Download The mosquitoes Aedes

Zika Virus Infection
Thomas M. File, Jr. M.D., M.Sc.
Chair, Infectious Disease Division
Summa Health System;
Professor of Internal Medicine,
Chair Infectious Disease Section
Northeast Ohio Medical University
Fever in Traveler returning from
Caribbean
• Returning traveler from the Caribbean(5 days)
• Within 24 hours c/o pain to back of knees, both
ankles and feet, wrists and hands-symmetric, no
swelling nor erythema, lasted 3-4 days
• Severe spinal pain, inability to stand upright -3 days
• Fevers –constant for up to 72 hours 101-102F
• Malaise, myalgia, fatigue for 1 week
• 2-3 days later, faint erythema to trunk, followed by
photosensitivity rash to arms face legs-transient
pruritus
• No headaches, URI symptoms
Chikungunya
•Viral infection
•No vaccine or treatment
•No person-to-person transmission
•Mosquito vectors
•Aedes aegypti or Aedes albopictus
widespread
•Mosquitoes can “hitchhike”
Chikungunya
•The mosquitoes
• Aedes species; same types for dengue virus
• Bite mostly during the daytime
•Symptoms
• Usually begin 3‒7 days after being bitten by an
infected mosquito
• Most common symptoms are fever and severe
joint pains, often in the hands and feet
• Joint pains persist in 50% for > 1 year
• Other symptoms may include headache,
muscle pain, joint swelling, or rash
Chikungunya
• Sudden high fever (usually >102º F) which may be continuous
or intermittent
• Severe joint pain that commonly involves the hands and feet
• Joint swelling
• Back pain
• Rash usually 2-5 days after fever starts
• Other symptoms may include headache, body ache, nausea,
vomiting, and redness around the eyes. In unusual cases,
infection can involve the brain, eyes, heart, kidney and other
organs.
• Fatal infections are rare, however many patients have chronic
joint pain, arthritis, loss of energy and depression lasting
weeks to years.
Differential diagnosis
Chikungunya vs Dengue viral fever
Dengue more pronounced retro-orbital pain
More commonly hypotension and mild bleeding
complications
Fatigue can last for months
Associated with higher mortality
?influenza-like, but no URI symptoms
Outbreak Dengue in Hawaii (Nov, 2015, Big
Island)
Diagnostic testing
•Performed on the 3rd day given
persistent symptoms
•CBC, mild lymphopenia, mild
thrombocytopenia
•LFT not done
•Mild CPK elevation
•Chikungunya PCR+
•Other options: paired sera for
Chikungunya IgM
Chikungunya
Treatment/Prevention
• No medication to treat or prevent infection
• Vaccine under development
• Reduce mosquito exposure
• Use air conditioning or window/door screens
• Use mosquito repellents on exposed skin. Repellents
containing DEET, picaridin, IR3535, and some oil of
lemon eucalyptus and para-menthane-diol products
provide long lasting protection.
• Wear long-sleeved shirts and long pants
• Empty standing water from outdoor containers
• Support local vector control programs
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Flaviviridae virus family; related to dengue, West Nile, Chikungunya
Started Uganda; new to West Hemisphere, Fla…..
Transmission: Mosquitoes, Sexual contact, ?other
Incubation: 2-12 days
Only 1 in 5 people infected with Zika virus experience symptoms
• fever, rash, joint pain and conjunctivitis, and sometimes headaches, muscle
pain and vomiting. The illness lasts about a week.
• linked to some alarming complications-microcephaly in fetuses of infected
pregnant women; Guillan Barre Syndrome…….
• Test: PCR of blood (within 7-14 days illness); Serology (after 14 days)
14
TRANSMISSION
Zika Virus Clinical Course
•Clinical course usually mild
•Symptoms last several days to a week
•Severe disease requiring hospitalization
infrequent
•Fatalities rare
•Neurologic sequelae uncommon
Neurologic manifestations of
Zika virus
•Burden higher than Microcephaly
•Other Childhood concerns
•Other neurological sequelae:
•GBS
•Encephalitis
•Myelitis
•Acute disseminated encephalomyelitis (ADEM)
•Opsoclonus-myoclonus-ataxia syndrome( OMS)
James J. Sejvar, MD, Neuroepidemiologist CDC. Nov 11, 2016
ZIKA SYMPTOMS
Typically starts on face
; spreads
NEJM March 3, 2016
ZIKA: Therapy Prevention
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• 72 Pregnant women + Zika; 5-38 wks gestation
• Pred features;
• pruritic descendng rash (maculopapulrar), arthralgia, HA;
28% fever, lymphadenopthy
• 42 with fetal US
• Abn in 12 (29%)
• Fetal death-2
• Growth restriction with or without microcephaly- 5
• CNS lesions- 7; ABN cerebral or umbilical artery flow-7
Conclusion: Despite mild clinical symptoms, ZIKV infection during
pregnancy appears to be associated with grave outcomes,
including fetal death, placental insufficiency, fetal growth
restriction, and CNS injury
NEJM March 3, 2016
NEJM March 3, 2016
Zika and Microcephaly: US
•Report from CDC 2/25/2016
•9 woman with + tests (of 257 tested)
• 3 delivered: 2 healthy, 1 microcephaly
• 2 had miscarriages
• 2 abortions: one with microcephaly
• 2 pregnancies continuing
•2 of nine delivered healthy babies, but two
still pregnant
• 2 confirmed microcephaly
Zika: US
•Report 10/26/2016
•Total 32,814
•Locally acquired: 28,289
•99% in territories: PR, VI….
•139 in FLA
•Travel related 4048
•Preg outcomes in 50 US States
•25 births with defects.
CDC Recommendations: Pregnancy
•If pregnant avoid travel to areas of Zika infection
• Male partners to areas should abstain or use condoms
during entire pregnancy if traveled to area of Zika
infection; avoid impregnation for 6 months
•If Pregnant and has traveled to area of Zika
infection
• See algorithm next slide
•If not pregnant but child bearing age and going to
area of Zika infection
• Use reliable birth control (50% pregnancies in US
unplanned)
• Mosquito avoidance
• Avoid pregnancy 2 months
ZIKA Vaccine
• Under Development
• In June 2016 the FDA granted the first approval for
a human clinical trial for a Zika vaccine.
Healio Outbreak Tracker. Nov 24, 2016
Healio Outbreak Tracker. Nov 28, 2016