1. Zika Virus Update Elizabeth D. Barnett, MD June 21, 2016

2. Zika Virus Update What is zika virus? Why are we concerned about it? What can we do to protect ourselves and our family from zika virus infection?

3. Zika Virus Arthropod-borne virus (arbovirus) similar to West Nile virus, dengue virus, yellow fever virus Transmitted by mosquitoes Generally causes a mild illness but is associated with some severe problems Recently arrived in the Americas

4. Discovered in Zika Forest, Uganda 1947

12. 39 countries and territories have reported local vector- borne Zika cases

13. Ae. albopictus - potential vector Aedes aegypti - main vector Mosquito Vectors

14. Aedes spp. Distribution in the United States

15. How Do You Get Zika Virus Infection? Mosquito bites Sexual transmission: possible from incubation period up to 62 days (or longer?) Blood product transfusion Breast milk? Saliva?

16. What are the symptoms of zika virus infection? About 80% of cases have no symptoms Typical symptoms are: –Fever (65%) –Rash (lasting an average of 6 days, ranging from 2-14 days) –Muscle aches (lasting an average of 3.5 days, ranging from 1-14 days) –Conjunctivitis

17. Clinical symptoms and signs in 93 patients with Zika virus disease acquired in the Americas

18. Chen LH. Zika virus infection in a Massachusetts resident after travel to Costa Rica: a case report. Ann Int Med 2016 Rash post travel to Haiti

19. Clinical Features of ZIKV Brasil P et al. NEJM 2016

20. Complications of zika virus infection Congenital infection: microcephaly and other neurologic abnormalities in babies –Risk of fetal infection may be greatest if mother infected in first trimester; lowest if mother infected in third trimester Guillain Barre syndrome Bleeding problems (low platelets)

21. Complications of Zika

22. How is Zika Virus Infection Diagnosed? History of travel to an affected area Signs and symptoms typical of zika virus infection Blood and urine can be tested for the virus during the first 1-2 weeks after symptoms appear Blood can be tested for viral antibody beginning ~ 1 week after symptoms appear

23. Management of Zika Virus Disease No specific treatment is available Supportive treatment with acetaminophen, hydration, and rest Avoid aspirin and non-steroidal anti- inflammatory drugs (NSAIDs) until dengue virus infection has been ruled out Avoid mosquito bites for a week after infection to avoid transmitting to others

24. Dengue, Chikungunya, and Zika

25. Options for Prevention Wear long-sleeved shirts and long pants as weather permits Air conditioning or window/door screens to keep mosquitoes outside – –If no screens, sleep under a mosquito bed net or in a tent (can treat with permethrin) Mosquito repellents! Permethrin treating of clothing

26. Insect Repellents These provide long lasting protection: – –DEET (20-30%) – –Picaridin (icaridin) (20%) – –IR3535 – –Oil of lemon eucalyptus, para-menthane-diol If you use sunscreen and insect repellent, apply sunscreen first and then repellent Dark colors, strong smells, CO, pregnant women attract mosquitoes Permethrin insectide treatment of clothing

28. Travel Precautions – Pregnant Women Women who are pregnant should avoid travel to areas with ongoing Zika transmission –Modified (based on epidemiological data on Ae. aegypti distribution and dengue risk) to: Avoid travel to elevations <2000 m Pregnant women who have been in Zika-infected areas can be screened for infection

29. Prevention of Sexual Transmission of Zika Sexual partners of pregnant women, after visiting areas with local Zika transmission, should practice safe sex or abstain from sexual activity for duration of pregnancy Men with Zika virus-like symptoms after returning from Zika areas should wait at least 6 months before attempting conception Asymptomatic men returning from areas with Zika circulation should wait at least 8 weeks before attempting conception Asymptomatic and symptomatic women returning from areas with Zika circulation should wait at least 8 weeks before attempting conception

30. Sources of Information about Zika Virus Centers for Disease Control and Prevention (CDC) Website: –http://www.cdc.gov/zika/index.html http://www.cdc.gov/zika/index.html WHO and PAHO (Pan-American Health Organization) website: –http://www.paho.org/hq/index.php?option= com_content&view=article&id=11585&Item id=41688&lang=en