ZIKA VIRUS

OUTBREAK

JANET B. EDDY M.D.

KU-WICHITA PGY2

OBSTETRICS AND GYNECOLOGY RESIDENCY Dominican Republic 2016

Zika time line

1947: 1st isolated in rhesus monkey in Zika forest of Uganda1

12/2013: Outbreak in French Polynesia1

2015 1ST reported case in South America

1/8/16: 1ST reported US case of Zika infected mother with microcephaly. 2

Detected in Hawaii but thought to have acquired in Brazil

2/1/16: World Health Organization declared the Zika virus outbreak a

Public Health Emergency of International Concern

2/12/16: 120,256 total cumulative cases reported3

Zika Virus

It is a single stranded RNA virus that spreads primarily

through infected Aedes aegypti mosquitoes infecting both

humans and nonhuman primates4

Perinatal transmission

“Possible sexual and transfusion transmission”4

Can spread from infected human up to a week

Incubation period: 3-12 days

http://ais.paho.org/phip/viz/ed_zika_countrymap.asp

Signs and Symptoms

Need at least 2 symptoms3

Fever

Maculopapular rash

Joint pain

Conjunctivitis

Muscle pain

Headaches

Usually mild and rarely causes death

Only about 1 in 5 people become sypmtomatic4

Diagnosis4

Reverse transcription polymerase

chain reaction (RT-PCR) if onset of

symptoms in previous week

IgM and plague reduction

neutralizing (PRNT) antibody

Specimens collected >= 4 days of

symptom onset

IgM antibodies are present at least 2

wks after virus exposure and last up

to 12 weeks

Cross sensitivity with other flaviviruses

(dengue, yellow fever, west nile)

Negative results

Asymptomatic: can’t fully rule out

Symptomatic: suggest no recent

infection

Positive results

>= 4 –fold higher than dengue virus

Sequela & Management Symptoms

Rest, hydration, acetaminophen

Avoid aspirin and NSAIDs to avoid risk of hemorrhage in case of dengue fever4

Guillain-Barre Syndrome (GBS)

Fast increase in prevalence2

Microcephaly/CNS Malformation

Brazil: Between 2001- 2014 they had an average of 163 cases per year

Between 1/1/15 -1/30/16 they had 4,783 cases of microcephaly, CNS malformation & death (76) 2

Definition

< or =2 SD below or <3% for sex and wga.5

Prevention is Treatment

Prevent mosquito bites

Deet , picaridin & IR3535 repellents are safe in

pregnancy 6

Mosquito nets

Protective clothing (long sleeves/pants)

Avoid stagnant water

Don’t travel to affected areas

Vacation is planned. Plan your pregnancy.

There is no current vaccine or direct treatment for the

Zika virus.

ZIKA & pregnancy in the USA

It is unknown if pregnant patients are more susceptible to virus3.

Ask you pregnant patients about recent travel3

Offer serologic testing 2-12 wks after travel to areas with ongoing outbreak3

Who should get tested?

Symptoms during or within 2 weeks of travel to affected areas

US with microcephaly or intracranial calcifications

Positive test

Serial US exams to monitor growth and anatomy

Referral to MFM or infectious disease specializing in pregnancy

Or test neutralizing

antibodies on

serum

Reference #3

After 15 wga

ZIKA & Pregnancy in Outbreak Regions3

If symptomatic, test during 1st week of illness

If asymptomatic

Test at initiation of prenatal care

Test at mid 2nd trimester

ZIKA & Future Pregnancies

Viremia lasts approximately 1 week

No current evidence that Zika infection poses risk

to future pregnancies7

Male Female Sexual Transmission?

Replicative Zika found in semen sample with sexual transmission to

wife suspected1

Case 2: Colorado

Potential sexual transmission under investigation

Unpublished, 2016, Dallas County Health & Human Services

Male testing for risk assessment is not recommended at this time9

Males at risk should abstain from intercourse or use condoms for

duration of pregnancy9

Do you need to test a patient?

• 877-427-7317 option #5

• Kansas Health & Environment Department

Patient• Send to CDC

• Submission form to KHED

Sample

• PCR 4 days

• Serology14 days

Results

Results go to local health department (tier 1) physician patient

Epihotline@kdheks.gov

Where do we go from here?

Stay updated

Educate your patients and avoid travel to

affected areas while pregnant or trying to get

pregnant.

Ask your patients questions

Prevent mosquito bites

References1. Musso, Roche, et al. Potential Sexual Transmission of Zika Virus. Emerging infectious diseases;21,2, 2015.

2. Pan American Health Organization (PAHO) 2/10/16: Zika Epidemiological Alerts & Updates. Paho.org

3. Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:122–127. DOI:

4. CDC. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak- US 2016.

5. PAHO. Preliminary guidelines for the surveillance of microcephaly in newborns in settings with risk of Zika Virus Circulation. Paho.org. 1/21/2016

6. CDC. Travelers health: Protection against mosquitoes, ticks, & other arthropods. Atlanta, GA: US Department of Health & Human Services, CDC; 2015.

7. CDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/zika/index.html.

8. COLORADO CASE SLIDE 14

9. Petersen EE, Staples JE, Meaney-Delman, D, et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30–33. DOI: http://dx.doi.org/10.15585/mmwr.mm6502e1

10. http://www.kdheks.gov/zika/index.htm

11. ACOG: Practice Advisory: Updated Interim Guidance for Care of Obstetric Patients And Women Of Reproductive Age During a Zika Virus Outbreak

The End