Zika Outbreak: What Pharmacists Need to Know

Transcription

1 Zika Outbreak: What Pharmacists Need to Know Timothy Gauthier, PharmD, BCPS-AQ ID Miami Veterans Affairs Healthcare System Social Meghan Jeffres, PharmD University of Colorado Skaggs School of 2 Supporter Developed in partnership with the Society for Infectious Diseases Pharmacists. Disclosures The views expressed in this presentation are those of the presenters and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government. Timothy Gauthier declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria Meghan Jeffres declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 3 4 Learning Objectives Target Audience: Pharmacists ACPE#: L01-P Activity Type: Knowledge-based 1.Describe the epidemiology and transmission of Zika virus 2.List signs, symptoms, and complications of Zika virus 3.Evaluate strategies to prevent and treat infection 5 6

2 Which of the following is false? A. Zika virus was first discovered in the Zika Forest of Uganda B. Zika virus is an arbovirus, transmitted by Aedes mosquitos C.Active transmission of Zika virus has not yet occurred in the Americas D.Maternal-fetal transmission of Zika virus is possible How many hours will an insect repellent with 25% DEET protect the wearer? A. 1-2 hours B. 4-8 hours C hours D. 12 hours 7 8 Find me on social Speaking of social media How will Zika impact mardis gras How will Zika impact the olympics? 11 12

3 How will Zika impact the economy? How will Zika impact abortion? How will Zika impact sex? What are people searching google for? Would Zika impact your travel plans? Would Zika impact your travel plans? Poll from 2/9/

4 Would you be here if this conference was in Miami? But why are WE talking about Zika? 1. Ability to spread broadly and rapidly 2. Potential to cause serious health complications Staying in the know - WHO Staying in the know - PAHO Staying in the know - CDC Staying in the know FL DOH

5 Staying in the know Others Discovery & spread of Zika Discovery & spread of Zika Discovery & spread of Zika Discovery & spread of Zika Discovery & spread of Zika 29 30

6 Discovery & spread of Zika Countries w/ Zika virus (as of 2/3/2016) Zika in the United States As of 2/16/2016 As of 2/10/ Zika basics Single-stranded RNA virus Family Flaviviridae, genus Flavivirus An arbovirus Transmitted by Aedes species mosquitoes Similar to dengue, yellow fever, japanese encephalitis, west nile virus Zika Virus What Clinicians Need to Know. CDC. Jan 26, Zika Virus What Clinicians Need to Know. CDC. Jan 26,

7 Zika Virus What Clinicians Need to Know. CDC. Jan 26, Non-mosquito Zika transmission Maternal-fetal Intrauterine & perinatal Sexual Blood transfusion Laboratory exposure Potential: Organ or tissue transplantation Breast milk Zika Virus What Clinicians Need to Know. CDC. Jan 26, Zika Virus What Clinicians Need to Know. CDC. Jan 26, MENU Dengue Chikungunya Zika Symptoms of tropical mosquitorelated viral infections Sign or Symptom Zika, n=31 Dengue, n=127 Chikungunya, n>500 Rash 90% 35% 45% Fever 65% (low) 72% (high) Arthritis or arthralgia 65% 89% 90% Conjunctivitis 55% Myalgia 48% 50% Retro-orbital pain 39% Nausea/Vomiting 10% 78% 45% Hemorrhage 0% 68% 5% 41 NEJM 2009;360: J Clin Vir 2014;61: Antiviral Research 2013;99:

8 Severity of tropical mosquito-related viral infections 80% Zika Dengue Chikungunya Zika Complications (allegedly) Microcephaly Guillain-Barré 60% 40% 20% 0% Azymptomatic Mortality NEJM 2009;360: Am J Epidemiol. 2002;156(1):40. Lancet 2012;379: Causes of microcephaly Unknown 41% Likely genetic Postnatal injury 2% Infarct, encephalitis, trauma Craniosynostosis 2% Genetic 29% Chromosome deletion/duplication, syndromes Prenatal injury 27% Infections (toxoplasmosis, rubella, herpes, syphilis, CMV, HIV), heavy metals, EtOH, smoking, radiation, malnutrition Suspected Microcephaly Cases Brazil Health Ministry ov.br/prevencao-e-combate 46 Lots of noise. What is the signal? Causation vs. Association Feb 3, 2016 Brazil Health Ministry: "Of the cases examined so far, 404 have been confirmed as having microcephaly. Only 17 of them tested positive for the Zika virus. Feb 6, 2016 (Colombian President Juan Manuel) Santos said in the day that the number of people infected with zika in the country amounted to 25,645, of which 3,177 are pregnant women. He said that "in Colombia has not submitted a single case of infants with microcephaly in relation to the virus."(translated from Spanish) DOI: /NEJMoa

9 Guillain-Barré syndrome Worldwide prevalence Adults /100,000; Children /100,000 Per 100, GBS reporting in Brazilian States Alagoas Bahia Rio grande do Norte Piaui Neuroepidemiology 2009;32: Euro Surveill 2014;19(9):pii= Espirito Santo Rio de Janeiro 49 Prevention Source Control Mosquito British biotech firm Releases male genetically modified mosquitos Results in early prodigy death Claims 82% in wild mosquito larvae in Brazil (8 months, April-Dec 2015) 90% Aedes aegypti mosquito population in Brazil, Panama, Cayman Islands 50 Prevention Source Control Humans Sexual transmission 3 cases male to female All men were symptomatic Unknown if transmissible when asymptomatic Viremia x 1 week, semen is longer weeks/months? Recommendations after potential exposure Paul E. Sax, MD recommendations Unprotected sex after 4 weeks Protected sex during pregnancy Prevention Vaccine Development Flavivirus vaccine approval Japanese encephalitis 1930s Yellow fever 1950s Dengvaxia created by Sanofi Pasteur Dec 2015: Approved in Mexico, Brazil, Philippines, 19+ pending Cost: 20 years, $1.65 billion Projected recovery: $1.4 billion by 2020 MMWR February 5, 2016 / 65(5); Dengue vaccine initiative 52 How many years until a vaccine for Zika is publicly available? Timeline A. 1 year B. 2-4 years C. 5-9 years D. 10 years NIAID Predictions National Institutes of Allergy and Infectious Disease ideal vaccine development timeline Preclinical studies Summer 2016 Phase IIa/IIb January 2017 Accelerated approval from FDA December

10 Prevention Patient Education Children Cover crib, stroller, carrier with mosquito netting Clothing that covers arms and legs Repellent for those > 2 months avoid hands, eyes, mouth, open skin Traveling to Zika areas Stay in places with air conditioning, window/door screens Sleep under mosquito nets 55 Prevention Patient Education Repellent DEET, picaridin Apply to exposed skin and clothing Apply sunscreen before repellent Active ingredient 98% 25% 15% 7% Hours of Protection Minimum Maximum 56 Prevention Patient Education Insecticide permethrin Lice and scabies treatment of choice Clothing Do-it-yourself soak 6 washings Factory 70 washings Safe in pregnancy and children Tested and effective against Aedes aegypti mosquito Am J Trop Med Hyg. 2015;93(4): PLoS Negl Trop Dis 2015;9(10):e Supportive Treatment Fluids prevent dehydration Symptom management Fever and pain Acetaminophen maximum 3-4 g/day Avoid aspirin and NSAIDs until dengue is ruled out Good reads Paul E. Sax, MD Twelve Zika Questions, One ID Doctor s Answers (Sort Of): Associated Press Everything we know about the Zika virus in 5 slides:

11 Key Points Pharmacist are well positioned to provide information and direct patients to reliable resources 80% of infected patients are asymptomatic Practice safe sex after returning from Zika infected areas Avoid mosquito bites through multiple methodologies Which of the following is false? A. Zika virus was first discovered in the Zika Forest of Uganda B. Zika virus is an arbovirus, transmitted by Aedes mosquitos C.Active transmission of Zika virus has not yet occurred in the Americas D.Maternal-fetal transmission of Zika virus is possible How many hours will an insect repellent with 25% DEET protect the wearer? A. 1-2 hours B. 4-8 hours C hours D. 12 hours 63