Zika and Emerging Infectious Diseases. Clifford T. Mauriello, MD, FAAP Assistant Clinical Professor May 31, 2016

Transcription

1 Zika and Emerging Infectious Diseases Clifford T. Mauriello, MD, FAAP Assistant Clinical Professor May 31, 2016

2 Famous Last Words The time has come to close the book on infectious diseases. We have basically wiped out infection in the United States. William Stewart, Surgeon General of the United States, 1967.

3 Until.

4 Human Immunodeficiency Virus A truly novel pathogen which was the etiology of a truly novel disease which changed everything

5 Contemporary Emerging Viruses Severe Respiratory Distress Syndrome Coronavirus Middle Eastern Respiratory Distress Syndrome Coronavirus Enterovirus D68 and Acute Flaccid Paralysis Parechovirus 2009 H1N1 Pandemic Swine Origin Influenza Virus

6 Emerging Drug Resistant Organisms Community acquired Methicillin resistant Staphylococcus aureus Vancomycin resistant Staphylococcus aureus Vancomycin resistant Enterococcus species Extended spectrum beta lactamase producing Gram Negative Bacilli Carbapenemase producing Enterobacteraciae Colistin resistant Enterobacteraciae Ceftriaxone resistant Neisseria gonorrhea Multi-drug resistant Mycobacterium tuberculosis Extremely drug resistant Mycobacterium tuberculosis

7 Geographical Barriers to Migration Oceans Rivers Mountains Deserts Overwhelming Distances

8 Diseases Introduced by Migrations Historical Examples: Plague and Genghis Khan Syphilis and Christopher Columbus Smallpox and European Settlers

9 Contemporary Examples H1N pandemic swine origin influenza Enterovirus D68 Acute Flaccid Paralysis West Nile Virus Community Acquired Methicillin Resistant Staphylococcus aureus

10 A Medical Mystery The time: October 2015 The Setting: The Brazilian Ministry of Health The Problem: Newborns with small heads

11 Numbers I d Like You to Remember 1.5 Million Brazilians Infected newborns with clinically diagnosed microcephaly

12 The Suspect

13 The History of Zika Virus Discovered in 1947 Outbreaks Yap 2007 French Polynesia 2013 to 2014 Brazil 2015 to present

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15 Taxonomy Yellow Fever Dengue Chikungunya West Nile

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20 Symptoms of Zika Majority of patients will be asymptomatic. Maculopapular rash Arthralgia Nonpurulent conjunctivitis Complication: Guillen-Barre Syndrome

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24 Zika RNA in Body Fluids Blood Urine Saliva Semen

25 Transmission via Breast Milk? RNA can be found in Breast Milk BUT No cases of known transmission. Infection is not a contraindication to breast feeding.

26 Local Zika Virus Transmission

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29 Introducing Aedes aegypti

30 Range of Aedes aegypti

31 Introducing Aedes albopticus

32 Range of Aedes albopticus

33 US Cases of Zika Virus Disease States Territories Travel Associated Locally Acquired Guillen Barre Syndrome 1 5

34 Reported Zika Disease Cases

35 Congenital Zika Virus Disease What is known? Vertical transmission of Zika Virus from mother to child does occur and does result in disease

36 Congenital Zika Virus Disease What is not known? The risk of vertical transmission from mother to child of Zika Virus during pregnancy has not been established. The percentage of symptomatic neonates with perinatal or congenital Zika Virus infection has not been quantified.

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40 Definitions Congenital infection Transmission occurs in utero, prior to labor. Example: Congenital Varicella Syndrome Perinatal infection Transmission occurs during or just before or after labor. Example: Perinatal Varicella

41 Flaviviruses and Congenital Infection Exceptionally rare. If Zika is indeed proven to efficiently cause disease in fetuses, then it would have unique properties not common to other Flaviviruses.

42 US Outcomes of Zika in Pregnancy 9 Cases Published in MMWR 2 spontaneous abortions 2 elective abortions 3 live births 1 with microcephaly 2 healthy 2 uncomplicated pregnancies approaching term

43 Fetal Features Microcephaly Brain Atrophy Brain Asymmetry Hydranecephaly Ventriculomegaly Cerebral Calcifications Absent Brain Structures

44 Fetal Features Cataracts Intra-ocular Calcifications Microphthalmia Optic nerve pallor Macular chorioretinitis

45 Fetal Features Arthrogryposis Hypertonia Dysphagia Seizures Placental Calcifications

46 Perinatal Features At least two cases of proven disease One symptomatic and one not. Both recovered.

47 Diagnosis Serology IgM Seroconversion of IgG Plaque Reduction Neutralizing Titers Molecular RNA RT-PCR: Blood, urine, saliva, placenta, tissue

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50 Definitions Exposure: Contact with a pathogen, vector with the capability to transmit a pathogen, or contagious host that has the capacity to transmit a pathogen Infection: Replication of the pathogen in the host with or without symptoms Disease: Replication of the organism in the host with symptoms

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55 Registries Pregnant persons Infected infants

56 Therapy None

57 Immunization

58 Prevention Mosquito Control

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60 Prevention

61 Why all of this investigation? Data collection on the incidence and spectrum of congenital infection and disease Identification of imported cases in order to help determine the possibility of local transmission Determine the need for vaccination To identify children in need of services

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