1. Zika virus how it emerged
Pontiano Kaleebu
Director MRC/UVRI Uganda Research Unit and
Acting Director
Uganda Virus Research Institute, Entebbe

2. 2014–16 Zika virus epidemic
As early as August 2014, physicians in Brazil began to investigate an outbreak of illness characterized by a flat pinkish rash, bloodshot eyes, fever, joint pain and headaches.
While the symptoms resembled dengue fever, testing ruled out this and several other potential causes.
Then, in May 2015, researchers in Brazil determined, using the RT-PCR technique, that the illness was an outbreak of Zika virus.

3. 2014–16 Zika virus epidemic…
In February 2016, WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika can cause birth defects as well as neurological problems.
The virus can be transmitted from an infected pregnant woman to her fetus, then can cause microcephaly and other severe brain anomalies in the infant.

4. What is Zika virus and how did it emerged

5. Uganda Virus Research Institute
UVRI at present
Yellow fever laboratory in Entebbe, Uganda, est.1936

6. Zika forest

7. Zika Virus Single stranded RNA virus
Genus Flavivirus, Family Flaviviridea
Closely related to dengue, yellow fever, Japanese encephalitis and West Nile viruses
Transmitted to humans primarily by Aedes species mosquitoes
Zika virus co-discover Alexander Haddow at the Uganda Virus Institute circa 1960 when he was Director

8. Viral genome organization
HIV-1 genome ~9,700 bp

9. Zika virus vectors: Aedes mosquitoes
Aedes species mosquitoes
Ae aegypti more efficient vectors for humans
Ae albopictus
Also transmit dengue and chikungunya viruses
Lay eggs in domestic water- holding containers
Live in and around households
Aggressive daytime biters

10. Geographical distribution of Zika Virus
2016
Cabo Verde
Mexico
2015
Puerto Rico
2013 Canada
1948
Tanzania
1954
Nigeria
USA

11. Genetic diversity of Zika virus lineages
Nigeria
Senegal
African
lineage
Uganda (1947)
Central R. Africa
Senegal
Indian/Pacific Oceans
Asian
lineage
Americas

12. What are the symptoms
Many people infected with Zika virus don’t have symptoms. 
For people with symptoms (20%), the most common symptoms are
Fever
Rash
Joint pain
Conjunctivitis (red eyes)
Other symptoms include
Muscle pain
Headache

13. Zika virus clinical disease course and outcomes
Clinical illness usually mild
Symptoms last several days to a week
Severe disease requiring hospitalization uncommon
Fatalities are rare
Guillain-Barre Syndrome reported in patients following suspected Zika virus infection
GBS is an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes paralysis.

14. Zika virus and microcephaly
Reports of a substantial increase in 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 losses
Some of the infants with microcephaly have tested negative for Zika virus
Incidence of microcephaly among fetuses with congenital Zika infection is unknown

15. Is the Ugandan Population Vulnerable to a Zika epidemic
Is the Ugandan Population Vulnerable to a Zika epidemic? MRC-UK,Wellome Trust and Newton Fund Funded

16. UVRI Arbovirus Laboratory Testing Flowchart
Samples arrive and logged in
Non-inactivated aliquot
Inactivated aliquot
Re-assay any
equivocal results
IgM ELISAs
Virus Isolation
Any IgM positive
PRNTs
Negative
Negative or
uninformative
Positive and
definitive
Report Results
Continue
Virus Isolate?
Go to next page

17. Zika genome detection Taqman RT PCR Next Generation Sequencing
Miseq system at UVRI

18. Universal Taqman RT-PCR assay detects both african and asian lineages of ZIKV
Ugandan MR766 ZIKV RNA
Fluorescence (dRn)
Cycle number
Brazilian ZIKV RNA – PE strain
Brazilian ZIKV RNA – AB strain
Fluorescence (dRn)
Fluorescence (dRn)
Cycle number
Cycle number

19. Prevention New approaches in devp Reduce mosquitoes bites
Cover yourself, long sleeves
Bed nets
Insecticides/repellants
Vertical transmission
Avoid mosquito bites
Pregnant women consider postponing travel to areas where Zika is present
Condoms to avoid sexual transmission where the epidemic is
New approaches in devp
Use of mosquitoes with wolbalchia
Genetically modified mosquitoes
Vaccines (killed virus, recombinant, in trials appear safe and immugonenic in animal studies)

20. WHO recent announcement
18 November 2016 –
“Zika virus and associated consequences remain a significant public health challenge requiring intense action, but they no longer represent a Public Health Emergency of International Concern”

21. Final remarks THANK YOU
Zika, Ebola etc outbreaks remind us to be prepared for the emerging and re-emerging infections
Importance of surveillance and building health systems
The importance of building capacity
The importance of collaboration
THANK YOU