Zika

Outline

•Etiology
•Epidemiology
•Pathophysiology
•Case Definition
•Clinical Manifestation
•Investigations
•Differential Diagnosis
•Management
•Public Health Control Measures
 Aetiology

ZIKA:

- Single stranded RNA virus

- Flaviviridae family
- Related to dengue, yellow fever, West Nile and Japanese encephalitis
viruses.
- 2 major lineages: African (reported in only Africa) and Asian (reported in
Asia, the Americas, Western Pacific Region and Cabo Verde)
Aetiology
Epidemiology
Epidemiology - local
Pathophysiology
1. Transmitted from person to
person via Aedes spp.
a. A. aegypti
b. A. albopictus

2. Ingests infected blood meal

3. Replicated in midgut epithelial

cells→ salivary glands (extrinsic
incubation period 5-10 days)

4. Mosquito inoculates healthy

person.
Response to Infection

Konstanze Stiba. EUROIMMUN Anti-Zika Virus ELISA (IgA) closes a diagnostic gap in Zika virus
.
infections.
http://www.euroimmunblog.com/euroimmun-anti-zika-virus-elisa-iga-closes-a-diagnostic-gap-in-zi
ka-virus-infections/ (accessed 4 February 2018).

● During the first weeks post-infection, the virus is excreted at relatively high load in urine,
saliva and other bodily fluids consistent with a systemic infection.

Konstanze Stiba. EUROIMMUN Anti-Zika Virus ELISA (IgA) closes a diagnostic gap in Zika virus infections.
http://www.euroimmunblog.com/euroimmun-anti-zika-virus-elisa-iga-closes-a-diagnostic-gap-in-zika-virus-infections/ (accessed 4
February 2018).
Response to Infection
●

●
ZIKV- Tissue Tropism
Tissue tropism is the cells
and tissues of a host that
support growth of a particular
virus or bacterium.
 Sexual transmission
● Sex includes vaginal, anal, and oral sex and the sharing of sex toys.

● The timeframes that men and women can pass Zika through sex are different because Zika virus

can stay in semen longer than in other body fluids.

● It can be passed from a person with Zika before their symptoms start, while they have

symptoms, and after their symptoms end.

● Though not well documented, the virus may also be passed by a person who carries the virus but

never develops symptoms.

Center for Disease Control. Zika virus- Sexual transmission & prevention.
https://www.cdc.gov/zika/prevention/sexual-transmission-prevention.html (accessed 4 February 2018)
Zika isolated in fetal tissue

Zika virus has been shown to be present in fetal tissue

• Amniotic fluid

• Placenta

• Fetal brain tissue

• Products of conception
Congenital Zika Syndrome
Case Definition
According to WHO zika case definitions can be classified into:

1. Suspected cases
2. Probable cases
3. Confirmed cases

According to the centre of disease control and prevention(CDC), it can be classified into:

1. Zika virus disease congenital

2. Zika virus disease non-congenital
 Case Definition
WHO classification:
Suspected case
A person presenting with rash
and/or fever and at least one of
the following signs or symptoms:
● Arthralgia;
● or arthritis;
● or conjunctivitis
(nonpurulent/hyperaemic)
Confirmed case
Probable case
A person with laboratory
● A suspected case with confirmation of recent Zika virus
presence of IgM infection:
antibody against Zika ● presence of Zika virus
virus 1 and an RNA or antigen in serum
epidemiological link. ● IgM antibody against
ZIKV positive and
PRNT90 for ZIKV with
titre ≥20
Case Definition
Case Definition
CDC classification:

Congenital: Probable Case Confirmed cases:

● Clinical criteria
Clinical criteria:
● A neonate meets ● ZIKV detection by
clinical criteria for culture, viral
● Microcephaly congenital disease antigen, or viral
● Intracranial calcification ● The neonate’s mother RNA
● Structural brain or eye has an epidemiologic ● Positive ZIKV IgM
abnormalities linkage or meets antibody test of
● CNS related disorders not laboratory criteria for umbilical cord
recent ZIKV blood, neonatal
accounted by other disorders ● The neonate has serum or CSF
laboratory evidence of collected
ZIKV
Case Definition
CDC Classification(non-congenital) 2. Complication of pregnancy
● fetal loss; OR
Clinical Criteria ● fetus or neonate with congenital
A person with one or more of the following not microcephaly, congenital intracranial
explained by another etiology: calcifications
1. Clinically compatible illness that includes 3. Guillain-Barré syndrome or other
➢ acute onset of fever (measured or neurologic manifestations
reported), OR
➢ maculopapular rash, OR
➢ arthralgia, OR
➢ conjunctivitis
Case Definition
Probable Cases Confirmed Cases

● Meets clinical criteria for ● Meets clinical criteria for

non-congenital disease; non-congenital disease

● Has an epidemiologic linkage ● Has laboratory evidence of recent ZIKV

● Has laboratory evidence of recent infection

ZIKV or flavivirus
Clinical Features

Symptoms: Signs:

● Fever ● Arthralgia
● Muscle and joint pain ● Conjunctivitis
● Elevated body
● Malaise
temperature
● Skin rashes
● headache
Clinical features
 Investigations
● Infection with Zika virus may be suspected based on symptoms and recent
history of travel (e.g. residence in or travel to an area with active Zika virus
transmission)and activities.
● Laboratory diagnosis is generally accomplished by testing whole blood (also
serum and plasma), urine, cerebrospinal fluid, amniotic fluid, semen and
saliva to detect virus, viral nucleic acid, or virus-specific immunoglobulin
M and neutralizing antibodies.
● There is accumulating evidence that Zika virus is present in urine and semen
for longer periods than in whole blood or saliva.

http://apps.who.int/iris/bitstream/10665/204671/1/WHO_ZIKV_LAB_16.1_eng.pdf
Molecular Test for Zika Virus
1. RNA NAT (nucleic acid testing) should be performed on paired serum and urine specimens. A
Negative NAT does not rule out ZIKA

2. The Trioplex Real time

RT-PCR is a laboratory test
designed to detect Zika virus,
dengue virus, and
chikungunya virus RNA.
Serologic Test for Zika Virus
1. Zika virus-specific IgM and neutralizing antibodies typically develop toward the
end of the first week of illness. IgM levels are variable, but generally are positive
starting near day 4 after onset of symptoms and continuing for up to 12 weeks post
symptom onset or exposure, but may persist longer
2. The Zika IgM Antibody Capture Enzyme-Linked Immunosorbent
Assay (Zika MAC-ELISA) is used for the qualitative detection of
Zika virus IgM antibodies in serum or cerebrospinal fluid; however,
due to cross-reaction with other flaviviruses and possible nonspecific
reactivity, results may be difficult to interpret.
Consequently, presumed positive, equivocal, or inconclusive tests
must be forwarded for confirmation by plaque-reduction
neutralization testing
(PRNT).

IgM testing cannot be relied upon to distinguish between recent

or distant infection.
 Differential Diagnosis
The differential diagnosis for Zika virus infection is broad.
● dengue,
other considerations include
● alphavirus infections (e.g., chikungunya, Mayaro,
Ross River, Barmah Forest, o’nyong-nyong, and sindbis viruses)
● leptospirosis,
● malaria,
● rickettsia,
● group A streptococcus,
● rubella,
● measles
● parvovirus, enterovirus, adenovirus,
.

https://www.cdc.gov/zika/hc-providers/preparing-for-zika/clinicalevaluationdisease.html
Management
Management of Pregnant Women with Zika
If you are caring for a person with Zika

●
●

●
 Public Health Management

WHO. Zika Virus Infection- Trinidad & Tobago. http://www.who.int/csr/don/29-february-2016-zika-trinidad-and-tobago/en/ (accessed 4

February 2018)
 References
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MCQ 1

How do people get infected with Zika?

Through the bite of an infected Aedes species mosquito (Aedes aegypti )

A. Maternal fetal Transmission (during Pregnancy)

B. Sexual intercourse with affect partner

C. Via Blood Transfusions

D. All of the above

 MCQ 2
What can you do to you protect yourself from Zika virus?

I. Empty, clean, or cover containers holding water.

II. Use insect repellent and physical barriers to protect yourself from mosquitoes. Wear light coloured clothing that covers as
much of the body as possible.
III. Practice safer sex; wear condoms during sex or abstain.
MCQ 3
Thank you for Listening:)