- Low grade fever (usually <38.5C)
- Myalgias/arthralgias (hands/feet)
- Retro-orbital pain
- Maculopapular rash
- 359 Zika travel related cases
- 2 sexually transmitted cases
- 16 Zika infected pregnancies
- Of these 16 pregnancies 2 had vertical transmission
- 1 of these neonates had Zika related abnormalities at birth
- PCR to detect the virus itself
- Serology to detect antibodies to the virus
- < 10 days of symptoms – PCR and serology needs to be completed
- > 10 days of symptoms – only serology needed
- PCR – up to 14 days
- Serology – 3-8 weeks
- Patients with symptoms
- Asymptomatic pregnant women
- Asymptomatic women who may become pregnant
- Travel location
- Dates of travel
- Symptoms & onset
- Pregnancy status
- Flavivirus vaccinations
- Japanese encephalitis
- Yellow fever
- Guillain-Barre syndrome is the most commonly reported and most researched serious complication of Zika virus2
- Cao-Lormeau et al., 2016 conducted a case control study in French Polynesia9
- 2 sets of controls
- 1 – patients with non-febrile illness who presented to ED
- 2 – patients with Zika but no GBS symptoms
- Had 42 patients with GBS during study
- 98% had anti-Zika 1gM or IgG
- All had neutralizing antibodies
- Found incidence of GBS during outbreak was 1 in 4 000 Zika infected patients
- Fetal death
- Placental insufficiency
- Fetal growth restriction
- CNS injury
- 2 fetal deaths (36 + 38 wks GA)
- 5 IUGR (+/- microcephaly)
- 4 ventricular calcifications
- 4 abnormal cerebral or umbilical artery flow
- 2 abnormal amniotic fluid volume
- 2 CNS lesions
Abnormalities on US were found in women who contracted the virus through all trimesters (see figure below).
Brasil P, Pereira J,Jose P., Raja Gabaglia C, Damasceno L, Wakimoto M, Ribeiro Nogueira RM, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro — Preliminary Report. N Engl J Med 2016;ePub.
Cauchemez etal. 2016 conducted a retrospective analysis looking at the gestational age at which the risk of Zika induced microcephaly peaks.10 They collected serological and surveillance data to estimate infection risk. They then used this data in conjunction with information regarding 8 cases of microcephaly found during the outbreak to find the best mathematical model to predict periods of risk during pregnancy.
The best model found risk highest in 1st trimester and possibly early 2nd trimester. The risk of microcephaly was predicted to be 1% in women who contract Zika in the 1st trimester.
Top 5 Take Home Points
1. List of Zika infected countries is constantly changing
o Refer patients to the Zika websites at WHO, CDC or Health Canada for current information
2. Most patients who contract Zika will have a benign viral illness
3. Risk of GBS with Zika is 1 in 4 000
4. Zika causes microcephaly, especially in 1st trimester
5. In the ED for a patient suspected of having Zika:
o Draw blood work (and complete the 2 requisitions)
o Refer to Tropical Medicine Clinic
Dr. Julia Traer, MD, CCFP is a 3rd year resident in the CCFP-EM Program at the University of Ottawa.
-- Edited and Formatted by Dr. R Suttie, PGY2 at the University of Ottawa
1. Government of Canada. Surveillance of Zika virus. http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/zika-virus/surveillance-eng.php#s2-1. Accessed November 7, 2016.
2. Zika Working Group on behalf of the Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian recommendations on the prevention and treatment of Zika virus: Update. Can Comm Dis Rep 2016;42:101-11
3. Brasil P, Pereira J,Jose P., Raja Gabaglia C, Damasceno L, Wakimoto M, Ribeiro Nogueira RM, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro — Preliminary Report. N Engl J Med 2016;ePub.
4. Centers for Disease Control and Prevention. Zika Basics: Flipbook for Community Health Workers. https://www.cdc.gov/zika/pdfs/zika_basics_low-literacy_flipbook.pdf. Accessed November 7, 2016.
5. European Centre for Disease Prevention and Control. Current Zika transmission. http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/zika-outbreak/pages/zika-countries-with-transmission.aspx. Accessed November 7, 2016.
6. World Health Organization. Zika virus, Microcephaly and Guillain-Barré Syndrome Situation Report 3 November 2016. 2016; http://apps.who.int/iris/bitstream/10665/250724/1/zikasitrep3Nov16-eng.pdf?ua=1 Accessed November 7, 2016.
7. Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveil 2014;19(14):20761.
8. The Ottawa Hospital. TOH Zika Management Plan & Information for Health Care Providers. The Ottawa Hospital intranet. Accessed November 20, 2016.
9. Cao-Lormeau V, Blake A, Mons S, Lastere S, Roche C, Vanhomwegen J, et al. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case- control study. Lancet 2016;ePub.
10. Cauchemez S, Besnard M, Bompard P, Dub T, Guillemette-Artur P, Eyrolle-Guignot D, et al. Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study. Lancet 2016;ePub.