Zika Virus (Zv) Infections

The Zika virus is a flavivirus that is similar to viruses, dengue fever, yellow fever and West Nile fever. cause. A Zika virus infection is usually asymptomatic, but can cause fever, rash, joint pain, or conjunctivitis; a Zika virus infection during pregnancy can cause (a serious birth defects) and eye abnormalities microcephaly. The diagnosis is by enzyme-linked immunosorbent assay or a reverse transcriptase-PCR. posed. The treatment is symptomatic. Prevention includes avoiding mosquito bites, by unprotected sex with a partner who has the risk of having a Zika virus infection, and for pregnant women, travel to areas with ongoing transmission.

(See also Overview of infections by Arbovirus, Arena virus and filovirus.)

The Zika virus is a flavivirus that is similar to viruses, dengue fever, yellow fever and West Nile fever. cause. A Zika virus infection is usually asymptomatic, but can cause fever, rash, joint pain, or conjunctivitis; a Zika virus infection during pregnancy can cause (a serious birth defects) and eye abnormalities microcephaly. The diagnosis is by enzyme-linked immunosorbent assay or a reverse transcriptase-PCR. posed. The treatment is symptomatic. Prevention includes avoiding mosquito bites, by unprotected sex with a partner who has the risk of having a Zika virus infection, and for pregnant women, travel to areas with ongoing transmission .. (See also Overview of infections arbovirus, Arena virus and filovirus.) the Zika virus (ZV) as causing virus, dengue fever, yellow fever and Chikungunya disease is transmitted by the Aedes mosquitoes that breed in stagnant water. These mosquitoes prefer to bite people and to live near, indoors and outdoors; they bite aggressively during the day. They bite at night. The main vectors are A. aegypti and A. albopictus. In the US, A. aegypti limited to the Deep South, but A. albopictus, which is better adapted to colder climates, is present in much of the Southeast. A. aegypti is considered the main vector for epidemic Zika virus infection; It is believed that A. albopictus is an important vector of the epidemic Zika virus infection in the tropics, but he is also in the temperate climate of the United States is unclear. Epidemiology In 1947 was the Zika virus first isolated from monkeys in Zika Forest of Uganda, but is not considered as an important human pathogen until it came to the first major outbreaks on the islands in the South Pacific in the year of 2007. In May 2015 was first reported by a local transmission, first in South America and then in Central America and the Caribbean, Mexico in late November 2015 has been reached. Currently, reports on a sustained local transmission of Zika virus in the following regions: South America Central America Caribbean Islands Pacific Islands Cape Verde (a nation of islands off the northwest coast of Africa) South East Asia (sporadic cases) The CDC in the United States issued travel warnings for many countries in these regions. Currently been reported no locally transmitted Zika- virus cases in the continental United States. However, it was reported by the Zika virus infection among travelers who zurückzukehrten in the United States. Predicting where the Zika virus will spread is difficult. However, because the same mosquito that transmits the Zika virus, and dengue and chikungunya transfers, local transmissions of the Zika- virus can be expected where dengue or chikungunya have been transferred. Dengue was acquired in Texas, Florida and Hawaii; Chikungunya was purchased in Florida. Even in areas of the US where dengue is now at home (Puerto Rico and the Virgin Islands in the Caribbean, American-Samoa, Guam and the Northern Mariana Islands in the Pacific), the Zika virus infection can also be endemic. Transfer During the first week of infection, the Zika virus is in the blood. Mosquitoes can acquire the virus when they bite infected people; the mosquitoes can then transmit the virus to other people through bites. Travelers from areas with ongoing transmission of the Zika virus can Zika virus in your blood when they return home, and when mosquito vectors are present locally, the local transmission of the Zika virus is possible. However, since the contact between Aedes mosquitoes and people in most parts of the continental US and Hawaii is rare (due to mosquito control, and because people are living in air-conditioned environments and work), a local transmission of the Zika virus is rare and limited. Although the Zika virus is transmitted primarily by mosquitoes, other transmission routes are possible. These include: Sexual transmission Transmission through blood transfusion Transmission by organ or tissue transplantation (theoretical) intrauterine transmission from the mother to the fetus, resulting in congenital infection, the Zika virus is present in semen and can range from men through sexual intercourse their sex partners are transferred, including vaginal and anal sex and oral sex probably (fellatio). Both ways – male to female and male to male transmission in unprotected sexual activity (condoms) have occurred (see also the CDC: Clinical Guidance for Health Care Providers for Prevention of Sexual Transmission of Zika virus). The Zika virus remains in the vaginal fluid after it has disappeared from the blood and urine; recently been reported sexual transmission of Zika virus from female to male. (1). Of transmission through blood transfusion was reported in Brazil; but currently there are no cases of transmission through blood transfusions in the United States known (see also confirms CDC: About Zika virus disease). The, Zika virus as cause viruses, dengue fever, Chikungunya disease, West Nile fever and yellow fever can be transmitted from mother to child during pregnancy. The viruses that cause dengue fever and West Nile fever can be transmitted in breast milk. Currently, there were no reports of Zika- virus transmission through breastfeeding, and because breastfeeding has many advantages, encourages the CDC mothers to breastfeed in areas where the transmission of the Zika virus still persists. About the transmission 1. CDC media statement: The first sexual transmission of Zika virus infection from female to male, was reported by the New York. July 2016 symptoms and complaints Most infected patients have no symptoms. The symptoms of Zika virus infection are fever, maculopapular rash, conjunctivitis (pink eye), arthralgia, retro-orbital pain, headache and muscle pain. The symptoms last for 4 to 7 days. Most infections are weak. Severe infections that make requiring hospitalization, are unusual. Death due to Zikavirusinfektion is rare. Very rarely, Guillain Barre Syndrome (GBS) developed after a Zika virus infection. BS is an acute, usually very rapidly progressive, however self-limiting inflammatory polyneuropathy, is suspected of that it is caused by an autoimmune reaction. GBS has developed even after dengue and Chikungunya disease. Microcephaly Zika virus infection during pregnancy can microcephaly (an inherited disorder with incomplete development of the brain and small head size), and other severe fetal brain defects cause (see also CDC: Clinical Guidance for Healthcare Providers Caring for Infants and Children). In the US, several cases of microcephaly with the Zika virus were connected; the mothers of these children have the infection probably contracted by traveling to a country with endemic infection. The CDC monitors a number of pregnant women with Zika virus infection who live on the US mainland or in Puerto Rico and other US territories; these women have acquired the virus through travel or an infected partner. Diagnosis Serological tests Reverse transcriptase-PCR (RT-PCR) test (See the CDC Revised diagnostic testing for Zika, chikungunya, and dengue viruses.) Doctors are obliged to notify the CDC, when a case of Zika virus identify infection. A Zika virus infection is due to symptoms, places and data associated with travel, suspected. However, clinical manifestations of Zika- virus infections are similar (eg. As malaria, leptospirosis, other arbovirus infections) many febrile tropical diseases, and the geographic distribution similar to that of other arboviruses. Therefore, the diagnosis of Zika virus infection requires laboratory confirmation by one of the following options: Serological tests (enzyme-linked immunosorbent assay [ELISA] for IgM, plaque reduction neutralization test [PRNT] for Zika virus antibodies) RT-PCR viral RNA detectable in serum virus specific IgM and neutralizing antibodies develop typically towards the end of the first week of illness, but a cross-reaction with related flaviviruses (eg. as dengue and yellow fever viruses) is widespread. The PRNT measures virus-specific neutralizing antibodies and helps cross-reacting antibodies of closely related flaviviruses to distinguish. During the first week after the onset of symptoms, the Zika virus can often be found using RT-PCR in the serum; Urine samples should be collected for RT-PCR assays <14 days after symptom onset. In the US, an emergency authorization for the following diagnostic tests for Zika virus was issued: Zika MAC ELISA Trioplex real-time RT-PCR analysis These tests are distributed to laboratories that are certified to perform highly complex tests in the US (more information on these tests, see the CDC Zika virus: Diagnostic testing and Zika virus: information for State and Local Public Health Laboratories). To assist in the diagnosis and treatment of Zika virus infection, the CDC has interim guidelines for pregnant women and interim guidelines for children of mothers who have traveled during pregnancy in areas with ongoing Zika virus transmission or lived there. Currently, it is not recommended to test men to assess the risk of sexual transmission (see also CDC: Clinical Guidance for Health Care Providers for Prevention of Sexual Transmission of Zika virus). Men, who reside in an area with active Zika virus transmission or traveled there and have a pregnant partner should refrain from sexual activity or consistently and correctly condoms during sex (ie, vaginal intercourse, anal intercourse, fellatio) for the duration of use pregnancy. Testing the mother for pregnant travelers returning from areas with ongoing Zika virus transmission, the CDC recommended guidelines serological tests for all pregnant women, regardless of whether they have symptoms of Zika virus infection or not. In addition, when pregnant women were exposed to the Zika virus, an abdominal ultrasound is recommended in order to assess the fetal anatomy (see also Zika virus: Clinical Guidance for Healthcare Providers Caring for Pregnant Women). For asymptomatic pregnant women: The tests should be 2 to 12 weeks after pregnant women have returned from the trip, take place. In symptomatic pregnant women: The tests should be carried out while they are symptomatic. For pregnant women living in areas with ongoing Zika virus transmission, provides the Zika virus infection a risk during pregnancy. If pregnant women develop symptoms suggestive of Zika virus infection, the investigation should during take place the first week of illness. For asymptomatic pregnant women who live virus in areas with ongoing transmission of Zika-, the CDC recommends testing at the first prenatal and - if the results are negative - in the middle of the second trimester; fetal ultrasound should be performed in the SSE 18 to 20 (see Interim Guidance for Healthcare Providers Caring for Women of Reproductive Age with Possible Zika virus Exposure - United States, 2016). Compared to pregnant travelers it is in pregnant women living in areas with ongoing Zika virus transmission to have a false-positive IgM result likely because the possibility is greater that they have been exposed to a related flavivirus sind.Kinnderuntersuchung and follow-up, when infants have a possible congenital Zika virus infection and traveled their mother during pregnancy in an area with Zika virus infection or has lived there, should be directed investigations by the Zika virus test results of the mother and by whether the child be microcephaly, intracranial calcification or eye abnormalities. If mothers have negative Zika virus test results or were not tested for Zika virus and her child has no microcephaly or intracranial calcification, the child should receive routine care. When mothers regarding positive or equivocal test results. The Zika virus have and their infants suffering from microcephaly or intracranial calcification, the CDC Interim Guidelines for the Evaluation and Testing of Infants with Congenital Possible Zika virus infection should be followed. Therapy Supportive treatment for a Zikavirusinfektion there is no specific antiviral therapy. Treatment is supportive; it includes the following measures: repose fluids to prevent dehydration acetaminophen to relieve fever and pain avoidance of aspirin and other NSAIDs, aspirin and other NSAIDs usually are not used during pregnancy and should especially for all patients due to Zika virus infection be treated to avoid can be excluded to dengue, because of the risk of bleeding. Even death and serious infection due to the Zika virus were treated with immune thrombocytopenia and bleeding brought in connection (1, 2). If laboratory evidence of the Zika virus are present in pregnant women in serum or amniotic fluid, it should be considered that they will receive a serial ultrasound every 3 to 4 weeks to monitor fetal anatomy and growth. A referral to a specialist in maternal-fetal medicine or infectious disease with expertise in pregnancy treatment is recommended. Treatment Notes 1. Sharp TM, Muñoz-Jordán J, Perez-Padilla J, et al: Zika virus infection associated with severe thrombocytopenia. Clin Infect Dis 2016 (Epub ahead of print). 2. Karimi O, Goorhuis A, Schinkel J, et alThrombocytopenia and subcutaneous bleedings in a patient with Zika virus infection. The Lancet 387 (10022): 939-940. 2016. prevention Until more is known, the CDC recommends that pregnant women who want to travel to areas with ongoing Zika virus transfer move this (see also CDC: For Pregnant Women). When choosing women to go they should talk with their doctor about the risks of Zika virus infection and precautions to avoid mosquito bites while driving. Currently there is no vaccine to prevent Zika virus infection. Preventing transmission by mosquitoes Prevention of infection with the Zika virus depends instead of controlling Aedes mosquitoes and preventing mosquito bites when traveling to countries with the ongoing Zika virus transmission. To prevent mosquito bites, the following precautions should be taken (see also the CDC Protection against Mosquitoesand Zika virus: Prevention): Long-sleeved shirts and long pants wear Stay in places with air conditioning or where windows and doors are fitted with fly screens, to keep mosquitoes. Sleeping under a mosquito bed net in places that are not adequately screened or air-conditioned. Use at the Environmental Protection Agency registered insect repellents with ingredients such as DEET (diethyl toluamide) or other approved drugs to exposed skin surfaces. (Not directly to the skin) Treat clothing and equipment with demInsektizid permethrin. For children, the following precautions are recommended: Do not use insect repellent in infants <2 months. Do not use products containing oil of lemon eucalyptus (para-menthane-diol) included in children <3 years. In older children, parents should spray the repellent spray on their hands and then spread to the skin of children. Pull kids clothes that cover their arms and legs or cover the crib, the stroller or baby carrier with a mosquito net. Do not apply insect repellent to the hands, eyes, mouth or on cut or irritated skin of children. Prevention of transmission through blood transfusions, even if the risk of Zika- virus transmission through blood transfusions is considered to be extremely low, the FDA has recommended that donors wait 28 days when there is danger of Zika virus infection in them for any of the following reasons ( see are CDC: Zika and Blood transfusion): travel to or residence in an area with ongoing Zika virus transmission Past Zika virus infection (4 weeks after dissolving the symptoms wait before the donation is done) symptoms of Zika virus infection within 2 weeks of travel in an area with ongoing Zika virus transmission sexual contact with a man who was diagnosed with Zika virus infection sexual contact with a man in the three months before that in an area with ongoing Zika virus transmission or transited lived there ha t. When donors give blood and then develop symptoms of Zika virus infection, requested the Red Cross that will be informed so that it may provide the donors concerned quarantined kann.Prävention sexual transmission Since the Zika virus can be transmitted via semen Men, who reside in an area with active Zika virus transmission or traveled there and have a pregnant partner, abstain from sexual activity or consistently and correctly condoms during sex (ie, vaginal intercourse, anal intercourse, fellatio) for the duration should use pregnancy. This recommendation applies whether men have symptoms or not, because most Zika virus infections are asymptomatic, and if symptoms develop, they are usually mild. RNA of Zika virus was detected up to 62 days after the onset of symptoms in seeds. The CDC has therefore established the following specific recommendations: For men who were diagnosed with Zika virus infection or have symptoms or have had: You should consider condoms or consider to be sexually abstinent for ? 6 months. For couples with a male partner who has traveled an area with ongoing Zika virus transmission: If a Zika virus infection was diagnosed in the male partner or if he has symptoms, the couple should consider to use condoms or for ? 6 months not to have sex after symptom onset. If the male partner does not develop any symptoms, the couple should consider condoms to be used or for ? 8 weeks have sex after the man returned. For couples with a male partner, who live in an area with continuous Zika virus transmission: If a Zika virus infection was diagnosed in the male partner or if he has symptoms, the couple should consider to use condoms or ? not to have sex six months after symptom onset. If the male partner has never developed symptoms, the couple should consider condoms to use or as long not to have sex as Zika is in the area, it has been a case of sexual transmission from female to male. Although not been reported cases of sexual transmission from woman to woman, the CDC now recommends that all pregnant women who have a sexual partner (male or female) have the / who has traveled to an area with Zika or lives there, every time or to use during sex barrier methods not to have sex during pregnancy (1). The CDC published its recommendations for sexually active people. If a partner is not pregnant and lives or in an area with ongoing Zika virus transmission has traveled there, the couple may want to consider condoms to use or not to have sex (see also using CDC: Zika and sexual transmission) .Note 1. for prevention CDC media statement: the first sexual transmission of Zika virus infection from female to male, was reported by the New York. July 2016 Key Points The Zikavirus is primarily transmitted by Aedes mosquitoes. Most of Zika virus infections are asymptomatic; symptomatic infections are usually mild, causing fever, maculopapular rash, conjunctivitis, arthralgia, retro-orbital pain, headache and muscle pain (myalgia). Zika virus infection during pregnancy can cause severe birth defects, called microcephaly. Test pregnant women with a serological test to Zika virus if they have traveled to areas with ongoing Zika virus transmission or living (enzyme-linked immunosorbent assay for IgM, plaque reduction neutralization test) or reverse transcriptase-PCR , Treat supportive; Treat fever with acetaminophen and avoid aspirin or NSAIDs was ruled to dengue. Pregnant women should be counseled to shift their travel to areas with ongoing Zika virus transmission. The prevention of Zika virus infection depends on the control from over the Aedes mosquitoes and avoiding mosquito bites. Since the Zika virus can be transmitted sexually, men and women who live in an area with ongoing Zika virus transmission or have traveled there should refrain from sexual activity or consistently and correctly use barrier methods during sex, while their partner is pregnant. For more information CDC: Zika virus for healthcare providers CDC: Zika virus CDC: Zika travel information CDC: Clinical Guidance for Health Care Providers for Prevention of Sexual Transmission of Zika virus CDC: Zika and Sexual transmission CDC: Zika and blood transfusion CDC: Zika virus: Clinical Guidance for healthcare providers Caring for Infants and Children Temporary guidelines for health care providers who care for pregnant women and women of reproductive age and may be exposed to the Zika virus. CDC: Zika virus: Clinical Guidance for Healthcare Providers Caring for Pregnant Women Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika virus infection CDC: Zika virus: For Pregnant Women CDC: Zika virus: Prevention CDC: Protection against Mosquitoes CDC : Revised diagnostic testing for Zika, chikungunya, and dengue viruses CDC media statement: First female-to-male sexual transmission of Zika virus infection Zika virus: Diagnostic tests Zika virus: information for State and Local Public Health Laboratories

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