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Zika Flashcards

1
Q

Why is it called Zika?

A
  • it comes from the Zika forest
  • identified in 1947 from studying a rhesus monkey
  • it means overgrown
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2
Q

Zika epidemiology?

A
  • first isolated from a monkey in Uganda in 1947
  • prior to 2007, only sporadic human disease cases reported from Africa and Southeast Asia
  • In 2007, first outbreak reported on Yap island, Federated States of Micronesia
  • In 2013-2014, more than 28,000 suspected cases reported in French Polynesia
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3
Q

Zika virus vectors?

A
  1. Aedes species mosquitoes
    - Aedes aegypti more efficient vectors for humans
    - Aedes albopictus
  2. also transmit yellow fever, dengue and chikungunya viruses
  3. lay eggs in domestic water holding containers
  4. live in and around households
  5. aggressive daytime biters
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4
Q

Location of mosquito populations? (10)

A

pic

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5
Q

Criteria for an outbreak?

A
  • infected person must enter USA
  • vector should bite the person during viremic phase
  • vector should live long enough for the virus to multiply and infect another person
  • cycle needs to continue over time
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6
Q

Life span and flight range of Aedes aegypti?

A
  • life span 30 days
  • flight range 150 meters
  • cockroach of mosquitos
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7
Q

Zika virus transmission cycle? (12)

A
  • Africa, slyvatic, jungle cycle between nonhuman primates and forest dwelling species
  • urban setting- human to mosquito to human
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8
Q

Vector competence?

A

intrinsic ability to biologically transmit a pathogen

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9
Q

Vectoral capacity?

A

ability of a vector to transmit a pathogen in a given location and at a specific time

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10
Q

What did PHEIC declare?

A
  • WHO declared it an extraordinary event of 2/1/16
  • clusters of microcephaly and other neurological disorders
  • constitutes a health risk through international spread
  • coordinated response (as it is unexpected, serious and unusual)
  • implications beyond the affected country
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11
Q

How does a mosquito spread a virus? (15)

A
  • mosquito bites infected person and gets infected
  • spreads it to other people
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12
Q

Symptoms of Zika?

A
  • fever
  • rash
  • joint pain
  • conjunctivitis (red eyes)
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13
Q

How can Zika be transmitted person to person?

A
  1. Maternal to fetal
    - intrauterine
    - perinatal
  2. sexual transmission
    - and non sexual transmission
    - blood transfusion
  3. lab exposure
  4. theoretical
    - organ or tissue transplant
    - breast milk
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14
Q

Zika virus incidence and attack rates?

A
  • infection rate 73%
  • symptomatic attack rate among infected, 18%
  • all age groups affected
  • adults more likely to present for medical care
  • no severe diseases, hospitalizations, or deaths
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15
Q

Zika virus clinical disease course and outcomes?

A
  • clinical illness usually mild
  • symptoms last several days to weeks
  • severe disease requiring hospitalization uncommon
  • fatalities rare
  • GBS reported in patients following zika (relationship not known)
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16
Q

Zika and microcephaly in Brazil?

A
  • reports of increase of number of babies born with microcephaly in 2015 in Brazil
  • zika virus infection identified in several infants born with microcephaly (including deaths) and in early fetal loss (some tested negative for zika, had microcephaly)
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17
Q

What is good test for Zika?

A

urine because it stays in urine for 14 days

18
Q

Diagnostic testing for Zika?

A
  • reverse transcriptase PCR for viral RNA in serum collected less than 7 days after onset
  • serology for IgM and neutralizing antibodies in serum collected over 4 days after onset
  • plaque reduction neutralization test (PRNT)
  • immunohistochemical (IHC) staining for viral antigens
19
Q

Serology cross reactions with other flaviviruses?

A
  • Zika virus serology (IgM) can be positive due to antibodies against related flaviviruses (dengue and yellow fever)
  • neutralizing antibody testing may discriminate between cross reacting antibodies in primary flavivirus infections
  • difficult to distinguish infecting virus in people previously infected with or vaccinated against a related flavivirus
  • healthcare providers should work with state and local health departments to ensure test results are interpreted correctly
20
Q

Initial assessment and treatment?

A
  • no specific antiviral therapy
  • treatment is supportive (rest, fluids, analgesics, antipyretics)
  • suspected Zika virus infections should be evaluated and managed for possible dengue or chikungunya virus infections
  • non steroidal should be given (tylenol)
  • aspirin and NSAIDS should be avoided until dengue is ruled out to avoid hemorrhage
21
Q

What other viruses are hard to distinguish from Zika? (29)

A
  • dengue
  • chikungunya
22
Q

Zika virus disease surveillance?

A
  • consider in travelers with acute onset of fever, rash, arthralgia, or conjunctivitis within 2 weeks of return
  • inform and evaluated women who traveled to areas with Zika transmission while pregnant
  • evaluate fetuses/infants of women infected during pregnancy for possible congenital infection and microcephaly
  • be aware of areas with Aedes species mosquitos
23
Q

Zika virus and pregnancy?

A
  • limited info available
  • no evidence of increased susceptibility
  • infection can occur in any trimester
  • incidence of Zika in this population is not known
  • no evidence of more severe disease
  • edema
  • rash
24
Q

Maternal fetal transmission of Zika?

A
  • evidence of maternal fetal transmission:
  • zika infection confirmed in infants with microcephaly in brazil and in infants whose mothers have traveled to brazil but delivered in US
  • zika RNA identified in specimens of fetal losses
  • zika detected prenatally in amniotic fluid
  • pregnant women should be tested
  • wear permethrin treated clothes
25
Q

What is microcephaly? causes? (39)

A
  • small head- occipital frontal circumference below third percentile
  • causes:
  • genetic
  • nutritional
  • environmental toxins
  • TORCH agents vascular drugs
  • radiation
26
Q

What else can an infant have a problem with zika?

A
  • eye problems
  • limb spasms at birth
27
Q

How long can zika persist in semen? (52)

A

up to 6 months

28
Q

Zika and GBS? (48)

A

pic

29
Q

late sexual transmission? (51)

A

pic

30
Q

congenital zika syndrome?

A
  • craniofacial malformations
  • flat nasal bridge
  • anteverted nares
  • limb deformities
  • calcifications and skin folds, skull asymmetry
31
Q

Arthogryposis?

A

joint contractures at birth

-crooked joint

32
Q

What can happen to platelets in zika?

A
  • thrombocytopenia (low platelets)
  • alveolar and intracranial hemorrhage
33
Q

Zika kit?

A
  • literature
  • mosquito repellant
  • mosquito netting
  • condoms
  • oral digital thermometer
  • tablets to kill mosquito larvae in standing water
34
Q

Zika preventive measures?

A
  • no vaccine or medication to prevent infection
  • primary prevention is to reduce mosquito exposure
  • pregnant women should consider postponing travel to areas with outbreaks
  • protect infected people form mosquito exposure during first week of illness to prevent further transmission
35
Q

What is DEET?

A
  • 20%
  • can provide 10 hours of protection (permethrin)
36
Q

Potential outbreak areas in US?

A
  • mostly florida
  • up the east coast
37
Q

Zika dynamics? (69)

A
  • R<1 means that one infected person in infecting less than one person, virus will not spread
  • R>1 virus will spread
  • measles > 18, highly contagious
38
Q

Capacity of A. albopictus to spread zika?

A
  • doesnt spread it yet
  • could down the road
39
Q

Risk of microcephaly at different stages?

A
  • earlier risk is higher
  • there is risk through the whole process
40
Q

Summary of Zika? (72)

A

pic

IP (29 decks)

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