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2/22/2016
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Clarence W Blea, MDMFM
www.maduraiblooddonors.org Aedes Mosquito
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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