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Zika Virus InfectionLelete Holson-Patterson
RN, RM, Cert. Admin, Dip. HRM, BSc, MSc, Doctoral Candidate
2016
Situation Summary
1947- Zika Virus first isolated in the Zika Forest (Uganda) in a Rhesus Monkey
1952- Zika Virus first isolated in humans in Uganda, Tanzania
1968- Zika Virus detected in human samples in Nigeria
2013- Outbreak of Zika Virus in French Polynesia with 10,000 registered cases of which 70 were
severe cases including Guillian Barre’ syndrome, meningoencephalitis, leukopenia
2007- First major outbreak of Zika Virus on the island of Yap (Micronesia) with 185
suspected cases
2015- Zika Virus detected in New Caledonia and in the Cook Islands
May, 2015- confirmed transmission of Zika virus in Brazil
October, 2015, - Colombia health authorities confirmed transmission of Zika virus
December 1, 2015- 9 member states in the Americas confirmed circulation of Zika virus and
include Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, Paraguay, Suriname and
Venezuala
January, 2016- 20 Member States of the Americas including Haiti and Barbados
In October 2015, Brazilian health authorities reported an unusual increase in microcephaly cases
As of 30 November 2015, 1,248 cases of microcephaly have been reported in 14 states of Brazil.
Situation Summary
2000 2010 Nov. 20150
20
40
60
80
100
120
5.5/100,000 5.7/100,000
99.7/100,000
Prevalence of Microcephaly in Newborns in Brazil
On November 28, 2015, the Brazil Ministry of Health notified 3 deaths associated with Zika Virus infection.
The fatal cases were 2 adults and 1 newborn
Zika Virus Related Deaths
The first case was a male adult with history of lupus erythematosus, chronic use of corticosteroid drugs, rheumatoid arthritis and alcoholism who was admitted with suspected dengue fever
The second case was a 16 year old female The third case was a newborn
Zika Virus Related Deaths
This is a disease caused by the Zika virus (ZIKAV).
Very close phylogenetically to viruses such as dengue, yellow fever, Japanese encephalitis, or West Nile virus.
Zika Virus Infection
Zika Virus (ZIKAV)◦ An arbovirus the flavivirus genus (family
Flaviviridea)
Aetiology
The Zika virus is transmitted by the Aedes aegypti mosquitoes
Mode of Transmission
After an infected mosquito bite, the disease symptoms usually appear following an incubation period of 3-12 days
Incubation Period
Life Cycle
Life Cycle
Fever Non-purulent conjunctivitis Headache Myalgia Arthralgia Asthenia Maculopapular rash Oedema of the lower limbs
Common Clinical Features
Retro-orbital pain Anorexia Vomiting Diarrhoea Abdominal pain Mild Thrombocytopenia (laboratory findings) Mild Leucopenia (laboratory findings)
Less Common Clinical Features
Guillian Barre’ Meningoencephalitis Thrombocytopenia purpura
Severe Clinical Features
Microcephaly
Patients with rash or elevated temperature (> 37.2°C) with one or more of the following symptoms (not explained by other medical conditions):◦ Arthralgia or myalgia◦ Non-purulent conjunctivitis or conjunctival
hyperaemia◦ Headache or malaiseIn someone who resides in or has visited epidemic or endemic areas within 2 weeks prior to the onset of symptoms
Suspected Case (Preparedness Phase)
A suspected case with laboratory positive result for the specific detection of Zika virus
Confirmed Case
Algorithm for the Detection of Zika VirusZika suspected cases (Regarding
the symptoms and epidemic scenario)
Acute Phase(1-5 days after
symptoms arise)
Onset of symptoms vs
taking of samples
PositiveCHIK V
Confirmed
IgMDengue IgM ChikV
PositivePresumptive
ZIKA V
PositivePresumptive
DENGV
RT-PCR/NS4Dengue
Convalescent phase(> 6 days after symptom onset)
(Real Time) PCR-
CHIK V
PositiveDENV
Confirmed
NegativeConsider CHIK V
NegativeConsider
ZIkV(Real time)
PCR-ZikV
NegativeDiscard
PositiveZik V Confirmed
NegativeDiscarded
IgMZIKV
PositivePresumptiv
e CHIK VNegative
Consider ZIK V
Zika Fever is a Class 1 Notifiable disease and is notified on suspicion within 24 hours to the Parish Health Department and the National Epidemiology Unit, Ministry of Health
Cases (confirmed by laboratory testing) should also be notified as a Class 1 Notifiable disease to the Parish Health Department and the Epidemiology Unit, Ministry of Health
Class 1 Notifiable Disease
Samples for serology should be sent to the National Public Health Laboratory along with the completed CARPHA Laboratory form.
The following are the requirements for the sampling:◦ Type of sample: Serum- 4-5 mls. Of blood in a
plain red top tube Acute phase: Until 8 days after symptom onset Convalescent phase: 10-15 days after symptom
onset
Laboratory Testing for Zika
Keep refrigerated (2-8°C) if sample will be processed within 48 hours at the NPHL.
Keep frozen (-10 to -20°C) if sample will be processed after the first 48 hours
Maintain frozen (-70°C) if sample will be processed after one week
Conservation of the sample
Samples should be transported on ice or with ice packs to the National Public Health Laboratory once the Notification is made to the Parish Health Department
Transporting & Handling Samples
Nucleic Acid detection of Zika viral RNA using real time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) performed on an “acute sample” collected during the first five (5) days of illness
Serological detection of anti-Zika IgM and IgG antibodies using Enzyme-Linked Immunosorbent Assay (ELISA) and immunofluorescence assays may be performed on blood samples collected 6 days after the onset of symptoms
Laboratory Tests
If the following is not included in the test request form, the sample cannot be referred and will be REJECTED:◦ Name of patient◦ Age of patient◦ Date of symptom onset◦ Date sample collected◦ Clinical features- full description◦ Clinical Tests Performed and Results◦ Pertinent Travel History
Samples
Dengue Chikungunya Malaria Leptospirosis Acute HIV infection Measles Rubella Rickettsial infections Epstein Barr Virus- Infectious mononucleosis
Differential Diagnosis
There is no vaccine or specific treatment for Zika Virus
It is important to differentiate Zika virus from other diseases
Cases of co-infection, Zika and Dengue, could occur
Compared with dengue, fever associated with Zika virus infection is more acute and shorter in duration
Case Management
Symptomatic Rest Acetaminophen to relieve fever Antihistamines to control pruritus Using aspirin is not advised due to the risk of
bleeding and the developing of Reye’s syndrome in children younger than 12 years of age
The use of NSAID is not advised as the clinical symptoms may be Dengue or Chikungunya.
Treatment
Increased oral fluids Patient isolation especially during the first
week of illness◦ Stay under mosquito net treated or without
insecticide◦ Stay in places with intact windows, doors and
screens◦ Staff who take care of these patients should
protect against mosquito bites using insect repellent (DEET, IR3535 or Icaridin) and wearing long sleeves and pants
Management
There is no evidence of any restriction of the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label
Management
EVERYONE’S RESPONSIBILITY Eliminate breeding sites of the mosquitoes Identify areas of high risk transmission Select appropriate insecticide
Vector Control Measures
Stop the birth of Mosquitoes
Stop Mosquito from Biting you
Management
There is no evidence of any restriction of the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label
References PAHO/WHO. (2016). Zika virus infection.
Thank You!!