the emergence of a novel threat:

Zika

March 10, 2017Swedish Family Medicine

1947Zika in Rhesus Macaques

2015-2016Aedes Aegypti mosquito with Zika

Range of Ae. aegypti

Aedes aegypti likes people

Complications of ZikaMaternal infection

CZS

Range of neurological problems

Zika infects glial cells: Guillain-Barré

CDC Update: Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016

Women after exposure to Zika (or actual infection) should wait 2 months to conceive

Men after Zika infection should wait 6 months to conceive*

*after infection or exposure

When to test for Zika if exposed and pregnant?

one of the following within 2 weeks:

• If tests are positive or inconclusive, order serial US

How to test for Zika? Based on time after onset of symptoms.Early: viral PCR

Within 1 week of symptom onset: serum rRT-PCR

Within 2 weeks: urine rRT-PCR

Later: antibodies

After two week from onset of Sx: IgM (Zika MAC-ELISA)

If IgM positive, order PRNT (Plaque-reduction neutralization test) to rule out other flavivirusAb that cross react with Zika (dengue, yellow fever, West Nile)

Other teratogenicviruses

Rubella

CMV

Herpes Simplex

Venezuelan Equine Encephalitis

Varicella

Congenital Rubella Syndrome

40-90% of pregnancies in the 1st TM will be effected

> 40 % deafness

> 40 % blindness

> 50 % heart disease

intellectual deficits

Before vaccine: 4 babies in 1000 had CRS

2016: > 100,000 babies with CRS

1981 to present -- HIV

2002-2003 -- SARS

2006 -- Bird Flu: H5N1

2008-2009: H1N1Swine Flu Pandemic

2012-2013MERS Co-V

2014Ebola in West Africa

Obrigado!

References:

Duffy MR, Chen, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick M, Marfel M, Holzbauer S, Dubray C, Guillaumot L, Griggs A, Bel M, Lambert AJ, Laven J, Kosoy O, Panella A, Biggerstaff BJ, Fischer M, Hayes EB. Zika Virus Outbreak on Yap Island, Federated States of Micronesia. 2009 June. The New England Journal of Medicine. 360:2536-43

Musso D, Nilles EJ, Cao-Lormeau VM. Rapid spread of emerging Zika virus in the Pacific area. 2014. Clinical Microbiology and Infection. 20(10):O595-6

Roth A, Mericer A, Lepers C, Hoy D, Duituturanga S, Benyon E, Guillaumot L, Souares Y. Concurrent outbreaks of dengue, chikungunya and Zika virus infections - an unprecedented epidemic wave of mosquito-borne viruses in the Pacific, 2012-2014. 2014. Eurosurveillance. 19(41)

Shinichi N. Mosquito Fauna in the Federated States of Micronesia: A Discussion of the Vector Species of the Dengue Virus. 2014. South Pacific Studies. 34(2):117-27

Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study

Published Online: 15 March 2016

Dr Simon Cauchemez, PhD; Marianne Besnard, MD; Priscillia Bompard, MPH; Timothée Dub, MPH; Prisca Guillemette-Artur, MD…

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2900651-6/abstract?version=meter+at+null&module=meter-Links&pgtype=article&contentId=&mediaId=&referrer=https%3A%2F%2Fwww.google.com%2F&priority=true&action=click&contentCollection=meter-links-click

Zika Virus: Medical Countermeasure Development Challenges Published: March 2, 2016; Robert W. Malone , et al James Wilson , Zika Response Working Group

http://dx.doi.org/10.1371/journal.pntd.0004530