the emergence of a novel threat: zika - swedish medical center/media/images/swedish/cme... · laven...
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the emergence of a novel threat:
Zika
March 10, 2017Swedish Family Medicine
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1947Zika in Rhesus Macaques
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2015-2016Aedes Aegypti mosquito with Zika
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Range of Ae. aegypti
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Aedes aegypti likes people
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Complications of ZikaMaternal infection
CZS
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Range of neurological problems
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Zika infects glial cells: Guillain-Barré
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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
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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
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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)
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Other teratogenicviruses
Rubella
CMV
Herpes Simplex
Venezuelan Equine Encephalitis
Varicella
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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
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1981 to present -- HIV
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2002-2003 -- SARS
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2006 -- Bird Flu: H5N1
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2008-2009: H1N1Swine Flu Pandemic
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2012-2013MERS Co-V
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2014Ebola in West Africa
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Obrigado!
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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
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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