What Pediatricians and Other Clinicians Should Know About Zika Virus

The Zika virus is a recent epidemic that has been spreading across parts of Africa and much of South America. The virus has begun spreading at increasing alarming rates and is on its way to become a global health crisis. The issue with the virus is that while it may cause some symptoms in newly infected hosts, it has a large impact on those for women who may become pregnant. The virus can cause birth defects which will influence and often hinder a child’s development. Due to easier global travel the virus is able to spread more quickly and is no longer in isolated geographical location. The virus is often transmitted by mosquitos. There is not current cure of vaccine for the Zika virus, the only prevention and recommendations that have been made are to wear DEET or paricardian containing bug repellant along with long sleeves and long pants.

I think the major issue with the Zika virus is that it will be affecting a whole infant population in certain regions and countries. These regions and countries must then begin to develop programs and allocate appropriate resources for these affected infants as they grow and mature. These issues may place even more stress on areas with low levels of medical care and governmental resources. As healthcare providers I believe it is our job to help educate others and help find possible solutions in the battle against the virus. I think pharmacist would be essential in providing information and care for individuals who have infants affected by the virus.

 

 

http://archpedi.jamanetwork.com/article.aspx?articleid=2496286

 

Kline MW, Schutze GE. What Pediatricians and Other Clinicians Should Know About Zika Virus. JAMA Pediatr. Published online February 18, 2016. doi:10.1001/jamapediatrics.2016.0429.

Study finds strong link between Zika virus and Guillain-Barre Syndrome

The Zika virus has been in the headlines quite often recently. It is a disease spread by daytime mosquitoes that leads to symptoms including rash, fever, joint pain and red eyes. Currently, it is concentrated in central and south America. However, the disease is spreading into North America and there have been 107 reported cases of the Zika virus in Americans who have travelled from the infected area.

Between October 2013 and April 2014, French Polynesia experienced the largest Zika virus outbreak ever described to date. A study was conducted once a correlation was noticed between areas with the Zika virus and increased cases of the neurological disorder, Guillain-Barre syndrome. Of those who developed Guillain-Barre, 98% of them had Zika virus antibodies, suggesting the virus could be causing the disease.

Guillain-Barre syndrome results in symptoms starting with weakness and tingling in the feet and legs that spread to the upper body. Paralysis can even occur. Overall, it is a condition in which the immune system attacks the nerves and it is triggered by an acute bacterial or viral infection. Treatment is extensive, and includes plasma exchange and immunoglobulin therapy to relieve symptoms. Physical therapy is needed, too.

This newly discovered risk associated with the Zika virus only stresses the importance of preventing its spread. Strategies should be shared on how to avoid daytime mosquitoes and protect yourself. Pharmacists can play a role in this by educating patients in community pharmacy settings on which products work the best to deter mosquitoes and what to look out for as far as early symptoms of the virus.

 

Read the full study here.

Cao-Lormeau VM, Blake A, Mons S, et.al. Guillain-Barre Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016;(published online):1-9

The Emerging Zika Pandemic Enhancing Preparedness

The Zika virus is related to the yellow fever, West Nile, and dengue. It was first discovered in 1947 and since May 2015, it has appeared in at least 20 countries in the Americas. The virus infection typically have mild symptoms and fatalities are uncommon. The main concerning symptom is microcephaly, where newborns are born with a non-exisiting forehead. This is a concern because, the effects of this mutation is unknown. To prepare for the Zika virus, the United States should adopt strategies set by the International Health Regulations.

Strategies include vector control, risk communications, enhanced Zika surveillance, travel advisories and many more. Vector control is controlling mosquito breeding grounds. Risk communication is educating the public to avoid mosquito exposures, such as using insect repellents and using physical barriers to keep out mosquitoes. Countries are required to report unusal Zika-related cases which falls under enhanced Zika surveillance. Travel advisories are strageties to decrease the spread of the Zika virus such as advising women to consider avoid traveling to Zika infected countries. The implementations of these strategies are the responsibilities of the IHR.  The World Health Organization (WHO) has yet to created a IHR Emergency Committee to advise countries on how to prepared for the Zika virus.

In 2015 during the Ebola Panel, WHO did not react appropriately to the Ebola epidemic, costing thousands of lives and now during the Zika pandemic, WHO is still not taking a leadership role. The article mentions the director-general of WHO was heavily criticized for  declaring a Public Health Emergency of International Concern(PHEIC) four months after the first cross border transmission of Ebola. The authors are hoping WHO will not have a repeat of the Ebola incident with the current Zika pandemic.

I’m sure that the Zika virus will appear in the news more often as the weather becomes warmer. The United States is predicted to be affected by the Zika virus too. There is currently no vaccine or drug to combat the Zika virus so how should the healthcare field respond if this prediction is correct?

Citation

Gostin Lawrence, Lucey Daniel. The Emerging Zika Pandemic Enhancing Preparedness. JAMA. doi:10.1001/jama.2016.0904 (published January 27, 2016)

http://jama.jamanetwork.com/article.aspx?articleid=2485361

Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazi

The Zika Virus is a arbovirus that is named after a forest in Uganda. It is primarily transmitted through mosquito bites and other methods of blood transmission but has also been known to be transferred through sexual contact. The only current methodology of diagnosing the Zika Virus is through real time polymerase chain reaction however this method is not effective in detecting the virus in newborns.

Since 2015 an epidemic of the Zika Virus has been plaguing the country of Brazil. 6 months after the first onset it has shown that 1248 new cases were reported. In January of 2016 it was reported that 3,174 newborns had been infected with the virus. Through this great abundance of newborn infections it was noted that newborns with the disease had developed ocular lesions on their eyes. This article provides a study that was done on 29 infants to evaluate whether or not ophthalmologic evaluations should be done in areas with high rates of Zika Virus transmission as a means to diagnose newborns with the infection.

The findings showed that 10 of the 29 newborns or about 35% had ocular abnormalities. The study believes that this information can provide valuable clinical analysis insight on diagnosing the Zika Virus. Newborns should be continually given ocular examinations in order to constantly screen for this condition. This can help lower the spread of the virus in high transmission areas.

Do you feel that this information will help stop or at least halt the transmission of the Zika Virus? Is 10 out of 29 enough evidence to be used as sufficient clinical analysis? Why or Why Not?

Citation:

de Paula Freitas B, de Oliveira Dias J, Prazeres J, et al. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol.Published online February 09, 2016. doi:10.1001/jamaophthalmol.2016.0267.

Guidelines for the Zika virus in pregnant women

According to the CDC, the Zika virus is transmitted through a certain type of mosquito that also transmits other viruses that have been found in the United States. Although the Zika virus has not yet been identified in the United States, there have been infections reported throughout the world in people returning from travel to an area that has seen this virus, which could result in disease transfer from human to human rather than from mosquito and human. This increases the risk of the virus entering the United States.

Pregnant women are not thought to be more at risk for this disease or to have more serious symptoms. However, there is currently an outbreak of this virus in Brazil, and there has been an increase in infants born with microcephaly, which is a disease characterized by abnormal brain growth and an underdeveloped head size. Because of this, there are studies underway to see if the Zika virus is the cause, but until then, the CDC is recommending that all pregnant women hold off on traveling to areas that have a Zika virus outbreak, and if they do travel to this area, to wear long sleeved shirts and use insect repellants. There is no vaccine to prevent this infection and there is currently no cure, just the recommendation of rest, fluids and acetaminophen for fever and pain. In addition, if a woman has been tested positive for this virus, she should receive regular ultrasounds to monitor the growth of her baby and talk with a fetal medicine specialist.

MMWR Morb Mortal Wkly Rep. 2016;65(Early Release):1-4.

I thought this article was very interesting because it was proactive, discussing emerging health risks in other areas of the world before they hit the United States. I believe looking at health information from other areas of the world, especially those neighboring the U.S., and initiating studies based on that information should be done more often to help prevent large outbreaks that can turn into epidemics, which were seen with Ebola and the West Nile Virus. In addition, working on preventative measures, such as vaccines, as early as possible is one step that can be made to help prepare for potential disease outbreaks, because it is better to be over prepared than to be working against an epidemic.