ed_zika_countrymap.asp
Signs and Symptoms
Need at least 2 symptoms3
Fever
Maculopapular rash
Joint pain
Conjunctivitis
Muscle pain
Headaches
Usually mild and rarely causes death
Only about 1 in 5 people become sypmtomatic4
Diagnosis4
Reverse transcription polymerase
chain reaction (RT-PCR) if onset of
symptoms in previous week
IgM and plague reduction
neutralizing (PRNT) antibody
Specimens collected >= 4 days of
symptom onset
IgM antibodies are present at least 2
wks after virus exposure and last up
to 12 weeks
Cross sensitivity with other flaviviruses
(dengue, yellow fever, west nile)
Negative results
Asymptomatic: can’t fully rule out
Symptomatic: suggest no recent
infection
Positive results
>= 4 –fold higher than dengue virus
Sequela & Management Symptoms
Rest, hydration, acetaminophen
Avoid aspirin and NSAIDs to avoid risk of hemorrhage in case of dengue fever4
Guillain-Barre Syndrome (GBS)
Fast increase in prevalence2
Microcephaly/CNS Malformation
Brazil: Between 2001- 2014 they had an average of 163 cases per year
Between 1/1/15 -1/30/16 they had 4,783 cases of microcephaly, CNS malformation & death (76) 2
Definition
< or =2 SD below or <3% for sex and wga.5
Prevention is Treatment
Prevent mosquito bites
Deet , picaridin & IR3535 repellents are safe in
pregnancy 6
Mosquito nets
Protective clothing (long sleeves/pants)
Avoid stagnant water
Don’t travel to affected areas
Vacation is planned. Plan your pregnancy.
There is no current vaccine or direct treatment for the
Zika virus.
ZIKA & pregnancy in the USA
It is unknown if pregnant patients are more susceptible to virus3.
Ask you pregnant patients about recent travel3
Offer serologic testing 2-12 wks after travel to areas with ongoing outbreak3
Who should get tested?
Symptoms during or within 2 weeks of travel to affected areas
US with microcephaly or intracranial calcifications
Positive test
Serial US exams to monitor growth and anatomy
Referral to MFM or infectious disease specializing in pregnancy
Or test neutralizing
antibodies on
serum
Reference #3
After 15 wga
ZIKA & Pregnancy in Outbreak Regions3
If symptomatic, test during 1st week of illness
If asymptomatic
Test at initiation of prenatal care
Test at mid 2nd trimester
ZIKA & Future Pregnancies
Viremia lasts approximately 1 week
No current evidence that Zika infection poses risk
to future pregnancies7
Male Female Sexual Transmission?
Replicative Zika found in semen sample with sexual transmission to
wife suspected1
Case 2: Colorado
Potential sexual transmission under investigation
Unpublished, 2016, Dallas County Health & Human Services
Male testing for risk assessment is not recommended at this time9
Males at risk should abstain from intercourse or use condoms for
duration of pregnancy9
Do you need to test a patient?
• 877-427-7317 option #5
• Kansas Health & Environment Department
Patient• Send to CDC
• Submission form to KHED
Sample
• PCR 4 days
• Serology14 days
Results
Results go to local health department (tier 1) physician patient
Epihotline@kdheks.gov
Where do we go from here?
Stay updated
Educate your patients and avoid travel to
affected areas while pregnant or trying to get
pregnant.
Ask your patients questions
Prevent mosquito bites
References1. Musso, Roche, et al. Potential Sexual Transmission of Zika Virus. Emerging infectious diseases;21,2, 2015.
2. Pan American Health Organization (PAHO) 2/10/16: Zika Epidemiological Alerts & Updates. Paho.org
3. 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. DOI:
4. CDC. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak- US 2016.
5. PAHO. Preliminary guidelines for the surveillance of microcephaly in newborns in settings with risk of Zika Virus Circulation. Paho.org. 1/21/2016
6. CDC. Travelers health: Protection against mosquitoes, ticks, & other arthropods. Atlanta, GA: US Department of Health & Human Services, CDC; 2015.
7. CDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/zika/index.html.
8. COLORADO CASE SLIDE 14
9. 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. DOI: http://dx.doi.org/10.15585/mmwr.mm6502e1
10. http://www.kdheks.gov/zika/index.htm
11. ACOG: Practice Advisory: Updated Interim Guidance for Care of Obstetric Patients And Women Of Reproductive Age During a Zika Virus Outbreak
The End