* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download JANET B. EDDY M.D. KU-WICHITA PGY2 OBSTETRICS AND
Survey
Document related concepts
Prenatal testing wikipedia , lookup
HIV and pregnancy wikipedia , lookup
Maternal physiological changes in pregnancy wikipedia , lookup
Transmission and infection of H5N1 wikipedia , lookup
Transmission (medicine) wikipedia , lookup
Maternal health wikipedia , lookup
Mosquito control wikipedia , lookup
Infection control wikipedia , lookup
Fetal origins hypothesis wikipedia , lookup
Canine distemper wikipedia , lookup
Reproductive health wikipedia , lookup
Canine parvovirus wikipedia , lookup
Transcript
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