Zika Zika Central/South America - PowerPoint Presentation

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Zika

Zika

Central/South America

Carribean

, Puerto Rico

Papua New Guinea and American Samoa

Geography

Timing

Signs and Symptoms

Classic Features

3-12 days

Conjunctivitis, arthralgia, rash, or fever

Mimics dengue, chikungunya

Conjunctivitis

Microcephaly due to congenital infection

Zika

Arbovirus, genus

Flavivirus

Related to dengue, yellow fever, West Nile virus

Only 1 in 5 infections are symptomatic

Symptoms usually mild, lasting up to a week

Before 2015, reported in Africa, SE Asia, Pacific Islands

Guillain-Barré

reported following

Zika

infection

Zika

2015 Brazil outbreak associated with increase in babies born with microcephaly

Transmission routes now known:

From mosquito bite

In utero mother to fetus

Sexual transmission from male partner

Blood transfusion

Zika: Q and A

Where is Zika?

Evaluation of Congenital Zika

What is a positive Zika test?

Where is Zika in the US?

Testing for Congenital Zika

Guillain-Barré Syndrome

Breastfeeding

How do I test for acute Zika?

When do I test for acute Zika?

Long term follow-up of Congenital Zika

Guidance for Travel

Sexual Transmission

Where is Zika?

http://www.cdc.gov/zika/geo/index.html

, May 26th

What about the US?

Active transmission in Puerto Rico, US Virgin Islands, American Samoa

935 cases, 142 pregnant women591 US travel-associated cases168 pregnant women11 sexually transmitted1 with Guillain-Barré

What is a positive Zika test?

Zika virus RNA on reverse transcriptase-PCRZika virus IgM with neutralizing antibody titers >= 4 times higher than dengue virus neutralizing antibody titersIf antibody titers <4x higher, test is considered inconclusiveRT-PCR may be negative after in utero infectionFalse positive IgM due to dengue and yellow fever

When to Test for Acute Zika

Patients with travel to an affected area within 2 weeks and 2 or more of the followingFever, rash, conjunctivitis, or arthralgiaInfants under 2 weeks if mother travelled to an affected area within 2 weeks of delivery and the infant has 2 or more of above symptoms

How to Test for Acute Zika

Serum RT-PCR within 7 days of symptomsUrine RT-PCR within 14 days of symptomsIgM serology and neutralizing antibodies >4 days of symptomsCSF can be tested for Zika virus RNA if clinical concern

Figure 6:

CDC testing algorithm for Chikungunya, Dengue &

Zika

virus

Guillain-Barré Syndrome

Zika virus infection associated with increased rates of GBSCausal relationship not yet establishedRisk increases with increasing age

Testing for Congenital Zika

Infants with microcephaly or intracranial calcifications and a positive maternal travel history should be tested within 48 hours of birthInfants without those abnormalities should be tested if the mother had positive or inconclusive Zika serum testsInfants without abnormalities do not need to be tested if the mother was negative or had travel but no testingRT-PCR and IgM should both be sentPlacenta and umbilical cord tissue can also be tested

Evaluation of Congenital Zika

Physical examinationHead circumference, length, weight, gestational ageNeurologic examDysmorphic featuresHepatosplenomegalyRashCranial ultrasound if not documented as normal in third trimesterOphthalmology examNewborn hearing screenIf abnormalities, consider genetics, neurology & ID

Congenital Neurologic Abnormalities

Microcephaly with intracranial calcifications, ventriculomegaly, lissencephaly, pachygyriaFetal Brain Disruption SyndromeCongenital contractures, clubfootAbnormal eye findings

Zika's ground zero: Generation of babies born with microcephaly face uncertain future

Long-term Follow-Up

Infants with positive or inconclusive Zika virus testAdditional hearing screen at 6 monthsAudiology follow-up for abnormal hearing screensHead circumference and developmental milestones through age 1 yearRefer for abnormalities (neurology, developmental pediatrics, physical or speech therapy)No known abnormalities from Zika acquired around time of delivery

What about breastfeeding?

Zika virus RNA has been found in breastmilkNo reported cases of transmission through breastfeedingBenefits outweigh “theoretical” risk of transmissionCDC encourages infected mothers and mothers in endemic areas to breastfeed

What about sexual transmission?

Zika virus detected in semen up to 62 days after symptom onsetNot detected in vaginal swabsIn men with clinical illness, transmission occurred before, during, and after symptomatic periodCondoms or abstinence x 6 monthsMen diagnosed with ZikaPossibly exposed male partners of pregnant women (travel to affected area)

References

Testing:

Centers for Disease Control and Prevention. Memorandum, CDC Division of Vector-Borne Diseases: Revised diagnostic testing for

Zika

, chikungunya, and dengue viruses in US Public Health Laboratories. Available at:

http://www.cdc.gov/zika/pdfs/denvchikvzikv-testing-algorithm.pdf

. Accessed September 22,

2016.