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WHO declares ‘public health emergency’ for microcephaly linked to Zika virus
The World Health Organization has declared a “public health emergency of international concern” related to the clusters of microcephaly and other neurological complications reported in Brazil and earlier in French Polynesia.
Though there is a strong association between these cases and the Zika virus, a causal link still has not been scientifically proven, according to the WHO.
The WHO’s emergency declaration clears the way for the international health community to move forward with a coordinated response. Dr. Margaret Chan, WHO Director-General, said her organization plans to take a number of precautionary measures, including improving surveillance and detection of infections, congenital malformations, and neurological complications. They will also work with countries to intensify control of mosquito populations and help expedite the development of diagnostic tests and vaccines to protect at-risk populations.
The recommendations came after a Feb. 1 meeting of the International Health Regulations Emergency Committee, which Dr. Chan convened last week in response to the Zika virus outbreak and the observed increase in neurological disorders and neonatal malformations.
The group of 18 experts advised that the clusters of microcephaly and other complications constitute an “extraordinary event and a public health threat to other parts of the world.” The group did not recommend any restrictions on travel or trade with areas where the Zika virus transmission is ongoing, however.
“At present, the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals, especially pregnant women,” Dr. Chan said during a press briefing.
Dr. Chan said it’s unclear how long it will take to determine if Zika virus is causing the uptick in microcephaly and other congenital malformations and neurological abnormalities, but health officials are working to set up case-control studies that are scheduled to start in the next 2 weeks.
On Twitter @maryellenny
The World Health Organization has declared a “public health emergency of international concern” related to the clusters of microcephaly and other neurological complications reported in Brazil and earlier in French Polynesia.
Though there is a strong association between these cases and the Zika virus, a causal link still has not been scientifically proven, according to the WHO.
The WHO’s emergency declaration clears the way for the international health community to move forward with a coordinated response. Dr. Margaret Chan, WHO Director-General, said her organization plans to take a number of precautionary measures, including improving surveillance and detection of infections, congenital malformations, and neurological complications. They will also work with countries to intensify control of mosquito populations and help expedite the development of diagnostic tests and vaccines to protect at-risk populations.
The recommendations came after a Feb. 1 meeting of the International Health Regulations Emergency Committee, which Dr. Chan convened last week in response to the Zika virus outbreak and the observed increase in neurological disorders and neonatal malformations.
The group of 18 experts advised that the clusters of microcephaly and other complications constitute an “extraordinary event and a public health threat to other parts of the world.” The group did not recommend any restrictions on travel or trade with areas where the Zika virus transmission is ongoing, however.
“At present, the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals, especially pregnant women,” Dr. Chan said during a press briefing.
Dr. Chan said it’s unclear how long it will take to determine if Zika virus is causing the uptick in microcephaly and other congenital malformations and neurological abnormalities, but health officials are working to set up case-control studies that are scheduled to start in the next 2 weeks.
On Twitter @maryellenny
The World Health Organization has declared a “public health emergency of international concern” related to the clusters of microcephaly and other neurological complications reported in Brazil and earlier in French Polynesia.
Though there is a strong association between these cases and the Zika virus, a causal link still has not been scientifically proven, according to the WHO.
The WHO’s emergency declaration clears the way for the international health community to move forward with a coordinated response. Dr. Margaret Chan, WHO Director-General, said her organization plans to take a number of precautionary measures, including improving surveillance and detection of infections, congenital malformations, and neurological complications. They will also work with countries to intensify control of mosquito populations and help expedite the development of diagnostic tests and vaccines to protect at-risk populations.
The recommendations came after a Feb. 1 meeting of the International Health Regulations Emergency Committee, which Dr. Chan convened last week in response to the Zika virus outbreak and the observed increase in neurological disorders and neonatal malformations.
The group of 18 experts advised that the clusters of microcephaly and other complications constitute an “extraordinary event and a public health threat to other parts of the world.” The group did not recommend any restrictions on travel or trade with areas where the Zika virus transmission is ongoing, however.
“At present, the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals, especially pregnant women,” Dr. Chan said during a press briefing.
Dr. Chan said it’s unclear how long it will take to determine if Zika virus is causing the uptick in microcephaly and other congenital malformations and neurological abnormalities, but health officials are working to set up case-control studies that are scheduled to start in the next 2 weeks.
On Twitter @maryellenny
Zika virus lessons from Colombia
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
On Twitter @richpizzi
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
On Twitter @richpizzi
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
On Twitter @richpizzi
FROM EMERGING INFECTIOUS DISEASES
Zika could soon infect 4 million; U.S. impact likely to be much smaller
The Zika virus continues to spread, with the potential to infect up to 4 million people throughout the Americas.
But although locally transmitted infections are all almost certainly inevitable in the United States, federal health officials don’t expect large-scale infections.
“We do expect to see local transmission, but we are not likely to see widespread outbreaks,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a press briefing on Jan. 28. “We think these would occur in pockets, similar to what we now see with dengue and chikungunya. We are not being cavalier about this; we are preparing. But large-scale outbreaks are not something we are likely to see, based on our experience with dengue and chikungunya.”
Dr. Fauci’s comments were in contrast to warnings issued simultaneously by the World Health Organization and the Pan American Health Organization (PAHO), WHO’s South American arm.
On Jan. 28, the WHO announced it would convene a meeting of its International Health Regulations Emergency Committee. WHO Director-General Margaret Chan said the virus is now present in 23 countries and territories in the region, as well as in parts of the South Pacific.
“The level of alarm is extremely high,” she said during the meeting. Although a causal link between the virus and outbreaks of microcephaly and Guillain-Barré syndrome is yet unproven, she said it is strongly suspected. “The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions.”
Dr. Marcos Espinal, PAHO’s director of communicable diseases and health analysis, outlined the potential spread. His agency expects to see 3-4 million cases throughout North and South America, which could occur in any region that has endemic dengue fever. Both viruses are carried by mosquitoes of the Aedes genus. Two of these, the Asian tiger mosquito and the yellow fever mosquito, are commonly found in the United States, particularly in warmer regions.
Thus far, 31 cases of Zika virus have been confirmed in the United States (11 states and Washington), Dr. Anne Schuchat, principal deputy director for the Centers for Disease Control and Prevention, said in that agency’s briefing. All of these cases have been associated with travel to endemic areas, she said. She was unable to say how many cases had occurred in pregnant women.
There have been 19 confirmed cases in Puerto Rico and 1 in the U.S. Virgin Islands. These could be locally acquired cases, although that has not been confirmed. However, Zika infection is now a notifiable illness and any confirmed cases must be reported to CDC, she said.
Nearly a million cases have been laboratory confirmed in South America since 2015, Dr. Espinal noted. The vast majority of those have caused mild, transient symptoms. But in Brazil alone – the epicenter of the epidemic – there has been a substantial increase in newborn microcephaly. Almost 4,000 cases of this rare birth defect have been identified since October, when tracking began. Although the cases coincide with the rise of Zika infections, no one knows how many were related or what pathology could be mediating the association.
This is just one question muddying the Zika waters right now, Dr. Chan of the WHO said. Several difficult-to-address issues are hampering an effective response, including the widespread range of the mosquito vectors, which allows international spread; a lack of population immunity; and the absence of rapid diagnostic tests, effective treatment, and any vaccine.
Another concern is the potential for illness-potentiating coinfection. In the lab, Zika virus has shown cross-reactions with dengue types 1-4, yellow fever, and West Nile virus – all of which are carried by Aedes mosquitoes.
Scientists at the CDC and National Institutes of Health are working on the problem now, Dr. Fauci said. Efforts include the creation of animal models to study disease transmission and its effect on pre- and postnatal outcomes, and of diagnostic platforms that could easily and quickly identify Zika infections. These would quickly differentiate Zika from dengue infections, which are also caused by a strain of flavivirus.
An effective vaccine will not be quickly forthcoming, he cautioned, although a phase I trial is in the works and could begin later this year. The candidate is a DNA-based vaccine similar to the one now used to protect against dengue. It would almost certainly not be approved in less than 2 years, Dr Fauci added.
Until some of these questions have been answered, or until the epidemic slows, the CDC continues to caution pregnant women against travel to endemic areas. For those who do travel or who live in endemic areas, Dr. Schuchat reiterated CDC’s long-held advice to take precautions against mosquito bites: long-sleeved shirts and long pants; staying inside; and using an effective insect repellent. Those containing DEET are most effective and are safe for pregnant women to use, Dr. Schuchat said.
For now, the CDC’s Zika travel alert includes 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.
A transcript of the press briefing is available online.
This article was updated 2/1/2016.
On Twitter @Alz_Gal
The Zika virus continues to spread, with the potential to infect up to 4 million people throughout the Americas.
But although locally transmitted infections are all almost certainly inevitable in the United States, federal health officials don’t expect large-scale infections.
“We do expect to see local transmission, but we are not likely to see widespread outbreaks,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a press briefing on Jan. 28. “We think these would occur in pockets, similar to what we now see with dengue and chikungunya. We are not being cavalier about this; we are preparing. But large-scale outbreaks are not something we are likely to see, based on our experience with dengue and chikungunya.”
Dr. Fauci’s comments were in contrast to warnings issued simultaneously by the World Health Organization and the Pan American Health Organization (PAHO), WHO’s South American arm.
On Jan. 28, the WHO announced it would convene a meeting of its International Health Regulations Emergency Committee. WHO Director-General Margaret Chan said the virus is now present in 23 countries and territories in the region, as well as in parts of the South Pacific.
“The level of alarm is extremely high,” she said during the meeting. Although a causal link between the virus and outbreaks of microcephaly and Guillain-Barré syndrome is yet unproven, she said it is strongly suspected. “The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions.”
Dr. Marcos Espinal, PAHO’s director of communicable diseases and health analysis, outlined the potential spread. His agency expects to see 3-4 million cases throughout North and South America, which could occur in any region that has endemic dengue fever. Both viruses are carried by mosquitoes of the Aedes genus. Two of these, the Asian tiger mosquito and the yellow fever mosquito, are commonly found in the United States, particularly in warmer regions.
Thus far, 31 cases of Zika virus have been confirmed in the United States (11 states and Washington), Dr. Anne Schuchat, principal deputy director for the Centers for Disease Control and Prevention, said in that agency’s briefing. All of these cases have been associated with travel to endemic areas, she said. She was unable to say how many cases had occurred in pregnant women.
There have been 19 confirmed cases in Puerto Rico and 1 in the U.S. Virgin Islands. These could be locally acquired cases, although that has not been confirmed. However, Zika infection is now a notifiable illness and any confirmed cases must be reported to CDC, she said.
Nearly a million cases have been laboratory confirmed in South America since 2015, Dr. Espinal noted. The vast majority of those have caused mild, transient symptoms. But in Brazil alone – the epicenter of the epidemic – there has been a substantial increase in newborn microcephaly. Almost 4,000 cases of this rare birth defect have been identified since October, when tracking began. Although the cases coincide with the rise of Zika infections, no one knows how many were related or what pathology could be mediating the association.
This is just one question muddying the Zika waters right now, Dr. Chan of the WHO said. Several difficult-to-address issues are hampering an effective response, including the widespread range of the mosquito vectors, which allows international spread; a lack of population immunity; and the absence of rapid diagnostic tests, effective treatment, and any vaccine.
Another concern is the potential for illness-potentiating coinfection. In the lab, Zika virus has shown cross-reactions with dengue types 1-4, yellow fever, and West Nile virus – all of which are carried by Aedes mosquitoes.
Scientists at the CDC and National Institutes of Health are working on the problem now, Dr. Fauci said. Efforts include the creation of animal models to study disease transmission and its effect on pre- and postnatal outcomes, and of diagnostic platforms that could easily and quickly identify Zika infections. These would quickly differentiate Zika from dengue infections, which are also caused by a strain of flavivirus.
An effective vaccine will not be quickly forthcoming, he cautioned, although a phase I trial is in the works and could begin later this year. The candidate is a DNA-based vaccine similar to the one now used to protect against dengue. It would almost certainly not be approved in less than 2 years, Dr Fauci added.
Until some of these questions have been answered, or until the epidemic slows, the CDC continues to caution pregnant women against travel to endemic areas. For those who do travel or who live in endemic areas, Dr. Schuchat reiterated CDC’s long-held advice to take precautions against mosquito bites: long-sleeved shirts and long pants; staying inside; and using an effective insect repellent. Those containing DEET are most effective and are safe for pregnant women to use, Dr. Schuchat said.
For now, the CDC’s Zika travel alert includes 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.
A transcript of the press briefing is available online.
This article was updated 2/1/2016.
On Twitter @Alz_Gal
The Zika virus continues to spread, with the potential to infect up to 4 million people throughout the Americas.
But although locally transmitted infections are all almost certainly inevitable in the United States, federal health officials don’t expect large-scale infections.
“We do expect to see local transmission, but we are not likely to see widespread outbreaks,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a press briefing on Jan. 28. “We think these would occur in pockets, similar to what we now see with dengue and chikungunya. We are not being cavalier about this; we are preparing. But large-scale outbreaks are not something we are likely to see, based on our experience with dengue and chikungunya.”
Dr. Fauci’s comments were in contrast to warnings issued simultaneously by the World Health Organization and the Pan American Health Organization (PAHO), WHO’s South American arm.
On Jan. 28, the WHO announced it would convene a meeting of its International Health Regulations Emergency Committee. WHO Director-General Margaret Chan said the virus is now present in 23 countries and territories in the region, as well as in parts of the South Pacific.
“The level of alarm is extremely high,” she said during the meeting. Although a causal link between the virus and outbreaks of microcephaly and Guillain-Barré syndrome is yet unproven, she said it is strongly suspected. “The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions.”
Dr. Marcos Espinal, PAHO’s director of communicable diseases and health analysis, outlined the potential spread. His agency expects to see 3-4 million cases throughout North and South America, which could occur in any region that has endemic dengue fever. Both viruses are carried by mosquitoes of the Aedes genus. Two of these, the Asian tiger mosquito and the yellow fever mosquito, are commonly found in the United States, particularly in warmer regions.
Thus far, 31 cases of Zika virus have been confirmed in the United States (11 states and Washington), Dr. Anne Schuchat, principal deputy director for the Centers for Disease Control and Prevention, said in that agency’s briefing. All of these cases have been associated with travel to endemic areas, she said. She was unable to say how many cases had occurred in pregnant women.
There have been 19 confirmed cases in Puerto Rico and 1 in the U.S. Virgin Islands. These could be locally acquired cases, although that has not been confirmed. However, Zika infection is now a notifiable illness and any confirmed cases must be reported to CDC, she said.
Nearly a million cases have been laboratory confirmed in South America since 2015, Dr. Espinal noted. The vast majority of those have caused mild, transient symptoms. But in Brazil alone – the epicenter of the epidemic – there has been a substantial increase in newborn microcephaly. Almost 4,000 cases of this rare birth defect have been identified since October, when tracking began. Although the cases coincide with the rise of Zika infections, no one knows how many were related or what pathology could be mediating the association.
This is just one question muddying the Zika waters right now, Dr. Chan of the WHO said. Several difficult-to-address issues are hampering an effective response, including the widespread range of the mosquito vectors, which allows international spread; a lack of population immunity; and the absence of rapid diagnostic tests, effective treatment, and any vaccine.
Another concern is the potential for illness-potentiating coinfection. In the lab, Zika virus has shown cross-reactions with dengue types 1-4, yellow fever, and West Nile virus – all of which are carried by Aedes mosquitoes.
Scientists at the CDC and National Institutes of Health are working on the problem now, Dr. Fauci said. Efforts include the creation of animal models to study disease transmission and its effect on pre- and postnatal outcomes, and of diagnostic platforms that could easily and quickly identify Zika infections. These would quickly differentiate Zika from dengue infections, which are also caused by a strain of flavivirus.
An effective vaccine will not be quickly forthcoming, he cautioned, although a phase I trial is in the works and could begin later this year. The candidate is a DNA-based vaccine similar to the one now used to protect against dengue. It would almost certainly not be approved in less than 2 years, Dr Fauci added.
Until some of these questions have been answered, or until the epidemic slows, the CDC continues to caution pregnant women against travel to endemic areas. For those who do travel or who live in endemic areas, Dr. Schuchat reiterated CDC’s long-held advice to take precautions against mosquito bites: long-sleeved shirts and long pants; staying inside; and using an effective insect repellent. Those containing DEET are most effective and are safe for pregnant women to use, Dr. Schuchat said.
For now, the CDC’s Zika travel alert includes 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.
A transcript of the press briefing is available online.
This article was updated 2/1/2016.
On Twitter @Alz_Gal
Experts: WHO failing to lead on Zika pandemic
The World Health Organization has failed to act decisively in response to the growing Zika virus outbreak, global health experts said in a JAMA viewpoint article published Jan. 27.
While the global public health dimensions of Zika are quite clear, the WHO is “still not taking a leadership role in the crisis,” wrote coauthors Dr. Daniel R. Lucey of Georgetown University and Lawrence O. Gostin of Georgetown University Law Center, both in Washington. They called on the WHO to convene an emergency committee to advise Director-General Margaret Chan about the conditions necessary to declare a Public Health Emergency of International Concern, a process that would catalyze international attention, funding, and research.
“WHO headquarters has thus far not been proactive, given potentially serious ramifications,” the coauthors said. They encouraged the WHO to learn lessons from its handling of the Ebola epidemic, a key one being the need for an “intermediate-level response to emerging crises,” thus avoiding overreaction while still galvanizing global action.
In the interim, Dr. Lucey and Mr. Gostin assert that the international community cannot wait for the WHO to act, as infectious disease modeling anticipates significant international spread by travelers from Brazil – the epicenter of the current outbreak – to the rest of the Americas, Europe, and Asia. The coauthors emphasize seven key international health system strategies that countries should adopt and fund in preparation for a Zika pandemic. These strategies are critical for countries already affected by the virus and those with significant Aedes mosquito populations – the vectors for Zika virus.
The seven health system strategies recommended by Dr. Lucey and Mr. Gostin are:
• Vector control. Mosquito-borne diseases require reducing source populations, including physical and biological controls. Effective mosquito surveillance is also essential to ensure focused interventions.
• Risk communication. Health information campaigns should advise the public to avoid mosquito exposure.
• Enhanced Zika surveillance. The International Health Regulations (IHR) require countries to report unusual Zika-related cases. Countries must train health workers to observe and report Zika-related disease and create robust systems for collecting and analyzing surveillance data to complement public health strategies.
• Travel advisories. To minimize harm to high-risk travelers, agencies should consider issuing travel advisories, which include guidance on reducing mosquito exposure and greater awareness of symptoms. On returning home, symptomatic individuals should report their travel histories to their physician.
• Clinical management. An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days. On Jan. 19, the U.S. Centers for Disease Control and Prevention issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing.
• Accelerated research and development. When Zika infection was seen as usually asymptomatic and self-limited, the coauthors say researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications have altered this equation, making research on new vaccines urgent. However, a safe and effective Zika virus vaccine is probably 3-10 years away, even with accelerated research.
• Public health emergency declarations. The coauthors say that a national declaration of a public health emergency could help to focus political attention, while financing a surge in resources. They suggest that countries experiencing major Zika virus outbreaks could invoke heightened emergency powers.
Read the complete viewpoint essay in JAMA (2016 Jan 27. doi: 10.1001/jama.2016.0904)
On Twitter @richpizzi
The World Health Organization has failed to act decisively in response to the growing Zika virus outbreak, global health experts said in a JAMA viewpoint article published Jan. 27.
While the global public health dimensions of Zika are quite clear, the WHO is “still not taking a leadership role in the crisis,” wrote coauthors Dr. Daniel R. Lucey of Georgetown University and Lawrence O. Gostin of Georgetown University Law Center, both in Washington. They called on the WHO to convene an emergency committee to advise Director-General Margaret Chan about the conditions necessary to declare a Public Health Emergency of International Concern, a process that would catalyze international attention, funding, and research.
“WHO headquarters has thus far not been proactive, given potentially serious ramifications,” the coauthors said. They encouraged the WHO to learn lessons from its handling of the Ebola epidemic, a key one being the need for an “intermediate-level response to emerging crises,” thus avoiding overreaction while still galvanizing global action.
In the interim, Dr. Lucey and Mr. Gostin assert that the international community cannot wait for the WHO to act, as infectious disease modeling anticipates significant international spread by travelers from Brazil – the epicenter of the current outbreak – to the rest of the Americas, Europe, and Asia. The coauthors emphasize seven key international health system strategies that countries should adopt and fund in preparation for a Zika pandemic. These strategies are critical for countries already affected by the virus and those with significant Aedes mosquito populations – the vectors for Zika virus.
The seven health system strategies recommended by Dr. Lucey and Mr. Gostin are:
• Vector control. Mosquito-borne diseases require reducing source populations, including physical and biological controls. Effective mosquito surveillance is also essential to ensure focused interventions.
• Risk communication. Health information campaigns should advise the public to avoid mosquito exposure.
• Enhanced Zika surveillance. The International Health Regulations (IHR) require countries to report unusual Zika-related cases. Countries must train health workers to observe and report Zika-related disease and create robust systems for collecting and analyzing surveillance data to complement public health strategies.
• Travel advisories. To minimize harm to high-risk travelers, agencies should consider issuing travel advisories, which include guidance on reducing mosquito exposure and greater awareness of symptoms. On returning home, symptomatic individuals should report their travel histories to their physician.
• Clinical management. An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days. On Jan. 19, the U.S. Centers for Disease Control and Prevention issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing.
• Accelerated research and development. When Zika infection was seen as usually asymptomatic and self-limited, the coauthors say researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications have altered this equation, making research on new vaccines urgent. However, a safe and effective Zika virus vaccine is probably 3-10 years away, even with accelerated research.
• Public health emergency declarations. The coauthors say that a national declaration of a public health emergency could help to focus political attention, while financing a surge in resources. They suggest that countries experiencing major Zika virus outbreaks could invoke heightened emergency powers.
Read the complete viewpoint essay in JAMA (2016 Jan 27. doi: 10.1001/jama.2016.0904)
On Twitter @richpizzi
The World Health Organization has failed to act decisively in response to the growing Zika virus outbreak, global health experts said in a JAMA viewpoint article published Jan. 27.
While the global public health dimensions of Zika are quite clear, the WHO is “still not taking a leadership role in the crisis,” wrote coauthors Dr. Daniel R. Lucey of Georgetown University and Lawrence O. Gostin of Georgetown University Law Center, both in Washington. They called on the WHO to convene an emergency committee to advise Director-General Margaret Chan about the conditions necessary to declare a Public Health Emergency of International Concern, a process that would catalyze international attention, funding, and research.
“WHO headquarters has thus far not been proactive, given potentially serious ramifications,” the coauthors said. They encouraged the WHO to learn lessons from its handling of the Ebola epidemic, a key one being the need for an “intermediate-level response to emerging crises,” thus avoiding overreaction while still galvanizing global action.
In the interim, Dr. Lucey and Mr. Gostin assert that the international community cannot wait for the WHO to act, as infectious disease modeling anticipates significant international spread by travelers from Brazil – the epicenter of the current outbreak – to the rest of the Americas, Europe, and Asia. The coauthors emphasize seven key international health system strategies that countries should adopt and fund in preparation for a Zika pandemic. These strategies are critical for countries already affected by the virus and those with significant Aedes mosquito populations – the vectors for Zika virus.
The seven health system strategies recommended by Dr. Lucey and Mr. Gostin are:
• Vector control. Mosquito-borne diseases require reducing source populations, including physical and biological controls. Effective mosquito surveillance is also essential to ensure focused interventions.
• Risk communication. Health information campaigns should advise the public to avoid mosquito exposure.
• Enhanced Zika surveillance. The International Health Regulations (IHR) require countries to report unusual Zika-related cases. Countries must train health workers to observe and report Zika-related disease and create robust systems for collecting and analyzing surveillance data to complement public health strategies.
• Travel advisories. To minimize harm to high-risk travelers, agencies should consider issuing travel advisories, which include guidance on reducing mosquito exposure and greater awareness of symptoms. On returning home, symptomatic individuals should report their travel histories to their physician.
• Clinical management. An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days. On Jan. 19, the U.S. Centers for Disease Control and Prevention issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing.
• Accelerated research and development. When Zika infection was seen as usually asymptomatic and self-limited, the coauthors say researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications have altered this equation, making research on new vaccines urgent. However, a safe and effective Zika virus vaccine is probably 3-10 years away, even with accelerated research.
• Public health emergency declarations. The coauthors say that a national declaration of a public health emergency could help to focus political attention, while financing a surge in resources. They suggest that countries experiencing major Zika virus outbreaks could invoke heightened emergency powers.
Read the complete viewpoint essay in JAMA (2016 Jan 27. doi: 10.1001/jama.2016.0904)
On Twitter @richpizzi
FROM JAMA
U.S. Virgin Islands, Dominican Republic added to Zika travel advisory
Officials at the Centers for Disease Control and Prevention have added the U.S. Virgin Islands and the Dominican Republic to the rapidly growing list of areas that are part of the Zika virus travel alert.
The level 2 travel alert cautions travelers to use enhanced precautions to prevent mosquito bites when traveling to areas with ongoing Zika virus transmission. Though the Zika virus is generally mild, with symptoms lasting up to a week, there are more serious risks for pregnant women. Health officials are investigating the connection between microcephaly and other poor outcomes in the babies of pregnant women who were infected with Zika virus.
Until more is known, the CDC is advising pregnant women and those who are trying to become pregnant to postpone travel to these areas. If such travel is necessary, CDC recommends consulting a physician beforehand and strictly following steps to avoid mosquito bites, including wearing long-sleeved shirts and pants, staying indoors, and using insect repellent.
The CDC’s Zika travel alert also includes Puerto Rico (a U.S. territory), Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, and Venezuela.
On Twitter @maryellenny
Officials at the Centers for Disease Control and Prevention have added the U.S. Virgin Islands and the Dominican Republic to the rapidly growing list of areas that are part of the Zika virus travel alert.
The level 2 travel alert cautions travelers to use enhanced precautions to prevent mosquito bites when traveling to areas with ongoing Zika virus transmission. Though the Zika virus is generally mild, with symptoms lasting up to a week, there are more serious risks for pregnant women. Health officials are investigating the connection between microcephaly and other poor outcomes in the babies of pregnant women who were infected with Zika virus.
Until more is known, the CDC is advising pregnant women and those who are trying to become pregnant to postpone travel to these areas. If such travel is necessary, CDC recommends consulting a physician beforehand and strictly following steps to avoid mosquito bites, including wearing long-sleeved shirts and pants, staying indoors, and using insect repellent.
The CDC’s Zika travel alert also includes Puerto Rico (a U.S. territory), Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, and Venezuela.
On Twitter @maryellenny
Officials at the Centers for Disease Control and Prevention have added the U.S. Virgin Islands and the Dominican Republic to the rapidly growing list of areas that are part of the Zika virus travel alert.
The level 2 travel alert cautions travelers to use enhanced precautions to prevent mosquito bites when traveling to areas with ongoing Zika virus transmission. Though the Zika virus is generally mild, with symptoms lasting up to a week, there are more serious risks for pregnant women. Health officials are investigating the connection between microcephaly and other poor outcomes in the babies of pregnant women who were infected with Zika virus.
Until more is known, the CDC is advising pregnant women and those who are trying to become pregnant to postpone travel to these areas. If such travel is necessary, CDC recommends consulting a physician beforehand and strictly following steps to avoid mosquito bites, including wearing long-sleeved shirts and pants, staying indoors, and using insect repellent.
The CDC’s Zika travel alert also includes Puerto Rico (a U.S. territory), Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, and Venezuela.
On Twitter @maryellenny
New testing guidelines for infants with possible Zika virus infection
The Centers for Disease Control and Prevention has released interim guidelines for U.S. clinicians caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy.
The guidelines, released Jan. 26, address the evaluation and testing of infants with possible congenital Zika virus infection, and follow the Jan. 19 release of similar guidelines for the care of pregnant women with possible exposure to the mosquito-borne virus. Most importantly, the new guidelines say Zika virus testing should be performed for infants with microcephaly or intracranial calcifications who are born to women with possible Zika virus exposure during pregnancy, and for infants born to women with positive or inconclusive Zika virus test results.
“Pediatric health are providers should work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission),” according to the guidelines, which were published in Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 26;65[Early Release:1-5]).
Infants with laboratory evidence of a possible congenital Zika virus infection should undergo additional clinical evaluation, and state or territorial health departments should be contacted to facilitate testing. Zika virus disease is an arboviral disease and thus is a nationally notifiable condition, according to guideline authors Dr. J. Erin Staples and her colleagues at the CDC, Atlanta.
Both molecular and serologic tests are recommended for infants undergoing evaluation for possible congenital Zika virus infection, they noted.
Serum specimens for reverse-transcription-polymerase chain reaction testing should be collected from the umbilical cord or directly from the infant within 2 days of birth, and cerebrospinal fluid collected for other studies, as well as frozen and fixed placenta obtained at delivery, should also be tested by RT-PCR.
IgM ELISA for Zika virus and dengue virus should also be performed on infant serum, infant CSF, and maternal serum, but results from these assays can be falsely positive because of cross-reacting antibodies, the authors noted.
Other tests that can be considered include a plaque reduction neutralization test to measure virus-specific neutralizing antibodies and to discriminate between cross-reacting antibodies and closely related flaviviruses, and immunohistochemical staining to detect the virus antigen on fixed placenta and umbilical cord tissues.
Further clinical evaluation and laboratory testing is recommended for infants with microcephaly or intracranial calcifications detected prenatally or at birth if the mother was potentially infected during pregnancy, they said.
In infants with possible Zika virus exposure during pregnancy, but without microcephaly or intracranial calcification, subsequent evaluation depends on maternal testing results. Routine care is recommended if maternal test results are negative, and testing for a possible congenital infection is recommended if maternal results are positive or inconclusive.
If all of an infant’s tests are negative for Zika virus infection, no further Zika virus testing or evaluation is recommended. In the event of any positive or inconclusive test, further evaluation and follow-up is recommended.
Other considerations
Abnormal eye findings have been reported in infants with possible congenital infection, therefore an opthalmologic evaluation, including retinal examination is advised during the first month of life, as is a repeat hearing screen at age 6 months – even if the initial screen was normal, the authors said.
The infant should be followed to assess for long-term sequelae, and the case should be reported. Follow-up should include a cranial ultrasound to assess for subclinical findings, unless a third trimester ultrasound showed no brain abnormalities, they added.
No specific antiviral treatment or vaccine exists for Zika virus infection; treatment is supportive and should address specific medical and neurodevelopmental issues, and mothers should be encouraged to breastfeed infants regardless of exposure, as available evidence suggests the benefits of breastfeeding outweigh the theoretical risks of transmission through breast milk, they said.
The authors stressed that prevention of maternal infection is the only way to prevent congenital Zika virus infection and is achieved by avoiding areas with ongoing Zika virus transmission or by strictly following steps to avoid mosquito bites by using air-conditioning or window and door screens, wearing protective clothing, and using insect repellents.
Environmental Protection Agency–registered insect repellents are safe for pregnant women when used according to the product label, they noted.
The Centers for Disease Control and Prevention has released interim guidelines for U.S. clinicians caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy.
The guidelines, released Jan. 26, address the evaluation and testing of infants with possible congenital Zika virus infection, and follow the Jan. 19 release of similar guidelines for the care of pregnant women with possible exposure to the mosquito-borne virus. Most importantly, the new guidelines say Zika virus testing should be performed for infants with microcephaly or intracranial calcifications who are born to women with possible Zika virus exposure during pregnancy, and for infants born to women with positive or inconclusive Zika virus test results.
“Pediatric health are providers should work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission),” according to the guidelines, which were published in Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 26;65[Early Release:1-5]).
Infants with laboratory evidence of a possible congenital Zika virus infection should undergo additional clinical evaluation, and state or territorial health departments should be contacted to facilitate testing. Zika virus disease is an arboviral disease and thus is a nationally notifiable condition, according to guideline authors Dr. J. Erin Staples and her colleagues at the CDC, Atlanta.
Both molecular and serologic tests are recommended for infants undergoing evaluation for possible congenital Zika virus infection, they noted.
Serum specimens for reverse-transcription-polymerase chain reaction testing should be collected from the umbilical cord or directly from the infant within 2 days of birth, and cerebrospinal fluid collected for other studies, as well as frozen and fixed placenta obtained at delivery, should also be tested by RT-PCR.
IgM ELISA for Zika virus and dengue virus should also be performed on infant serum, infant CSF, and maternal serum, but results from these assays can be falsely positive because of cross-reacting antibodies, the authors noted.
Other tests that can be considered include a plaque reduction neutralization test to measure virus-specific neutralizing antibodies and to discriminate between cross-reacting antibodies and closely related flaviviruses, and immunohistochemical staining to detect the virus antigen on fixed placenta and umbilical cord tissues.
Further clinical evaluation and laboratory testing is recommended for infants with microcephaly or intracranial calcifications detected prenatally or at birth if the mother was potentially infected during pregnancy, they said.
In infants with possible Zika virus exposure during pregnancy, but without microcephaly or intracranial calcification, subsequent evaluation depends on maternal testing results. Routine care is recommended if maternal test results are negative, and testing for a possible congenital infection is recommended if maternal results are positive or inconclusive.
If all of an infant’s tests are negative for Zika virus infection, no further Zika virus testing or evaluation is recommended. In the event of any positive or inconclusive test, further evaluation and follow-up is recommended.
Other considerations
Abnormal eye findings have been reported in infants with possible congenital infection, therefore an opthalmologic evaluation, including retinal examination is advised during the first month of life, as is a repeat hearing screen at age 6 months – even if the initial screen was normal, the authors said.
The infant should be followed to assess for long-term sequelae, and the case should be reported. Follow-up should include a cranial ultrasound to assess for subclinical findings, unless a third trimester ultrasound showed no brain abnormalities, they added.
No specific antiviral treatment or vaccine exists for Zika virus infection; treatment is supportive and should address specific medical and neurodevelopmental issues, and mothers should be encouraged to breastfeed infants regardless of exposure, as available evidence suggests the benefits of breastfeeding outweigh the theoretical risks of transmission through breast milk, they said.
The authors stressed that prevention of maternal infection is the only way to prevent congenital Zika virus infection and is achieved by avoiding areas with ongoing Zika virus transmission or by strictly following steps to avoid mosquito bites by using air-conditioning or window and door screens, wearing protective clothing, and using insect repellents.
Environmental Protection Agency–registered insect repellents are safe for pregnant women when used according to the product label, they noted.
The Centers for Disease Control and Prevention has released interim guidelines for U.S. clinicians caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy.
The guidelines, released Jan. 26, address the evaluation and testing of infants with possible congenital Zika virus infection, and follow the Jan. 19 release of similar guidelines for the care of pregnant women with possible exposure to the mosquito-borne virus. Most importantly, the new guidelines say Zika virus testing should be performed for infants with microcephaly or intracranial calcifications who are born to women with possible Zika virus exposure during pregnancy, and for infants born to women with positive or inconclusive Zika virus test results.
“Pediatric health are providers should work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission),” according to the guidelines, which were published in Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 26;65[Early Release:1-5]).
Infants with laboratory evidence of a possible congenital Zika virus infection should undergo additional clinical evaluation, and state or territorial health departments should be contacted to facilitate testing. Zika virus disease is an arboviral disease and thus is a nationally notifiable condition, according to guideline authors Dr. J. Erin Staples and her colleagues at the CDC, Atlanta.
Both molecular and serologic tests are recommended for infants undergoing evaluation for possible congenital Zika virus infection, they noted.
Serum specimens for reverse-transcription-polymerase chain reaction testing should be collected from the umbilical cord or directly from the infant within 2 days of birth, and cerebrospinal fluid collected for other studies, as well as frozen and fixed placenta obtained at delivery, should also be tested by RT-PCR.
IgM ELISA for Zika virus and dengue virus should also be performed on infant serum, infant CSF, and maternal serum, but results from these assays can be falsely positive because of cross-reacting antibodies, the authors noted.
Other tests that can be considered include a plaque reduction neutralization test to measure virus-specific neutralizing antibodies and to discriminate between cross-reacting antibodies and closely related flaviviruses, and immunohistochemical staining to detect the virus antigen on fixed placenta and umbilical cord tissues.
Further clinical evaluation and laboratory testing is recommended for infants with microcephaly or intracranial calcifications detected prenatally or at birth if the mother was potentially infected during pregnancy, they said.
In infants with possible Zika virus exposure during pregnancy, but without microcephaly or intracranial calcification, subsequent evaluation depends on maternal testing results. Routine care is recommended if maternal test results are negative, and testing for a possible congenital infection is recommended if maternal results are positive or inconclusive.
If all of an infant’s tests are negative for Zika virus infection, no further Zika virus testing or evaluation is recommended. In the event of any positive or inconclusive test, further evaluation and follow-up is recommended.
Other considerations
Abnormal eye findings have been reported in infants with possible congenital infection, therefore an opthalmologic evaluation, including retinal examination is advised during the first month of life, as is a repeat hearing screen at age 6 months – even if the initial screen was normal, the authors said.
The infant should be followed to assess for long-term sequelae, and the case should be reported. Follow-up should include a cranial ultrasound to assess for subclinical findings, unless a third trimester ultrasound showed no brain abnormalities, they added.
No specific antiviral treatment or vaccine exists for Zika virus infection; treatment is supportive and should address specific medical and neurodevelopmental issues, and mothers should be encouraged to breastfeed infants regardless of exposure, as available evidence suggests the benefits of breastfeeding outweigh the theoretical risks of transmission through breast milk, they said.
The authors stressed that prevention of maternal infection is the only way to prevent congenital Zika virus infection and is achieved by avoiding areas with ongoing Zika virus transmission or by strictly following steps to avoid mosquito bites by using air-conditioning or window and door screens, wearing protective clothing, and using insect repellents.
Environmental Protection Agency–registered insect repellents are safe for pregnant women when used according to the product label, they noted.
FROM MMWR
Zika virus: What clinicians must know
The recent spike in Zika virus cases in Central and South America brings with it the alarming risk – and even the expectation – of outbreaks occurring in the United States. How should U.S.-based clinicians prepare for the inevitable?
“The current outbreaks of Zika virus are the first of their kind in the Americas, so there isn’t a previous history of Zika virus spreading into the [United States],” explained Dr. Joy St. John, director of surveillance, disease prevention and control at the Caribbean Public Health Agency in Trinidad.
But now that the virus has hit the United States, with a confirmed case in Texas last week and more emerging since then, Dr. St. John said the most important thing is for U.S. health care providers to recognize the signs and symptoms of Zika virus infection. The virus is carried and transmitted by the Aedes aegypti species of mosquito, the same vector that transmits the dengue and chikungunya viruses. Zika virus symptoms are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis. Only one in five individuals with a Zika virus infection develop symptoms, but patients who present as such and who have traveled to Central or South America in the week prior to the onset of symptoms should be considered likely infected.
"At present, there is no rapid test available for diagnosis of Zika,” said Dr. St. John. “Diagnosis is primarily based on detection of viral RNA from clinical serum specimens in acutely ill patients.”
To that end, polymerase chain reaction (PCR) testing can be conducted on serum samples collected within 3-5 days of symptom onset. Beyond that, elevated levels of IgM antibodies can be confirmed by serology, based on the neutralization, seroconversion, or four-fold increase of Zika-specific antibodies in paired samples. However, Dr. St. John warned that “Due to the possibility of cross reactivity with other viruses, for example, dengue, it is strongly recommended samples be collected early enough for PCR testing.”
Zika and pregnancy
Zika virus has now been identified in more than 20 countries and territories worldwide, most of them in the Americas, although outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands. While most infected patients experience relatively mild symptoms, Zika may be particularly dangerous when it infects a pregnant woman. There have been multiple cases of microcephaly in children whose mothers were infected with Zika virus during pregnancy, although the association of microcephaly with Zika virus infection during pregnancy has not been definitively confirmed. The Centers for Disease Control and Prevention recently issued a warning to Americans – particularly pregnant women – about traveling to high-risk areas.
“Scientifically, we’re not 100% sure if Zika virus is causing microcephaly, [but] what we’re seeing is in certain Brazilian districts, there’s been a 20-fold increase in rates of microcephaly at the same time that there’s been a lot more Zika virus in pregnant women,” explained Dr. Sanjaya Senanayake of Australian National University in Canberra.
According to data from the CDC, 1,248 suspected cases of microcephaly had been reported in Brazil as of Nov. 28, 2015, compared with the annual rate of just 150-200 such cases during 2010-2014. “Examination of the fetus [and] amniotic fluid, in some cases, has shown Zika virus, so there seems to be an association,” Dr. Senanayake clarified, adding that “the [ANVISA – Brazilian Health Surveillance Agency] has told women in certain districts where there’s been a lot of microcephaly not to get pregnant.”
Brazil is set to host millions of guests from around the world as the 2016 Olympics get underway in only a few months’ time. Women who are pregnant or anticipate becoming pregnant should consider the risks if they are planning to travel to Rio de Janeiro. The risk of microcephaly does not apply to infected women who are not pregnant, however, as the CDC states that “Zika virus usually remains in the blood of an infected person for only a few days to a week,” and therefore, “does not pose a risk of birth defects for future pregnancies.”
Dr. St. John also stated that “public health personnel are still cautioning pregnant women to take special care to avoid mosquito bites during their pregnancies,” adding that the “[Pan-American Health Organization] is working on their guidelines for surveillance of congenital abnormalities.”
Clinical insights
With treatment options so sparse – there is no vaccine or drug available specifically meant to combat a Zika virus infection – what can health care providers do for their patients? The CDC advises health care providers to “treat the symptoms,” which means telling patients to stay in bed, stay hydrated, and, most importantly, stay away from aspirin and NSAIDs “until dengue can be ruled out to reduce the risk of hemorrhage.” Acetaminophen is safe to use, in order to mitigate fever symptoms.
Those who are infected are also advised to stay indoors and remain as isolated as possible for at least a week after symptoms first present. While the risk of a domestic outbreak is probably low, Dr. St. John said, the more exposure a Zika virus–infected individual has to the outside world, the more likely he or she is to be bitten by another mosquito, which can then carry and transmit the virus to another person.
“Chikungunya and dengue virus, which are transmitted by the same vectors [as Zika virus], have not managed to establish ongoing transmission in the U.S., despite repeated importations, [so] it is likely that Zika virus’ spread would follow a similar pattern,” Dr. St. John noted.
Though rare, sexual transmission of Zika virus has also been found in at least one case, although it had been previously suspected for some time. In December 2013, a 44-year-old Tahitian man sought treatment for hematospermia. Analysis of his sperm, however, found Zika virus, indicating possible sexual transmission of the virus.
“The observation that [Zika virus] RNA was detectable in urine after viremia clearance in blood suggests that, as found for [dengue] and [West Nile virus] infections, urine samples can yield evidence of [Zika virus] for late diagnosis, but more investigation is needed,” the study concluded.
“The best way to control all this is to control the mosquito,” said Dr. Senanayake. “You get a four-for-one deal; not only do you get rid of Zika virus, but also chikungunya, dengue, and yellow fever.” Dr. Senanayake added that advanced research is currently underway in mosquito-control efforts, including the idea of releasing mosquitoes into the wild which have been genetically modified so they can’t breed.
Now that the Illinois Department of Health has confirmed two new cases of Zika virus infection in that state, with other new cases cropping up in Saint Martin and Guadeloupe and El Salvador, providers should remain vigilant, taking note of patients who have traveled to afflicted regions and show mosquito bites. Person-to-person transmission is “rare as hen’s teeth,” said Dr. Senanayake, which is to say, it is highly unlikely to occur. Nonetheless, he said information and communication is the best way to ensure that Zika virus does not spread widely in the United States.
*This story was updated 1/25/2016.
The recent spike in Zika virus cases in Central and South America brings with it the alarming risk – and even the expectation – of outbreaks occurring in the United States. How should U.S.-based clinicians prepare for the inevitable?
“The current outbreaks of Zika virus are the first of their kind in the Americas, so there isn’t a previous history of Zika virus spreading into the [United States],” explained Dr. Joy St. John, director of surveillance, disease prevention and control at the Caribbean Public Health Agency in Trinidad.
But now that the virus has hit the United States, with a confirmed case in Texas last week and more emerging since then, Dr. St. John said the most important thing is for U.S. health care providers to recognize the signs and symptoms of Zika virus infection. The virus is carried and transmitted by the Aedes aegypti species of mosquito, the same vector that transmits the dengue and chikungunya viruses. Zika virus symptoms are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis. Only one in five individuals with a Zika virus infection develop symptoms, but patients who present as such and who have traveled to Central or South America in the week prior to the onset of symptoms should be considered likely infected.
"At present, there is no rapid test available for diagnosis of Zika,” said Dr. St. John. “Diagnosis is primarily based on detection of viral RNA from clinical serum specimens in acutely ill patients.”
To that end, polymerase chain reaction (PCR) testing can be conducted on serum samples collected within 3-5 days of symptom onset. Beyond that, elevated levels of IgM antibodies can be confirmed by serology, based on the neutralization, seroconversion, or four-fold increase of Zika-specific antibodies in paired samples. However, Dr. St. John warned that “Due to the possibility of cross reactivity with other viruses, for example, dengue, it is strongly recommended samples be collected early enough for PCR testing.”
Zika and pregnancy
Zika virus has now been identified in more than 20 countries and territories worldwide, most of them in the Americas, although outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands. While most infected patients experience relatively mild symptoms, Zika may be particularly dangerous when it infects a pregnant woman. There have been multiple cases of microcephaly in children whose mothers were infected with Zika virus during pregnancy, although the association of microcephaly with Zika virus infection during pregnancy has not been definitively confirmed. The Centers for Disease Control and Prevention recently issued a warning to Americans – particularly pregnant women – about traveling to high-risk areas.
“Scientifically, we’re not 100% sure if Zika virus is causing microcephaly, [but] what we’re seeing is in certain Brazilian districts, there’s been a 20-fold increase in rates of microcephaly at the same time that there’s been a lot more Zika virus in pregnant women,” explained Dr. Sanjaya Senanayake of Australian National University in Canberra.
According to data from the CDC, 1,248 suspected cases of microcephaly had been reported in Brazil as of Nov. 28, 2015, compared with the annual rate of just 150-200 such cases during 2010-2014. “Examination of the fetus [and] amniotic fluid, in some cases, has shown Zika virus, so there seems to be an association,” Dr. Senanayake clarified, adding that “the [ANVISA – Brazilian Health Surveillance Agency] has told women in certain districts where there’s been a lot of microcephaly not to get pregnant.”
Brazil is set to host millions of guests from around the world as the 2016 Olympics get underway in only a few months’ time. Women who are pregnant or anticipate becoming pregnant should consider the risks if they are planning to travel to Rio de Janeiro. The risk of microcephaly does not apply to infected women who are not pregnant, however, as the CDC states that “Zika virus usually remains in the blood of an infected person for only a few days to a week,” and therefore, “does not pose a risk of birth defects for future pregnancies.”
Dr. St. John also stated that “public health personnel are still cautioning pregnant women to take special care to avoid mosquito bites during their pregnancies,” adding that the “[Pan-American Health Organization] is working on their guidelines for surveillance of congenital abnormalities.”
Clinical insights
With treatment options so sparse – there is no vaccine or drug available specifically meant to combat a Zika virus infection – what can health care providers do for their patients? The CDC advises health care providers to “treat the symptoms,” which means telling patients to stay in bed, stay hydrated, and, most importantly, stay away from aspirin and NSAIDs “until dengue can be ruled out to reduce the risk of hemorrhage.” Acetaminophen is safe to use, in order to mitigate fever symptoms.
Those who are infected are also advised to stay indoors and remain as isolated as possible for at least a week after symptoms first present. While the risk of a domestic outbreak is probably low, Dr. St. John said, the more exposure a Zika virus–infected individual has to the outside world, the more likely he or she is to be bitten by another mosquito, which can then carry and transmit the virus to another person.
“Chikungunya and dengue virus, which are transmitted by the same vectors [as Zika virus], have not managed to establish ongoing transmission in the U.S., despite repeated importations, [so] it is likely that Zika virus’ spread would follow a similar pattern,” Dr. St. John noted.
Though rare, sexual transmission of Zika virus has also been found in at least one case, although it had been previously suspected for some time. In December 2013, a 44-year-old Tahitian man sought treatment for hematospermia. Analysis of his sperm, however, found Zika virus, indicating possible sexual transmission of the virus.
“The observation that [Zika virus] RNA was detectable in urine after viremia clearance in blood suggests that, as found for [dengue] and [West Nile virus] infections, urine samples can yield evidence of [Zika virus] for late diagnosis, but more investigation is needed,” the study concluded.
“The best way to control all this is to control the mosquito,” said Dr. Senanayake. “You get a four-for-one deal; not only do you get rid of Zika virus, but also chikungunya, dengue, and yellow fever.” Dr. Senanayake added that advanced research is currently underway in mosquito-control efforts, including the idea of releasing mosquitoes into the wild which have been genetically modified so they can’t breed.
Now that the Illinois Department of Health has confirmed two new cases of Zika virus infection in that state, with other new cases cropping up in Saint Martin and Guadeloupe and El Salvador, providers should remain vigilant, taking note of patients who have traveled to afflicted regions and show mosquito bites. Person-to-person transmission is “rare as hen’s teeth,” said Dr. Senanayake, which is to say, it is highly unlikely to occur. Nonetheless, he said information and communication is the best way to ensure that Zika virus does not spread widely in the United States.
*This story was updated 1/25/2016.
The recent spike in Zika virus cases in Central and South America brings with it the alarming risk – and even the expectation – of outbreaks occurring in the United States. How should U.S.-based clinicians prepare for the inevitable?
“The current outbreaks of Zika virus are the first of their kind in the Americas, so there isn’t a previous history of Zika virus spreading into the [United States],” explained Dr. Joy St. John, director of surveillance, disease prevention and control at the Caribbean Public Health Agency in Trinidad.
But now that the virus has hit the United States, with a confirmed case in Texas last week and more emerging since then, Dr. St. John said the most important thing is for U.S. health care providers to recognize the signs and symptoms of Zika virus infection. The virus is carried and transmitted by the Aedes aegypti species of mosquito, the same vector that transmits the dengue and chikungunya viruses. Zika virus symptoms are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis. Only one in five individuals with a Zika virus infection develop symptoms, but patients who present as such and who have traveled to Central or South America in the week prior to the onset of symptoms should be considered likely infected.
"At present, there is no rapid test available for diagnosis of Zika,” said Dr. St. John. “Diagnosis is primarily based on detection of viral RNA from clinical serum specimens in acutely ill patients.”
To that end, polymerase chain reaction (PCR) testing can be conducted on serum samples collected within 3-5 days of symptom onset. Beyond that, elevated levels of IgM antibodies can be confirmed by serology, based on the neutralization, seroconversion, or four-fold increase of Zika-specific antibodies in paired samples. However, Dr. St. John warned that “Due to the possibility of cross reactivity with other viruses, for example, dengue, it is strongly recommended samples be collected early enough for PCR testing.”
Zika and pregnancy
Zika virus has now been identified in more than 20 countries and territories worldwide, most of them in the Americas, although outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands. While most infected patients experience relatively mild symptoms, Zika may be particularly dangerous when it infects a pregnant woman. There have been multiple cases of microcephaly in children whose mothers were infected with Zika virus during pregnancy, although the association of microcephaly with Zika virus infection during pregnancy has not been definitively confirmed. The Centers for Disease Control and Prevention recently issued a warning to Americans – particularly pregnant women – about traveling to high-risk areas.
“Scientifically, we’re not 100% sure if Zika virus is causing microcephaly, [but] what we’re seeing is in certain Brazilian districts, there’s been a 20-fold increase in rates of microcephaly at the same time that there’s been a lot more Zika virus in pregnant women,” explained Dr. Sanjaya Senanayake of Australian National University in Canberra.
According to data from the CDC, 1,248 suspected cases of microcephaly had been reported in Brazil as of Nov. 28, 2015, compared with the annual rate of just 150-200 such cases during 2010-2014. “Examination of the fetus [and] amniotic fluid, in some cases, has shown Zika virus, so there seems to be an association,” Dr. Senanayake clarified, adding that “the [ANVISA – Brazilian Health Surveillance Agency] has told women in certain districts where there’s been a lot of microcephaly not to get pregnant.”
Brazil is set to host millions of guests from around the world as the 2016 Olympics get underway in only a few months’ time. Women who are pregnant or anticipate becoming pregnant should consider the risks if they are planning to travel to Rio de Janeiro. The risk of microcephaly does not apply to infected women who are not pregnant, however, as the CDC states that “Zika virus usually remains in the blood of an infected person for only a few days to a week,” and therefore, “does not pose a risk of birth defects for future pregnancies.”
Dr. St. John also stated that “public health personnel are still cautioning pregnant women to take special care to avoid mosquito bites during their pregnancies,” adding that the “[Pan-American Health Organization] is working on their guidelines for surveillance of congenital abnormalities.”
Clinical insights
With treatment options so sparse – there is no vaccine or drug available specifically meant to combat a Zika virus infection – what can health care providers do for their patients? The CDC advises health care providers to “treat the symptoms,” which means telling patients to stay in bed, stay hydrated, and, most importantly, stay away from aspirin and NSAIDs “until dengue can be ruled out to reduce the risk of hemorrhage.” Acetaminophen is safe to use, in order to mitigate fever symptoms.
Those who are infected are also advised to stay indoors and remain as isolated as possible for at least a week after symptoms first present. While the risk of a domestic outbreak is probably low, Dr. St. John said, the more exposure a Zika virus–infected individual has to the outside world, the more likely he or she is to be bitten by another mosquito, which can then carry and transmit the virus to another person.
“Chikungunya and dengue virus, which are transmitted by the same vectors [as Zika virus], have not managed to establish ongoing transmission in the U.S., despite repeated importations, [so] it is likely that Zika virus’ spread would follow a similar pattern,” Dr. St. John noted.
Though rare, sexual transmission of Zika virus has also been found in at least one case, although it had been previously suspected for some time. In December 2013, a 44-year-old Tahitian man sought treatment for hematospermia. Analysis of his sperm, however, found Zika virus, indicating possible sexual transmission of the virus.
“The observation that [Zika virus] RNA was detectable in urine after viremia clearance in blood suggests that, as found for [dengue] and [West Nile virus] infections, urine samples can yield evidence of [Zika virus] for late diagnosis, but more investigation is needed,” the study concluded.
“The best way to control all this is to control the mosquito,” said Dr. Senanayake. “You get a four-for-one deal; not only do you get rid of Zika virus, but also chikungunya, dengue, and yellow fever.” Dr. Senanayake added that advanced research is currently underway in mosquito-control efforts, including the idea of releasing mosquitoes into the wild which have been genetically modified so they can’t breed.
Now that the Illinois Department of Health has confirmed two new cases of Zika virus infection in that state, with other new cases cropping up in Saint Martin and Guadeloupe and El Salvador, providers should remain vigilant, taking note of patients who have traveled to afflicted regions and show mosquito bites. Person-to-person transmission is “rare as hen’s teeth,” said Dr. Senanayake, which is to say, it is highly unlikely to occur. Nonetheless, he said information and communication is the best way to ensure that Zika virus does not spread widely in the United States.
*This story was updated 1/25/2016.
CDC expands Zika virus travel warnings; more U.S. cases confirmed
Officials at the Centers for Disease Control and Prevention have issued an expanded travel alert for regions where travelers may be at risk of contracting Zika virus.
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. Women who are pregnant or considering becoming pregnant should consider avoiding travel to countries included in the Zika virus alert.
The CDC’s expanded warning includes Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa. This is in addition to the previous travel alert for Puerto Rico (a U.S. territory), Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, and Venezuela.
In the United States, about a dozen cases of Zika virus have been reported, according to the CDC. States thus far where individuals have tested positive for the virus are Texas, Florida, Illinois, New Jersey, and Hawaii. These dozen cases include two pregnant women who tested positive for the Zika virus in Illinois this week. In Hawaii, a woman who had lived in Brazil while pregnant has given birth to a baby with microcephaly and congenital Zika virus infection. To date, all confirmed cases of Zika virus in the U.S. have been in individuals who traveled to areas with Zika virus transmission.
Zika virus, a member of the family of viruses that includes dengue fever, is spread by mosquitoes of the Aedes species, according to Dr. Amesh Adalja.
Dr. 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, noted that though the virus has been known since the 1940s, “it was not considered a major public health threat” because of the generally mild course of the disease.
Infection is asymptomatic in 80% of individuals, he said. Symptoms of Zika virus 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.
A recent explosion of Zika virus cases in Brazil, however, has been associated with a large increase in cases of microcephaly in newborns. Though the association has not been confirmed, Zika virus has been found in infants born with microcephaly and in the placentas of mothers of babies with microcephaly.
The CDC has issued interim guidance for diagnosis, treatment, and management of suspected Zika virus in pregnant women. All pregnant women should be asked about travel to countries with known Zika virus exposure, with surveillance by fetal ultrasound and, in some cases, testing for Zika virus guided by symptoms and likelihood of exposure.
The CDC recommends vigilance against mosquito bites for pregnant women who do travel to areas with Zika virus activity, including the use of effective insect repellent, protective clothing, and remaining in and sleeping in air-conditioned rooms when possible.
In the United States, there is reason to be concerned about Zika virus, since “the scale of travel is very, very high” to the Central and South American and Caribbean countries where Zika virus transmission is active, Dr. Adalja said. However, since the same vector also transmits dengue fever and the Chikungunya virus – currently the focus of increasing concern in the U.S. – aggressive vector control measures are already underway in parts of the country where Aedes species mosquitoes are resident.
Though the consequences of the apparent association between maternal Zika virus infection and infant microcephaly are devastating, said Dr. Adalja, “it’s important that people put this in the proper public health perspective. Dengue fever kills thousands of people each year.”*
Dr. Adalja said that he expects commercially available testing for Zika virus to be developed; currently, testing is currently only available from the CDC and from some states’ departments of public health.
Additional resources for physicians
American College of Obstetricians and Gynecologists: www.acog.org/About-ACOG/News-Room/Practice-Advisories
CDC: www.cdc.gov/zika/
*Correction, 1/25/2016: An earlier version of this story misstated the number of deaths from dengue fever.
On Twitter @karioakes
Officials at the Centers for Disease Control and Prevention have issued an expanded travel alert for regions where travelers may be at risk of contracting Zika virus.
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. Women who are pregnant or considering becoming pregnant should consider avoiding travel to countries included in the Zika virus alert.
The CDC’s expanded warning includes Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa. This is in addition to the previous travel alert for Puerto Rico (a U.S. territory), Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, and Venezuela.
In the United States, about a dozen cases of Zika virus have been reported, according to the CDC. States thus far where individuals have tested positive for the virus are Texas, Florida, Illinois, New Jersey, and Hawaii. These dozen cases include two pregnant women who tested positive for the Zika virus in Illinois this week. In Hawaii, a woman who had lived in Brazil while pregnant has given birth to a baby with microcephaly and congenital Zika virus infection. To date, all confirmed cases of Zika virus in the U.S. have been in individuals who traveled to areas with Zika virus transmission.
Zika virus, a member of the family of viruses that includes dengue fever, is spread by mosquitoes of the Aedes species, according to Dr. Amesh Adalja.
Dr. 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, noted that though the virus has been known since the 1940s, “it was not considered a major public health threat” because of the generally mild course of the disease.
Infection is asymptomatic in 80% of individuals, he said. Symptoms of Zika virus 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.
A recent explosion of Zika virus cases in Brazil, however, has been associated with a large increase in cases of microcephaly in newborns. Though the association has not been confirmed, Zika virus has been found in infants born with microcephaly and in the placentas of mothers of babies with microcephaly.
The CDC has issued interim guidance for diagnosis, treatment, and management of suspected Zika virus in pregnant women. All pregnant women should be asked about travel to countries with known Zika virus exposure, with surveillance by fetal ultrasound and, in some cases, testing for Zika virus guided by symptoms and likelihood of exposure.
The CDC recommends vigilance against mosquito bites for pregnant women who do travel to areas with Zika virus activity, including the use of effective insect repellent, protective clothing, and remaining in and sleeping in air-conditioned rooms when possible.
In the United States, there is reason to be concerned about Zika virus, since “the scale of travel is very, very high” to the Central and South American and Caribbean countries where Zika virus transmission is active, Dr. Adalja said. However, since the same vector also transmits dengue fever and the Chikungunya virus – currently the focus of increasing concern in the U.S. – aggressive vector control measures are already underway in parts of the country where Aedes species mosquitoes are resident.
Though the consequences of the apparent association between maternal Zika virus infection and infant microcephaly are devastating, said Dr. Adalja, “it’s important that people put this in the proper public health perspective. Dengue fever kills thousands of people each year.”*
Dr. Adalja said that he expects commercially available testing for Zika virus to be developed; currently, testing is currently only available from the CDC and from some states’ departments of public health.
Additional resources for physicians
American College of Obstetricians and Gynecologists: www.acog.org/About-ACOG/News-Room/Practice-Advisories
CDC: www.cdc.gov/zika/
*Correction, 1/25/2016: An earlier version of this story misstated the number of deaths from dengue fever.
On Twitter @karioakes
Officials at the Centers for Disease Control and Prevention have issued an expanded travel alert for regions where travelers may be at risk of contracting Zika virus.
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. Women who are pregnant or considering becoming pregnant should consider avoiding travel to countries included in the Zika virus alert.
The CDC’s expanded warning includes Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa. This is in addition to the previous travel alert for Puerto Rico (a U.S. territory), Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, and Venezuela.
In the United States, about a dozen cases of Zika virus have been reported, according to the CDC. States thus far where individuals have tested positive for the virus are Texas, Florida, Illinois, New Jersey, and Hawaii. These dozen cases include two pregnant women who tested positive for the Zika virus in Illinois this week. In Hawaii, a woman who had lived in Brazil while pregnant has given birth to a baby with microcephaly and congenital Zika virus infection. To date, all confirmed cases of Zika virus in the U.S. have been in individuals who traveled to areas with Zika virus transmission.
Zika virus, a member of the family of viruses that includes dengue fever, is spread by mosquitoes of the Aedes species, according to Dr. Amesh Adalja.
Dr. 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, noted that though the virus has been known since the 1940s, “it was not considered a major public health threat” because of the generally mild course of the disease.
Infection is asymptomatic in 80% of individuals, he said. Symptoms of Zika virus 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.
A recent explosion of Zika virus cases in Brazil, however, has been associated with a large increase in cases of microcephaly in newborns. Though the association has not been confirmed, Zika virus has been found in infants born with microcephaly and in the placentas of mothers of babies with microcephaly.
The CDC has issued interim guidance for diagnosis, treatment, and management of suspected Zika virus in pregnant women. All pregnant women should be asked about travel to countries with known Zika virus exposure, with surveillance by fetal ultrasound and, in some cases, testing for Zika virus guided by symptoms and likelihood of exposure.
The CDC recommends vigilance against mosquito bites for pregnant women who do travel to areas with Zika virus activity, including the use of effective insect repellent, protective clothing, and remaining in and sleeping in air-conditioned rooms when possible.
In the United States, there is reason to be concerned about Zika virus, since “the scale of travel is very, very high” to the Central and South American and Caribbean countries where Zika virus transmission is active, Dr. Adalja said. However, since the same vector also transmits dengue fever and the Chikungunya virus – currently the focus of increasing concern in the U.S. – aggressive vector control measures are already underway in parts of the country where Aedes species mosquitoes are resident.
Though the consequences of the apparent association between maternal Zika virus infection and infant microcephaly are devastating, said Dr. Adalja, “it’s important that people put this in the proper public health perspective. Dengue fever kills thousands of people each year.”*
Dr. Adalja said that he expects commercially available testing for Zika virus to be developed; currently, testing is currently only available from the CDC and from some states’ departments of public health.
Additional resources for physicians
American College of Obstetricians and Gynecologists: www.acog.org/About-ACOG/News-Room/Practice-Advisories
CDC: www.cdc.gov/zika/
*Correction, 1/25/2016: An earlier version of this story misstated the number of deaths from dengue fever.
On Twitter @karioakes
CDC: Ask pregnant women about Zika virus exposure
The Centers for Disease Control and Prevention has released interim guidelines for the care of pregnant women during a Zika virus outbreak.
The guidelines, developed in consultation with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, come on the heels of a Jan. 15 advisory warning pregnant women to avoid traveling to tropical countries and territories with outbreaks of the mosquito-borne virus. The virus is typically associated with only mild symptoms, but has been linked with cases of microcephaly and other poor outcomes in pregnancy.
“Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department,” according to the guidelines, which were published Jan. 19 in an early release of the Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 19;65[Early Release]:1-4).
Testing is not indicated for women who have not traveled to areas with Zika virus transmission, according to CDC.
For women who test positive for the virus, serial ultrasounds to monitor fetal growth and anatomy should be considered, as well as referral to a maternal-fetal medicine specialist or infectious disease specialist with expertise in pregnancy management, according to the guidelines.
While a positive reverse-transcription polymerase chain reaction (RT-PCR) result on amniotic fluid would suggest intrauterine infection and could potentially be useful to pregnant women and their health care providers, it is currently not known how sensitive or specific the test is for congenital infection or whether a positive result is predictive of a subsequent fetal abnormality.
“Health care providers should discuss the risks and benefits of amniocentesis with their patients,” CDC officials wrote in the interim guidance.
The following tests are advised for live births with evidence of infection: histopathological examination of the placenta and umbilical cord, testing of frozen placental tissue and cord tissue for Zika virus RNA, and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies. Guidelines for infected infants are currently being developed.
No specific treatment exists for Zika virus infection; supportive care, including rest, fluids, use of analgesics and antipyretics, and acetaminophen for fever is advised.
The CDC continues to recommend that pregnant women avoid travel to areas where Zika virus transmission is ongoing. Strict steps to avoid mosquito bites are advised for those who do travel to such areas. This includes use of protective clothing and U.S. Environmental Protection Agency–registered insect repellents, as well as staying and sleeping in screened-in or air-conditioned rooms. Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women when used as directed on the label, according to the CDC.
Updates on areas with ongoing Zika virus transmission are available on the CDC website.
The Centers for Disease Control and Prevention has released interim guidelines for the care of pregnant women during a Zika virus outbreak.
The guidelines, developed in consultation with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, come on the heels of a Jan. 15 advisory warning pregnant women to avoid traveling to tropical countries and territories with outbreaks of the mosquito-borne virus. The virus is typically associated with only mild symptoms, but has been linked with cases of microcephaly and other poor outcomes in pregnancy.
“Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department,” according to the guidelines, which were published Jan. 19 in an early release of the Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 19;65[Early Release]:1-4).
Testing is not indicated for women who have not traveled to areas with Zika virus transmission, according to CDC.
For women who test positive for the virus, serial ultrasounds to monitor fetal growth and anatomy should be considered, as well as referral to a maternal-fetal medicine specialist or infectious disease specialist with expertise in pregnancy management, according to the guidelines.
While a positive reverse-transcription polymerase chain reaction (RT-PCR) result on amniotic fluid would suggest intrauterine infection and could potentially be useful to pregnant women and their health care providers, it is currently not known how sensitive or specific the test is for congenital infection or whether a positive result is predictive of a subsequent fetal abnormality.
“Health care providers should discuss the risks and benefits of amniocentesis with their patients,” CDC officials wrote in the interim guidance.
The following tests are advised for live births with evidence of infection: histopathological examination of the placenta and umbilical cord, testing of frozen placental tissue and cord tissue for Zika virus RNA, and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies. Guidelines for infected infants are currently being developed.
No specific treatment exists for Zika virus infection; supportive care, including rest, fluids, use of analgesics and antipyretics, and acetaminophen for fever is advised.
The CDC continues to recommend that pregnant women avoid travel to areas where Zika virus transmission is ongoing. Strict steps to avoid mosquito bites are advised for those who do travel to such areas. This includes use of protective clothing and U.S. Environmental Protection Agency–registered insect repellents, as well as staying and sleeping in screened-in or air-conditioned rooms. Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women when used as directed on the label, according to the CDC.
Updates on areas with ongoing Zika virus transmission are available on the CDC website.
The Centers for Disease Control and Prevention has released interim guidelines for the care of pregnant women during a Zika virus outbreak.
The guidelines, developed in consultation with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, come on the heels of a Jan. 15 advisory warning pregnant women to avoid traveling to tropical countries and territories with outbreaks of the mosquito-borne virus. The virus is typically associated with only mild symptoms, but has been linked with cases of microcephaly and other poor outcomes in pregnancy.
“Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department,” according to the guidelines, which were published Jan. 19 in an early release of the Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 19;65[Early Release]:1-4).
Testing is not indicated for women who have not traveled to areas with Zika virus transmission, according to CDC.
For women who test positive for the virus, serial ultrasounds to monitor fetal growth and anatomy should be considered, as well as referral to a maternal-fetal medicine specialist or infectious disease specialist with expertise in pregnancy management, according to the guidelines.
While a positive reverse-transcription polymerase chain reaction (RT-PCR) result on amniotic fluid would suggest intrauterine infection and could potentially be useful to pregnant women and their health care providers, it is currently not known how sensitive or specific the test is for congenital infection or whether a positive result is predictive of a subsequent fetal abnormality.
“Health care providers should discuss the risks and benefits of amniocentesis with their patients,” CDC officials wrote in the interim guidance.
The following tests are advised for live births with evidence of infection: histopathological examination of the placenta and umbilical cord, testing of frozen placental tissue and cord tissue for Zika virus RNA, and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies. Guidelines for infected infants are currently being developed.
No specific treatment exists for Zika virus infection; supportive care, including rest, fluids, use of analgesics and antipyretics, and acetaminophen for fever is advised.
The CDC continues to recommend that pregnant women avoid travel to areas where Zika virus transmission is ongoing. Strict steps to avoid mosquito bites are advised for those who do travel to such areas. This includes use of protective clothing and U.S. Environmental Protection Agency–registered insect repellents, as well as staying and sleeping in screened-in or air-conditioned rooms. Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women when used as directed on the label, according to the CDC.
Updates on areas with ongoing Zika virus transmission are available on the CDC website.
FROM MMWR
Zika virus: CDC warns pregnant women to avoid some tropical travel
Pregnant women and those planning to become pregnant should avoid traveling to 14 tropical countries and territories in Central and South America and the Caribbean, where there is a rapidly escalating outbreak of the mosquito-borne zika virus, according to the Centers for Disease Control & Prevention in an advisory issued Jan. 15.
The CDC advisory covers Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.
Although illness due to the zika virus tends to be mild with symptoms lasting from several days to a week, research has indicated a correlation between the virus and a skyrocketing number of babies born with microcephaly and other poor outcomes in Brazil. The Brazilian Ministry of Health has declared a national health emergency (link in Portuguese) as officials there fear the numbers of cases will go higher.
“Until more is known, and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant,” the CDC said in a statement. Specifically, women at any trimester of pregnancy should cancel or postpone travel to the areas covered by the advisory. Any pregnant women who must travel should consult with a physician prior to travel and take great care to avoid mosquito bites. The advice should be observed by women who are thinking of becoming pregnant, according to the CDC.
The government of Canada has issued a similar travel warning for pregnant women.
CDC warns that because the mosquitoes of the Aedes aegypti species that spread zika virus are found worldwide, further outbreaks are likely in other countries. Indeed, zika virus transmission has been seen in several countries in Africa and Asia.
In December 2015, Puerto Rico reported its first confirmed zika virus case. Although zika has not been reported in the continental United States, the CDC reports there have been infected travelers returning from affected countries.
Advice for those who must travel to areas where zika virus transmission has been documented can be found on the CDC website.
On Twitter @whitneymcknight
Pregnant women and those planning to become pregnant should avoid traveling to 14 tropical countries and territories in Central and South America and the Caribbean, where there is a rapidly escalating outbreak of the mosquito-borne zika virus, according to the Centers for Disease Control & Prevention in an advisory issued Jan. 15.
The CDC advisory covers Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.
Although illness due to the zika virus tends to be mild with symptoms lasting from several days to a week, research has indicated a correlation between the virus and a skyrocketing number of babies born with microcephaly and other poor outcomes in Brazil. The Brazilian Ministry of Health has declared a national health emergency (link in Portuguese) as officials there fear the numbers of cases will go higher.
“Until more is known, and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant,” the CDC said in a statement. Specifically, women at any trimester of pregnancy should cancel or postpone travel to the areas covered by the advisory. Any pregnant women who must travel should consult with a physician prior to travel and take great care to avoid mosquito bites. The advice should be observed by women who are thinking of becoming pregnant, according to the CDC.
The government of Canada has issued a similar travel warning for pregnant women.
CDC warns that because the mosquitoes of the Aedes aegypti species that spread zika virus are found worldwide, further outbreaks are likely in other countries. Indeed, zika virus transmission has been seen in several countries in Africa and Asia.
In December 2015, Puerto Rico reported its first confirmed zika virus case. Although zika has not been reported in the continental United States, the CDC reports there have been infected travelers returning from affected countries.
Advice for those who must travel to areas where zika virus transmission has been documented can be found on the CDC website.
On Twitter @whitneymcknight
Pregnant women and those planning to become pregnant should avoid traveling to 14 tropical countries and territories in Central and South America and the Caribbean, where there is a rapidly escalating outbreak of the mosquito-borne zika virus, according to the Centers for Disease Control & Prevention in an advisory issued Jan. 15.
The CDC advisory covers Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.
Although illness due to the zika virus tends to be mild with symptoms lasting from several days to a week, research has indicated a correlation between the virus and a skyrocketing number of babies born with microcephaly and other poor outcomes in Brazil. The Brazilian Ministry of Health has declared a national health emergency (link in Portuguese) as officials there fear the numbers of cases will go higher.
“Until more is known, and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant,” the CDC said in a statement. Specifically, women at any trimester of pregnancy should cancel or postpone travel to the areas covered by the advisory. Any pregnant women who must travel should consult with a physician prior to travel and take great care to avoid mosquito bites. The advice should be observed by women who are thinking of becoming pregnant, according to the CDC.
The government of Canada has issued a similar travel warning for pregnant women.
CDC warns that because the mosquitoes of the Aedes aegypti species that spread zika virus are found worldwide, further outbreaks are likely in other countries. Indeed, zika virus transmission has been seen in several countries in Africa and Asia.
In December 2015, Puerto Rico reported its first confirmed zika virus case. Although zika has not been reported in the continental United States, the CDC reports there have been infected travelers returning from affected countries.
Advice for those who must travel to areas where zika virus transmission has been documented can be found on the CDC website.
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