Download JANET B. EDDY M.D. KU-WICHITA PGY2 OBSTETRICS AND

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
Diagnosis


4
Reverse transcription polymerase
chain reaction (RT-PCR) if onset of
symptoms in previous week

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
IgM and plague reduction
neutralizing (PRNT) antibody

Specimens collected >= 4 days of
symptom onset


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)
Definition

< or =2 SD below or <3% for sex and wga.5
2
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
After 15 wga
Reference #3
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
Patient • Kansas
Health &
Environment
Department
Sample
• Send to CDC
• Submission form
to KHED
Results
• PCR 4 days
• Serology
14 days

Results go to local health department (tier 1)  physician  patient

[email protected]
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
References
1.
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