Mar 4, 2016

Zika Virus UPDATE

Mosquito

Mosquito

 

March 4th, 2016.
Department of Obstetrics and Gynaecology - University of Toronto.  Version #3
Zika virus information and screening recommendations

 

 

 

Zika virus is a mosquito-borne flavivirus. Fetuses exposed to Zika are believed to be at risk of congenital abnormalities, specifically intracranial calcifications and microcephaly.

Symptoms of Zika may develop between 3 and 12 days following bites from infected mosquitoes and include fever, rash, joint pains and conjunctivitis. However, 80% of infections are asymptomatic. Individuals mount an immune response, first IgM antibodies, approximately 4-14 days following exposure and then IgG antibodies.

Most people exposed to Zika develop immunity without further sequelae, however it appears that 1-5 in 10,000 go on to develop Guillain-Barré syndrome.

Countries at risk and where CDC has issued a travel advisory currently include: Barbados, Bolivia, Brazil, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, St. Martine, Suriname, Venezuela and Puerto Rico. This list is being frequently updated.

Testing Recommendations:

  1. Serologic testing for all pregnant individuals (symptomatic or not) who have traveled to a Zika affected area within the last 12 weeks.
  2. PCR testing (whole blood & urine) and serology testing for acutely ill pregnant individuals who have or have had symptoms (fever, rash, joint pains, conjunctivitis) compatible with Zika virus infection within 2 weeks of travel to an endemic area and within 2 weeks of the symptoms.
  3. Consider amniocentesis for individuals who test positive for Zika virus and/or for those with travel history and whose fetus demonstrates signs of fetal infection (intracranial calcifications, microcephaly).

Recommendations:

  1. Pregnant individuals who test positive for Zika virus should be referred to a Maternal Fetal Medicine Specialist or Reproductive Infectious Disease Specialist.
  2. For pregnant individuals, who have traveled to a Zika affected area and test negative for Zika virus, consideration should be given for an ultrasound assessment between 28-32 weeks and 34-36 weeks.
  3. Male partners of pregnant women who have traveled to a Zika affected area should use condoms with sexual activity for the remainder of the pregnancy.

Travel Recommendations:

  1. Pregnant individuals should AVOID travel to Zika affected areas. Currently there is NO treatment.
  2. If pregnant, avoid mosquito bites. Wear long sleeved shirts, pants and bug repellent with DEET in mosquito infested areas.


References:

  1. CDC
  2. Public Health Agency of Canada 
  3. SOGC  
  4. WHO