Anda di halaman 1dari 21

ZIKV TRANSMISSION

PRIMARY MODE: INCUBATION PERIOD:


BITE OF AEDES MOSQUITO 2-7 DAYS
OTHER MODES:
BLOOD TRANSFUSION
SEXUAL TRANSMISSION
PERINATAL TRANSMISSION
! TRANSMISSION THROUGH BREASTMILK HAS
NOT BEEN DOCUMENTED !
ZIKV CLINICAL MANIFESTATIONS

PRESENTATION VERY SIMILAR WITH DENGUE VIRUS INFECTION


MACULO-POPULAR RASHES, FEVER, HEADACHE, MYALGIA, ARTHRALGIA
CASE DEFINITION OF ZIKV DISEASE
(PER DOH DM 2016-0116A)

SUSPECTED CASE: SUSPECTED CASE


PATIENT WITH SKIN RASH AND MOTHER WHOSE FETUS OR NEWBORN/INFANT
ONE OF THE FOLLOWING: HAS ANY OF THE FOLLOWING NEUROLOGICAL
FEVER ( <38.5C) OR REPORTED HISTORY CONDITION (CANNOT BE EXPLAINED BY OTHER ETIOLOGIES):
OF FEVER IN THE PAST 5 DAYS PRIOR TO
CONSULATION
HEAD CIRCUMFERENCE < - 3 SD OR OCCIPITOFRONTAL
CIRCUMFERENCE LESS THAN 3RD PERCENTILE ON STANDARD GROWTH
ARTHRALGIA CHART OR
ARTHRITIS DISPROPORTIONATELY SMALL HEAD COMPARED TO LENGTH

CONJUNCTIVITIS INTRA-CRANIAL CALCIFICATIONS


CASE DEFINITION OF ZIKV DISEASE
(PER DOH DM 2016-0116A)

SUSPECTED CASE SUSPECTED CASE


FETUS/NEWBORN/INFANT WHOSE MOTHER ALL NEWLY DIAGNOSED GUILLAIN-
HAD CONFIRMED OR BARRE SYNDROME (GBS)
PRESUMED INFECTION OF ZIKV
DURING PREGNANCY
CASE DEFINITION OF ZIKV DISEASE
(PER DOH DM 2016-0116A)

PROBABLE CASE CONFIRMED CASE


A SUSPECTED CASE WITH ZIKV WHO TESTED A SUSPECTED OR PROBABLE CASE OF ZIKV WHO
POSITIVE FOR IGM SEROLOGY TESTED POSITIVE IN:
FOR ZIKV
REAL-TIME PCR OR

VIRUS ISOLATION IN ANY BODY


FLUID
LABORATORY WORK-UP

DIAGNOSTIC TESTS
VIRAL NUCLEIC ACID DETECTION THROUGH POLYMERASE CHAIN REACTION
VIRUS ISOLATION
SEROLOGICAL TESTING ONCE AVAILABLE
ZIKV DIAGNOSTIC TESTS
INDICATIONS FOR ZIKV TESTING

1. ALL SUSPECTED CASES OF ZIKV INFECTION


2. ALL PREGNANT WOMEN WITH HISTORY OF TRAVEL TO AN AREA WITH ZIKV TRANSMISSION DURING
PREGNANCY, WITH OR WITHOUT SIGNS AND SYMPTOMS REFERABLE TO ZIKV INFECTION
3. ALL PREGNANT WOMEN WHO HAD UNPROTECTED SEX WITH THEIR PARTNERS WHO LIVED OR
TRAVELLED IN AREAS WITH TRANSMISSION OF ZIKV DURING THEIR PREGNANCY
INDICATIONS FOR ZIKV TESTING

4. NEWBORNS/INFANTS WITH MICROCEPHALY OR INTRACRANIAL CALCIFICATIONS BORN TO WOMEN


WHO TRAVELLED TO, RESIDED OR HAD UNPROTECTED SEX WITH THEIR PARTNERS WHO LIVED OR
TRAVELLED IN AREAS WITH ZIKV TRANSMISSION DURING THEIR PREGNANCY
5. NEWBORNS/INFANTS BORN TO MOTHERS WITH POSITIVE OR INCONCLUSIVE TEST RESULTS FOR ZIKV
INFECTION
ALGORITHM FOR PREGNANT WOMEN
ALGORITHM FOR PREGNANT WOMEN

*If pregnant is (+) for ZIKV thru PCR, serology is no longer required
** If pregnant is (-) for ZIKV thru PCR, serology is required to rule out previous ZIKV
ALGORITHM FOR PREGNANT WOMEN

*** If serology is (-) for ZIKV, test for Dengue and Chikungunya
ZIKV TESTING FOR NEWBORNS/INFANTS
INITIAL SAMPLE: CORD BLOOD OR DIRECTLY FROM THE NEWBORN WITHIN 2 DAYS OF BIRTH
TEST NEWBORN/INFANT SERUM FOR ZIKV RNA, ZIKV IGM & NEUTRALIZING ANTIBODIES, AND DENGV IGM &
NEUT AB
TEST UMBILICAL CORD BLOOD USING RT-PCR
CSF: ZIKV RNA, ZIKV IGM & NEUT AB, DENGV IGM & NEUT AB
FIXED TISSUE OF PLACENTA & UMBILICAL CORD: ZIKV IMMUNOHISTOCHEMCIAL STAIN
FIXED & FROZEN TISSUE OF PLACENTA & UMBILICAL CORD: ZIKV RT-PCR
TEST MOTHERS SERUM FOR ZIKV IGM & NEUT AB, DENGV IGM & NEUT AB
CLINICAL MANAGEMENT

TREATMENT IS MAINLY SUPPORTIVE.


NO VACCINES OR SPECIFIC ANTI-VIRAL DRUGS AVAILABLE
NSAIDS SHOULD NOT BE USED UNTIL DENGV IS RULED OUT
CLINICAL MANAGEMENT
PREGNANT WOMEN WITH LAB EVIDENCE OF ZIKV : REFERRAL TO

PERINATOLOGIST, OB-INFECTIOUS DISEASE OR IM-INFECTIOUS DISEASE


SPECIALISTS

NEWBORNS WITH CONGENITAL ZIKV INFECTION: SUPPORTIVE TREATMENT & SPECIFIC


PEDIATRIC MANAGEMENT, NEURODEVELOPMENTAL ASSESSMENT & SUPPORT

INITIATE BREASTFEEDING AT BIRTH & EXCLUSIVELY BREASTFEED FOR 6 MONTHS


REFER TO TERTIARY HOSPITAL FOR PROPER MANAGEMENT
CARE FOR PREGNANT WOMEN SUSPECTED
FOR ZIKA
ALL PREGNANT WOMEN SHOULD BE ADVISED TO PRESENT FOR THEIR SCHEDULED ANTENATAL VISITS (AT LEAST
1-1-2)
WOMEN SHOULD BE COUNSELLED TO PRESENT EARLY FOR TREATMENT AND DIAGNOSTIC WORK-UP IF THEY
DEVELOP ANY OF THE SYMPTOMS OF ZIKV INFECTION
DURING ALL ANTENATAL VISITS: PROVIDE INFO ON STANDARD ENVIRONMENTAL AND PERSONAL PROTECTION
MEASURES FOR VECTOR-BORNE DISEASES, INCLUDE SANITATION & HYGIENE
SCREEN FOR ZIKA USING CHECKLIST AT EVERY ANTENATAL VISIT
FETAL ULTRASOUND IN LATE 2ND OR EARLY 3RD TRIMESTER (BETWEEN 28-30 WEEKS AOG) TO IDENTIFY FETAL
MICROCEPHALY AND/OR OTHER BRAIN ABNORMALITIES
CARE FOR PREGNANT WOMEN CONFIRMED
FOR ZIKA

ALL WOMEN SHOULD BE OFFERED CONGENITAL ANOMALY SCAN AT LEAST AT 20 WEEKS AOG
OFFER 1ST TRIMESTER ULTRASOUND TO ACCURATELY DETERMINE GESTATIONAL AGE
CARE FOR PREGNANT WOMEN WITH POSSIBLE ZIKV-RELATED
MICROCEPHALY AND/OR OTHER BRAIN ABNORMALITIES
IF (+) FETAL BRAIN ABNORMALITIES CONFIRMED BY ULTRASOUND AND (+) ZIKV TEST CONFIRMED BY
MATERNAL SERUM OR AMNIOCENTESIS
REFER FOR SPECIALIZED CARE
SHOULD RECEIVE INDIVIDUALIZED CARE AND COUNSELING ALONG WITH THE PARTNER
PROVIDE APPROPRIATE CARE TO MANAGE ANXIETY, STRESS AND THE BIRTH ENVIRONMENT

PLANS FOR CARE & MGT OF THE BABY SOON AFTER BIRTH SHOULD BE DISCUSSED WITH THE PARENTS IN
CONSULTATION WITH A PEDIA OR PEDIA-NEURO
ALL WOMEN, WHATEVER THEIR INDIVIDUAL CHOICES WITH RESPECT TO THEIR PREGNANCIES, MUST BE
TREATED WITH RESPECT AND DIGNITY
PREVENTION AND CONTROL
PROTECTION OF THE SKIN FROM EXPOSURE TO MOSQUITOES BY WEARING CLOTHES THAT COVER AS
MUCH OF THE BODY AS POSSIBLE
USE OF MOSQUITO BEDNETS, EVEN WHEN SLEEPING DURING THE DAYTIME
USE OF MOSQUITO SCREENS/MESH ON WINDOWS AND DOORS
USE OF INSECT REPELLENT APPROVED BY THE FDA TO BE SAFE TO USE DURING PREGNANCY
SAFE SEXUAL PRACTICES: CORRECT AND CONSISTENT CONDOM USE OR ABSTAIN FROM SEXUAL
ACTIVITY FOR THE DURATION OF THE PREGNANCY