ZIKA VIRUS WHAT IS IT? WHERE DID IT COME FROM? HOW DID IT GET HERE? - PowerPoint PPT Presentation

ZIKA VIRUS WHAT IS IT? WHERE DID IT COME FROM? HOW DID IT GET HERE? L I L I A N A V . R I O S , M . D . I N F E C T I O U S D I S E A S E C O N S U L T A N T S

EPIDEMIOLOGY • A single stranded RNA virus • Genus: Flavivirus • Classified amongst better known : Dengue Virus (DEN), West Nile Virus (WNV), Yellow Fever (YF) Virus, Japanese encephalitis (JE) virus 2

EPIDEMIOLOGY • Vector: spread by the bite of an infected female Aedes mosquito. • Distinctive black & white markings • Usually bites during the daytime • Breeds in standing water, particularly manmade containers [1] 3

ZIKA VIRUS DISEASE • Presents similarly to Dengue and Chikungunya • Asymptomatic infection 80% • Or a mild febrile illness 20% • Symptoms include: • Fever • Rash • Joint pains • Red eyes • In less than 1%, neurologic syndromes can occur • Guillain-Barré syndrome • Microcephaly In the developing fetus [2] 4

THE ORIGIN OF THE VIRUS • Discovered: 1947 • As scientists worked on YF transmission. • A. J. Haddow, MD • Aedes Africanis • Rhesus monkey • Officially named in1948, after the Zika Forest in Uganda. [3] 5

ZIKA VIRUS : AN EMERGING VIRUS • Between 1947 and 2006 • Only 14 reports of human cases documented • First native case in 1954 • A 10 yr old girl in Nigeria who had a mild febrile illness and recovered completely. [4] • First experimental infection in a human volunteer in 1956 • Experienced a mild febrile illness and recovered completely . [5] 6

ZIKA VIRUS : AN EMERGING VIRUS • In 2007 • An outbreak occurred on the island of Yap (Federal States of Micronesia). • 49 confirmed and 59 probable cases of Zika virus disease • An estimated 73% of Yap residents >3 years of age had been recently infected with Zika virus • Aedes hensilli was the mosquito identified [6] 7

ZIKA VIRUS : AN EMERGING VIRUS • In 2013 • An epidemic of Zika virus emerged in French Polynesia where Dengue is endemic. • A larger scale of people were exposed at an estimated 28,000 cases ; approximately 11% of the population. • And yet the true incidence of exposure was likely under reported as infection is most commonly asymptomatic. 8

ZIKA VIRUS : AN EMERGING VIRUS • In contrast to YAP , serious effects become obvious when the virus affects a lot of people in French Polynesia . • Correlations to the more uncommon clinical neurologic manifestations of Guillain-Barré syndrome are unmasked and first associated to Zika virus. [7] • Smaller outbreaks then followed from French Polynesia to the cook islands, Easter Island and the Solomon Islands. [8] 9

ZIKA VIRUS : AN EMERGING VIRUS 10

RACE TO THE AMERICAS • Northeastern Brazil, 2015 • The Aedes mosquito is endemic here as is Dengue fever. • However, up to 60,000 cases with non-Dengue and non-Chikungunya began accumulating. • Thus, scientists take note at the Oswaldo Cruz foundation and began investigating. • On June 2015 , the first domestic transmission of Zika virus was confirmed and documented in Brazil. • They used phylogenetic analysis and traced the virus to the Asian clade of Zika virus • confirmed by PCR DNA sequencing [9] 11

RACE TO THE AMERICAS • The precise means by which Zika Virus was introduced to the Western Hemisphere is unknown. • Brazil reported 1.5 million cases , and more than 4,000 suspected cases of microcephaly in babies. • The predominant incidence however was in the poorer northeast. • Zika rapidly spread throughout Latin America and the Caribbean, such that within 1 year most countries in the region reported local transmission. [10] 12

HOW IT GOT TO THE AMERICAS • Postulates from Journal of Virology and Scientific American: • The viremic traveler from the French Polynesia via: • FIFA Confederations Cup, which was held in Brazil from 15 June to 30 June 2013 • World cup soccer competition July 2014 (what an upset!) • Va’a world sprint Championship canoe race in Rio de Janeiro Brazil in August 2014 13

THE ZIKAVIRUS, CLASS DIVIDE, AND CLIMATE CLASH • In our current scholarly articles; Asian Pac J Trop Biomed and New England Journal of Medicine: • Emergence of the world as a global village. • Climate change • summer heat waves, drought, and heavy rains with flash floods. • Human factors • many inhabitants in large cities • Lack of : electricity, running water, garbage collection, sewers and drains for rain. • Inadequate health service • Dev of vector resistance to insecticides [11 -12] 14

AN ESTABLISHED GLOBAL THREAT • On Nov 1 , 2015 the Brazil Ministry of Health declared a public health emergency as the number of cases of microcephaly continued to increase. • On February 1 , 2016 The World Health Organization ( WHO ) declared the cluster of microcephaly cases and other neurological disorders a health emergency. • On February 8 , 2016 , the Centers for Disease Control ( CDC) elevated its response efforts to a Level 1 activation. • The WHO launched the global Strategic Response Framework to encompass surveillance, response activities and research. 15

HOW IT GOT TO THE US*? FLORIDA DEPT. OF HEALTH • Local transmission via domestic mosquito vector has been reported in Puerto Rico (*US territory), but not elsewhere in the United States. • Cases of Zika fever have been reported in travelers returning to the United States. -secondary transmission is possible via sex. 16

CDC UPDATE JANUARY 1, 2015 – JUNE 1, 2016. US States • Travel-associated cases reported: 618 • Florida cases – 128 • Locally acquired vector-borne cases reported: 0 • Total: 618 • Sexually transmitted: 11 • Guillain-Barré syndrome: 1 US Territories • Travel-associated cases reported: 4 • Locally acquired cases reported: 1,110 • Total: 1,114 • Guillain-Barré syndrome: 8 17

THE ZIKA VIRUS TIME LINE 18

AS OF 1 JUNE 2016, THE WHO R E P O R T S 6 0 C O U N T R I E S A N D T E R R I T O R I E S R E P O R T C O N T I N U I N G M O S Q U I T O - B O R N E T R A N S M I S S I O N . 19

INFECTIOUS DISEASE CONSULTANTS • We specialize in Infectious Diseases & Travel Health. • For an appointment call: 407.830.5577 20

CITATIONS 1. http://www.floridahealth.gov/diseases-and-conditions/zika-virus/index.html 2. CDC.gov 3. Zika Virus (I). Isolations and serological specificity . G.W. A. Dick, S.F. Kitchen, A. J. Haddow. Trans R Soc Trop Med Hyg (1952)46 (5): 509- 520.doi: 10.1016/0035-9203(52)90042-4. 4. MacNamara, F.N. (March 1954). " Zika virus: a report on three cases of human infection during an epidemic of jaundice in Nigeria." . Transactions of the Royal Society of Tropical Medicine and Hygiene 48 (2): 139 – 45. 5. Bearcroft, W.G. (September 1956). " Zika virus infection experimentally induced in a human volunteer. " Transactions of the Royal Society of Tropical Medicine and Hygiene 50 (5): 442 – 8. 6. Tai-Ho Chen, M.D., W. et al. Zika Virus Outbreak on Yap Island, Federated States of Micronesia . Mark R. Duffy, D.V.M., M.P.H., N Engl J Med 2009; 360:2536-2543 21

CITATIONS 7. Search and one will find: Zika virus everywhere Trans R Soc Trop Med Hyg (2016)110 (4): 207-208.doi: 10.1093/trstmh/trw020. 8. Musso D. Zika virus transmission from French Polynesia to Brazil . Emerg Infect Dis . 2015;21(10):1887. 9. Camila Zanluca et al. Mem. Inst. Oswaldo Cruz vol.110 no.4 Rio de Janeiro June 2015 Epub June 09, 2015. 10. Zika Virus: New Clinical Syndromes and Its Emergence in the Western Hemisphere. Helen M. Lazear and Michael S. Diamond. J. Virol. May 2016 vol. 90 no. 104864-4875 11. Troncoso A, Zika threatens to become a huge worldwide pandemic. Asian Pac J Trop Biomed (2016) 12. Anthony S. Fauci, M.D., and David M. Morens, M.D. Zika Virus in the Americas — Yet Another Arbovirus Threat. N Engl J Med 2016; 374:601-604. 22