Zika and Dengue: Creating Partnerships to Interrupt Transmission (Honein)
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Transcript of Zika and Dengue: Creating Partnerships to Interrupt Transmission (Honein)
Zika and Dengue:Creating Partnerships to Interrupt Transmission.
ESRAGHOF #2921
June 12, 2017
Zika and Dengue: Creating Partnerships to Interrupt Transmission.
Zika, a virus borne by mosquitoes and globetrotting
humans, threatens the fetuses of pregnant women with
microcephaly and other devastating defects. A warming
world enables the viruses that cause Zika, Dengue and
other infectious tropical diseases, to flourish as the range
of their mosquito carriers expands. Though there are no
vaccines for Zika or Dengue, Clubs can implement service
projects that educate about Zika, clean up mosquito
habitat, promote personal prevention and implement an
exciting new method to interrupt mosquitos’ ability to
transmit these viruses.
Zika Advisory Madison AirportWisconsin, USA
Zika, Dengue and Chikungunya Travel
Advisories 2017
Margaret (Peggy) Honein, PhD, MPH Co-Lead, Pregnancy and Birth Defects Task Force, Zika Virus Response TeamChief, Birth Defects Branch, National Center on Birth Defects and Developmental Disabilities
Margaret (Peggy) Honein, PhD, MPH is an epidemiologist and co-lead of the Pregnancy and Birth Defects Task Force at the Centers for Disease Control and Prevention (CDC). Dr. Honein is also chief of the Birth Defects Branch at CDC, and was credentialed as a Distinguished Consultant/Senior Scientist in 2010. Dr. Honein received her BS degree in Biology from the University of California, Riverside in 1986, her MPH from the University of California, Los Angeles (UCLA) in 1992, and her PhD in Epidemiology from UCLA in 1995. Dr. Honein’s research interests include evaluating the effect of infections during pregnancy, assessing the safety or risk of medication use and vaccine use during pregnancy, understanding the role of smoking in birth defects, and examining longer term outcomes and costs associated with congenital heart defects and other birth defects across the lifespan.
CDC’S Response to Zika
Zika Virus: Update on a New Teratogen
Margaret Honein, PhD, MPHCenters for Disease Control and Prevention
Rotary International ConventionAtlanta, GeorgiaJune 12, 2017
First time in history…
“Never before in history has there been a situation where a bite from a mosquito could result in a devastating malformation.”– Dr. Tom Frieden, former CDC DirectorFortune, April 13, 2016
“…the last time an infectious pathogen (rubella virus) caused an epidemic of congenital defects was more than 50 years ago…”– New England Journal of Medicine, April 13, 2016
Level 1 is highest level
Level 1 Activations• Hurricane Katrina 2005• H1N1 Pandemic Flu 2009• Ebola 2014• Zika 2016
CDC Emergency Response Levels
Zika: The Basics
• Single-stranded RNA virus
• Flavivirus, closely related to dengue virus
• Primarily transmitted by Aedes aegypti
Additional modes of transmission
» Intrauterine and perinatal transmission
(mother-to-fetus)
» Sexual transmission
» Laboratory exposure
» Blood transfusion
Aedes aegypti mosquito
Aedes albopictus mosquito
What is Zika Virus?
• Clinical illness usually mild or asymptomatic
• Most common symptoms» Fever
» Rash
» Joint pain
» Conjunctivitis
» Headache
» Muscle pain
• Symptoms last several days to a week
• Severe disease uncommon
• Fatalities rare
• Once a person has been infected, likely to be protected from future infections
Clinical Presentation
• No vaccine or specific antiviral treatment
• Treat the symptoms» Rest
» Drink fluids to prevent dehydration
» Take medicine such as acetaminophen to reduce fever and pain
» Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) until dengue can be ruled out to reduce the risk of bleeding
• Serious implications for Zika virus infection during pregnancy
Clinical Management
Areas with Risk of Zika
As of May 26, 2017
https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika
Note: Zika risk is determined according to altitude (height above sea level). Mosquitoes that spread Zika usually do not live at high altitudes (above 6,500 feet or 2,000 meters). The risk of getting Zika from a mosquito at high altitudes is less than at low altitudes.
Zika, Pregnancy, and Congenital Zika Virus Infection
• Preventing Zika virus infection during pregnancy
• Clinical guidance and outreach to obstetric and pediatric providers
» Testing and clinical management
• Monitoring effect of Zika virus infection on pregnant women and infants
» Pregnancy registries
» Birth defects surveillance
• Research to better characterize timing of risk and potential co-factors
Protecting Pregnant Women and Infants from Zika
• Zika virus can pass from a pregnant woman to her fetus during pregnancy
• Zika during pregnancy can cause damage to the brain, microcephaly, and congenital Zika syndrome
• Linked to other problems such as miscarriage, stillbirth, and birth defects
• No evidence that past infection will affect future pregnancies once the virus has cleared the body
How can Zika affect pregnancies?
• Recognized pattern of congenital anomalies associated with Zika virus infection
during pregnancy that includes» Severe microcephaly (small head size) resulting
in a partially collapsed skull
» Decreased brain tissue with brain damage
» Damage to the back of the eye
» Limited range of joint motion
» High muscle tone restricting body movement
• Zika virus also linked to» Hearing loss
» Limb abnormalities
» Impaired growth
Moore CA, Staples JE, Dobyns WB, Pessoa A, Ventura CV, Fonseca EBD, Ribeiro EM, Ventura LO, Neto NN, Arena JF, Rasmussen SA. Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians. JAMA Pediatr. Published online November 03, 2016. doi:10.1001/jamapediatrics.2016.3982
Congenital Zika Syndrome
Ocular Findings and Congenital Contractures
Moore CA, Staples JE, Dobyns WB, Pessoa A, Ventura CV, Fonseca EBD, Ribeiro EM, Ventura LO, Neto NN, Arena JF, Rasmussen SA. Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians. JAMA Pediatr. Published online November 03, 2016. doi:10.1001/jamapediatrics.2016.3982
Congenital Zika Syndrome – Other Neurologic Sequelae
• Information on long-term medical and developmental outcomes or mortality sparse
• Neurologic sequelae reported to date in addition to contractures include the following
» Motor and cognitive disabilities
» Epilepsy
» Swallowing difficulties
» Vision loss and hearing impairment
» Hypertonia and spasticity with tremors
» Irritability with excessive crying
• Microcephaly from congenital infection can occur after birth
• The full spectrum of poor outcomes caused by Zika virus infection during pregnancy
remains unknown
Head circumference in normal range at birth
(0.8 SD below the mean)
Microcephaly at age 12 months (4.3 SD below the mean)
Congenital Zika Syndrome without Microcephaly at Birth
Potential Risk of Birth Defects Related to Zika
• 5% with possible Zika had birth defects
• 10% with confirmed Zika had birth defects
Nearly 1,000 US pregnant women with laboratory evidence of Zika completed their pregnancies in 2016*, and some had babies with Zika-related birth defects:
Reynolds MR, Jones AM, Petersen EE, et al. Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S.Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016. MMWR Morb Mortal Wkly Rep 2017;66:366-373.
*Data from US Zika Pregnancy Registry (50 states and DC)
Pregnant women with any laboratory evidence of possible Zika virus infection in the 50 US states and DC
Pregnant women with any laboratory evidence of possible Zika virus infection in US territories
3,916
Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection in the United States and Territories
1,883
*Includes aggregated data reported to the US Zika Pregnancy Registry as of May 23, 2017**Includes aggregated data from the US territories reported to the US Zika Pregnancy Registry and data from Puerto Rico reported to the Zika Active Pregnancy Surveillance as of May 23, 2017
* *
• Number of completed pregnancies with or without birth defects: 1,579
• Of these
» 72 live born infants born with a birth defect consistent with congenital Zika infection
» 8 pregnancy losses affected by a birth defect consistent with congenital Zika infection
*Outcomes for Completed Pregnancies in the US States and District of Columbia, 2016-2017As of May 23, 2017
Pregnancy Outcomes among US Women* with Evidence of Zika
*Late breaking data; as of April 25, 2017
Zika-Related Pregnancy Outcomes in US Territories*
• 2,549 women in the US territories with laboratory evidence of recent possible Zika virus infection completed their pregnancy
» 122 (5%) had fetuses or infants with Zika-related birth defects
• Among pregnant women with positive nucleic acid test results confirming Zika virus infection
» 8% infected in the 1st trimester had a fetus or infant with birth defects
» 5% infected in the 2nd trimester had a fetus or infant with birth defects
» 4% infected in the 3rd trimester had a fetus or infant with birth defects
Zika Prevention and Testing
• Pregnant women should not travel to
areas with risk of Zika
• If a pregnant woman must travel, she should
» Talk with her healthcare provider before she goes
» Strictly follow steps to prevent mosquito bites during
the trip
» Take steps to prevent sexual transmission
» Talk with her healthcare provider after she returns,
even if she doesn’t feel sick
http://wwwnc.cdc.gov/travel/page/zika-information
Do Not Travel to Areas with Risk of Zika
• Wear long-sleeved shirts and long pants
• Stay and sleep in places with air conditioning or that
use window and door screens
• Use EPA-registered insect repellents with one of the
following active ingredients:
» DEET, picaridin, IR3535, oil of lemon eucalyptus, para-
menthane-diol, or 2-undecanone
• Once a week, empty and scrub, turn over, cover, or
throw out items that hold water, such as trash
containers, tires, buckets, toys, planters, flowerpots,
birdbaths or pools
If a pregnant woman lives in or travels to an area with Zika, she should
Prevent Mosquito Bites
A pregnant woman whose partner lives in or has traveled
to an area with risk of Zika should
Prevent Sexual Transmission of Zika Virus
• Use condoms correctly every time they have sex, or
• Not have sex
For the duration of the pregnancy, even if the pregnant
woman’s partner does not have symptoms or feel sick.
• A doctor or other healthcare provider may
order tests to look for Zika or similar types
of infections
• CDC developed tests that received FDA
Emergency Use Authorizations to diagnose
Zika virus infection
» rRT-PCR Trioplex
» MAC-ELISA
• Commercial lab assays are increasingly
available
How is Zika Diagnosed?
• Limited timeframe for detection of Zika
virus RNA or IgM antibodies
• Cross-reactivity of Zika virus antibodies
with antibodies of other similar viruses,
like dengue
• Limited data on viral persistence
Challenges for Zika Diagnostics
• All pregnant women (regardless of symptoms) who
» Live in or recently traveled to an area with risk of Zika that has a CDC
Zika travel notice, or
» Had unprotected sex with a partner who lives in or traveled to an area
with risk of Zika that has a CDC Zika travel notice
• Pregnant women who live in or recently traveled to an area with
risk of Zika but without a CDC Zika travel notice
» If they develop symptoms of Zika, or
» If their fetus has abnormalities on an ultrasound that may be related
to Zika virus infection
https://www.cdc.gov/zika/hc-providers/pregnant-women/testing-pregnant-women.html
Who Should Be Tested for Zika?
CDC recommends laboratory testing for
• All infants born to mothers with laboratory evidence
of Zika virus infection during pregnancy
• Infants who have abnormal clinical or neuroimaging
findings suggestive of congenital Zika syndrome and a
mother with a possible exposure to Zika virus,
regardless of maternal Zika virus testing results
Testing Babies for Zika
https://www.cdc.gov/zika/hc-providers/infants-children/evaluation-testing.html
What is CDC Doing?
• Purpose
» Monitor pregnancy and infant outcomes in pregnancies with Zika virus infection to inform clinical guidance and public health response
• Who is included
» Pregnant women with laboratory evidence of possible Zika virus infection
» Infants with laboratory evidence of congenital Zika virus infection
» In Colombia – based on maternal symptomatic Zika virus disease
US Zika Pregnancy Registry
Zika Active Pregnancy Surveillance System (Puerto Rico)
Proyecto Vigilancia deEmbarazadas con Zika (Colombia)
Collecting Data: Zika Pregnancy and Infant Registries
Sharing Up-to-Date Information
• Providing updated clinical guidance» Travel, testing, and other recommendations for pregnant women
» Published updates to clinical guidance and algorithms for healthcare providers caring for pregnant women and infants
• Responding to your inquiries» Email: [email protected]
» Zika Pregnancy Hotline: 770-488-7100
• Providers and the general public can also ask questions through CDC-INFO
» Call 1-800-CDC-INFO (1-800-232-4636)
» Visit www.cdc.gov/cdc-info
https://www.cdc.gov/zika/hc-providers/index.html*Free materials available in English, Spanish, and other languages
Developing Tools for Healthcare Providers
For more resources to share with families, visit: http://www.cdc.gov/zika/fs-posters/index.htmlAvailable in English, Spanish and other languages
Resources for Families
• Referral Network
Identify specialty healthcare providers
» Maternal-fetal medicine, mental health services, audiology, radiology, pediatric ophthalmology, pediatric neurology, developmental pediatrics, infectious disease, and endocrinology
» Consider joining the network if you are a healthcare professional located within one of the Zika Care Connect focus areas
• Professional Resources
Information for healthcare professionals caring for patients with Zika
» Links to materials from American Academy of Pediatrics,
American College of Obstetricians and Gynecologists, CDC,
and March of Dimes
» Contact information for the CDC Zika Pregnancy Hotline
Website: www.zikacareconnect.org
HelpLine: 1-844-677-0447 (toll-free)
Zika Care Connect: Improving Access to Clinical Services
What Can You Do?
Educate families on Zika prevention
Connect with local health departments
Support babies and families
How You Can Help
Available online at https://www.cdc.gov/zika/comm-resources/toolkits.html
CDC Zika Educational Materials
CDC’S Response to Zika
More information on Zikawww.cdc.gov/zikahttps://www.cdc.gov/mmwr/zika_reports.html
For questions about CDC’s work related to Zika and unintended pregnancy, contact CDC-INFO at 1-800-232-4636 or www.cdc.gov/cdc-info
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.