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Updated Zika virus information for clinicians

Monday, February 8, 2016   (0 Comments)
Posted by: DCMS
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The following information was provided by the Florida Department of Helath on February 8, 2016:

Zika Fever - Information for CliniciansVersion 1.3 2/8/2016

Please contact your county health department immediately upon initial suspicion if you suspect a patient has Zika fever to ensure prompt mosquito control efforts. Patient health status reporting is also required.

Zika fever, a dengue-like illness caused by a mosquito-borne flavivirus, has been identified in numerous countries in Central and South America, Mexico and the Caribbean including Puerto Rico. Outbreaks have previously been reported in Africa, Southeast Asia and the Pacific Islands. The Ministry of Health of Brazil has reported an increase in the number of babies born with microcephaly and other poor pregnancy outcomes in areas experiencing Zika virus outbreaks. Further studies are being conducted to investigate this concern. Fetuses and infants of women infected with Zika virus during pregnancy should be evaluated for possible congenital infection and neurologic abnormalities. Suspected links between Zika virus infection and Guillain-Barre syndrome (GBS) have also been reported in infected persons.

Transmission occurs through the bite of an infected mosquito. Perinatal, in utero, sexual and transfusion transmission has also been reported. Suspect cases should be advised to avoid mosquito bites while ill to prevent infection of local mosquitoes. Potentially infected men with pregnant partners should either abstain from sex or use condoms during intercourse for the duration of the pregnancy.

Incubation period is approximately 2 to 14 days.

Clinical Presentation: Only about 1 in 5 people infected with Zika virus are symptomatic. Zika fever is a mild illness with symptoms similar to those of mild dengue fever. Severe disease requiring hospitalization is uncommon. Treatment is symptomatic and illness typically resolves within a week. Co-infections with dengue or chikungunya are possible and should be considered. Aspirin and other non-steroidal anti-inflammatory drugs are not advised in case of co-infection with dengue. Pregnant women with fever should be treated with acetaminophen. Signs/symptoms of Zika fever may include:

- Acute fever (often low grade)
- Maculopapular rash
-Arthralgia
-Conjunctivitis
-Myalgia
-Headache
-Retro-orbital pain
-Vomiting

Laboratory testing: Polymerase chain reaction (PCR) at Florida Department of Health can be used to detect viral RNA in serum, urine and saliva samples collected during the first three weeks after illness onset. Serum antibody tests are also available for samples collected ≥4 days after illness onset. However, cross-reaction with related flaviviruses (e.g. dengue) is common and results may be difficult to interpret. Commercial testing for Zika virus is currently not available.

Please contact your county health department to request Zika virus testing for patients meeting the following:

? All persons, including pregnant women, with two or more of the following signs/symptoms: fever, maculopapular rash, arthralgia or conjunctivitis (GBS could follow) and a history of travel to an area reporting Zika virus activity in the two weeks prior to illness onset or is a suspect local case should be immediately reported and tested.

OR

? Cases involving mothers of an infant or fetus with microcephaly or intracranial calcifications or poor fetal outcome diagnosed after the first trimester and with history of travel to an area with Zika virus activity during pregnancy should be immediately reported. Testing of both mother and infant is recommended.

OR

? Testing is available for currently pregnant women who, while pregnant, traveled to an area reporting Zika virus activity regardless of the length of time since the travel/illness occurred, but ideally within 2-12 weeks of

Guidance will be updated as additional information becomes available.

Florida Department of Health in Duval County: 904-253-1850

DOH: www.floridahealth.gov/zika

CDC: http://www.cdc.gov/zika/