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Objectives
At the conclusion of this session, the participant
will be able to:
TODAYS PRESENTER
TODAYS PRESENTER
TODAYS PRESENTER
Zika Virus
The latest emerging arbovirus in the Americas
Ingrid Rabe
Medical Epidemiologist
Arboviral Diseases Branch
Centers for Disease Control and Prevention
January 26, 2016
Zika Virus
Single stranded RNA Virus
Genus Flavivirus, Family Flaviviridae
Closely related to dengue, yellow fever, Japanese encephalitis and West
Nile viruses
Transmitted to humans primarily by Aedes (Stegomyia) species
mosquitoes
Aedes Mosquitoes
Aedes species mosquitoes
Ae aegypti more efficient vectors for humans
Ae albopictus
Also transmit dengue and chikungunya viruses
Lay eggs in domestic water-holding containers
Live in and around households
Aggressive daytime biters
Aedes aegypti
Aedes albopictus
Zika Virus:
Countries and Territories with Active Zika Virus Transmission
*http://ecdc.europa.eu/en/publications/Publications/Zika-virus-French-Polynesia-rapid-risk-assessment.pdf
N
(n=31)
28
90%
Subjective fever
20
65%
Arthralgia
20
65%
Conjunctivitis
17
55%
Myalgia
15
48%
Headache
14
45%
Retro-orbital pain
12
39%
Edema
19%
Vomiting
10%
Data Source:
Reported from the
IHR National Focal
Points and through
the Ministry of
Health websites.
Map Production:
PAHO-WHO AD
CHA IR ARO
Country limits
Brazil State Boundaries
Clinical Features:
Zika
Dengue
Chikungunya
Fever
++
+++
+++
Rash
+++
++
Conjunctivitis
++
Arthralgia
++
+++
Myalgia
++
Headache
++
++
Hemorrhage
++
Shock
Group A streptococcus
Chikungunya
Rubella
Leptospirosis
Measles
Malaria
Adenovirus
Rickettsia
Enterovirus
Parvovirus
CDC Recommendations:
Pregnant Women
http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1er.htm?s_cid=mm6502e1er_e
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Peripartum:
Histopathologic examination of the placenta and umbilical cord;
Testing of frozen placental tissue and cord tissue for Zika virus RNA
Testing of cord serum for Zika and dengue virus IgM and neutralizing
antibodies
What is Microcephaly?
Mechanisms
primary due to abnormal development (often with a genetic etiology)
secondary due to arrest or destruction of normally-forming brain
tissue (by infection, vascular disruption)
scattered intracranial
Note scattered
intracranial
calcifications
calcifications
enlarged ventricles
and volume loss
2.
*Refer to the Interim Guidelines for the Evaluation and Testing of Infants
with Possible Congenital Zika Virus Infection MMWR, 2016
Recommended tests
Clinical specimens
*When indicated, including: 1) infants with microcephaly or intracranial calcifications born to women potentially exposed to Zika virus during pregnancy, or 2) infants
born to mothers with positive or inconclusive test results for Zika virus infection.
Interim Guidelines:
Evaluation and Testing of Infants with
Possible Congenital Zika Virus Infection
Among infants
with microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of Infants with
Possible Congenital Zika Virus Infection
Among infants
without microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of Infants with
Possible Congenital Zika Virus Infection
Among infants
without microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of Infants with
Possible Congenital Zika Virus Infection
Among infants
without microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of Infants with
Possible Congenital Zika Virus Infection
Among infants
without microcephaly
or intracranial
calcifications
Further evaluation
neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or
other skin lesions*
hearing by evoked otoacoustic emissions testing or auditory brainstem response testing,
either before discharge from the hospital or within 1 month after birth*
eye exam to include visualization of the retina, optic nerve, and macula either before
discharge from the hospital or within 1 month after birth*
Pediatric infectious disease specialist should be considered after testing for other congenital
infections such as syphilis, toxoplasmosis, rubella, cytomegalovirus, lymphocytic
choriomeningitis virus, and herpes simplex viruses
Report case to state, territorial, or local health department and monitor for
additional guidance as it released
Conduct additional hearing screen at age 6 months, plus any appropriate follow-up
of hearing abnormalities detected through newborn hearing screening
Summary
Zika virus continues to circulate and cause locally-transmitted disease in
the Americas
Consider the possibility of Zika virus infection in travelers with acute fever,
rash, arthralgia, or conjunctivitis within 2 weeks after return
A substantial increase in rates of congenital microcephaly have been
reported in Brazil
Studies are underway to characterize the relationship between Zika
and congenital microcephaly
Additional resources
CDC Zika virus information: http://www.cdc.gov/zika/
PAHO Zika virus pages:
http://www.paho.org/hq/index.php?option=com_topics&view=article&id
=427&Itemid=41484&lang=en
Zika virus information for clinicians: http://www.cdc.gov/zika/hcproviders/index.html
Selected references
Besnard M, et al. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014 .
Euro Surveill 2014;19(13):20751.
Duffy MR, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:25362543.
Foy BD, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011;17(5):880882.
Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15(9)13471350.
Kusana S, et al. Two cases of Zika fever imported from French Polynesia to Japan, December to January 2013. Euro
Surveill 2014;19(4):20683.
Kwong JC, et al. Case report: Zika virus infection acquired during brief travel to Indonesia. Am J Trop Med
Hyg 2013;89(3):516517.
Lanciotti RS, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007.
Emerg Infect Dis 2008;14(8):12321239.
Musso D, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French
Polynesia, November 2013 to February 2014. Euro Surveill 2014;19(14):20761.
Oehler E, et al. Zika virus infection complicated by Guillain-Barre syndrome case report, French Polynesia, December 2013.
Euro Surveill 2014;19(9):20720.
Tappe D, et al. First case of laboratory-confirmed Zika virus infection imported into Europe, November 2013. Euro
Surveill 2014;19(4):20685.
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention.
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