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CDC: Zika virus expected to spread through Puerto Rico
Updated Zika virus figures from the U.S. territory of Puerto Rico show that more than two dozen locally acquired cases have occurred since December 2015, and more can be expected, according to the Centers for Disease Control and Prevention.
In a Feb. 12 report published in the Morbidity and Mortality Weekly Report, CDC officials said, “Because the most common mosquito vector of Zika virus, Aedes aegypti, is present throughout Puerto Rico, Zika virus is expected to continue to spread throughout the island.”
During the period of Nov. 23, 2015, to Jan. 28, 2016, the Puerto Rico Department of Health (PRDH) reported a total of 30 laboratory-confirmed cases of Zika virus. The first locally acquired case of Zika virus in Puerto Rico was reported on Dec. 31, 2015, in a patient from the southeastern region (Morb Mortal Wkly Rep. 2016 Feb;65[early release]:1-6. doi: http://dx.doi.org/10.15585/mmwr.mm6506e2er.).
The PRDH is using passive and enhanced surveillance to track the spread of the mosquito-borne Flavivirus, a disease that in humans has a generally benign course but that has a suspected association with microcephaly in infants born to Zika-infected mothers. Investigators are also tracking a suspected association with Guillain-Barré syndrome.
Patients, who mainly resided in metropolitan San Juan or areas of eastern Puerto Rico, had mostly mild illness. Patients most frequently experienced rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three patients were hospitalized.
One case of Guillain-Barré syndrome in a Zika-infected individual was reported to the PRDH, but the department saw no cases of microcephaly that were suspected of being associated with Zika virus.
The CDC is coordinating with the PRDH in ongoing surveillance efforts and response to the Zika virus. All clinicians in Puerto Rico are urged to report cases of Guillain-Barré syndrome, microcephaly, and suspected Zika infection to the PRDH. Residents of Puerto Rico should use strict mosquito avoidance and bite prevention measures, including the use of window screens, protective clothing, and an effective insect repellent.
On Twitter @karioakes
Updated Zika virus figures from the U.S. territory of Puerto Rico show that more than two dozen locally acquired cases have occurred since December 2015, and more can be expected, according to the Centers for Disease Control and Prevention.
In a Feb. 12 report published in the Morbidity and Mortality Weekly Report, CDC officials said, “Because the most common mosquito vector of Zika virus, Aedes aegypti, is present throughout Puerto Rico, Zika virus is expected to continue to spread throughout the island.”
During the period of Nov. 23, 2015, to Jan. 28, 2016, the Puerto Rico Department of Health (PRDH) reported a total of 30 laboratory-confirmed cases of Zika virus. The first locally acquired case of Zika virus in Puerto Rico was reported on Dec. 31, 2015, in a patient from the southeastern region (Morb Mortal Wkly Rep. 2016 Feb;65[early release]:1-6. doi: http://dx.doi.org/10.15585/mmwr.mm6506e2er.).
The PRDH is using passive and enhanced surveillance to track the spread of the mosquito-borne Flavivirus, a disease that in humans has a generally benign course but that has a suspected association with microcephaly in infants born to Zika-infected mothers. Investigators are also tracking a suspected association with Guillain-Barré syndrome.
Patients, who mainly resided in metropolitan San Juan or areas of eastern Puerto Rico, had mostly mild illness. Patients most frequently experienced rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three patients were hospitalized.
One case of Guillain-Barré syndrome in a Zika-infected individual was reported to the PRDH, but the department saw no cases of microcephaly that were suspected of being associated with Zika virus.
The CDC is coordinating with the PRDH in ongoing surveillance efforts and response to the Zika virus. All clinicians in Puerto Rico are urged to report cases of Guillain-Barré syndrome, microcephaly, and suspected Zika infection to the PRDH. Residents of Puerto Rico should use strict mosquito avoidance and bite prevention measures, including the use of window screens, protective clothing, and an effective insect repellent.
On Twitter @karioakes
Updated Zika virus figures from the U.S. territory of Puerto Rico show that more than two dozen locally acquired cases have occurred since December 2015, and more can be expected, according to the Centers for Disease Control and Prevention.
In a Feb. 12 report published in the Morbidity and Mortality Weekly Report, CDC officials said, “Because the most common mosquito vector of Zika virus, Aedes aegypti, is present throughout Puerto Rico, Zika virus is expected to continue to spread throughout the island.”
During the period of Nov. 23, 2015, to Jan. 28, 2016, the Puerto Rico Department of Health (PRDH) reported a total of 30 laboratory-confirmed cases of Zika virus. The first locally acquired case of Zika virus in Puerto Rico was reported on Dec. 31, 2015, in a patient from the southeastern region (Morb Mortal Wkly Rep. 2016 Feb;65[early release]:1-6. doi: http://dx.doi.org/10.15585/mmwr.mm6506e2er.).
The PRDH is using passive and enhanced surveillance to track the spread of the mosquito-borne Flavivirus, a disease that in humans has a generally benign course but that has a suspected association with microcephaly in infants born to Zika-infected mothers. Investigators are also tracking a suspected association with Guillain-Barré syndrome.
Patients, who mainly resided in metropolitan San Juan or areas of eastern Puerto Rico, had mostly mild illness. Patients most frequently experienced rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three patients were hospitalized.
One case of Guillain-Barré syndrome in a Zika-infected individual was reported to the PRDH, but the department saw no cases of microcephaly that were suspected of being associated with Zika virus.
The CDC is coordinating with the PRDH in ongoing surveillance efforts and response to the Zika virus. All clinicians in Puerto Rico are urged to report cases of Guillain-Barré syndrome, microcephaly, and suspected Zika infection to the PRDH. Residents of Puerto Rico should use strict mosquito avoidance and bite prevention measures, including the use of window screens, protective clothing, and an effective insect repellent.
On Twitter @karioakes
FROM MMWR
Dermatologic features may help distinguish Zika infection
Dermatologists may be seeing patients who have recently traveled to an area affected by the current Zika outbreaks, who present with a rash and possibly a fever.
Before serology and possibly virology confirms the diagnosis, there are certain distinguishing characteristics that may help distinguish Zika initially from dengue and Chikungunya, according to Dr. Stephen K. Tyring.
Dr. Tyring, clinical professor of dermatology at the University of Texas, Houston, said in an interview that serology is required to confirm the diagnosis, and should be obtained via state and local health departments, which are increasingly being provided with test kits. Virology via polymerase chain reaction also may be needed to diagnose the infection.
About 20% of people infected with Zika virus develop symptoms. In Texas, by early February, 10 cases had been diagnosed statewide.
The Zika rash is characterized by blanchable macules and papules, which may start on the face or trunk 3-5 days after the febrile phase, and become more diffuse, said Dr. Tyring.
The erythematous macules with areas of sparing is similar to the rash seen with Chikungunya and dengue, two other viral infections that have cutaneous manifestations. With a Zika rash, macules are more likely than papules, but papules are certainly possible, he said.
In addition, someone with a Zika infection is more likely to have conjunctivitis than someone with dengue or Chikungunya, and may have red sclera, he noted. But all the other symptoms associated with dengue and Chikungunya, such as the arthralgias, headaches, and myalgias, could certainly be present with Zika as well, as the three diseases have similar clinical features.
Dr. Tyring referred to a study published in 2009 describing 31 cases in a 2007 Zika outbreak in Micronesia, which reported that 90% (28 patients) had a macular or papular rash. In addition, 20 (65%) had a mild fever, 20 (65%) had arthralgia of the small joints, and 17 (55%) had nonpurulent conjunctivitis (N Engl J Med. 2009 Jun 11;360[24]:2536-43).
In September, when Dr. Tyring was attending the Brazilian Society of Dermatology meeting in Sao Paolo, he visited some clinics and saw some of the first patients diagnosed with Zika virus – before the connection with the microcephaly or Guillain-Barre had been made. Serologic testing had confirmed that the cases were Zika infections, not Chikungunya or dengue.
At that time, cases were being viewed as a mild versions of Chikungunya or dengue, “in other words, nothing that they were fearing any more than all the other arboviruses that are so common,” Dr. Tyring said in an interview.
With some of the patients, “we saw a bit of desquamation of the extremities, such as the fingertips,” he said. (See photos.) “But generally, it’s not very distinguishable between dengue and Chikungunya.”
Health care providers are encourage to report suspected cases to their state health departments.
Dermatologists may be seeing patients who have recently traveled to an area affected by the current Zika outbreaks, who present with a rash and possibly a fever.
Before serology and possibly virology confirms the diagnosis, there are certain distinguishing characteristics that may help distinguish Zika initially from dengue and Chikungunya, according to Dr. Stephen K. Tyring.
Dr. Tyring, clinical professor of dermatology at the University of Texas, Houston, said in an interview that serology is required to confirm the diagnosis, and should be obtained via state and local health departments, which are increasingly being provided with test kits. Virology via polymerase chain reaction also may be needed to diagnose the infection.
About 20% of people infected with Zika virus develop symptoms. In Texas, by early February, 10 cases had been diagnosed statewide.
The Zika rash is characterized by blanchable macules and papules, which may start on the face or trunk 3-5 days after the febrile phase, and become more diffuse, said Dr. Tyring.
The erythematous macules with areas of sparing is similar to the rash seen with Chikungunya and dengue, two other viral infections that have cutaneous manifestations. With a Zika rash, macules are more likely than papules, but papules are certainly possible, he said.
In addition, someone with a Zika infection is more likely to have conjunctivitis than someone with dengue or Chikungunya, and may have red sclera, he noted. But all the other symptoms associated with dengue and Chikungunya, such as the arthralgias, headaches, and myalgias, could certainly be present with Zika as well, as the three diseases have similar clinical features.
Dr. Tyring referred to a study published in 2009 describing 31 cases in a 2007 Zika outbreak in Micronesia, which reported that 90% (28 patients) had a macular or papular rash. In addition, 20 (65%) had a mild fever, 20 (65%) had arthralgia of the small joints, and 17 (55%) had nonpurulent conjunctivitis (N Engl J Med. 2009 Jun 11;360[24]:2536-43).
In September, when Dr. Tyring was attending the Brazilian Society of Dermatology meeting in Sao Paolo, he visited some clinics and saw some of the first patients diagnosed with Zika virus – before the connection with the microcephaly or Guillain-Barre had been made. Serologic testing had confirmed that the cases were Zika infections, not Chikungunya or dengue.
At that time, cases were being viewed as a mild versions of Chikungunya or dengue, “in other words, nothing that they were fearing any more than all the other arboviruses that are so common,” Dr. Tyring said in an interview.
With some of the patients, “we saw a bit of desquamation of the extremities, such as the fingertips,” he said. (See photos.) “But generally, it’s not very distinguishable between dengue and Chikungunya.”
Health care providers are encourage to report suspected cases to their state health departments.
Dermatologists may be seeing patients who have recently traveled to an area affected by the current Zika outbreaks, who present with a rash and possibly a fever.
Before serology and possibly virology confirms the diagnosis, there are certain distinguishing characteristics that may help distinguish Zika initially from dengue and Chikungunya, according to Dr. Stephen K. Tyring.
Dr. Tyring, clinical professor of dermatology at the University of Texas, Houston, said in an interview that serology is required to confirm the diagnosis, and should be obtained via state and local health departments, which are increasingly being provided with test kits. Virology via polymerase chain reaction also may be needed to diagnose the infection.
About 20% of people infected with Zika virus develop symptoms. In Texas, by early February, 10 cases had been diagnosed statewide.
The Zika rash is characterized by blanchable macules and papules, which may start on the face or trunk 3-5 days after the febrile phase, and become more diffuse, said Dr. Tyring.
The erythematous macules with areas of sparing is similar to the rash seen with Chikungunya and dengue, two other viral infections that have cutaneous manifestations. With a Zika rash, macules are more likely than papules, but papules are certainly possible, he said.
In addition, someone with a Zika infection is more likely to have conjunctivitis than someone with dengue or Chikungunya, and may have red sclera, he noted. But all the other symptoms associated with dengue and Chikungunya, such as the arthralgias, headaches, and myalgias, could certainly be present with Zika as well, as the three diseases have similar clinical features.
Dr. Tyring referred to a study published in 2009 describing 31 cases in a 2007 Zika outbreak in Micronesia, which reported that 90% (28 patients) had a macular or papular rash. In addition, 20 (65%) had a mild fever, 20 (65%) had arthralgia of the small joints, and 17 (55%) had nonpurulent conjunctivitis (N Engl J Med. 2009 Jun 11;360[24]:2536-43).
In September, when Dr. Tyring was attending the Brazilian Society of Dermatology meeting in Sao Paolo, he visited some clinics and saw some of the first patients diagnosed with Zika virus – before the connection with the microcephaly or Guillain-Barre had been made. Serologic testing had confirmed that the cases were Zika infections, not Chikungunya or dengue.
At that time, cases were being viewed as a mild versions of Chikungunya or dengue, “in other words, nothing that they were fearing any more than all the other arboviruses that are so common,” Dr. Tyring said in an interview.
With some of the patients, “we saw a bit of desquamation of the extremities, such as the fingertips,” he said. (See photos.) “But generally, it’s not very distinguishable between dengue and Chikungunya.”
Health care providers are encourage to report suspected cases to their state health departments.
Borrelia mayonii is new cause of Lyme disease variant
A new species of Borrelia has been linked to a variant of Lyme disease with symptoms that differ somewhat from typical Lyme borreliosis.
Of 100,545 routine clinical specimens tested at the Mayo Clinic in Rochester, Minn., for Lyme borreliosis between 2003 and 2014, six clinical specimens – all from 2012 or later – yielded an atypical oppA1 PCR result, according to a study published in Lancet Infectious Diseases.
In patients with specimens yielding atypical results, medical records were reviewed and additional samples were examined by a research team led by Dr. Bobbi Pritt of Mayo Clinic.
The researchers performed DNA sequencing, microscopy, or culturing of the diagnostic specimens (five blood and one synovial), as well as oppA1 PCR testing of Ixodes scapularis ticks (black-legged or “deer” ticks) from regions of suspected patient tick exposure. Among the five blood specimens tested, the median oppA1 copy number was 180 times higher than that found in 13 specimens testing positive for B. burgdorferi during the same time period.
Multigene sequencing identified the spirochete as a novel B. burgdorferi genospecies – the same genospecies detected in ticks collected at a probable patient exposure site.
The newly discovered bacteria, provisionally named Borrelia mayonii, caused Lyme disease with symptoms similar to those caused by B. burgdorferi, but with some distinct clinical features. Similar to classic Lyme disease, fever, headache, rash, and neck pain were experienced in the early stages of infection (days after exposure) and arthritis in the later stages (weeks after exposure). But patients infected with B. mayonii also presented with nausea and vomiting, diffuse rashes (as opposed to the typical “bull’s-eye” rash), and a higher concentration of bacteria in the blood.
“In view of the differing clinical manifestations for patients infected with the novel B. burgdorferi sensu lato genospecies, it is likely that Lyme borreliosis is not being considered – and therefore not diagnosed – in some patients with this infection,” said Dr. Pritt and her colleagues. They added that the clinical range of illness must be better defined in additional patients to ensure the infection is recognized and distinguished from other tick-borne infections, and oppA1 PCR is used for diagnosing infection with B. mayonii.
Read the full study in Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00464-8).
On Twitter @richpizzi
A new species of Borrelia has been linked to a variant of Lyme disease with symptoms that differ somewhat from typical Lyme borreliosis.
Of 100,545 routine clinical specimens tested at the Mayo Clinic in Rochester, Minn., for Lyme borreliosis between 2003 and 2014, six clinical specimens – all from 2012 or later – yielded an atypical oppA1 PCR result, according to a study published in Lancet Infectious Diseases.
In patients with specimens yielding atypical results, medical records were reviewed and additional samples were examined by a research team led by Dr. Bobbi Pritt of Mayo Clinic.
The researchers performed DNA sequencing, microscopy, or culturing of the diagnostic specimens (five blood and one synovial), as well as oppA1 PCR testing of Ixodes scapularis ticks (black-legged or “deer” ticks) from regions of suspected patient tick exposure. Among the five blood specimens tested, the median oppA1 copy number was 180 times higher than that found in 13 specimens testing positive for B. burgdorferi during the same time period.
Multigene sequencing identified the spirochete as a novel B. burgdorferi genospecies – the same genospecies detected in ticks collected at a probable patient exposure site.
The newly discovered bacteria, provisionally named Borrelia mayonii, caused Lyme disease with symptoms similar to those caused by B. burgdorferi, but with some distinct clinical features. Similar to classic Lyme disease, fever, headache, rash, and neck pain were experienced in the early stages of infection (days after exposure) and arthritis in the later stages (weeks after exposure). But patients infected with B. mayonii also presented with nausea and vomiting, diffuse rashes (as opposed to the typical “bull’s-eye” rash), and a higher concentration of bacteria in the blood.
“In view of the differing clinical manifestations for patients infected with the novel B. burgdorferi sensu lato genospecies, it is likely that Lyme borreliosis is not being considered – and therefore not diagnosed – in some patients with this infection,” said Dr. Pritt and her colleagues. They added that the clinical range of illness must be better defined in additional patients to ensure the infection is recognized and distinguished from other tick-borne infections, and oppA1 PCR is used for diagnosing infection with B. mayonii.
Read the full study in Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00464-8).
On Twitter @richpizzi
A new species of Borrelia has been linked to a variant of Lyme disease with symptoms that differ somewhat from typical Lyme borreliosis.
Of 100,545 routine clinical specimens tested at the Mayo Clinic in Rochester, Minn., for Lyme borreliosis between 2003 and 2014, six clinical specimens – all from 2012 or later – yielded an atypical oppA1 PCR result, according to a study published in Lancet Infectious Diseases.
In patients with specimens yielding atypical results, medical records were reviewed and additional samples were examined by a research team led by Dr. Bobbi Pritt of Mayo Clinic.
The researchers performed DNA sequencing, microscopy, or culturing of the diagnostic specimens (five blood and one synovial), as well as oppA1 PCR testing of Ixodes scapularis ticks (black-legged or “deer” ticks) from regions of suspected patient tick exposure. Among the five blood specimens tested, the median oppA1 copy number was 180 times higher than that found in 13 specimens testing positive for B. burgdorferi during the same time period.
Multigene sequencing identified the spirochete as a novel B. burgdorferi genospecies – the same genospecies detected in ticks collected at a probable patient exposure site.
The newly discovered bacteria, provisionally named Borrelia mayonii, caused Lyme disease with symptoms similar to those caused by B. burgdorferi, but with some distinct clinical features. Similar to classic Lyme disease, fever, headache, rash, and neck pain were experienced in the early stages of infection (days after exposure) and arthritis in the later stages (weeks after exposure). But patients infected with B. mayonii also presented with nausea and vomiting, diffuse rashes (as opposed to the typical “bull’s-eye” rash), and a higher concentration of bacteria in the blood.
“In view of the differing clinical manifestations for patients infected with the novel B. burgdorferi sensu lato genospecies, it is likely that Lyme borreliosis is not being considered – and therefore not diagnosed – in some patients with this infection,” said Dr. Pritt and her colleagues. They added that the clinical range of illness must be better defined in additional patients to ensure the infection is recognized and distinguished from other tick-borne infections, and oppA1 PCR is used for diagnosing infection with B. mayonii.
Read the full study in Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00464-8).
On Twitter @richpizzi
FROM LANCET INFECTIOUS DISEASES
New evidence strengthens link between Zika and microcephaly
While scientists can’t say with certainty that congenital Zika virus is causing the massive spike in cases of microcephaly seen in Brazil, evidence of a strong association continues to mount.
Two reports, published Feb. 10 in the Morbidity and Mortality Weekly Report and in the New England Journal of Medicine, confirm through laboratory testing that fetuses and infants with microcephaly also were positive for Zika virus infection.
In the MMWR report, researchers from the United States and Brazil present evidence of a link between Zika virus infection and microcephaly and fetal demise through detection of viral RNA and antigens in brain tissues with infants with microcephaly, as well as placental tissues from early miscarriages.
The findings are based on laboratory testing of tissue samples from two newborns with microcephaly who died within 20 hours of birth and two miscarriages (at 11 and 13 weeks’ gestation). The samples were submitted to the Centers for Disease Control and Prevention from the state of Rio Grande do Norte, Brazil, in December 2015. All four mothers had clinical signs of Zika virus infection during the first trimester but did not have signs of active infection at the time of delivery or miscarriage.
Specimens from all four cases were positive by reverse transcription-polymerase chain reaction (RT-PCR) testing, and sequence analysis provided additional evidence of Zika virus infection (Morb Mortal Wkly Rep. 2016 Feb;65:1-2. doi: 10.15585/mmwr.mm6506e1er).
“To better understand the pathogenesis of Zika virus infection and associated congenital anomalies and fetal death, it is necessary to evaluate autopsy and placental tissues from additional cases, and to determine the effect of gestational age during maternal illness on fetal outcomes,” the researchers wrote.
In the New England Journal of Medicine report, Dr. Jernej Mlakar of the University of Ljubljana, Slovenia, and colleagues, presented the case of a previously healthy 25-year-old pregnant woman who had become ill while living in Brazil. During the 13th week of gestation, she had a high fever, followed by severe musculoskeletal and retro-ocular pain, as well as an itchy generalized maculopapular rash. Zika virus was suspected at the time but virologic diagnostic testing was not performed.
Ultrasound at 14 weeks and 20 weeks showed normal fetal growth and anatomy, but ultrasound at 29 weeks showed signs of fetal abnormalities. At 32 weeks, physicians confirmed intrauterine growth retardation and microcephaly with calcifications in the fetal brain and placenta.
The woman requested termination of the pregnancy and an autopsy was performed on the fetus. Positive results for Zika virus were obtained on RT-PCR assay in the fetal brain sample. All autopsy samples were tested on PCR assay and found to be negative for other flaviviruses, including dengue, yellow fever, West Nile, and tick-borne encephalitis (N Engl J Med. 2016 Feb 10. doi: 10.1056/NEJMoa1600651).
In an editorial accompanying the report, physicians from the Harvard School of Public Health and Massachusetts General Hospital, both in Boston, wrote that there are still many unanswered questions about Zika virus in pregnancy. Assuming the association between Zika virus and microcephaly exists, researchers do not know whether the timing of the infection during pregnancy has an effect on the risk of fetal abnormalities. Additionally, it’s unknown whether asymptomatic or minimally symptomatic disease poses a risk to the fetus (N Engl J Med. 2016 Feb 10. doi: 10.1056/NEJMe1601862).
The researchers for both case reports had no financial disclosures.
On Twitter @maryellenny
While scientists can’t say with certainty that congenital Zika virus is causing the massive spike in cases of microcephaly seen in Brazil, evidence of a strong association continues to mount.
Two reports, published Feb. 10 in the Morbidity and Mortality Weekly Report and in the New England Journal of Medicine, confirm through laboratory testing that fetuses and infants with microcephaly also were positive for Zika virus infection.
In the MMWR report, researchers from the United States and Brazil present evidence of a link between Zika virus infection and microcephaly and fetal demise through detection of viral RNA and antigens in brain tissues with infants with microcephaly, as well as placental tissues from early miscarriages.
The findings are based on laboratory testing of tissue samples from two newborns with microcephaly who died within 20 hours of birth and two miscarriages (at 11 and 13 weeks’ gestation). The samples were submitted to the Centers for Disease Control and Prevention from the state of Rio Grande do Norte, Brazil, in December 2015. All four mothers had clinical signs of Zika virus infection during the first trimester but did not have signs of active infection at the time of delivery or miscarriage.
Specimens from all four cases were positive by reverse transcription-polymerase chain reaction (RT-PCR) testing, and sequence analysis provided additional evidence of Zika virus infection (Morb Mortal Wkly Rep. 2016 Feb;65:1-2. doi: 10.15585/mmwr.mm6506e1er).
“To better understand the pathogenesis of Zika virus infection and associated congenital anomalies and fetal death, it is necessary to evaluate autopsy and placental tissues from additional cases, and to determine the effect of gestational age during maternal illness on fetal outcomes,” the researchers wrote.
In the New England Journal of Medicine report, Dr. Jernej Mlakar of the University of Ljubljana, Slovenia, and colleagues, presented the case of a previously healthy 25-year-old pregnant woman who had become ill while living in Brazil. During the 13th week of gestation, she had a high fever, followed by severe musculoskeletal and retro-ocular pain, as well as an itchy generalized maculopapular rash. Zika virus was suspected at the time but virologic diagnostic testing was not performed.
Ultrasound at 14 weeks and 20 weeks showed normal fetal growth and anatomy, but ultrasound at 29 weeks showed signs of fetal abnormalities. At 32 weeks, physicians confirmed intrauterine growth retardation and microcephaly with calcifications in the fetal brain and placenta.
The woman requested termination of the pregnancy and an autopsy was performed on the fetus. Positive results for Zika virus were obtained on RT-PCR assay in the fetal brain sample. All autopsy samples were tested on PCR assay and found to be negative for other flaviviruses, including dengue, yellow fever, West Nile, and tick-borne encephalitis (N Engl J Med. 2016 Feb 10. doi: 10.1056/NEJMoa1600651).
In an editorial accompanying the report, physicians from the Harvard School of Public Health and Massachusetts General Hospital, both in Boston, wrote that there are still many unanswered questions about Zika virus in pregnancy. Assuming the association between Zika virus and microcephaly exists, researchers do not know whether the timing of the infection during pregnancy has an effect on the risk of fetal abnormalities. Additionally, it’s unknown whether asymptomatic or minimally symptomatic disease poses a risk to the fetus (N Engl J Med. 2016 Feb 10. doi: 10.1056/NEJMe1601862).
The researchers for both case reports had no financial disclosures.
On Twitter @maryellenny
While scientists can’t say with certainty that congenital Zika virus is causing the massive spike in cases of microcephaly seen in Brazil, evidence of a strong association continues to mount.
Two reports, published Feb. 10 in the Morbidity and Mortality Weekly Report and in the New England Journal of Medicine, confirm through laboratory testing that fetuses and infants with microcephaly also were positive for Zika virus infection.
In the MMWR report, researchers from the United States and Brazil present evidence of a link between Zika virus infection and microcephaly and fetal demise through detection of viral RNA and antigens in brain tissues with infants with microcephaly, as well as placental tissues from early miscarriages.
The findings are based on laboratory testing of tissue samples from two newborns with microcephaly who died within 20 hours of birth and two miscarriages (at 11 and 13 weeks’ gestation). The samples were submitted to the Centers for Disease Control and Prevention from the state of Rio Grande do Norte, Brazil, in December 2015. All four mothers had clinical signs of Zika virus infection during the first trimester but did not have signs of active infection at the time of delivery or miscarriage.
Specimens from all four cases were positive by reverse transcription-polymerase chain reaction (RT-PCR) testing, and sequence analysis provided additional evidence of Zika virus infection (Morb Mortal Wkly Rep. 2016 Feb;65:1-2. doi: 10.15585/mmwr.mm6506e1er).
“To better understand the pathogenesis of Zika virus infection and associated congenital anomalies and fetal death, it is necessary to evaluate autopsy and placental tissues from additional cases, and to determine the effect of gestational age during maternal illness on fetal outcomes,” the researchers wrote.
In the New England Journal of Medicine report, Dr. Jernej Mlakar of the University of Ljubljana, Slovenia, and colleagues, presented the case of a previously healthy 25-year-old pregnant woman who had become ill while living in Brazil. During the 13th week of gestation, she had a high fever, followed by severe musculoskeletal and retro-ocular pain, as well as an itchy generalized maculopapular rash. Zika virus was suspected at the time but virologic diagnostic testing was not performed.
Ultrasound at 14 weeks and 20 weeks showed normal fetal growth and anatomy, but ultrasound at 29 weeks showed signs of fetal abnormalities. At 32 weeks, physicians confirmed intrauterine growth retardation and microcephaly with calcifications in the fetal brain and placenta.
The woman requested termination of the pregnancy and an autopsy was performed on the fetus. Positive results for Zika virus were obtained on RT-PCR assay in the fetal brain sample. All autopsy samples were tested on PCR assay and found to be negative for other flaviviruses, including dengue, yellow fever, West Nile, and tick-borne encephalitis (N Engl J Med. 2016 Feb 10. doi: 10.1056/NEJMoa1600651).
In an editorial accompanying the report, physicians from the Harvard School of Public Health and Massachusetts General Hospital, both in Boston, wrote that there are still many unanswered questions about Zika virus in pregnancy. Assuming the association between Zika virus and microcephaly exists, researchers do not know whether the timing of the infection during pregnancy has an effect on the risk of fetal abnormalities. Additionally, it’s unknown whether asymptomatic or minimally symptomatic disease poses a risk to the fetus (N Engl J Med. 2016 Feb 10. doi: 10.1056/NEJMe1601862).
The researchers for both case reports had no financial disclosures.
On Twitter @maryellenny
Ocular symptoms accompany microcephaly in Brazilian newborns
In a sample of infants born with microcephaly and a presumed diagnosis of congenital Zika virus, about one-third were found to have vision-threatening eye abnormalities, according to researchers working in a Zika hot spot in Brazil.
The group, led by Dr. Bruno de Paula Freitas of the Hospital Geral Roberto Santos, in Salvador, Brazil, evaluated 29 infants with microcephaly born at a single hospital in December following suspected maternal infection with the mosquito-borne Zika virus. In a paper published online Feb 9., Dr. de Paula Freitas and his colleagues reported eye abnormalities in 10 of these children (34.5%) (JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0267.).
Brazil first reported an outbreak of Zika virus infections in April 2015, followed months later by a spike in the number of infants born with microcephaly, a birth defect defined by a cephalic circumference of 32 cm or less in newborns. The most common ocular abnormalities seen in the cohort of affected infants were pigment mottling of the retina and chorioretinal atrophy (11 of 17 abnormal eyes); optic nerve abnormalities (8 eyes); and iris coloboma (affecting 2 eyes in one infant).
While a previous study of a Zika virus outbreak in Micronesia found conjunctivitis among infected individuals, none of the mothers of the current cohort of infants disclosed having had conjunctivitis. Altogether 23 of the mothers (79%) reported having had any symptoms of Zika virus infection during pregnancy.
Dr. de Paula Freitas and his colleagues acknowledged that their results were limited by a small sample size and single-site study design. However, the investigators noted, the findings suggest the possibility “that even oligosymptomatic or asymptomatic pregnant patients presumably infected [with Zika virus] may have microcephalic newborns with ophthalmoscopic lesions” and those newborns should be routinely evaluated for ocular symptoms.
An important question that requires further investigation, they noted, is whether newborns without microcephaly, but whose mothers may have been infected with the Zika virus, should be screened to identify possible ocular lesions.
Funding for the study came from Hospital Geral Roberto Santos, Federal University of São Paulo, Vision Institute, and Conselho Nacional de Desenvolvimento Científico e Tecnológico in Brasília, Brazil. The authors reported having no financial disclosures.
Ophthalmologic manifestations of congenital Zika virus infection are not yet well described. The report by de Paula Freitas et al. implicates this infection as the cause of chorioretinal scarring and possibly other ocular abnormalities in infants with microcephaly recently born in Brazil.
Microcephaly can be genetic, metabolic, drug related, or caused by perinatal insults such as hypoxia, malnutrition, or infection. The present 20-fold reported increase of microcephaly in parts of Brazil is temporally associated with the outbreak of Zika virus. However, this association is still presumptive because definitive serologic testing for Zika virus was not available in Brazil at the time of the outbreak, and confusion may occur with other causes of microcephaly. Similarly, the currently described eye lesions are presumptively associated with the virus.
Based on current information, in our opinion, clinicians in areas where Zika virus is present should perform ophthalmologic examinations on all microcephalic babies. Because it is still unclear whether the eye lesions occur in the absence of microcephaly, it is premature to suggest ophthalmic screening of all babies born in epidemic areas.
Dr. Lee M. Jampol and Dr. Debra A Goldstein are from the department of ophthalmology, Northwestern University, Chicago. These comments are excerpted from an accompanying editorial (JAMA Ophthalmol. doi:10.1001/jamaopthalmol.2016.0284.). The authors reported having no financial disclosures.
Ophthalmologic manifestations of congenital Zika virus infection are not yet well described. The report by de Paula Freitas et al. implicates this infection as the cause of chorioretinal scarring and possibly other ocular abnormalities in infants with microcephaly recently born in Brazil.
Microcephaly can be genetic, metabolic, drug related, or caused by perinatal insults such as hypoxia, malnutrition, or infection. The present 20-fold reported increase of microcephaly in parts of Brazil is temporally associated with the outbreak of Zika virus. However, this association is still presumptive because definitive serologic testing for Zika virus was not available in Brazil at the time of the outbreak, and confusion may occur with other causes of microcephaly. Similarly, the currently described eye lesions are presumptively associated with the virus.
Based on current information, in our opinion, clinicians in areas where Zika virus is present should perform ophthalmologic examinations on all microcephalic babies. Because it is still unclear whether the eye lesions occur in the absence of microcephaly, it is premature to suggest ophthalmic screening of all babies born in epidemic areas.
Dr. Lee M. Jampol and Dr. Debra A Goldstein are from the department of ophthalmology, Northwestern University, Chicago. These comments are excerpted from an accompanying editorial (JAMA Ophthalmol. doi:10.1001/jamaopthalmol.2016.0284.). The authors reported having no financial disclosures.
Ophthalmologic manifestations of congenital Zika virus infection are not yet well described. The report by de Paula Freitas et al. implicates this infection as the cause of chorioretinal scarring and possibly other ocular abnormalities in infants with microcephaly recently born in Brazil.
Microcephaly can be genetic, metabolic, drug related, or caused by perinatal insults such as hypoxia, malnutrition, or infection. The present 20-fold reported increase of microcephaly in parts of Brazil is temporally associated with the outbreak of Zika virus. However, this association is still presumptive because definitive serologic testing for Zika virus was not available in Brazil at the time of the outbreak, and confusion may occur with other causes of microcephaly. Similarly, the currently described eye lesions are presumptively associated with the virus.
Based on current information, in our opinion, clinicians in areas where Zika virus is present should perform ophthalmologic examinations on all microcephalic babies. Because it is still unclear whether the eye lesions occur in the absence of microcephaly, it is premature to suggest ophthalmic screening of all babies born in epidemic areas.
Dr. Lee M. Jampol and Dr. Debra A Goldstein are from the department of ophthalmology, Northwestern University, Chicago. These comments are excerpted from an accompanying editorial (JAMA Ophthalmol. doi:10.1001/jamaopthalmol.2016.0284.). The authors reported having no financial disclosures.
In a sample of infants born with microcephaly and a presumed diagnosis of congenital Zika virus, about one-third were found to have vision-threatening eye abnormalities, according to researchers working in a Zika hot spot in Brazil.
The group, led by Dr. Bruno de Paula Freitas of the Hospital Geral Roberto Santos, in Salvador, Brazil, evaluated 29 infants with microcephaly born at a single hospital in December following suspected maternal infection with the mosquito-borne Zika virus. In a paper published online Feb 9., Dr. de Paula Freitas and his colleagues reported eye abnormalities in 10 of these children (34.5%) (JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0267.).
Brazil first reported an outbreak of Zika virus infections in April 2015, followed months later by a spike in the number of infants born with microcephaly, a birth defect defined by a cephalic circumference of 32 cm or less in newborns. The most common ocular abnormalities seen in the cohort of affected infants were pigment mottling of the retina and chorioretinal atrophy (11 of 17 abnormal eyes); optic nerve abnormalities (8 eyes); and iris coloboma (affecting 2 eyes in one infant).
While a previous study of a Zika virus outbreak in Micronesia found conjunctivitis among infected individuals, none of the mothers of the current cohort of infants disclosed having had conjunctivitis. Altogether 23 of the mothers (79%) reported having had any symptoms of Zika virus infection during pregnancy.
Dr. de Paula Freitas and his colleagues acknowledged that their results were limited by a small sample size and single-site study design. However, the investigators noted, the findings suggest the possibility “that even oligosymptomatic or asymptomatic pregnant patients presumably infected [with Zika virus] may have microcephalic newborns with ophthalmoscopic lesions” and those newborns should be routinely evaluated for ocular symptoms.
An important question that requires further investigation, they noted, is whether newborns without microcephaly, but whose mothers may have been infected with the Zika virus, should be screened to identify possible ocular lesions.
Funding for the study came from Hospital Geral Roberto Santos, Federal University of São Paulo, Vision Institute, and Conselho Nacional de Desenvolvimento Científico e Tecnológico in Brasília, Brazil. The authors reported having no financial disclosures.
In a sample of infants born with microcephaly and a presumed diagnosis of congenital Zika virus, about one-third were found to have vision-threatening eye abnormalities, according to researchers working in a Zika hot spot in Brazil.
The group, led by Dr. Bruno de Paula Freitas of the Hospital Geral Roberto Santos, in Salvador, Brazil, evaluated 29 infants with microcephaly born at a single hospital in December following suspected maternal infection with the mosquito-borne Zika virus. In a paper published online Feb 9., Dr. de Paula Freitas and his colleagues reported eye abnormalities in 10 of these children (34.5%) (JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0267.).
Brazil first reported an outbreak of Zika virus infections in April 2015, followed months later by a spike in the number of infants born with microcephaly, a birth defect defined by a cephalic circumference of 32 cm or less in newborns. The most common ocular abnormalities seen in the cohort of affected infants were pigment mottling of the retina and chorioretinal atrophy (11 of 17 abnormal eyes); optic nerve abnormalities (8 eyes); and iris coloboma (affecting 2 eyes in one infant).
While a previous study of a Zika virus outbreak in Micronesia found conjunctivitis among infected individuals, none of the mothers of the current cohort of infants disclosed having had conjunctivitis. Altogether 23 of the mothers (79%) reported having had any symptoms of Zika virus infection during pregnancy.
Dr. de Paula Freitas and his colleagues acknowledged that their results were limited by a small sample size and single-site study design. However, the investigators noted, the findings suggest the possibility “that even oligosymptomatic or asymptomatic pregnant patients presumably infected [with Zika virus] may have microcephalic newborns with ophthalmoscopic lesions” and those newborns should be routinely evaluated for ocular symptoms.
An important question that requires further investigation, they noted, is whether newborns without microcephaly, but whose mothers may have been infected with the Zika virus, should be screened to identify possible ocular lesions.
Funding for the study came from Hospital Geral Roberto Santos, Federal University of São Paulo, Vision Institute, and Conselho Nacional de Desenvolvimento Científico e Tecnológico in Brasília, Brazil. The authors reported having no financial disclosures.
FROM JAMA OPTHALMOLOGY
Key clinical point: Serious ocular abnormalities may accompany microcephaly in babies born to mothers infected with the Zika virus.
Major finding: More than one-third (34.5%) of a cohort of 29 infants born with microcephaly and with a presumed diagnosis of congenital Zika virus had ocular abnormalities in one or both eyes.
Data source: A single-site cohort study evaluating 29 infants born with microcephaly in a single hospital in Salvador, Brazil.
Disclosures: Funding for the study came from Hospital Geral Roberto Santos, Federal University of São Paulo, Vision Institute, and Conselho Nacional de Desenvolvimento Científico e Tecnológico in Brasília, Brazil. The authors reported having no financial disclosures.
CDC’s emergency operations center moves to Level 1 for Zika
Officials at the Centers for Disease Control and Prevention are ramping up their response to the Zika virus – moving their Emergency Operations Center to Level 1 activation.
The agency’s Emergency Operations Center (EOC) was initially activated for Zika response on Jan. 22 to better coordinate the response to the Zika outbreak and bring together CDC scientists in arboviruses, reproductive health, and birth and developmental defects. On Feb. 8, the CDC accelerated its efforts “in anticipation of local Zika virus transmission by mosquitoes in the continental U.S.”
The EOC is currently at work on developing diagnostic tests for Zika virus, investigating links between the virus and microcephaly and Guillain-Barré syndrome, conducting surveillance in the United States, and providing on-the-ground support in Puerto Rico, Brazil, and Colombia.
The CDC recently updated its guidance on Zika virus, advising pregnant women to use condoms or abstain from sex with men who have traveled to Zika-infected areas. The agency also advised offering testing to pregnant women without symptoms of Zika virus 2-12 weeks after returning from areas with ongoing Zika virus transmission.
The CDC’s current Zika virus travel alert includes American Samoa, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Costa Rica, Curacao, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, Tonga, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
An up-to-date list of affected countries and regions is available at www.cdc.gov/zika/geo/index.html.
On Twitter @maryelleny
Officials at the Centers for Disease Control and Prevention are ramping up their response to the Zika virus – moving their Emergency Operations Center to Level 1 activation.
The agency’s Emergency Operations Center (EOC) was initially activated for Zika response on Jan. 22 to better coordinate the response to the Zika outbreak and bring together CDC scientists in arboviruses, reproductive health, and birth and developmental defects. On Feb. 8, the CDC accelerated its efforts “in anticipation of local Zika virus transmission by mosquitoes in the continental U.S.”
The EOC is currently at work on developing diagnostic tests for Zika virus, investigating links between the virus and microcephaly and Guillain-Barré syndrome, conducting surveillance in the United States, and providing on-the-ground support in Puerto Rico, Brazil, and Colombia.
The CDC recently updated its guidance on Zika virus, advising pregnant women to use condoms or abstain from sex with men who have traveled to Zika-infected areas. The agency also advised offering testing to pregnant women without symptoms of Zika virus 2-12 weeks after returning from areas with ongoing Zika virus transmission.
The CDC’s current Zika virus travel alert includes American Samoa, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Costa Rica, Curacao, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, Tonga, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
An up-to-date list of affected countries and regions is available at www.cdc.gov/zika/geo/index.html.
On Twitter @maryelleny
Officials at the Centers for Disease Control and Prevention are ramping up their response to the Zika virus – moving their Emergency Operations Center to Level 1 activation.
The agency’s Emergency Operations Center (EOC) was initially activated for Zika response on Jan. 22 to better coordinate the response to the Zika outbreak and bring together CDC scientists in arboviruses, reproductive health, and birth and developmental defects. On Feb. 8, the CDC accelerated its efforts “in anticipation of local Zika virus transmission by mosquitoes in the continental U.S.”
The EOC is currently at work on developing diagnostic tests for Zika virus, investigating links between the virus and microcephaly and Guillain-Barré syndrome, conducting surveillance in the United States, and providing on-the-ground support in Puerto Rico, Brazil, and Colombia.
The CDC recently updated its guidance on Zika virus, advising pregnant women to use condoms or abstain from sex with men who have traveled to Zika-infected areas. The agency also advised offering testing to pregnant women without symptoms of Zika virus 2-12 weeks after returning from areas with ongoing Zika virus transmission.
The CDC’s current Zika virus travel alert includes American Samoa, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Costa Rica, Curacao, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, Tonga, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
An up-to-date list of affected countries and regions is available at www.cdc.gov/zika/geo/index.html.
On Twitter @maryelleny
VIDEO: SMFM panelist addresses Zika virus testing
ATLANTA – Information about managing pregnant patients who have potential exposure to the Zika virus is evolving rapidly, and in light of new recommendations on sexual transmission of the infection, officials from the Society for Maternal-Fetal Medicine convened an expert panel to address the matter.
Leaders from the society joined officials from the Centers for Disease Control and Prevention to discuss the updated guidance – particularly a new recommendation for initially conducting serologic testing in pregnant women who have traveled to endemic areas.
Panel members advised physicians to keep a log of patients with possible Zika virus exposure, so those women can be managed properly in the event of future changes to the guidelines.
In an interview at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, panelist Dr. Brenna Hughes of Brown University, Providence, R.I., stressed the need to work with state health officials to develop local guidelines and testing mechanisms. “It will take a little time to build up the infrastructure for that kind of testing,” she said, adding that it is important to avoid delays.
Dr. Hughes reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ATLANTA – Information about managing pregnant patients who have potential exposure to the Zika virus is evolving rapidly, and in light of new recommendations on sexual transmission of the infection, officials from the Society for Maternal-Fetal Medicine convened an expert panel to address the matter.
Leaders from the society joined officials from the Centers for Disease Control and Prevention to discuss the updated guidance – particularly a new recommendation for initially conducting serologic testing in pregnant women who have traveled to endemic areas.
Panel members advised physicians to keep a log of patients with possible Zika virus exposure, so those women can be managed properly in the event of future changes to the guidelines.
In an interview at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, panelist Dr. Brenna Hughes of Brown University, Providence, R.I., stressed the need to work with state health officials to develop local guidelines and testing mechanisms. “It will take a little time to build up the infrastructure for that kind of testing,” she said, adding that it is important to avoid delays.
Dr. Hughes reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ATLANTA – Information about managing pregnant patients who have potential exposure to the Zika virus is evolving rapidly, and in light of new recommendations on sexual transmission of the infection, officials from the Society for Maternal-Fetal Medicine convened an expert panel to address the matter.
Leaders from the society joined officials from the Centers for Disease Control and Prevention to discuss the updated guidance – particularly a new recommendation for initially conducting serologic testing in pregnant women who have traveled to endemic areas.
Panel members advised physicians to keep a log of patients with possible Zika virus exposure, so those women can be managed properly in the event of future changes to the guidelines.
In an interview at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, panelist Dr. Brenna Hughes of Brown University, Providence, R.I., stressed the need to work with state health officials to develop local guidelines and testing mechanisms. “It will take a little time to build up the infrastructure for that kind of testing,” she said, adding that it is important to avoid delays.
Dr. Hughes reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE PREGNANCY MEETING
NIH announces Zika virus research priorities
The National Institutes of Health seeks applications for research on the Zika virus in reproduction, pregnancy, and the developing fetus and announced priorities for that research in a statement issued on Feb. 5.
“One of the highest priorities is to establish conclusively what role, if any, Zika virus has played in the marked increase in suspected microcephaly cases,” NIH officials said, noting that over 4,000 case of microcephaly have been reported in newborns in Brazil since October 2015. “It is possible that these microcephaly cases could have another cause, or that a contributing factor in addition to Zika virus – another virus, for example – could be leading to the condition.”Learning more about sexual transmission of the virus is also a priority. NIH is soliciting studies to determine if the virus is present in semen or vaginal secretions. Other studies “of interest” include whether infection with the virus – currently circulating in about 30 countries and territories – affects long-term fertility in both men and women and increases risk in subsequent pregnancies.
Current research can be modified, the statement points out, and may include modifying ongoing studies of pregnant women and infants to check tissue samples for the virus and evaluate the effects of exposure.
The full statement is available on the NIH website.
The National Institutes of Health seeks applications for research on the Zika virus in reproduction, pregnancy, and the developing fetus and announced priorities for that research in a statement issued on Feb. 5.
“One of the highest priorities is to establish conclusively what role, if any, Zika virus has played in the marked increase in suspected microcephaly cases,” NIH officials said, noting that over 4,000 case of microcephaly have been reported in newborns in Brazil since October 2015. “It is possible that these microcephaly cases could have another cause, or that a contributing factor in addition to Zika virus – another virus, for example – could be leading to the condition.”Learning more about sexual transmission of the virus is also a priority. NIH is soliciting studies to determine if the virus is present in semen or vaginal secretions. Other studies “of interest” include whether infection with the virus – currently circulating in about 30 countries and territories – affects long-term fertility in both men and women and increases risk in subsequent pregnancies.
Current research can be modified, the statement points out, and may include modifying ongoing studies of pregnant women and infants to check tissue samples for the virus and evaluate the effects of exposure.
The full statement is available on the NIH website.
The National Institutes of Health seeks applications for research on the Zika virus in reproduction, pregnancy, and the developing fetus and announced priorities for that research in a statement issued on Feb. 5.
“One of the highest priorities is to establish conclusively what role, if any, Zika virus has played in the marked increase in suspected microcephaly cases,” NIH officials said, noting that over 4,000 case of microcephaly have been reported in newborns in Brazil since October 2015. “It is possible that these microcephaly cases could have another cause, or that a contributing factor in addition to Zika virus – another virus, for example – could be leading to the condition.”Learning more about sexual transmission of the virus is also a priority. NIH is soliciting studies to determine if the virus is present in semen or vaginal secretions. Other studies “of interest” include whether infection with the virus – currently circulating in about 30 countries and territories – affects long-term fertility in both men and women and increases risk in subsequent pregnancies.
Current research can be modified, the statement points out, and may include modifying ongoing studies of pregnant women and infants to check tissue samples for the virus and evaluate the effects of exposure.
The full statement is available on the NIH website.
CDC warns against sexual transmission of Zika virus
In updated guidance, the U.S. Centers for Disease Control and Prevention advised pregnant women to use condoms or abstain from sex with men who have traveled to Zika-infected areas. The CDC also expanded Zika testing recommendations to advise testing all pregnant women who have traveled to Zika-infected areas, regardless of whether they have symptoms of Zika virus infection.
The CDC also now recommends that pregnant women postpone travel to Zika-infected areas.
Precautions to avoid potential sexual transmission of Zika virus follow a report earlier this week of sexual transmission of Zika virus from an individual who had traveled to a Zika-infected area, to that person’s sexual partner, who had not traveled to a Zika-infected area. The recommendation to consistently and correctly use condoms, or to abstain from sex, includes oral, anal, and vaginal insertive sex (MMWR Morb Mortal Wkly Rep. 2016 Feb 5;65[5]:1-2).
In a telebriefing, CDC director Dr. Tom Frieden said, “Because this phenomenon is so new, we are quite literally discovering more about it every day.”
The mosquito-borne flavivirus may be associated with an increased risk of microcephaly and other intracranial and neurologic abnormalities in infants whose mothers were infected with Zika virus during pregnancy. A possible link to Guillain-Barré syndrome is also being explored.
Zika virus infection is asymptomatic in 80% of individuals. Symptoms of infection, if they appear, include initial fever, a maculopapular rash, arthralgia, and sometimes conjunctivitis. There is no treatment for the disease and care is supportive.
Women who have traveled to an area with active Zika virus transmission but who have not shown symptoms of Zika virus should now be offered testing, if available, between 2 and 12 weeks from the travel date.
Testing for women who show symptoms consistent with Zika virus disease should include Zika virus reverse transcription polymerase chain reaction, Zika virus Immunoglobulin M (IgM), and neutralizing antibodies on serum specimens. Patients should also be evaluated for dengue and chikungunya virus infection because of the overlap in symptoms and endemic regions for the diseases. For those women who are pregnant and have traveled to a Zika-infected area, but who do not have symptoms of Zika infection, testing should include Zika virus IgM and, for positive or inconclusive IgM tests, neutralizing antibodies on serum specimens (MMWR Morb Mortal Wkly Rep. 2016 Feb 5;65[05]:1-6).
Dr. Frieden said that the CDC was working around the clock to make more test kits available, and is in active discussion with private manufacturers to expand production of test kits.
Brazilian researchers have issued a brief report that Zika virus has been found in urine and saliva, but Dr. Frieden clarified that today’s updated guidance does not address having women avoid exposure to urine or saliva of infected or potentially infected individuals. “We have no data on that, and we try to stick to the science here at the CDC,” he said, so current guidelines don’t address other modes of transmission, though study is ongoing. A focus of current study is to determine how long the virus persists in semen, though Dr. Frieden said it will take “weeks to months to come up with reliable information.”
Dr. Amesh A. Adalja, a member of the public health committee of the Infectious Disease Society of America and an instructor in the department of infectious diseases at the University of Pittsburgh Medical Center, said in an interview that new and emerging information about previously unknown Zika virus presentations “doesn’t change what we do know.” For most, he said, this is an asymptomatic to very mild, self-limiting disease. However, Dr. Adalja said, “We need to unravel the microcephaly link.” He called for case control studies to determine definitively if microcephaly is a “real signal” in Zika virus infection.
“It is important to step back and emphasize that Zika virus is overwhelmingly a mosquito-borne disease,” said Dr. Frieden. He said that the broader public health effort must focus on mosquito control. “The Aedes aegypti mosquito is an aggressive mosquito. It is ideally suited to the urban environment,” and the mosquito bites four or five people at one blood meal, and feeds throughout the day, not just at dawn and dusk, said Dr. Frieden. He emphasized that mosquito control measures are labor intensive and technically demanding. “This is not easy work,” he said.
Dr. Frieden said that the situation is rapidly evolving, and the CDC will continue sharing information as it becomes available. “Zika reminds us that nature is a formidable enemy,” he said.
On Twitter @karioakes
In updated guidance, the U.S. Centers for Disease Control and Prevention advised pregnant women to use condoms or abstain from sex with men who have traveled to Zika-infected areas. The CDC also expanded Zika testing recommendations to advise testing all pregnant women who have traveled to Zika-infected areas, regardless of whether they have symptoms of Zika virus infection.
The CDC also now recommends that pregnant women postpone travel to Zika-infected areas.
Precautions to avoid potential sexual transmission of Zika virus follow a report earlier this week of sexual transmission of Zika virus from an individual who had traveled to a Zika-infected area, to that person’s sexual partner, who had not traveled to a Zika-infected area. The recommendation to consistently and correctly use condoms, or to abstain from sex, includes oral, anal, and vaginal insertive sex (MMWR Morb Mortal Wkly Rep. 2016 Feb 5;65[5]:1-2).
In a telebriefing, CDC director Dr. Tom Frieden said, “Because this phenomenon is so new, we are quite literally discovering more about it every day.”
The mosquito-borne flavivirus may be associated with an increased risk of microcephaly and other intracranial and neurologic abnormalities in infants whose mothers were infected with Zika virus during pregnancy. A possible link to Guillain-Barré syndrome is also being explored.
Zika virus infection is asymptomatic in 80% of individuals. Symptoms of infection, if they appear, include initial fever, a maculopapular rash, arthralgia, and sometimes conjunctivitis. There is no treatment for the disease and care is supportive.
Women who have traveled to an area with active Zika virus transmission but who have not shown symptoms of Zika virus should now be offered testing, if available, between 2 and 12 weeks from the travel date.
Testing for women who show symptoms consistent with Zika virus disease should include Zika virus reverse transcription polymerase chain reaction, Zika virus Immunoglobulin M (IgM), and neutralizing antibodies on serum specimens. Patients should also be evaluated for dengue and chikungunya virus infection because of the overlap in symptoms and endemic regions for the diseases. For those women who are pregnant and have traveled to a Zika-infected area, but who do not have symptoms of Zika infection, testing should include Zika virus IgM and, for positive or inconclusive IgM tests, neutralizing antibodies on serum specimens (MMWR Morb Mortal Wkly Rep. 2016 Feb 5;65[05]:1-6).
Dr. Frieden said that the CDC was working around the clock to make more test kits available, and is in active discussion with private manufacturers to expand production of test kits.
Brazilian researchers have issued a brief report that Zika virus has been found in urine and saliva, but Dr. Frieden clarified that today’s updated guidance does not address having women avoid exposure to urine or saliva of infected or potentially infected individuals. “We have no data on that, and we try to stick to the science here at the CDC,” he said, so current guidelines don’t address other modes of transmission, though study is ongoing. A focus of current study is to determine how long the virus persists in semen, though Dr. Frieden said it will take “weeks to months to come up with reliable information.”
Dr. Amesh A. Adalja, a member of the public health committee of the Infectious Disease Society of America and an instructor in the department of infectious diseases at the University of Pittsburgh Medical Center, said in an interview that new and emerging information about previously unknown Zika virus presentations “doesn’t change what we do know.” For most, he said, this is an asymptomatic to very mild, self-limiting disease. However, Dr. Adalja said, “We need to unravel the microcephaly link.” He called for case control studies to determine definitively if microcephaly is a “real signal” in Zika virus infection.
“It is important to step back and emphasize that Zika virus is overwhelmingly a mosquito-borne disease,” said Dr. Frieden. He said that the broader public health effort must focus on mosquito control. “The Aedes aegypti mosquito is an aggressive mosquito. It is ideally suited to the urban environment,” and the mosquito bites four or five people at one blood meal, and feeds throughout the day, not just at dawn and dusk, said Dr. Frieden. He emphasized that mosquito control measures are labor intensive and technically demanding. “This is not easy work,” he said.
Dr. Frieden said that the situation is rapidly evolving, and the CDC will continue sharing information as it becomes available. “Zika reminds us that nature is a formidable enemy,” he said.
On Twitter @karioakes
In updated guidance, the U.S. Centers for Disease Control and Prevention advised pregnant women to use condoms or abstain from sex with men who have traveled to Zika-infected areas. The CDC also expanded Zika testing recommendations to advise testing all pregnant women who have traveled to Zika-infected areas, regardless of whether they have symptoms of Zika virus infection.
The CDC also now recommends that pregnant women postpone travel to Zika-infected areas.
Precautions to avoid potential sexual transmission of Zika virus follow a report earlier this week of sexual transmission of Zika virus from an individual who had traveled to a Zika-infected area, to that person’s sexual partner, who had not traveled to a Zika-infected area. The recommendation to consistently and correctly use condoms, or to abstain from sex, includes oral, anal, and vaginal insertive sex (MMWR Morb Mortal Wkly Rep. 2016 Feb 5;65[5]:1-2).
In a telebriefing, CDC director Dr. Tom Frieden said, “Because this phenomenon is so new, we are quite literally discovering more about it every day.”
The mosquito-borne flavivirus may be associated with an increased risk of microcephaly and other intracranial and neurologic abnormalities in infants whose mothers were infected with Zika virus during pregnancy. A possible link to Guillain-Barré syndrome is also being explored.
Zika virus infection is asymptomatic in 80% of individuals. Symptoms of infection, if they appear, include initial fever, a maculopapular rash, arthralgia, and sometimes conjunctivitis. There is no treatment for the disease and care is supportive.
Women who have traveled to an area with active Zika virus transmission but who have not shown symptoms of Zika virus should now be offered testing, if available, between 2 and 12 weeks from the travel date.
Testing for women who show symptoms consistent with Zika virus disease should include Zika virus reverse transcription polymerase chain reaction, Zika virus Immunoglobulin M (IgM), and neutralizing antibodies on serum specimens. Patients should also be evaluated for dengue and chikungunya virus infection because of the overlap in symptoms and endemic regions for the diseases. For those women who are pregnant and have traveled to a Zika-infected area, but who do not have symptoms of Zika infection, testing should include Zika virus IgM and, for positive or inconclusive IgM tests, neutralizing antibodies on serum specimens (MMWR Morb Mortal Wkly Rep. 2016 Feb 5;65[05]:1-6).
Dr. Frieden said that the CDC was working around the clock to make more test kits available, and is in active discussion with private manufacturers to expand production of test kits.
Brazilian researchers have issued a brief report that Zika virus has been found in urine and saliva, but Dr. Frieden clarified that today’s updated guidance does not address having women avoid exposure to urine or saliva of infected or potentially infected individuals. “We have no data on that, and we try to stick to the science here at the CDC,” he said, so current guidelines don’t address other modes of transmission, though study is ongoing. A focus of current study is to determine how long the virus persists in semen, though Dr. Frieden said it will take “weeks to months to come up with reliable information.”
Dr. Amesh A. Adalja, a member of the public health committee of the Infectious Disease Society of America and an instructor in the department of infectious diseases at the University of Pittsburgh Medical Center, said in an interview that new and emerging information about previously unknown Zika virus presentations “doesn’t change what we do know.” For most, he said, this is an asymptomatic to very mild, self-limiting disease. However, Dr. Adalja said, “We need to unravel the microcephaly link.” He called for case control studies to determine definitively if microcephaly is a “real signal” in Zika virus infection.
“It is important to step back and emphasize that Zika virus is overwhelmingly a mosquito-borne disease,” said Dr. Frieden. He said that the broader public health effort must focus on mosquito control. “The Aedes aegypti mosquito is an aggressive mosquito. It is ideally suited to the urban environment,” and the mosquito bites four or five people at one blood meal, and feeds throughout the day, not just at dawn and dusk, said Dr. Frieden. He emphasized that mosquito control measures are labor intensive and technically demanding. “This is not easy work,” he said.
Dr. Frieden said that the situation is rapidly evolving, and the CDC will continue sharing information as it becomes available. “Zika reminds us that nature is a formidable enemy,” he said.
On Twitter @karioakes
FROM A BRIEFING BY THE CENTERS FOR DISEASE CONTROL
CDC expands Zika virus travel warnings again
Officials at the Centers for Disease Control and Prevention have added four more destinations to their Zika virus travel alert – American Samoa, Costa Rica, Curacao, and Nicaragua.
The Level 2 travel alert means that individuals are urged to take enhanced precautions against mosquito bites while in these regions to minimize their chances of contracting the Zika virus. Pregnant women are being advised to consider postponing travel to areas where Zika virus transmission in ongoing. Pregnant women and those trying to become pregnant who must travel to these areas are advised to consult with their physician before traveling and take steps to prevent mosquito bites.
The CDC has already issued a Level 2 travel alert for these areas where Zika virus transmission is ongoing: Puerto Rico, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
An up-to-date list of affected countries and regions is available at www.cdc.gov/zika/geo/index.html.
On Twitter @maryelleny
Officials at the Centers for Disease Control and Prevention have added four more destinations to their Zika virus travel alert – American Samoa, Costa Rica, Curacao, and Nicaragua.
The Level 2 travel alert means that individuals are urged to take enhanced precautions against mosquito bites while in these regions to minimize their chances of contracting the Zika virus. Pregnant women are being advised to consider postponing travel to areas where Zika virus transmission in ongoing. Pregnant women and those trying to become pregnant who must travel to these areas are advised to consult with their physician before traveling and take steps to prevent mosquito bites.
The CDC has already issued a Level 2 travel alert for these areas where Zika virus transmission is ongoing: Puerto Rico, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
An up-to-date list of affected countries and regions is available at www.cdc.gov/zika/geo/index.html.
On Twitter @maryelleny
Officials at the Centers for Disease Control and Prevention have added four more destinations to their Zika virus travel alert – American Samoa, Costa Rica, Curacao, and Nicaragua.
The Level 2 travel alert means that individuals are urged to take enhanced precautions against mosquito bites while in these regions to minimize their chances of contracting the Zika virus. Pregnant women are being advised to consider postponing travel to areas where Zika virus transmission in ongoing. Pregnant women and those trying to become pregnant who must travel to these areas are advised to consult with their physician before traveling and take steps to prevent mosquito bites.
The CDC has already issued a Level 2 travel alert for these areas where Zika virus transmission is ongoing: Puerto Rico, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
An up-to-date list of affected countries and regions is available at www.cdc.gov/zika/geo/index.html.
On Twitter @maryelleny
