Zika Virus Guidance for Medical Providers. Denise Smith, PHN, MPA Director of Disease Control Kern County Public Health Services Department

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1 Zika Virus Guidance for Medical Providers Denise Smith, PHN, MPA Director of Disease Control Kern County Public Health Services Department Kern Perinatal Symposium March 3, 2017

2 CME DISCLOSURE The Planners, and Faculty for this activity have no relevant relationships with commercial interest to disclose. The content of this activity was vetted by the Kern Medical CME Executive Group to assure objectivity and that this activity is free of commercial bias.

3 Zika 101 Primarily mosquito-borne transmission Other transmission routes: sexual, maternal-child, laboratory/healthcare exposure, blood transfusion 80% infections are asymptomatic Symptoms: fever, macropapular rash, distal joint pain, conjunctivitis Severe disease uncommon Guillain-Barre Adverse birth outcomes: microcephaly, brain damage, eye defects, hearing deficits Once infected protected from future infections No vaccine or specific treatment available

4 Laboratory Testing Symptomatic persons Differential should include Dengue, chikungunya, WNV Pregnant women can be tested at any time Interpretation of test may be limited depending on timing Even with negative/not detected results, serial ultrasounds may be helpful NOT recommended to test asymptomatic, nonpregnant persons Value of test is limited

5 Laboratory Testing Currently available tests not verified by FDA. All are approved under Emergency Use Authorization Test have high cross-reactivity with other flaviviruses and alpha viruses Available through most commercial laboratories May require patient history State or CDC confirmatory testing may be necessary Health Department approval NOT required to order tests

6 Laboratory Testing Molecular testing (RT-PCR) Serum and urine Within 14 days of symptom onset or last potential exposure Serologic testing (IgM, PRNT) Serum 2-12 weeks of symptom onset or last potential exposure Positive/equivocal IgM will be confirmed with PRNT Specimens other than serum and urine require special approval for testing

7 Necessary Patient History Pregnancy status Travel history (or residence in Zika region) Specific location, not just country Exact dates of travel Reason for suspicion Symptoms (including onset date) Fetal anomaly (microcephaly, calcifications) Guillian-Barre Syndrome History of yellow fever or Japanese equine encephalitis vaccine History of other arbovirus infections

8 Zika Virus Travel Advisories Pregnant women and women who may become pregnant should NOT travel to areas with ongoing Zika virus transmission If must travel, consult with healthcare provider first All persons should follow steps to prevent mosquito bites and practice safe sex Upon return home, all persons should protect themselves from mosquitoes to avoid spreading virus Travel advisories change often; need to check often CDC Zika Travel

9 Endemic Zika Transmission Travel notices NOT issued for endemic countries Risk is theoretically lower (but not zero) Consistent, but low levels of circulation People living in endemic areas likely infected when they are young not during childbearing age Travelers still at risk of infection during travel, particularly pregnant females

10 Prevention of Sexual Transmission Abstinence or barrier method (e.g. condom) People who may have been exposed to Zika virus should protect their sex partners from transmission Females: 8 weeks Males: 6 months Asymptomatic and persons who have recovered from symptoms can still infect their partner Just because the infected person is asymptomatic does not mean their partner will also be asymptomatic if infected

11 Zika Virus and Pregnancy No evidence that a previous infection will affect future pregnancies Partners of pregnant women who may have been exposed should abstain from sex or use condoms (consistently and correctly) for the duration of pregnancy Persons who may have been exposed should delay conception until 8 weeks (females) or 6 months (males) after exposure/symptom resolution Exposed persons not wanting to become pregnant should take precautions to avoid pregnancy

12 Zika Virus and Pregnancy U.S. Zika Pregnancy Registry follows pregnant women with Zika virus infection 1,047 completed pregnancies (as of February 7) 43 infants with birth defects 5 pregnancy losses with birth defects Continue to monitor infants through 1 year Some evidence of developmental delay even with normal presentation at birth Still much to learn about pregnancy outcomes

13 Zika Virus and Breastfeeding Theoretical risk of transmitting Zika virus through breastmilk, but not documented Benefits of breastfeeding outweigh risk No evidence of adverse neurological outcomes from postnatal infection

14 Advice to Patients Patients should always take precautions to avoid mosquitoes, both while traveling and at home Regardless of test results, recommendations to avoid sexual transmission remain the same Zika virus can transmit in semen and vaginal fluid even after it has cleared from the blood Pregnancy outcomes continue to be evaluated, but can be severe