Zika Virus North Carolina Department of Health and Human Services



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Zika Virus

North Carolina Department of Health and Human Services,

Division of Public Health

Background

  • Mosquito-borne emerging arbovirus
  • Closely related to dengue, yellow fever, Japanese encephalitis and West Nile viruses
  • First identified in Uganda in 1947
  • Since 2007: Outbreaks in Gabon, Micronesia, French Polynesia
  • Since 2015: Endemic transmission in Central & South America

Figure: Countries and territories with active Zika Virus Transmission (as of January 27, 2016)


AMERICAS
  • Bolivia
  • Brazil
  • Colombia
  • Dominican Republic
  • Ecuador
  • El Salvador
  • French Guiana
  • Guadeloupe
  • Guatemala
  • Guyana
  • Haiti
  • Honduras
  • Martinique
  • Mexico
  • Panama
  • Paraguay
  • Puerto Rico
  • Saint Martin
  • Suriname
  • US Virgin Islands
  • Venezuela

  • OCEANA/PACIFIC ISLANDS
  • Samoa

  • AFRICA
  • Cape Verde
  • Only travel-associated cases have been identified in the United States

Vectors: Aedes mosquitos

  • Aedes species mosquitos
    • Primary: Ae aegypti
    • Secondary: Ae albopictus
  • Aggressive day-time biters
  • Also transmit dengue and chikungunya viruses

Primary vector

Secondary vector

Clinical Presentation

  • ~1 in 5 people infected with Zika virus become ill
  • Symptoms include:
    • Mild fever
    • Rash (mostly maculopapular)
    • Headaches
    • Arthralgia
    • Myalgia
    • Non-purulent conjunctivitis
  • Presentation is similar to dengue and chikungunya infection
  • Severe disease requiring hospitalization and fatalities is rare

Zika, Dengue, Chikungunya virus Symptoms


Features

Zika

Dengue

Chikungunya

Fever

++

+++

+++

Rash

+++

+

++

Conjunctivitis

++

-

-

Arthralgia

++

+

+++

Myalgia

+

++

+

Headache

+

++

++

Hemorrhage

-

++

-

Case Management

  • Symptomatic patients should be evaluated and managed for possible Zika, dengue, and chikungunya infection
  • No specific antiviral treatment is available
  • Treatment is symptomatic (e.g. rest, fluids, acetaminophen)
  • Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue can be ruled out

Zika Virus Infection and Pregnancy


ECDC Rapid Risk Assessment. Microcephaly in Brazil potentially linked to the Zika virus epidemic. 24 November 2015

Brazil 2015: Reports of microcephaly and other poor outcomes in babies of mothers who were infected with Zika virus while pregnant


Zika Virus and Microcephaly in Brazil

  • 4,180 cases reported October–January
  • 732 examined
  • Zika virus identified in amniotic fluid from a small number of cases involving microcephaly

Zika Virus Testing

Specimen Submission Supplemental Information

Required information for testing

  • Travel history
  • Onset date
  • Specimen collection date
  • Specimen type
  • Submitter contact information
  • Recommended additional information

  • Description of clinical illness
  • Vaccination history (IgM Flavivirus cross-reactivity )
    • Yellow fever
    • Japanese encephalitis

Surveillance and Reporting

Surveillance and Reporting in NC

  • Dengue and chikungunya infections are specifically reportable per 10A NCAC 41A .0101
  • NC DPH is working on a temporary rule to make Zika virus disease reportable in North Carolina
  • Imported cases of Zika virus disease are expected
  • Please contact the Communicable Disease Branch at 919-733-3419 or your local health department if Zika virus infection is suspected

Resources

NC DPH

  • Diseases & Topics: Zika virus http://epi.ncpublichealth.info/cd/diseases/zika.html
  • Lab Submission Forms

  • NCSLPH submission form DHHS 3445 http://slph.ncpublichealth.com/Forms/DHHS-3445-SpecialSerology.pdf
  • CDC DASH form http://slph.ncpublichealth.com/Forms/CDC-5034-DashForm-120515.pdf
  • CDC Resources

  • Zika Virus http://www.cdc.gov/zika
  • Interim Guidelines for Pregnant Women http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm
  • Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e3er.htm?s_cid=mm6503e3er.htm_w
  • Q & A for Obstetrical Healthcare Providers http://www.cdc.gov/zika/pdfs/questions-answers-clinicians.pdf
  • Q & A for Pediatric Healthcare Providers http://www.cdc.gov/zika/hc-providers/qa-pediatrician.html
  • American Congress of Obstetricians and Gynecologists

  • Practice Advisory: Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak https://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak


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