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Zika Virus – An update Dr S Anuradha, Gold Coast Public Health Unit. What is Zika Virus?. Zika is a RNA virus of the Flavivirus family Spreads to people primarily through the bite of an infected Aedes species mosquito (vector)
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Zika Virus – An update Dr S Anuradha, Gold Coast Public Health Unit
What is Zika Virus? • Zika is a RNA virus of the Flavivirus family • Spreads to people primarily through the bite of an infected Aedes species mosquito (vector) • Vectors are the same as for dengue virus, Aedes aegypti (N & C Qld and some SW Qld) and Aedes albopictus (Torres Strait).
Zika – Clinical Context • Short, mild illness; 80% asymptomatic • Low grade Fever • Arthralgia (small joints) ~swelling • Headaches (retro-orbital), muscle pains • Conjunctivitis, maculo-papular rash • Tiredness, weakness
Zika - Clinical Context • Incubation Period: May be up to 10 days • Infectious Period: Unknown • No treatment nor vaccine yet • Differential Diagnosis (Zika is milder)
Global Update • Between 1 Jan 2007 and 17 Feb 2016, 48 countries and territories have reported local transmission of Zika virus • DoH website for list of countries: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-zika-countries.htm
Association with birth defects and neurological disorders • Increase in the cases of microcephaly (Brazil & French Polynesia) • Increase in cases of Guillain-Barré syndrome (GBS) (atleast 5 countries)
Public Health Emergency • WHO declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016 • WHO declared that “Surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk of such transmission”
Birth defects: the defence • Microcephaly is a measurement, not a syndrome • Reports mainly from NE Brazil, not elsewhere • Poverty, pesticides, other factors? • Birth cohort showing high rate before Zika (but steep rise in severe cases after)
What’s the risk of microcephaly? • Background rate ~5 per 100,000 births • Brazil, 2015 ~4700 (max) cases in 2.9M births • That would be 162 per 100,000 • If ~1.5M infections in population 200M • At same attack rate~ 21,000 affected pregnancies Risk (pregnancy with Zika) could be 3% – 15% Uncertainties: • Can silent infections damage fetus? • Stage of pregnancy? Cofactors? • What about breast-feeding?
Association with birth defects and neurological disorders • Circumstantial relationship?? • Clinical and Epidemiological information is emerging fast • Case-control study using 100 cases of microcephaly currently underway
Australia Update • In Australia there have been 27 cases notified, with the first in 2012 • The first case of Zika notified in Queensland was in 2014 • As at 15 Feb 2016, Qld’s total is 18 cases • 7 in 2014 • 4 in 2015 • 7 in 2016
Country of acquisition • All cases notified in Qld were acquired overseas • In 2016, cases were acquired from Samoa (3) and Tonga (3)
Qld Zika notifications • In 2016 one pregnant woman has been notified. • Most reported in SEQ
Minister’s Round Table • 03 February 2016 - Qld. Health Minister met with health experts and other stakeholders • Recognition that greatest risk for local transmission is in north Queensland Ministerial priorities: • Research • Laboratory testing capability • Community engagement • Local government engagement with mosquito surveillance and control
The specific vector • Elderly ♀Aedesaegypti • Day biting, shy, fussy, travels ≤ 200m • Hides indoors, under furniture, dark surfaces • Extrinsic Incubation period: 8 - 12 days • Infective for life • Not a bush mozzie
Getting ready- Receptive area • Encourage Eliminate Dengue (wolbachia mosquitoes)participation • Vector control at home using interior residual spray (IRS) (90% dengue protectionto occupants) • Zappers, coils, daytime / dusk clothing (legs, feet) and repellents • DEET, pyrethroids, methoprinesafe in pregnancy
Surveillance • Early detection is key to preventing and managing outbreaks • Labs in Townsville to test for Zika virus from March 2016
Testing for Zika • Returned from Zika country + sick • Returned from Zika country + Pregnant, (sick or not) • Test early for the virus (PCR: 0 - 7 days) • Pregnant: urine PCR can be positive up to 2 weeks • Semen? • Serology (testing for antibodies IgG & IgM)
Testing for Zika in Pregnancy Symptomatic Pregnant Women • H/o place of travel and date of symptom onset • Test for Zika + others relevant travel-related illness • Recommended specialist ID advice to discuss DD
Testing for Zika in Pregnancy Asymptomatic Pregnant Women • H/o dates/duration/place of travel • H/o mozzy bites • Blood collected at initial presentation irrespective of time of exposure • If presents < 2 weeks of exposure, blood collected held at lab for future testing
Sexual Transmission • Zika virus has been found in saliva or urine for more than one week after blood clears • Two cases of probable sexual transmission reported so far – both from men • Seminal fluid positive for virus for 9 weeks after onset of symptoms – so duration of infectivity currently unknown • No evidence that an infected woman can transmit Zika virus through sex
Sexual Transmission Recommendations for men who have recently travelled to areas with ongoing Zika virus transmission • Pregnant partner - Use condoms consistently or abstain from sexual activity for the duration of pregnancy • Confirmed Zika infection and non pregnant partner - Use condoms consistently or abstain from sexual activity for 3 months
Travel advice • Pregnant, contemplating pregnancy… “Don’t go to the listed countries” • No sexual partners • Safe sex throughout pregnancysemen may be positive for 2 months + • Mosquito avoidance • Insect repellants, clothes, bednet (daytime)
Unknowns?? • Real link to microcephaly , adult GBS? • Sensitivity and Specificity of tests? • Asymptomatic transmission? • Rate, duration of sexual transmission? • Low level circulation (Dengue endemic countries)?
Updates Qld Health website https://www.health.qld.gov.au/news-alerts/health-alerts/zika/ • Communicable disease control guidance • The Australian Government Department of Health Contact Public Health Unit on 5687 9000 or email gcphucdc@health.qld.gov.au