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Clarence W Blea, MDMFM

www.maduraiblooddonors.org Aedes Mosquito

2/22/2016

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Dr K. Solutions Blog Spot

A LITTLE BITOF CLEAN WATER,PLEASE!

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2008

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Zika Virus Transmission Cycles

Epidemic (urban) cycleSylvatic (jungle) cycle

CDC COCA Call 1/26/2016

CDC/COCA 1/26/2016

The Sipper & Skipper

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CDC/PAHO/WHO 1/26/2016

Feb 5 2016

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Costa Rica Nicaragua(Aruba Bonaire Curaco,

Jamiaca,Pac.Il Am. Samoa, Samoa, Tonga

65-80Yucatan-1

Jan 22, 2016CDC Emergency Operations

WHO Feb 1, 2016Public Health Emergency of International concern

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• Association, not yet causative

Lucia & Dad, Brazil

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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.

http://wwwnc.cdc.gov/travel/notices/

http://www.paho.org/hq/index.php?option=com_topics&view=article&id=427&Itemid=41484&lang=en

• Best repellents 25% DEET, 20% Picardin Consumer Reports

CDC.Gov and paho.org

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New guidelines delineate travel < 2 weeks and >2-12 weeks

2 weeks of Travel

• UNIVERSAL Fetal evaluation REGARDLESS of testing results in all exposed symptomatic women Test all with U/S abnormalities

Jan 19 2016

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• POSITIVE Ultrasound signs• Retest woman

• Offer amniocentesis

Offer testing to ALL

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ALL

ALL

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CDC/COCA 2016Future may entail Urine, saliva, other mucosal areas

POC’s

REFLEX BY CDC

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CDC Memorandum Feb 7, 2016

VIRAL SPECIFIC PCR

CDC Memorandum Feb 7, 2016

SEROLOGY AND PRNT TO FOLLOW

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“As with any diagnostic test, while a negative Zika IgM or RT-PCR test would suggest that an infection has not occurred, a negative Zika IgM or RT-PCR test result does not rule out infection with Zika virus. “

CDC Memorandum Feb 7, 2016

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2 cases from Paraiba, Brazilian cluster neg. testing, with positive U/S findings.

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a Absent vermisb dysgenesis of corpos callosum s. & vermis L.c interhemispheric fissure, calcificationsd calcifications

30 weeks, small HC 2.6 SD brain atrophy and calcifications.

ventriculomegaly, cystic dilated ventricle & cacifications

Absent thalamus, thin pons andbrainstem

Calcifications and atrophy

29.2 weeks HC small3.1 SD, AC < 3 % ile

Small eyes

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Amniocentesis, Urine, & serum

• Neg TORCH, Denge & chikungunya

• + IgM & + RT PCR forZika

• Sequenced Viral particles

• Viralogic & Genetic data implication Zika

• ?Possible causative agent

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A Cerebral calcifications and ventriculomegaly B Placental calcifications

A Disrupted cell

B Magnified Box =Virions

C Presumed Viral replication

D Stained virus particle c/w Flavivirus

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CDC/COCA 1/26/2016

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..& Partner

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10-20X increase in Microcephaly in BRAZIL

Probable independent sources of virus

Spread in Americas due to lack of herd immunity

Viral tropism to brain tissue & crosses BBB*

Autophagy altered to create viral factories*

Increase with travel and world economy

Atypical behavior of virus found in Nucleus

WHO concerned about “Other “Aedes infections

The Olympics are in Rio THIS SUMMER!

Additional notes…...

*Tetro JA, Zika and microcephaly: Causation, correlation, or coincidence?, Microbes and Infection (2016),http://dx.doi.org/ 10.1016/j.micinf.2015.12.010