ZIKA VIRUS OUTBREAK. JANET B. EDDY M.D. KU-WICHITA PGY2 OBSTETRICS AND GYNECOLOGY RESIDENCY Dominican Republic 2016

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1 ZIKA VIRUS OUTBREAK JANET B. EDDY M.D. KU-WICHITA PGY2 OBSTETRICS AND GYNECOLOGY RESIDENCY Dominican Republic 2016

2 Zika time line 1947: 1 st isolated in rhesus monkey in Zika forest of Uganda 1 12/2013: Outbreak in French Polynesia ST reported case in South America 1/8/16: 1 ST 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 reported 3

3 Zika Virus It is a single stranded RNA virus that spreads primarily through infected Aedes aegypti mosquitoes infecting both humans and nonhuman primates 4 Perinatal transmission Possible sexual and transfusion transmission 4 Can spread from infected human up to a week Incubation period: 3-12 days

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5 Signs and Symptoms Need at least 2 symptoms 3 Fever Maculopapular rash Joint pain Conjunctivitis Muscle pain Headaches Usually mild and rarely causes death Only about 1 in 5 people become sypmtomatic 4

6 Diagnosis 4 Reverse transcription polymerase chain reaction (RT-PCR) if onset of symptoms in previous week IgM and plague reduction neutralizing (PRNT) antibody Specimens collected >= 4 days of symptom onset 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 Asymptomatic: can t fully rule out Symptomatic: suggest no recent infection Positive results >= 4 fold higher than dengue virus

7 Sequela & Management Symptoms Rest, hydration, acetaminophen Avoid aspirin and NSAIDs to avoid risk of hemorrhage in case of dengue fever 4 Guillain-Barre Syndrome (GBS) Fast increase in prevalence 2 Microcephaly/CNS Malformation Brazil: Between 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) 2 Definition < or =2 SD below or <3% for sex and wga. 5

8 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.

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10 ZIKA & pregnancy in the USA It is unknown if pregnant patients are more susceptible to virus 3. Ask you pregnant patients about recent travel 3 Offer serologic testing 2-12 wks after travel to areas with ongoing outbreak 3 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

11 Or test neutralizing antibodies on serum After 15 wga Reference #3

12 ZIKA & Pregnancy in Outbreak Regions 3 If symptomatic, test during 1 st week of illness If asymptomatic Test at initiation of prenatal care Test at mid 2 nd trimester

13 ZIKA & Future Pregnancies Viremia lasts approximately 1 week No current evidence that Zika infection poses risk to future pregnancies 7

14 Male Female Sexual Transmission? Replicative Zika found in semen sample with sexual transmission to wife suspected 1 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 time 9 Males at risk should abstain from intercourse or use condoms for duration of pregnancy 9

15 Do you need to test a patient? Patient option #5 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 Epihotline@kdheks.gov

16 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

17 References 1. Musso, Roche, et al. Potential Sexual Transmission of Zika Virus. Emerging infectious diseases;21,2, 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, MMWR Morb Mortal Wkly Rep 2016;65: DOI: 4. CDC. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak- US PAHO. Preliminary guidelines for the surveillance of microcephaly in newborns in settings with risk of Zika Virus Circulation. Paho.org. 1/21/ CDC. Travelers health: Protection against mosquitoes, ticks, & other arthropods. Atlanta, GA: US Department of Health & Human Services, CDC; CDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; COLORADO CASE SLIDE Petersen EE, Staples JE, Meaney-Delman, D, et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak United States, MMWR Morb Mortal Wkly Rep 2016;65: DOI: ACOG: Practice Advisory: Updated Interim Guidance for Care of Obstetric Patients And Women Of Reproductive Age During a Zika Virus Outbreak

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