Editorial
Volume 3 Issue 1 - 2016
Zika Virus- The Microcephaly Inducing Flavivirus
Olukayode A Akinlaja*
Assistant Professor, Department of Obstetrics & Gynecology, University of Tennessee College of Medicine, Chattanooga
*Corresponding Author: Olukayode A Akinlaja, Assistant Professor, Department of Obstetrics & Gynecology, University of Tennessee College of Medicine, Chattanooga.
Received: February 25, 2016; Published: February 25, 2016
Citation: Olukayode A Akinlaja. “Zika Virus- The Microcephaly Inducing Flavivirus”. EC Gynaecology 3.1 (2016): 223-224.
Zika virus and it’s associated complication has been declared a Public Health emergency of International concern by the World Health Organization (WHO) and presently there is an ongoing epidemic in the Americas and Caribbean [1,2].
First detected in 1947 and named after the Ugandan forest where the rhesus monkey was localized before spreading to Southeast Asia and recently the Americas [3].
Zika virus is a member of the flavirus family, which includes yellow fever virus, dengue and West Nile virus. It is Mosquito-borne and primarily transmitted to humans through the bites of infected Aedes mosquitoes and recently cases of sexual transmission has been described while blood, semen, urine, saliva, amniotic fluid, cerebrospinal fluid and breast milk has been noted to have the viral RNA [4,5,6].
Intrauterine infection and intrapartum infection can result from maternal-fetal transmission [7].
An incubation period of 2 to 14 days between mosquito bite and clinical manifestation has been described and symptoms and signs of infection such as maculopapular rash associated with an acute onset of low grade fever, arthralgia, myalgia, headache, retro-orbital pain and non-purulent conjunctivitis are seen in about 20% of infected individuals [8,9]. Nausea, diarrhea, pruritus, mucus membrane ulceration and abdominal pain are rareoccurence [10]. It is confirmed by the presence of IgM antibody against Zika virus and the reverse-transcription polymerase chain reaction (RT-PCR) detection of viral RNA or antigen but the good news is that case-fatality is low and hospitalization is uncommon [9]. There is an association with Guillain-Barre syndrome while congenital microcephaly, intracranial calcifications, ventriculomegaly and first trimester fetal loss has been seen in infected pregnant womenthough the transmission mechanism and fetal susceptibility risk are unknown [10,11].
Currently, there is no vaccine for preventing transmission so pregnant women with Zika virus exposure needs to be closely followed with serial ultrasound examinations. Those with negative laboratory tests at less than 20 weeks of gestation should have screening ultrasound examinations at about 20 and 28 weeks gestation, while ultrasound examinations at 2 and 6 weeks are done in those with negative tests after 20 weeks of gestation.
For those with positive tests prior to 20weeks of gestation, serial ultrasound examination is recommended every 2 to 4 weeks commencing at 18 weeks gestational age while a positive test after 20 weeks gestation, necessitates an immediate commencement of serial ultrasound exam [12].
Diagnostic amniocentesis with RT-PCR testing for Zika virus can be offered and performed with ultrasound findings of fetal microcephaly, ventriculomegaly and intracranial calcification or with a positive/inconclusive test after 6weeks of maternal exposure.
Attention should be placed on preventing transmission, exposed males should avoid unprotected sex with their pregnant partners, environmental control to eliminate mosquito breeding sites should be implemented and measures to avoid mosquito bites should be adopted by individuals living in endemic region, this is especially so in pregnant women.
The center for disease control presently recommends for pregnant women to consider postponing travel to affected geographic areas and this needs to be taken seriously for the time being while efforts at developing a vaccine should be encouraged [13].
Bibliography
  1. World Health Organization. WHO Director-General briefs Executive Board on Zika situation. Accessed on February 22 (2016).
  2. Centers for Disease Control and Prevention. Zika Virus: Transmission.. Accessed on February 22 (2016).
  3. Hayes EB. “Zika virus outside Africa”.Emerging Infectious Diseases 15.9 (2009): 1347-1350.
  4. Gourinat AC., et al. “Detection of Zika virus in urine”. Emerging Infectious Diseases 21.1 (2015): 21: 84.
  5. Musso D., et al. “Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014”. Euro surveillance 19.14 (2014): 20761.
  6. Musso D., et al. “Detection of Zika virus in saliva”. Journal of Clinical Virology 68 (2015): 53-55.
  7. Besnard M., et al. “Evidence of perinatal transmission of Zika virus, French Polynesia December 2013 and February 2014”. Euro surveillance 19.13 (2014): 20751.
  8. Centers for Disease Control and Prevention. Zika virus: For Health Care Providers: Clinical Evaluation &Disease. Accessed on February 22 (2016).
  9. Ministry of Health- Manuatu Hauora. Zika virus. Accessed on February 22 (2016).
  10. Centers for Disease Control and Prevention. Emergency Preparedness and Response: Recognizing, Managing, and Reporting Zika Virus Infections in Travelers Returning from Central America, South America, the Caribbean, and Mexico. Accessed on February 22 (2016).
  11. World Health Organization. Emergencies preparedness, response: Information for travellers visiting Zika affected countries. (Accessed on February 22, 2016).
  12. The American Congress of Obstetricians and Gynecologists. Practice Advisory: Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak (Accessed on February 22, 2016).
  13. Centers for Disease Control and Prevention. CDC Newsroom: CDC adds countries to interim travel guidance related to Zika virus. Accessed on February 22 (2016).
Copyright: © 2016 Olukayode A Akinlaja. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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