EMERGING AND RE-EMERGING DISEASES

ZIKA VIRUS
BRIEF HISTORY
is a flavivirus that was first isolated in 1947 from a febrile rhesus macaque monkey in the Zika
Forest of Uganda and later identified in Aedes africanus mosquitoes from the same forest

In 1954, the first 3 cases of human infection were reported in Nigeria

This pattern changed in 2007, when the first major outbreak of Zika virus infection occurred in
Yap (Federated States of Micronesia), where 73% of the population were infected and
symptomatic disease developed in 18% of infected persons

May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first
confirmed Zika virus infection in Brazil and on Feb 1, 2016, the World Health Organization (WHO)
declared Zika virus a public health emergency of international concern (PHEIC).
NATIONAL NOTIFIABLE DISEASE
SYMPTOMS
ASYMPTOMATIC

common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common
symptoms include muscle pain and headache.
INCUBATION PERIOD: not known, but is likely to be a few days to a week.
IF PREGNANT: See your healthcare provider if you are pregnant and develop a fever, rash, joint
pain, or red eyes within 2 weeks after traveling to a place where Zika has been reported. Be sure
to tell your health care provider where you traveled.
Once a person has been infected, he or she is likely to be protected from future infections.
DIAGNOSIS
The symptoms of Zika are similar to those of dengue and chikungunya, diseases spread through
the same mosquitoes that transmit Zika.
diagnosed by performing reverse transcriptase-polymerase chain reaction (RT-PCR) on serum.
Virus-specific IgM and neutralizing antibodies typically develop toward the end of the first week of
illness; cross-reaction with related flaviviruses (e.g., dengue and yellow fever viruses) is common
and may be difficult to discern.
Plaque-reduction neutralization testing can be performed to measure virus-specific neutralizing
antibodies and discriminate between cross-reacting antibodies in primary flavivirus infections.
TREATMENT:
Get plenty of rest.
Drink fluids to prevent dehydration.
Take medicine such as acetaminophen (Tylenol) or paracetamol to reduce fever and pain.
Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) until dengue can
be ruled out to reduce the risk of bleeding
If you have Zika, prevent mosquito bites for the first week of your illness.
o During the first week of infection, Zika virus can be found in the blood and passed from
an infected person to a mosquito through mosquito bites.
o An infected mosquito can then spread the virus to other people.
ZIKA AND PREGNANCY
Most common complication during pregnancy: MICROCEPHALY
ADDITIONAL NOTES for ZIKA VIRUS:
Serum or cerebrospinal fluid (CSF)

RT-PCR, antibody testing (IgM and PRNT), and viral isolation can be performed on serum and
CSF. At least 0.5 mL of serum and/or 1.0 mL of CSF is required for antibody testing. Transfer serum
or CSF to a plastic tube with screw cap (possibly secured with thermoplastic, self-sealing lab film)
measuring no more than 5 cm tall and approximately 13 mm in diameter (e.g., 1.8 mL cryotube or 2.0
mL microtube).

For virus isolation testing, specimens should be frozen as soon as possible (-70 C, e.g. liquid
nitrogen).
For antibody testing, and RT-PCR specimens should be kept cold (2-6 C) or frozen (-70 C).

EBOLA VIRUS
Zoonotic disease
SPILLOVER EVENT- occurs when an animal or human becomes infected with Ebola virus
through contact with the reservoir hosts. This could occur thorugh hunting or preparing the
animals meat for eating.
The current outbreak in West Africa, (first cases notified in March 2014), is the largest and most
complex Ebola outbreak since the Ebola virus was first discovered in 1976.
There are five species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Ta
Forest.
Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large
outbreaks in Africa.
TRANSMISSION:
fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the
human population through close contact with the blood, secretions, organs or other bodily fluids
of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and
porcupines found ill or dead or in the rainforest.
spreads through human-to-human transmission via direct contact (through broken skin or mucous
membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with
surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
Burial ceremonies in which mourners have direct contact with the body of the deceased person
can also play a role in the transmission of Ebola.
People remain infectious as long as their blood contains the virus.
SEXUAL TRANSMISSION
Male Ebola survivors should be offered semen testing at 3 months after onset of disease,
and then, for those who test positive, every month thereafter until their semen tests negative
for virus twice by RT-PCR, with an interval of one week between tests.
Ebola survivors and their sexual partners should either:
o abstain from all types of sex, or
o observe safe sex through correct and consistent condom use until their semen
has twice tested negative.
Having tested negative, survivors can safely resume normal sexual practices without fear of
Ebola virus transmission.
Based on further analysis of ongoing research and consideration by the WHO Advisory Group
on the Ebola Virus Disease Response, WHO recommends that male survivors of Ebola virus
disease practice safe sex and hygiene for 12 months from onset of symptoms or until
their semen tests negative twice for Ebola virus.
Until such time as their semen has twice tested negative for Ebola, survivors should practise
good hand and personal hygiene by immediately and thoroughly washing with soap and water
after any physical contact with semen, including after masturbation.
Symptoms of Ebola virus disease

INCUBATION PERIOD: 2 21 days

First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat.
This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and
in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the
stools). Laboratory findings include low white blood cell and platelet counts and elevated liver
enzymes.

Confirmation that symptoms are caused by Ebola virus infection are made using the following
investigations:
o antibody-capture enzyme-linked immunosorbent assay (ELISA)
o antigen-capture detection tests
o serum neutralization test
o reverse transcriptase polymerase chain reaction (RT-PCR) assay
o electron microscopy
o virus isolation by cell culture

Middle East respiratory syndrome coronavirus (MERS-CoV)

Key facts

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a

novel coronavirus (MERSCoV) that was first identified in Saudi Arabia in 2012.
Coronaviruses are a large family of viruses that can cause diseases ranging from the
common cold to Severe Acute Respiratory Syndrome (SARS).
Typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is
common, but not always present. Gastrointestinal symptoms, including diarrhoea,
have also been reported.
Approximately 36% of reported patients with MERS have died.
Although the majority of human cases of MERS have been attributed to human-tohuman infections, camels are likely to be a major reservoir host for MERS-CoV and
an animal source of MERS infection in humans. However, the exact role of camels in
transmission of the virus and the exact route(s) of transmission are unknown.
The virus does not seem to pass easily from person to person unless there is close
contact, such as occurs when providing unprotected care to a patient.

Symptoms

The clinical spectrum of MERS-CoV infection ranges from no symptoms (asymptomatic) or

mild respiratory symptoms to severe acute respiratory disease and death.

A typical presentation of MERS-CoV disease is fever, cough and shortness of breath.

Pneumonia is a common finding, but not always present.

Gastrointestinal symptoms, including diarrhoea, have also been reported. Severe illness can
cause respiratory failure that requires mechanical ventilation and support in an intensive care
unit.

Approximately 36% of reported patients with MERS-CoV have died.

The virus appears to cause more severe disease in older people, people with weakened
immune systems, and those with chronic diseases such as cancer, chronic lung disease and
diabetes.

Source of the virus

MERS-CoV is a zoonotic virus that is transmitted from animals to humans.

The origins of the virus are not fully understood but, according to the analysis of different virus
genomes, it is believed that it originated in bats and was transmitted to camels sometime in
the distant past.

Transmission

Non-human to human transmission: The route of transmission from animals to humans is

not fully understood, but camels are likely to be a major reservoir host for MERS-CoV and an
animal source of infection in humans. Strains of MERS-CoV that are identical to human
strains have been isolated from camels in several countries, including Egypt, Oman, Qatar,
and Saudi Arabia.

Human-to-human transmission: The virus does not appear to pass easily from person to
person unless there is close contact, such as providing unprotected care to an infected
patient. There have been clusters of cases in healthcare facilities, where human-to-human
transmission appears to be more probable, especially when infection prevention and control
practices are inadequate. Thus far, no sustained community transmission has been
documented.

Prevention and treatment

Treatment is supportive
General hygiene
The consumption of raw or undercooked animal products, including milk and meat, carries a high
risk of infection from a variety of organisms that might cause disease in humans.