ZIKA VIRUS

PEDIATRICS DONE BY : MUSTAFA KHALIL IBRAHIM TBILISI STATE MEDICAL UNIVERSITY

Introduction Epidemiology Transmission Signs and symptoms Complications Risk factors Diagnosis Treatments Prevention

guidelines

WHO & CDC reported : The World Health Organization has declared

the Zika virus an international public health emergency, prompted by growing concern that it could cause birth defects. As many as four million people could be infected by the end of the year.

Officials at the Centers for Disease Control and Prevention have urged pregnant women against travel to more than thirty countries, mostly in the Caribbean and Latin America, where the outbreak is growing. Some pregnant women who have been to these regions should be tested for the infection, the agency has said.

Zika virus disease is a mosquito-borne viral infection that primarily occurs in tropical and subtropical areas of the world.

It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans

Genre: Flavivirus Vector: Aedes mosquitoes (which usually bite during the

morning and late afternoon/evening hours) Reservoir: mosquitoes (gut, blood, saliva ) human ( blood, prostate, semen and testes ) umknown (sliva, urine, milk …ect)

Introduction

1- Its viral infection . 2- infect all kinds of people . 3- rapid spread . The rapid spread of ZIKV will continue

until it reaches all countries of the region where the Aedes mosquito is found.

Why it’s dangrous ?

Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific.

Epidemiology

In 2007, a major epidemic was reported on the island of Yap (Micronesia), where nearly 75% of the population was infected.  

This was followed by an outbreak of the same strain in French Polynesia in 2013; since then there have been major outbreaks in other parts of the Pacific.

On 3 March 2014, Chile notified PAHO/WHO of autochthonous transmission of Zika virus on Easter Island, where the virus continued to be detected until June 2014. 

In May 2015, the public health authorities of Brazil confirmed the transmission of Zika virus in the country’s northeast. Since October 2015, other countries and territories of the Americas have reported the presence of the virus. 

As of 29 January 2016, 23 countries currently experiencing active transmission are: Barbados, Bolivia, Brazil, Cape

Verde, Colombia, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, Thailand, Venezuela, US Virgin Islands.

http://www.dailystar.co.uk/news/latest-news/492577/Zika-virus-will-hit-Summer-holidays-Mediterranean-south-america-brazil-mosquitos-transmit

1. The population in this part of the world had not previously been exposed to ZIKV and so lacked immunity.

2. Aedes mosquitoes, the main vector for ZIKV transmission, are present in all of these regions/countries .

ZIKV has not occurred naturally in the UK because we do not have the vectors .

imported cases have occurred in the UK in travellers that have returned from South and Central America (as well as one from the Cooks Islands in 2014)

Why it’s rapid spreaded over the past few months?

Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions.

This is the same mosquito that transmits dengue, chikungunya and yellow fever.

There is no evidence of transmission Zika virus in Europe to date

Few people here have immune defenses against the virus, so it is spreading rapidly.

Only 2 known species out of 176 species of mosquitoes spread Zika identified in the US.(cdc)

Millions of people in tropical regions of the Americas may now have been infected

Transmission

1- infected mosquito to human. 2- infected human to mosquito then to human. 3- from infected pregnant woman to fetus. 4-blood transfusion . 5- semen (sexual transmission) . sexual transmission of Zika virus has been

described in 10 cases, and the presence of the Zika virus in semen in additional cases.

umknown (sliva, urine, milk, air, …ect) under reporting .

Who Zika Virus Transmitted ?

There is no evidence that ZIKV can be transmitted to babies through breast milk and the advice to mothers to breastfeed remains unchanged

Wherever certain mosquitoes go. But the mosquito is common in the United

States only in Florida, along the Gulf Coast, and in Hawaii – although it has been found as far north as Washington, D.C., in hot weather.

The Asian tiger mosquito, Aedes albopictus, is also known to transmit the virus, but it is not clear how efficiently. That mosquito ranges as far north as New York and Chicago in summer.

What areas is Zika likely to reach?

The virus moves from its gut to its salivary glands.

Only female mosquitoes bite people: they need blood to lay eggs. They pick up the virus in the blood. It travels from their gut through their circulatory system to their salivary glands and is injected into its next human victim. Mosquito saliva contains proteins that keeps blood from clotting. When a mosquito bites, it first injects saliva so its prey’s blood does not clog its strawlike proboscis.

How does a mosquito transmit Zika?

Yes. Experts believe that the vast majority of Zika infections are

transmitted by mosquitoes, not sex. As of early March/2016, however,  more than a 10 cases of

transmission through sex have been reported in four countries.

In each case in which details were released, the virus was transmitted by a man who had visited a region where the infection circulates to a woman who had not.

Live virus has been found in semen more than two months after symptoms of infection disappeared. Scientists believe the prostate or testes can serve as a reservoir, sheltering the Zika virus from the immune system. In some cases, the men with infections had blood in their semen.

Can the Zika virus be sexually transmitted?

Health authorities now recommend that women who are pregnant or trying to become pregnant avoid contact with semen from men who have visited areas where the Zika virus is transmitted. Women who are pregnant should have sex only with partners using a condom

There are still many unknowns. Can a woman pass the virus to a man through sex? Can

it be passed through anal, oral or other forms of sexual contact?

Does a man have to have blood in his semen to be infectious? Is he infectious before the blood appears?

If there is no blood, must he have had symptoms of Zika infection, like fever and rash, to be contagious? How long does a man remain infectious?

Symptoms are similar to those of dengue or chikungunya, arbovirus infections, which are transmitted by the same type of mosquito.

1 out of 4 infected people develops symptoms of the disease .

When symptoms do occur, they usually begin 2 to 12 days after being bitten by an infected mosquito.

Most people recover fully, with symptoms resolving in about a week.

Signs and symptoms of Zika virus disease most commonly include:

Signs & Symptoms

mild fever

Rash (exanthema )

joint or muscle pain (arthralgia/arthritis )

headache

Red eyes (non-purulent conjunctivitis)

& Retro-orbital pain

Myalgia

Itchy (Pruritus)

general malaise

Which is the difference between Zika, dengue, and

chikungunya?Dengue Chikungunya Zika

• higher fever • more severe muscle

pain• bleeding

• higher fever• more intense joint pain,

affecting the hands, feet, knees, and back. It can disable people, bending them over so that they cannot walk or perform simple actions such as opening a water bottle. 

• Mild fever • skin rashes • conjunctivitis. 

Several reports now have shown that ZIKV can cross the placental barrier and enter the amniotic fluid (the protective fluid that surrounds a developing fetus within the womb) and attack fetal nerve cells, including some that develop into

the brain. the virus has been detected in

blood and tissues of fetuses & infants.

pathophysiology

Zika virus infections during pregnancy have been linked to miscarriage and microcephaly, a potentially fatal congenital brain condition.

Zika virus also may cause other neurological disorders such as Guillain-Barre syndrome.

Neurological and autoimmune complications are infrequent, but have been described in the outbreaks in Polynesia and, more recently, in Brazil.. 

. In adults, the virus is linked to a form of temporary paralysis.

Complications

In addition to microcephaly, other problems have been detected among fetuses and infants infected with Zika virus before birth:

1- Absent or poorly developed brain structures 2- Defects of the eye 3- Hearing deficits. 4- Impaired growth. Although Zika virus has been linked with these

other problems in infants, there is more to learn. Researchers are collecting data to better understand the extent Zika virus’ impact on mothers and their children. (cdc )

Zika & Other Birth defects :

An increase in Guillain-Barré syndrome (GBS) has been observed in areas where a Zika virus epidemic has been documented (e.gFrench Polynesia and Americas). Recent studies have documented this association.

GBS occurs when a person’s immune system attacks itself, in particular affecting the cells of the nervous system. This process can be initiated by infection with various viruses or bacteria.

The main symptoms include : 1- Muscular weakness. 2- Tingling (paresthesia) in the arms and legs. severe complications can occur if the respiratory

muscles are affected

Guillain-Barré syndrome and Zika virus? 

An usually small head, often accompanied by brain damage.

Babies with microcephaly have unusually small heads. In roughly 15 percent of cases, a small head is just a small head, and there is no effect on the infant, according to Dr. Constantine Stratakis, a pediatric geneticist and a scientific director at the National Institute of Child Health and Human Development.

But in the remainder of cases, the infant’s brain may not have developed properly during pregnancy or may have stopped growing in the first years of life. These children may develop a range of problems, like developmental delays, intellectual deficits or hearing loss.

What is microcephaly?

Microcephaly can happen for many reasons. Some babies have microcephaly because of

1- Changes in their genes. 2- Certain infections during pregnancy ex: measles, toxoplasmosis, chickenpox and cytomegalovirus. 3- A woman being close to or touching toxins during

pregnancy 4- Microcephaly may result if a pregnant woman

consumes alcohol, is severely malnourished or has diabetes.

There is no treatment for an unusually small head. “There is no way to fix the problem

Microcephaly causes:

In October 2015, the Brazilian Ministry of Health reported of increase in the number of babies born with microcephaly 20-times more than normal.

5.7:100,000 live births in 2010. 300:100,000 live births in 2014 . As of 23 January 2016, 4,180 cases of suspected

microcephaly, including 68 deaths, had been reported across 24 states in Brazil

Normally microcephaly occurs in about 1 in 5,000 to 1 in 10,000 of all births. Scientists analyzing that  1 in 100 of new borns are having microcephaly .

ZIKV in the Americas and Microcephaly

Officials in French Polynesia have suspicions about an outbreak two years ago.

In 2014-2015, 17 cases of fetal and neonatal central nervous system malformations were reported.

Four of these women were tested and had detectable IgG antibodies to flavivirus.

Has a Zika outbreak outside Brazil ever been linked to

microcephaly?

Based on the available evidence, we think that Zika virus infection in a woman who is not pregnant would not pose a risk for birth defects in future pregnancies after the virus has cleared from her blood.

From what we know about similar infections, once a person has been infected with Zika virus, he or she is likely to be protected from a future Zika infection.(cdc)

future pregnancies

It may be that the virus had never struck such a large population without immunity.

Microcephaly is rare, and it has many other causes, including infection of the fetus with rubella (German measles), cytomegalovirus or toxoplasmosis; poisoning of the fetus by alcohol, mercury or radiation; or severe maternal malnutrition and diabetes. It is also caused by several gene mutations, including Down syndrome.

Until recently, health officials paid little attention to the Zika virus. It circulated in the same regions as dengue and chikungunya, and compared with those two painful infections – nicknamed “break-bone fever” and “bending-up fever” – Zika was usually mild.

The virus is thought to have reached Asia from Africa at least 50 years ago. While it may have caused spikes in microcephaly as it first spread, there was no testing to pin down which of many possible causes was to blame.

By November 2015, when Brazil declared a health emergency, Pernambuco had had 646 such births.

If the Zika virus has been in Africa and Asia for decades, why wasn’t a

link to microcephaly detected earlier?

Risk factors Factors that put you at greater risk of developing

Zika virus disease include: 1- Living or traveling in countries where

there have been outbreaks. Being in tropical and subtropical areas increases your risk of exposure to the virus that causes Zika virus disease. Especially high-risk areas include several islands of the Pacific region, a number of countries in Central, South and North America, and islands near West Africa. Because the mosquito that carries Zika virus is found worldwide, it's likely that outbreaks will continue to spread to new regions.

2- Having unprotected sex. Isolated cases of sexually transmitted Zika virus have been reported. The CDC advises abstinence from sexual activity during pregnancy or condom use during all sexual contact for men with a pregnant sex partner if the man has traveled to an area of active Zika virus transmission.

There is no commercial test available for the Zika virus.

Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.

A pregnant woman with no symptoms of Zika virus infection with a history of recent travel to an area with active Zika virus transmission can be offered testing two to 12 weeks after her return.

Once the test shows that the virus is present the confirmation of all cases is not necessary, and laboratory testing will be adjusted to routine virological surveillance of the disease.  

Tests & dignosis

medical and travel history. Ask the patient about international trips

in detail and which countries he\she had visit.

As well as any contact you may have had with mosquitoes.

The time and duration of the signs and symptoms.

sexual partner.

1- The CDC has blood tests to look for Zika virus or similar diseases such as dengue or chikungunya viruses, which are spread by the same type of mosquitoes.

2- Perform an ultrasound to detect microcephaly or other abnormalities of the brain.

3- Offer to take a sample of amniotic fluid using a hollow needle inserted into the uterus (amniocentesis) to screen for Zika virus.

4- Virological Polymerase chain reaction PCR tests are useful in the first 3-5 days after the onset of symptoms.

5- serological tests detect the presence of antibodies but are useful only after five days.

6- Urine 7- Saliva 8- Semen

9- MRI may performed for adult people to lock for guillain-barré syndrome and other disorders (the pregnant women should not do this test ).

Other birth defects may be linked to the virus. Federal health officials say that newborns

should be tested for infection with the Zika virus if their mothers have visited or lived in any country experiencing an outbreak and if the mothers’ own tests are positive or inconclusive.

The reason, officials said in interviews, is that infection with the virus could be linked to defects in vision and hearing, among other abnormalities, even if the child does not suffer microcephaly. The other defects may require further assessments and testing.

Should infants be tested?

Treatments

No specific antiviral treatment for Zika virus disease exists.

Treatment is aimed at relieving symptoms with rest, fluids and medications such as:

Acetaminophen (Tylenol, others) Ibuprofen (Advil, Motrin IB, others)

— to relieve joint pain and fever. Drink fluids to prevent dehydration.

There is no vaccine against the Zika virus and it might take more than 10 years.

The first vaccine candidate will be trialing is what's known as a recombinant vaccine, which means it contains Zika DNA, but not the virus itself.

The second potential vaccine is 'inactivated', and contains whole particles of Zika virus that have been tweaked so that they can no longer replicate or cause infection - but can still trigger an immune response.

Testing these vaccine candidates on animals is expected to take around five months, and after that they'll need to be tested in humans.

“Source India’s Bharat Biotech company”

vaccine

Zika is a new virus for the Region of the Americas. In the past, it had very limited geographical and demographic distribution and there was no evidence that it caused death. However, in the current outbreak, sporadic cases have been reported of more serious manifestations and complications that have sometimes resulted in death. 

As of 23 January 2016, 4,180 cases of suspected microcephaly, including 68 deaths, had been reported across 24 states in Brazil

Can it cause death?

1- Avoid mosquitoes bites if you are in that area.

2 do not travel to that areas . 3. The CDC recommends all pregnant

women avoid traveling to areas where there is an outbreak of Zika virus.

4- If she have a male partner who lives in or has traveled to that areas ,the CDC recommends protective sex (using condom).

5- Zika virus transmitted through blood transfusion (avoid it if possible).

Prevention

When in areas with Zika and other diseases spread by mosquitoes, take the following steps:

Steps to prevent mosquito bites

1- Wear protective clothing (long-sleeved shirts and long pants) .

2- Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside.

3- Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.

4- Use Environmental Protection Agency (EPA)-registered insect repellents. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women. Always follow the product label

instructions. Reapply insect repellent as

directed. Do not spray repellent on the

skin under clothing. If you are also using sunscreen,

apply sunscreen before applying insect repellent.

If you have a baby or child: Do not use insect repellent on babies younger

than 2 months of age. Dress your child in clothing that covers arms

and legs Do not apply insect repellent onto a child’s

hands, eyes, mouth, and cut or irritated skin. Adults: Spray insect repellent onto your hands

and then apply to a child’s face.

Treat clothing and gear with permethrin or purchase permethrin-treated items. Treated clothing remains protective after

multiple washings. See product information to learn how long the protection will last.

If treating items yourself, follow the product instructions carefully.

Do NOT use permethrin products directly on skin. They are intended to treat clothing.

During the first week of infection, Zika virus can be found in the blood and passed from an infected person to another mosquito through mosquito bites. An infected mosquito can then spread the virus to other people.

Avoid mosqitoes bite . Zika virus can be spread during sex by a man infected

with Zika to his sex partners. We do not know how long the virus is present in the semen of

men who have had Zika. We do know that the virus can stay in semen longer than in

blood. To help prevent spreading Zika from sex, you can use

condoms the right way every time you have sex

If you have Zika, protect others from

getting sick

Zika virus transmitted through blood transfusion A blood donor screening test for Zika virus is not currently

available. To reduce the risk of transmitting Zika virus through blood transfusion in areas where there are no active Zika virus outbreaks, the Food and Drug Administration recommends not donating blood for four weeks if you:

1- Have a history of Zika virus infection 2- Traveled or lived in an area with active Zika virus transmission 3- Have symptoms that are suggestive of Zika virus infection

within two weeks of travel from an area with Zika virus 4- Have had sexual contact with a male partner who has been

diagnosed with Zika virus infection 5- Have had sexual contact with a male partner who has

traveled or lived in an area with active Zika virus transmission in the past three months

blood donor screening test

Health officials in five countries — Brazil, Colombia, Ecuador, El Salvador and Haiti — and Puerto Rico have suggested that women delay pregnancy temporarily.

Once infected residents have recovered and have become immune, these officials argue, the epidemic will fade and women can safely become pregnant again. Also, many companies are working on Zika vaccines, and delaying pregnancy will buy time for them to arrive.

The Centers for Disease Control and Prevention recently recommended that women who have had symptoms of the virus or tested positive for it should wait at least eight weeks after their symptoms first appeared before trying to get pregnant.

Officials recommended that men who had symptoms should wait six months before having unprotected sex. The virus has been known to live longer in semen. Symptoms can include rashes and sore joints.

If I live in an area where the virus is circulating, should I delay becoming

pregnant?

Women should be advised to avoid becoming pregnant while travelling in an area with active ZIKV transmission. On returning to the UK,

they should avoid becoming pregnant for a further 28 days; this allows for a maximum two week incubation period and possible two-week viraemia.

Women whose partner has been to an area with ZIKV transmission

for 6 months following recovery if he did experience ZIKV symptoms during that period

Women planning pregnancy

Even if they do not feel sick, travelers returning to the United States from an area with Zika should take steps to prevent mosquito bites for 3 weeks so they do not spread Zika to uninfected mosquitoes.

Information for travelers

refferences http://www.cdc.gov/zika/prevention/index.html http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0 http://www.who.int/mediacentre/factsheets/zika/en/ http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/Pages/index.aspx http://jezebel.com/new-cdc-guidelines-advise-women-to-postpone-pregnancy-a-1767151359 http://www.cbc.ca/news/health/zika-cdc-guidelines-1.3507553 http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/zika-outbreak/Pages/zika-outbreak.aspx http://travelhealthpro.org.uk/zika-virus-update-and-advice-for-travellers-including-pregnant-women/ http://www.who.int/features/qa/zika/en/ http://www.mayoclinic.org/zika-virus/expert-answers/faq-20178199 http://www.mayoclinic.org/diseases-conditions/zika-virus/home/ovc-20189269 http://

www.paho.org/hq/index.php?option=com_content&view=article&id=9183:2015-preguntas-frecuentes-virus-fiebre-zika&Itemid=41711&lang=en

https://www.gov.uk/guidance/zika-virus http://www.webmd.com/a-to-z-guides/zika-virus-symptoms-prevention http://www.techtimes.com/articles/137003/20160227/us-now-has-147-cases-of-zika-virus-cdc.htm http://www.cdc.gov/zika/ http://www.cdc.gov/zika/about/ http://www.cdc.gov/zika/prevention/index.html http://

www.dailystar.co.uk/news/latest-news/492577/Zika-virus-will-hit-Summer-holidays-Mediterranean-south-america-brazil-mosquitos-transmit

http://www.sciencealert.com/an-indian-company-says-they-have-2-zika-vaccines-ready-for-pre-clinical-trials

THANK YOU FOR ATTENTION

BY : MUSTAFA KHALIL IBRAHIM