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CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this live activity
for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.0 contact hours.
IACET CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.1 CEU's for this
program.
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education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists
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advanced level continuing education contact hours available are 0. CDC provider number 98614.
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pharmacy education. This program is a designated event for pharmacists to receive 0.1 CEUs in pharmacy education. The Universal Activity Number is
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Objectives
At the conclusion of this session, the participant
will be able to:
Describe the epidemiology, clinical manifestations,
management, and prevention of Zika virus disease
u Discuss diagnostic testing for Zika virus infection and
interpretation of test results
u Articulate the importance of early recognition and
reporting of cases
u State the recommendations for pregnant women and
possible Zika virus exposure
u Discuss evaluation of infants with microcephaly and the
relationship of Zika and microcephaly
u
TODAYS PRESENTER
TODAYS PRESENTER
TODAYS PRESENTER
Zika Virus
Zika Virus
Single stranded RNA Virus
Genus Flavivirus, Family Flaviviridae
Closely
related
to
encephalitis and West
Nile viruses
dengue,
yellow
fever,
Japanese
Aedes Mosquitoes
Aedes species mosquitoes
Ae albopictus
Also transmit dengue and
chikungunya viruses
Lay eggs in domestic waterholding containers
Live in and around households
Aggressive daytime biters
Intrauterine
Perinatal
Other
Sexual
Blood transfusion
Laboratory exposure
Theoretical
Organ or tissue
transplantation
Zika Virus:
Countries and Territories with Active Zika
Virus Transmission
as of January 23,
2016
2013 2014,
>28,000
reported
suspected
on
*http://ecdc.europa.eu/en/publications/Publications/Zika-virus-FrenchPolynesia-rapid-risk-assessment.pdf
Yap
cases
Zika Virus
Rates
Incidence
and
Attack
attack
rate
among
infected:
18%
28
90%
20
65%
15
48%
12
39%
10%
of
52
Data Source:
Reported
from the IHR
National
Focal Points
and through
the Ministry
of Health
websites.
Map
Production:
PAHO-WHO AD
CHA IR ARO
Brazil State
Boundaries
Source: Pan American Health Organization, Epidemiological
Distinguishing
Chikungunya
Zika
from
Dengue
and
clinical
Clinical Features:
++
+++
+++
++
++
++
+++ + ++
Conjunctivitis
Arthralgia
++ + +++
Myalgia
Headache
+ ++ ++
Hemorrhage
Shock
- + -
neutralizing
antibodies
in
Serology
Cross-Reactions
Flaviviruses
with
Other
at
CDC
and
few
state
contact
their
(i.e.,
rest,
fluids,
be
avoided
until
Leptospirosis
Malaria
Rickettsia
Rubella
Measles
Adenovirus
Enterovirus
Parvovirus
* Similar
clinical features
to
or
medication
prevention
measure
to
is
prevent
to
infection
reduce
or
mosquito
exposure
From 20102014, 1.5 million dengue cases reported per year to PAHO
558 travel-related and 25 locally transmitted cases in U.S. states
No evidence of increased
susceptibility
Centers for Disease Control and Prevention, CDC Health Advisory: recognizing Managing and reporting Zika Virus Infections in
Travelers Returning from Cental America, South America, the Caribbean and Mexico, 2016.
Besnard, M., et al., Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro
Surveill, 2014. 19(14): p. 1-5.
Oliveira Melo, A., et al., Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?
Ultrasound in Obstetrics & Gynecology, 2016. 47(1): p. 6-7.
CDC Recommendations:
Pregnant Women
Avoid mosquito bites :
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Interim guidance:
Antepartum:
Consider serial ultrasounds every 3-4 weeks
Consider referral to specialist with expertise in pregnancy
management
Peripartum:
Histopathologic examination of the placenta and umbilical cord;
Testing of frozen placental tissue and cord tissue for Zika virus
RNA
Testing of cord serum for Zika and dengue virus IgM and neutralizing
antibodies
What is
Microcephaly?
a n a D
e p i l e F / s o t o h P
scattered
intracranial
t scattered
int
calcificati
ons
enlarged ventricles
and volume loss
Range of Microcephaly
Severity
in
1984
but
noted
in
earlier
Moore et al., J
Recommended for
1.Infants with microcephaly or intracranial
calcifications born to
women who traveled to or resided in an area
with Zika virus
transmission while pregnant
2.Infants born to mothers with positive or
inconclusive test results for
Zika virus infection
antibodies
Clinical specimens
possible)
umbilical cord)
tissue)
mothers serum
antibodies
*When indicated, including: 1) infants with microcephaly or intracranial calcifications born to women potentially exposed to Zika
virus during pregnancy, or 2) infants born to mothers with positive or inconclusive test results for Zika virus infection.
Interim Guidelines:
Evaluation and Testing of
Infants with
Possible Congenital Zika
Virus Infection
Among infants
with
microcephaly
or
intracranial
calcification
s
Interim Guidelines:
Evaluation and Testing of
Infants with
Possible Congenital Zika
Virus Infection
Among infants
without
microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of
Infants with
Possible Congenital Zika
Virus Infection
Among infants
without
microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of
Infants with
Possible Congenital Zika
Virus Infection
Among infants
without
microcephaly
or intracranial
calcifications
Interim Guidelines:
Evaluation and Testing of
Infants with
Possible Congenital Zika
Virus Infection
Among infants
without
microcephaly
or intracranial
calcifications
eye exam to include visualization of the retina, optic nerve, and macula either
before discharge from the hospital or within 1 month after birth*
Complete blood count, platelet count, and liver function and enzyme tests
including alanine aminotransferase, aspartate aminotransferase, and bilirubin
Summary
Zika virus continues to circulate and cause locally-transmitted
disease in
the Americas
Consider the possibility of Zika virus infection in travelers with
acute fever,
rash, arthralgia, or conjunctivitis within 2 weeks after return
A substantial increase in rates of congenital microcephaly have been
reported in Brazil
with
PAHO
and
other
regularly
with
clinicians
(COCA
Additional resources
CDC Zika virus information:http://www.cdc.gov/zika/
PAHO Zika virus pages:
http://www.paho.org/hq/index.php?
option=comtopics&view=article&id
=427&Itemid=41484&lang=en
Zika
virus
information
clinicians:http://www.cdc.gov/zika/hcproviders/index.html
Zika virus information
health providers:
for
travelers
for
and
travel
Selected references
Besnard M, et al. Evidence of perinatal transmission of Zika virus, French
Polynesia, December 2013 and February 2014 . Euro Surveill 2014;19(13):20751.
Duffy MR, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N
Engl J Med 2009;360:25362543.
Foy BD, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA.
Emerg Infect Dis 2011;17(5):880882.
Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15(9)13471350.
Kusana S, et al. Two cases of Zika fever imported from French Polynesia
to Japan, December to January 2013. Euro Surveill 2014;19(4):20683.
Kwong JC, et al. Case report: Zika virus infection acquired during
brief travel to Indonesia. Am J Trop Med Hyg 2013;89(3):516517.
Lanciotti RS, et al. Genetic and serologic properties of Zika virus associated
with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14(8):1232
1239.
Musso D, et al. Potential for Zika virus transmission through blood
transfusion demonstrated during an outbreak in French Polynesia, November 2013 to
February 2014. Euro Surveill 2014;19(14):20761.
Oehler E, et al. Zika virus infection complicated by Guillain-Barre syndrome
case report, French Polynesia, December 2013. Euro Surveill 2014;19(9):20720.
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