Zika Virus Infection
- 1. Lelete Holson-Patterson RN, RM, Cert. Admin, Dip. HRM, BSc, MSc, Doctoral Candidate 2016
- 2. 1947- Zika Virus first isolated in the Zika Forest (Uganda) in a Rhesus Monkey 1952- Zika Virus first isolated in humans in Uganda, Tanzania 1968- Zika Virus detected in human samples in Nigeria 2013- Outbreak of Zika Virus in French Polynesia with 10,000 registered cases of which 70 were severe cases including Guillian Barre’ syndrome, meningoencephalitis, leukopenia 2007- First major outbreak of Zika Virus on the island of Yap (Micronesia) with 185 suspected cases 2015- Zika Virus detected in New Caledonia and in the Cook Islands
- 3. May, 2015- confirmed transmission of Zika virus in Brazil October, 2015, - Colombia health authorities confirmed transmission of Zika virus December 1, 2015- 9 member states in the Americas confirmed circulation of Zika virus and include Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, Paraguay, Suriname and Venezuala January, 2016- 20 Member States of the Americas including Haiti and Barbados
- 4. In October 2015, Brazilian health authorities reported an unusual increase in microcephaly cases As of 30 November 2015, 1,248 cases of microcephaly have been reported in 14 states of Brazil.
- 6. On November 28, 2015, the Brazil Ministry of Health notified 3 deaths associated with Zika Virus infection. The fatal cases were 2 adults and 1 newborn
- 7. The first case was a male adult with history of lupus erythematosus, chronic use of corticosteroid drugs, rheumatoid arthritis and alcoholism who was admitted with suspected dengue fever The second case was a 16 year old female The third case was a newborn
- 8. This is a disease caused by the Zika virus (ZIKAV). Very close phylogenetically to viruses such as dengue, yellow fever, Japanese encephalitis, or West Nile virus.
- 9. Zika Virus (ZIKAV) ◦ An arbovirus the flavivirus genus (family Flaviviridea)
- 10. The Zika virus is transmitted by the Aedes aegypti mosquitoes
- 11. After an infected mosquito bite, the disease symptoms usually appear following an incubation period of 3-12 days
- 14. Fever Non-purulent conjunctivitis Headache Myalgia Arthralgia Asthenia Maculopapular rash Oedema of the lower limbs
- 15. Retro-orbital pain Anorexia Vomiting Diarrhoea Abdominal pain Mild Thrombocytopenia (laboratory findings) Mild Leucopenia (laboratory findings)
- 16. Guillian Barre’ Meningoencephalitis Thrombocytopenia purpura
- 18. Patients with rash or elevated temperature (> 37.2°C) with one or more of the following symptoms (not explained by other medical conditions): ◦ Arthralgia or myalgia ◦ Non-purulent conjunctivitis or conjunctival hyperaemia ◦ Headache or malaise In someone who resides in or has visited epidemic or endemic areas within 2 weeks prior to the onset of symptoms
- 19. A suspected case with laboratory positive result for the specific detection of Zika virus
- 20. Zika suspected cases (Regarding the symptoms and epidemic scenario) Acute Phase (1-5 days after symptoms arise) Onset of symptoms vs taking of samples Positive CHIK V Confirmed IgM Dengue IgM ChikV Positive Presumptive ZIKA V Positive Presumptive DENGV RT-PCR/NS4 Dengue Convalescent phase (> 6 days after symptom onset) (Real Time) PCR-CHIK V Positive DENV Confirmed Negative Consider CHIK V Negative Consider ZIkV (Real time) PCR-ZikV Negative Discard Positive Zik V Confirmed Negative Discarded IgM ZIKV Positive Presumptiv e CHIK V Negative Consider ZIK V
- 21. Zika Fever is a Class 1 Notifiable disease and is notified on suspicion within 24 hours to the Parish Health Department and the National Epidemiology Unit, Ministry of Health Cases (confirmed by laboratory testing) should also be notified as a Class 1 Notifiable disease to the Parish Health Department and the Epidemiology Unit, Ministry of Health
- 22. Samples for serology should be sent to the National Public Health Laboratory along with the completed CARPHA Laboratory form. The following are the requirements for the sampling: ◦ Type of sample: Serum- 4-5 mls. Of blood in a plain red top tube Acute phase: Until 8 days after symptom onset Convalescent phase: 10-15 days after symptom onset
- 23. Keep refrigerated (2-8°C) if sample will be processed within 48 hours at the NPHL. Keep frozen (-10 to -20°C) if sample will be processed after the first 48 hours Maintain frozen (-70°C) if sample will be processed after one week
- 24. Samples should be transported on ice or with ice packs to the National Public Health Laboratory once the Notification is made to the Parish Health Department
- 25. Nucleic Acid detection of Zika viral RNA using real time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) performed on an “acute sample” collected during the first five (5) days of illness Serological detection of anti-Zika IgM and IgG antibodies using Enzyme-Linked Immunosorbent Assay (ELISA) and immunofluorescence assays may be performed on blood samples collected 6 days after the onset of symptoms
- 26. If the following is not included in the test request form, the sample cannot be referred and will be REJECTED: ◦ Name of patient ◦ Age of patient ◦ Date of symptom onset ◦ Date sample collected ◦ Clinical features- full description ◦ Clinical Tests Performed and Results ◦ Pertinent Travel History
- 27. Dengue Chikungunya Malaria Leptospirosis Acute HIV infection Measles Rubella Rickettsial infections Epstein Barr Virus- Infectious mononucleosis
- 28. There is no vaccine or specific treatment for Zika Virus It is important to differentiate Zika virus from other diseases Cases of co-infection, Zika and Dengue, could occur Compared with dengue, fever associated with Zika virus infection is more acute and shorter in duration
- 29. Symptomatic Rest Acetaminophen to relieve fever Antihistamines to control pruritus Using aspirin is not advised due to the risk of bleeding and the developing of Reye’s syndrome in children younger than 12 years of age The use of NSAID is not advised as the clinical symptoms may be Dengue or Chikungunya.
- 30. Increased oral fluids Patient isolation especially during the first week of illness ◦ Stay under mosquito net treated or without insecticide ◦ Stay in places with intact windows, doors and screens ◦ Staff who take care of these patients should protect against mosquito bites using insect repellent (DEET, IR3535 or Icaridin) and wearing long sleeves and pants
- 31. There is no evidence of any restriction of the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label
- 32. EVERYONE’S RESPONSIBILITY Eliminate breeding sites of the mosquitoes Identify areas of high risk transmission Select appropriate insecticide
- 35. There is no evidence of any restriction of the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label
- 36. PAHO/WHO. (2016). Zika virus infection.