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Slide 1 - Prof. Hamed Adetunji Zika Virus
Slide 2 - Overview What is Zika virus disease? Cause? Transmission? Diagnosis? Treatment Prevention? Potential complications? Potential Pandemic? Control Measures (WHO response)?
Slide 3 - Introduction - Origin The virus was first discovered in the Zika Forest in Uganda in the 1940s Is linked to serious birth defects. The World Health Organization warned - Zika virus is "spreading explosively“ and could infect four million people by the end of the year. It's in 23 countries, including the U.S., where it is now being called a pandemic, with 31 cases in eleven states and D.C. since last year. All the patients in were infected by mosquitoes abroad.
Slide 4 - Introduction – challenges Zika virus is linked to children being born with small heads. Diagnostic tests are imperfect. There's no treatment No vaccine.
Slide 5 - Causes Genre : Flavivirus Vector : Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours) Reservoir : Unknown
Slide 6 - Zika Virus - Transmission Zika virus is a mosquito-borne virus transmitted by Aedes mosquitoes. The same mosquito also transmits 3 other vector-borne diseases -- dengue, chikungunya and yellow fever – across tropical and subtropical regions around the world.
Slide 7 - Diagnosis The case definition used is “person having rash with or without fever, of unknown etiology, and whose clinical profile does not fit in suspected case definitions of dengue, measles or rubella.”
Slide 8 - Diagnosis of microcephaly Early diagnosis of microcephaly can sometimes be made by fetal ultrasound. Ultrasounds have the best diagnosis possibility if they are made at the end of the second trimester, around 28 weeks, or in the third trimester of pregnancy. Babies should have their head circumference measured at least 24 hours after birth and compared with WHO growth standards. The result will be interpreted in relation to the gestational age of the baby, and also the baby’s weight and length. Suspected cases should be reviewed by a paediatrician, have brain imaging scans, and have their head circumference measured at monthly intervals in early infancy and compared with growth standards. Doctors should also test for known causes of microcephaly.
Slide 9 - Causes of microcephaly There are many potential causes of microcephaly, but often the cause remains unknown. The most common causes include: infections in the womb: toxoplasmosis (caused by a parasite found in undercooked meat), rubella, herpes, syphilis, cytomegalovirus and HIV; exposure to toxic chemicals: maternal exposure to heavy metals like arsenic and mercury, alcohol, radiation, and smoking; genetic abnormalities such as Down syndrome; and severe malnutrition during fetal life.
Slide 10 - Scope of the problem Microcephaly is a rare condition. Reported estimate incidence of microcephaly has wide variation due to the differences in the definition and target population. Although not proven, researchers are studying a potential link between this surge in microcephaly cases and Zika virus infection.
Slide 11 - Signs and Symptoms The incubation period (the time from exposure to symptoms) of Zika virus disease is not clear, but is likely to be a few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days. The most common symptoms of Zika virus are headache, muscle and joint pain, mild fever, rash, and inflammation of the underside of the eyelid.
Slide 12 - Duration of fever A model study (Majumder et al, 2016) suggests that 10 to 23 days may be a feasible serial interval range for Zika fever.
Slide 13 - Potential complications of Zika virus disease During large outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, national health authorities reported potential neurological and auto-immune complications of Zika virus disease. Recently in Brazil, local health authorities have observed an increase in Guillain-Barré syndrome which coincided with Zika virus infections in the general public, as well as an increase in babies born with microcephaly in northeast Brazil. Agencies investigating the Zika outbreaks are finding an increasing body of evidence about the link between Zika virus and microcephaly. However, more investigation is needed to better understand the relationship between microcephaly in babies and the Zika virus. Other potential causes are also being investigated.
Slide 14 - Introduction - Can it be pandemic? Dr. Anthony Fauci, head of the infectious diseases branch of the National Institutes of Health, says the outbreak is a pandemic.
Slide 15 - Zika virus at "pandemic" level, National Institutes of Health says
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Slide 17 - Zika Virus - Timeline 1947: Scientists conducting routine surveillance for yellow fever in the Zika forest of Uganda isolate the Zika virus in samples taken from a captive, sentinel rhesus monkey.1 1948: The virus is recovered from the mosquito Aedes (Stegomyia) africanus, caught on a tree platform in the Zika forest.1,2 1952: The first human cases are detected in Uganda and the United Republic of Tanzania in a study demonstrating the presence of neutralizing antibodies to Zikavirus in sera.3
Slide 18 - Zika Virus - Timeline… 1954: The virus is isolated from a young girl in Eastern Nigeria.4 1958: Two further Zika virus strains are isolated from Aedes africanus mosquitos caught in the Zika forest area.5 1964: A researcher in Uganda who fell ill while working with Zika strains isolated from mosquitoes provides the first proof, by virus isolation and re-isolation, that Zika virus causes human disease.6 1960s-1980s: Zika is now being detected in mosquitos and sentinel rhesus monkeys used for field research studies in a narrow band of countries that stretch across equatorial Africa. Altogether, virus is isolated from more than 20 mosquito species, mainly in the genus Aedes.
Slide 19 - Zika Virus - Timeline… 1969–1983: The known geographical distribution of Zika expands to equatorial Asia, including India, Indonesia, Malaysia and Pakistan, where the virus is detected in mosquitos. 2007: Zika spreads from Africa and Asia to cause the first large outbreak in humans on the Pacific island of Yap, in the Federated States of Micronesia. 2008: A US scientist conducting field work in Senegal falls ill with Zika infection upon his return home to Colorado and infects his wife in what is probably the first documented case of sexual transmission of an infection usually transmitted by insects.24
Slide 20 - Zika Virus - Timeline… 2012: Researchers publish findings on the characterization of Zika virus strains collected in Cambodia, Malaysia, Nigeria, Senegal, Thailand and Uganda, and construct phylogenetic trees to assess the relationships. Two geographically distinct lineages of the virus, African and Asian, are identified. 2013–2014: The virus causes outbreaks in four other groups of Pacific islands: French Polynesia, Easter Island, the Cook Islands, and New Caledonia.26,27 The outbreak in French Polynesia, generating thousands of suspected infections, is intensively investigated. The results of retrospective investigations are reported to WHO on 24 November 2015 and 27 January 2016. These reports indicate a possible association between Zika virus infection and congenital malformations and severe neurological and autoimmune complications.28
Slide 21 - Zika Virus - Timeline… December 2013: A patient recovering from Zika infection on Tahiti Island in French Polynesia seeks treatment for bloody sperm. Zika virus is isolated from his semen, adding to the evidence that Zika can be sexually transmitted.32 20 March 2014: During the 2013–14 outbreak of Zika virus in French Polynesia, two mothers and their new-borns are found to have Zika virus infection, confirmed by PCR performed on serum collected within four days of birth. The infants’ infections appear to have been acquired by trans-placental transmission or during delivery.33 31 March 2014: During the same outbreak of Zika virus in French Polynesia, 1505 asymptomatic blood donors are reported to be positive for Zika by PCR. These findings alert authorities to the risk of post-transfusion Zika fever.34
Slide 22 - Zika Virus - Timeline 2 March 2015: Brazil notifies WHO of reports of an illness characterized by skin rash in north-eastern states. February 2015 to 29 April 2015, nearly 7000 cases of illness with skin rash are reported in these states. All cases are mild, with no reported deaths. 29 March 2015: Brazil provides further details on reports of an illness, in four north-eastern states, characterized by skin rash, with and without fever. 7 May 2015: Brazil’s National Reference Laboratory confirms, by PCR, Zika virus circulation in the country. This is the first report of locally acquired Zika disease in the Americas.
Slide 23 - Zika Virus - Timeline… 7 May 2015: The Pan American Health Organization and WHO issue an epidemiological alert to Zika virus infection.35 15 July 2015: Brazil reports laboratory-confirmed Zika cases in twelve states. 17 July 2015: Brazil reports detection of neurological disorders associated with a history of infection, primarily from the north-eastern state of Bahia. 5 October 2015: Health centres in the Republic of Cabo Verde begin reporting cases of illness with skin rash, with and without fever, in the capital city of Praia, on the island of Santiago. By 14 October, 165 suspected cases are reported.
Slide 24 - Zika Virus - Timeline… 8 October 2015: Brazil reports the results of a review of 138 clinical records of patients with a neurological syndrome, detected between March and August. Of the 138, 58 (42%) present neurological syndrome with a previous history of viral infection. Of the 58, 32 (55%) have symptoms that are said to be consistent with Zika or dengue infection. 8 October 2015: Colombia reports the results of a retrospective review of clinical records which reveals the occurrence, since July, of sporadic clinical cases with symptoms consistent with Zika infection. 16 October 2015: Colombia reports PCR confirmed cases of locally acquired Zika infection.
Slide 25 - Zika Virus - Timeline… 1 February 2016: WHO declares that the recent association of Zika infection with clusters of microcephaly and other neurological disorders constitutes a Public Health Emergency of International Concern. 1 February 2016: Cabo Verde reports 7081 suspected cases of Zika between end September 2015 and 17 January 2016. The number of cases peaked at the end of November and began to decline. Though the reporting of cases of microcephaly is mandatory, no neurological complications are detected.
Slide 26 - Zika Virus - Timeline… 4 February 2016: Brazilian health officials confirm a case of Zika virus infection transmitted by transfused blood from an infected donor. 7 February 2016: Suriname reports an increase in Guillain - Barré syndrome, beginning in 2015, with 10 cases of Guillain - Barré syndrome positive for Zika (PCR test on urine sample). Four Zika-related deaths are reported over the preceding 2 weeks (including one Dutch visitor), with symptoms of diarrhoea or vomiting, dehydration and joint pain, rapidly followed by death. All deaths occurred in older males with underlying illnesses or risk factors that may have contributed to the fatal outcomes.
Slide 27 - Zika Virus - Timeline… 2 February 2016: Chile reports its first three PCR confirmed cases of Zika virus on the mainland in travellers returning from Colombia, the Bolivarian Republic of Venezuela, and Brazil. 2 February 2016: The United States reports a case of sexual transmission of Zika infection in Texas. One patient developed symptoms of illness after returning from the Bolivarian Republic of Venezuela. The second patient had not recently travelled outside of the United States, but subsequently developed symptoms after sexual contact with the traveller. This is the third indication that the virus can be sexually transmitted, which appears to be a rare event.44
Slide 28 - WHO Advice The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as repellents, insect screens, closed doors and windows, and long clothing. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should use insecticide-treated mosquito nets to provide protection. Mosquito coils or other insecticide vaporizers may also reduce the likelihood of being bitten. During outbreaks, space spraying of insecticides may be carried out periodically to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers. Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering. WHO does not recommend any travel or trade restriction to Honduras based on the current information available.
Slide 29 - Conclusion The future transmission of Zika infection is likely to coincide mainly with the distribution of Aedes mosquito vectors, although there may be rare instances of person-to-person transmission (other than mother to child, e.g. through semen). Beyond the range of mosquitos, infection has been, and will continue to be, carried widely by international travel.
Slide 30 - References / further reading http://www.naturalnews.com/052982_Zika_virus_pandemics_human_microbiome.html https://www.youtube.com/watch?v=6INY6UKz6c0&index=3&list=PL7EY84qpSc3PHDlGB5Tn8v7duRO7vZu85 Majumder MS, Cohn E, Fish D & Brownstein JS. Estimating a feasible serial interval range for Zika fever [Submitted]. Bull World Health Organ, E-pub: 9 Feb 2016. doi:http://dx.doi.org/10.2471/BLT.16.171009 Kindhauser MK, Allen T, Frank V, Santhana RS & Dye C. Zika: the origin and spread of a mosquito-borne virus [Submitted]. Bull World Health Organ E-pub: 9 Feb 2016. doi: http://dx.doi.org/10.2471/BLT.16.171082