Zika in Belgium

Joint symposium

BVIKM-SBIMC & WIV-ISP

19/5/2016

Marjan Van Esbroeck

• Epidemiology

• Transmission

• Clinical symptoms

• Laboratory diagnosis

2

Outline

Epidemiology

3

Petersen LR et al. Zika Virus. NEJM. 2016 Apr 21;374(16):1552-63.

Outbreaks Sporadic cases

Environmental suitability for Zika virus

4

Messina JP, et al. Mapping global environmental suitability for Zika virus. Elife. 2016 Apr 19;5. pii: e15272

Status of ZIKV reporting as of 2016 by country, showing countries that are highly environmentally suitable (having a suitable area of more than 10,000 square kilometres) but which have not yet reported symptomatic cases of ZIKV in humans. “Currently reporting” countries are those having reported cases since 2015.

Distribution of the vector USA / Europe

5

Belgium: 18 cases (17 confirmed)

6

ZIKV in Europe

Transmission

7

Rodriguez-Morales et al., Ann Clin Microb Antimicrobials 2016

Symptoms

8

Duffy MR et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. NEJM 2009; 360: 2536-43.

Zika virus (ZIKV)

9

Flavivirus enveloped pos. sense ss RNA virus, genome of 11 kbp

ELISA PCR

Zika virus (ZIKV)

10

Musso (2016) Clin Microbiol Rev

Laboratory diagnosis

11

stay incubation development of Ab

max. 12 days 1 week

Symptomatic PCR+ serology

Asymptomatic Serology 3 w after return

Pregnancy/wish (partner) repeat serology if neg.

Laboratory diagnosis

12

http://ecdc.europa.eu/en/publications/Publications/zika-virus-guidance-healthcare-providers-and-laboratory-diagnosis.pdf

13

ZIKV PCR

Reference imported in returning from days sample ZIKA RT-PCR flavi RT-PCR ZIKV IFFA

Tappe et al., 2014 Italy Thailand 10d serum neg neg pos

31d serum ND ND pos

67d serum ND ND pos

Tappe et al. 2014 Germany Borneo 3d serum neg ND neg

6d serum ND ND pos

11d serum ND ND pos

Waehre et al., 2014 Norway Tahiti 5d serum pos neg neg

36d serum neg ND pos

Zammarchi et al., 2015 Italy Brazil 3d serum neg neg pos

17d serum neg neg pos

Zammarchi et al., 2015 Italy French-Polynesia 3d serum pos ND neg

35d serum ND ND pos

62d serum ND ND pos

3d serum neg ND neg

33d serum ND ND pos

62d serum ND ND pos

Malvy 2015 (Promed) France Martinique 7d serum + urine pos ND ND

Goorhuis 2015 (Promed) the Netherlands Suriname 3d serum pos ND ND

Korhonen et al., 2016 Finland Madives 8d serum ND neg ND

9d urine ND pos ND

Case reported here Belgium Guatemala 3d serum pos pos neg

17d serum ND ND pos

Viremia in pregnant women

14

Driggers RW et al. Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities. NEJM. 2016 Mar 30.

4 weeks POS 10 weeks POS

ZIKV RNA in urine

15

Gourinat et al. Detection of Zika virus in urine. Emerg Infect Dis. 2015 Jan;21(1):84-6.

ZIKV RNA in urine

16

Bingham AM et al. Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016. MMWR; Early Release. Vol. 65 May 10, 2016

70 ZIKV-patients

time after Ʃ onset urine serum

≤ 5 days 52/55 (95%) 31/55 (56%)

> 5 (max. 20) 9/11 (82%) 0/11 (0%)

RT-PCR

17

ZIKV in Belgium

Number of requests for lab diagnosis

week

Number of requests for PCR on sperm

Federal Agency for Medicine and Health Products

Exclusion

Asymptomatic sperm donor

Sperm donor diagnosed with zika

6 months after return OR neg. NAT in sperm

Transplantation of tissue/cell/ organ/gamete/embryo

Exclusion

Asymptomatic donor

4 weeks after return OR neg. NAT in blood

Donor diagnosed with zika

4 weeks after recovery

Donor with male sexual partner diagnosed with zika or stay in endemic area < 6 months before

4 weeks after last sexual contact OR neg. NAT in blood

Quality/safety/efficacy of medicinal products for human use

18

Specificity of ZIKV ELISA

19

Huzly et al. High specificity of a novel Zika virus ELISA in European patients after exposure to different flaviviruses. Euro Surveill. 2016 21 (16).

20

Virus neutralization test

• Low/short viremia

• Extend diagnostic window – PCR on urine/semen

• Rapid decrease in IgM antibodies

Importance pregnancy

wish to become pregnant

Does semen becomes always positive?

If yes when?

Also in asymptomatic men?

21

Conclusions

Acknowledgements Lieselotte Cnops Dorien van den Bossche Kevin Ariën Jacob Verschueren Kathleen Meersman Ralph Huits Ula Maniewski-Kelner Lab personnel ITM

www.itg.be