ZIKA VIRAL INFECTIONS current concerns, diagnosis and prevention

1. ZIKA VIRAL INFECTIONS
current concerns, diagnosis and
prevention
Dr.T.V.Rao MD
10/12/2018 Dr.T.V.Rao MD @Zika virus update 2018 1

2. History of Zika
• Zika virus was first discovered in 1947 and is named after the
Zika Forest in Uganda. In 1952, the first human cases of Zika
were detected and since then, outbreaks of Zika have been
reported in tropical Africa, Southeast Asia, and the Pacific
Islands. Zika outbreaks have probably occurred in many
locations.
Before 2007, at least 14 cases of Zika had been documented,
although other cases were likely to have occurred and were
not reported. Because the symptoms of Zika are similar to
those of many other diseases, many cases may not have been
recognized.
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4. About Zika Virus
What we know
• Zika is spread mostly
by the bite of an
infected Aedes
species mosquito (Ae.
aegypti and Ae.
albopictus). These
mosquitoes bite
during the day and
night.10/12/2018 Dr.T.V.Rao MD @Zika virus update 2018 4

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7. Zika is transmitted
from Mother to fetus
• Zika can be passed from a
pregnant woman to her fetus.
Infection during pregnancy can
cause certain birth defects.
• There is no vaccine or medicine
for Zika.
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8. How Zika
spreads
• Zika can be transmitted
• Through mosquito bites
• From a pregnant woman to
her fetus
• Through sex
• Through blood transfusion
(very likely but not
confirmed)
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9. Zika symptoms
• Many people infected with Zika virus
won’t have symptoms or will only
have mild symptoms. The most
common symptoms of Zika are
• Fever
• Rash
• Headache
• Joint pain
• Red eyes
• Muscle pain10/12/2018 Dr.T.V.Rao MD @Zika virus update 2018 9

10. •Symptoms of
Zika are similar
to other
illnesses spread
through
mosquito bites,
like dengue and
chikungunya.
10/12/2018 Dr.T.V.Rao MD @Zika virus update 2018 10

11. Zika Symptoms
• Symptoms can last for several
days to a week. People
usually don’t get sick enough
to go to the hospital, and they
very rarely die of Zika.
Once a person has been
infected with Zika, they are
likely to be protected from
future infections.
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12. Why Zika is risky for some people
• Zika infection during pregnancy
can cause a birth defect of the
brain called microcephaly and
other severe brain defects. It is
also linked to other problems,
such as miscarriage, stillbirth,
and other birth defects. There
have also been increased reports
of Guillain-Barré syndrome, an
uncommon sickness of the
nervous system, in areas affected
by Zika.
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13. Some People
Need Zika
Testing
• Zika virus testing is
recommended only for
certain people. If you
have questions or visited
Zika endemic areas or
think you should be
tested, talk to your
healthcare provider.
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14. Pregnant Women at Risk
and fetus may be
infected
• Zika testing is recommended
for pregnant women who
don’t have Zika symptoms in
certain cases. You should be
tested for Zika if you are
pregnant and
• You have ongoing exposure to
Zika because you live in or
frequently travel to an area
with risk of Zika
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16. Early diagnosis of Zika
infections in Pregnancy
•Your doctor sees
Zika-associated
abnormalities on an
ultrasound or you
deliver a baby with
birth defects that
may be related to
Zika.
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18. How Zika is diagnosed
•Diagnosis of Zika is
based on a
person’s recent
travel history,
symptoms, and
test results.
•A blood or urine
test can confirm a
Zika infection.
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19. Testing and
Follow-up
• Zika virus disease is a nationally
notifiable condition. Healthcare
providers should report
suspected Zika virus disease
cases to their state, local, or
territorial health department to
facilitate diagnosis and mitigate
risk of local transmission.
State, local, and territorial
health departments should
report laboratory-confirmed and
probable cases to CDC.10/12/2018 Dr.T.V.Rao MD @Zika virus update 2018 19

20. ZIKA IS A COMMUNICABLE
DISEASE TO BE REPORTED TO
HEALTH AUTHORITES
•State, local,
and territorial
health
departments
should report
laboratory-
confirmed
and probable
cases to CDC.
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22. CDC recommends
• CDC recommends that pregnant women
should not travel to areas with risk of
Zika. This includes all areas with
documented or likely Zika virus
transmission (see WHO categories for
more information). If a pregnant
woman must travel to one of these
areas, she should be counseled to
strictly follow steps to avoid mosquito
bites and prevent sexual transmission of
Zika during and after the trip.
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24. Testing Guidance for
Symptomatic Pregnant
Women
• Symptomatic pregnant
women with possible Zika
virus exposure should
receive concurrent testing
of serum and urine by
NAT and Zika virus IgM
testing of serum as soon
as possible, up to 12
weeks after symptom
onset.
• .
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25. Trouble shooting
in Zika Diagnosis
• A negative NAT
result in conjunction
with a non-negative
Zika virus IgM test
result should be
followed by plaque
reduction
neutralization test
(PRNT)
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26. Trouble shooting
in Zika Diagnosis
• A positive NAT result on
either serum or urine, in
conjunction with a
positive Zika IgM, should
be interpreted as
evidence of acute Zika
virus infection
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28. Zika infections are
diagnosed with
different methods
• A negative NAT
result in conjunction
with a non-negative
Zika virus IgM test
result should be
followed by plaque
reduction
neutralization test
(PRNT)
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30. Pregnant women with
possible exposure to
Zika virus
• Pregnant women with possible
exposure to Zika virus and who
have a fetus with prenatal
ultrasound findings consistent
with congenital Zika virus infection
should be tested. NAT and IgM
testing should be performed on
maternal serum and urine
following the algorithm for
symptomatic pregnant women.
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31. Testing methods
in Zika Infections
• If amniocentesis is
being performed as
part of clinical care,
NAT testing of
amniocentesis
specimens should
also be performed.
Testing of placental
and fetal tissues may
also be considered.
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32. Testing is no
longer routinely
recommended
• Testing is no longer routinely
recommended for pregnant women
with no Zika symptoms who have
recent possible exposure to Zika but
no ongoing exposure. However,
testing should be considered using a
shared decision-making model that
includes pretest counseling,
individualized risk assessment,
clinical judgment, patient
preferences, and the jurisdiction’s
recommendations.
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34. FDA Approved Roche’s cobas Zika: First Donor Screening Test for Zika Virus
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35. CDC plans to control
Fetal Infections with
Zika virus
• CDC’s top priority
for Zika is to
protect pregnant
women because
of the risks
associated with
Zika virus
infection during
pregnancy.
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36. Every country has its own
recommendation
• Testing recommendations
for this group of pregnant
women may differ by
jurisdiction. Please contact
your state, tribal, local, or
territorial health
department for
jurisdiction specific
guidance.
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38. Laboratory testing in
Fetus
• Laboratory testing for
congenital Zika virus
infection is
recommended for infants
born to mothers with
laboratory evidence of
Zika virus infection during
pregnancy, and for
infants who have
abnormal clinical findings
suggestive of congenital
Zika virus syndrome and a
maternal epidemiologic
link suggesting possible
transmission, regardless
of maternal Zika virus
test results.
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39. Testing of placental
tissue specimens by
Zika virus
• Testing of placental tissue
specimens by Zika virus
reverse-transcription
polymerase chain reaction
(RT-PCR) is conducted at
CDC’s Infectious Diseases
Pathology Branch (IDPB). Zika
virus RT-PCR on placental
tissues from women with
possible
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40. Proposed testing for Zika in suspected
pregnant women
• Zika virus exposure can
be considered for
diagnostic purposes for
symptomatic pregnant
women and women with
infants with possible Zika
virus–associated birth
defects without a
definitive diagnosis of
laboratory-confirmed
Zika virus infection during
pregnancy
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41. Protect yourself and your family from
mosquito bites
• Use Insect Repellent
• Use Environmental Protection Agency (EPA)-registered insect repellents
with one of the active ingredients below. When used as directed, EPA-
registered insect repellents are proven safe and effective, even for
pregnant and breastfeeding women.
• DEET
• Picaridin (known as KBR 3023 and icaridin outside the US)
• IR3535
• Oil of lemon eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone
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42. Wear long-sleeved shirts and long Trousers
• Treat clothing and gear
• Use permethrin to treat clothing and gear (such as boots, pants, socks,
and tents) or buy permethrin-treated clothing and gear.
• Permethrin is an insecticide that kills or repels mosquitoes.
• Permethrin-treated clothing provides protection after multiple
washings.
• Read product information to find out how long the protection will last.
• If treating items yourself, follow the product instructions.
• Do not use permethrin products directly on skin.
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43. If you are caring for a person with Zika
• Take steps to protect yourself from exposure to the person’s blood and
body fluids (urine, stool, vomit). If you are pregnant, you can care for
someone with Zika if you follow these steps.
• Do not touch blood or body fluids or surfaces with these fluids on them
with exposed skin.
• Wash hands with soap and water immediately after providing care.
• Immediately remove and wash clothes if they get blood or body fluids on
them. Use laundry detergent and water temperature specified on the
garment label. Using bleach is not necessary.
• Clean the sick person’s environment daily using household cleaners
according to label instructions.
• Immediately clean surfaces that have blood or other body fluids on them
using household cleaners and disinfectants according to label instructions.
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44. Zika Virus Vaccines On Trial
source NIH USA
• NIAID is developing multiple vaccine candidates to prevent Zika virus
infection. These include:
• A DNA-based vaccine developed by scientists at NIAID’s Vaccine
Research Center (VRC). The strategy is similar to the VRC’s
investigational flavivirus vaccine for West Nile virus infection. The
DNA-based Zika vaccine candidate entered a Phase 1 clinical trial at
NIAID in August 2016. A second Phase 1 trial testing an optimized
vaccine design launched in December 2016. Results indicate the
optimized vaccine is safe and able to induce a neutralizing antibody
response against Zika virus.
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45. Zika Virus Vaccines On Trial
•In March 2017, NIAID launched a Phase 2 clinical trial
of the candidate, which is enrolling healthy adult and
adolescent participants in areas of confirmed or
potential active mosquito-transmitted Zika infection.
The trial, called VRC 705, further evaluates the safety
and immunogenicity of the vaccine and will assess
the optimal dose for administration. It also will
attempt to determine if the vaccine can effectively
prevent disease caused by Zika infection.
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49. •Program created with resources from
CDC / WHO for benefit of Health care
porfesssionals and people in the
developing countries
• Email
• doctortvrao@gmail.com
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