Zika virus

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Epidemiology

  • transmitted by mosquitoes in the genus Aedes (Aedes aegypti)
  • incubation is 3-14 days[159]
  • vertebrate hosts of the virus include monkeys & humans
  • Zika virus circulating in 38 countries & territories, March 2016[46]
  • Africa: Uganda, Tanzania, Egypt, Central African Republic, Sierra Leone & Gabon
  • Asia: India, Malaysia, the Philippines, Thailand, Vietnam, & Indonesia
  • South America: Brazil
  • Puerto Rico[3]
    • 30 cases in Puerto Rico Nov 2015 - Jan 2016[24]
    • 680 cases reported in Puerto Rico Nov 2015-April 2016, 1 death related to severe thrombocytopenia[61]
    • 1% of blood donors in Puerto Rico June 2016 infected with Zika virus[75]
    • HHS declares a public health emergency in Puerto Rico Aug 2016[100]
  • 2400 people in the U.S. contracted Zika virus disease during the first 7 months of 2016[113]
    • only 28 were locally acquired, mostly via mosquitoes, the rest were travel-associated
    • one case of Zika contracted by a laboratory finger stick[113]
    • Zika virus spreading explosively through Americas[12][13]
    • map of distribution of Aedes mosquitoes & risk for Zika virus U.S.A.[43]
    • case reported in Texas[4]
    • case reported in Hawaii[5]
    • case reports in Illinois & Florida[8]
    • case report in Massachusetts resident after travel to Costa Rica[23]
    • 182 cases of confirmed Zika virus infection in New York City related to travel exposure Jan-June 2016[76]
    • a person in Utah contracted the Zika virus after caring for another Zika patient who died in June[85]
    • possible non-travel related case of Zika infection in Miami-Dade County Florida July 2016[86]
      • active transmission of Zika virus expanding in Miami Beach, 4.5 square miles Sept 2016[115]
    • 35 non-travel-related Zika cases in Miami Beach, & 93 total in Florida Sept 2016[115]
    • active transmission of Zika in new area of Miami-Dade County[122]
    • FDA requests postponing blood donations in Miami-Dade & Broward counties of Florida until Zika-free blood can be assured[91]
    • potential risk of Zika Miami-Dade, Broward, & Palm Beach counties March 2017[139]
    • Florida's 17th infection Aug 2015 not related to foreign travel[97]
    • spread of Zika to Florida's gulf coast[104]
    • 1st confirmed Zika-related death in continental U.S.[80]
    • infant with Zika-linked microcephaly dies in Texas Aug 2016[98]
      • mother infected with Zika in Latin America during pregnancy
    • Texas resident acquired Zika infection during travel to Miami Aug 2016[101]
    • as of May 12, 279 pregnant women in the U.S. have tested positive for Zika[66]
    • 3 children of U.S. women infected with the Zika virus have been born with birth defects in 2016[74]
  • case reports of sexually transmitted Zika virus infection[14][54]
  • confirmed transmission of Zika via blood transfusion[17]
  • transmission via platelet transfusion reported[102]
  • maximal length of Zika viremia is thought to be < 28 days
  • Brazilian researchers at the Oswaldo Cruz Foundation say they have found active Zika virus in urine & saliva[18]
  • virus found in amniotic fluid associated with microcephaly[28]
  • cancelling or changing the location of the 2016 Olympics will not significantly alter the international spread of Zika virus[65][71] exception of perhaps 4 countries Chad, Djibouti, Eritrea, & Yemen[81] since they don't have significant travel to other countries with local transmission
  • requests for abortions up in Latin America June 2016 related to concerns of Zika virus[78]
  • January-November 2016, 476 microcephaly cases were reported in Colombia[131]
  • 33 Service members have acquired Zika overseas (Aug 2016)
  • Texas report case of local Zika transmission (Nov 2016)[129]
    • Texas reports 4 additional cases of suspected locally acquired Zika infection[133]
    • 5 cases of locally transmitted Zika virus identified in Brownsville, Texas Dec 2016[137]
    • Texas reports case of local Zika transmission (July 2017)[145]
  • prevalence of birth defects potentially related to Zika virus increased from 2.0 to 2.4 per 1000 live births in U.S. areas with local Zika transmission in 2016[150]
  • Zika virus outbreak in the Americas will likely diminish by 2019[83]
  • Zika remains significant enduring public health challenge but no longer represents a public health emergency (WHO)[127]
  • 5200 probable or confirmed, noncongenital Zika cases in U.S. states in 2016[151]

Pathology

Genetics

Pharmacology

Clinical manifestations

Laboratory

* < 1% of asymptomatic people with potential Zika exposure tested for Zika are actually infected[58]

* New York Department of Health recommends testing anyone > 5 years of age presenting with fever, generalized skin rash, arthralgias & conjunctivitis (3 of 4) for Zika virus[99]

CDC recommendations in areas where both Zika & dengue are endemic[157]

Diagnostic procedures

Radiology

Complications

Differential diagnosis

Management

  • avoid mosquito bites so as to prevent transmission[45]
  • all pregnant women should be asked if they have recently traveled to areas with active Zika virus transmission
  • pregnant women with recent travel to areas with active Zika virus transmission & with symptoms of fever, rash, myalgias, or conjunctivitis during or within 2 weeks of travel should be tested for Zika virus
  • pregnant women who test positive for Zika, should have ultrasound every 3-4 weeks to monitor the fetus's growth
  • women with Zika virus should breastfeed their infants[33]
  • pregnant women should avoid 2016 summer Olympics in Brazil[36]
  • couples in Zika-affected areas should consider delaying pregnancy[70]
  • asymptomatic persons with possible exposure to Zika (travel to areas with active Zika virus transmission) should wait at least 8 weeks before trying to conceive[47]
  • women infected with Zika should wait at least 8 weeks after symptom onset before trying to conceive; men should wait at least 6 months[47]
  • progressive Guillain-Barre syndrome
  • potential blood donors should defer giving blood for 28 dqys after visiting areas with Zika transmission[15][16][29], having symptoms suggestive of Zika virus in the past 4 weeks, or having sexual contact with a person who has traveled to, or resided in, an area with active Zika virus transmission during the prior 3 months[29]
  • potential blood donors living in Zika-affected donors are eligible for blood donation within the affected area[31]
    • donors should be deferred if Zika symptoms noted within the past 28 days[31]
  • people who develop Zika symptoms within 14 days of donating blood should contact the Red Cross so their donation can be quarantined
  • human cell & tissue donations if donor in past 6 months
    • has not been diagnosed with Zika
    • has not been in an area of active Zika transmission
    • has not had sex with a male having either of the above 2 risk factors[38]
  • standard precautions for health care providers[45]

Prevention:

Comparative biology

Notes

More general terms

References

  1. Wikipedia: Zika virus https://en.wikipedia.org/wiki/Zika_virus
  2. 2.0 2.1 World Health Organization (WHO) Disease Outbreak News. Dec 14, 2015 Microcephaly - Brazil http://www.who.int/csr/don/15-december-2015-microcephaly-brazil/en/
  3. 3.0 3.1 Orciari Herman A, Sadoughi S, Sofair A Zika Virus Hits Puerto Rico; Link to Microcephaly in Brazil under Investigation. Physician's First Watch, Jan 4, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  4. 4.0 4.1 Kelly JC First Zika Virus Case in United States Confirmed in Texas. Medscape Jan 11, 2016 http://www.medscape.com/viewarticle/857072
    Harris County Public Health & Environmental Services News Release. Jan 11, 2016 Travel-Related Zika Virus Infection Has Been Identified in the Harris County Area. http://hcphes.org/UserFiles/Servers/Server_72972/File/News%20and%20Media/Media%20Advisory_ZIKA%20virus_1%2011%2016.pdf
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