Zika Virus in Pregnancy Max Brinsmead MB BS PhD October 2018

Zika Virus Caused by a Favivirus related to yellow fever, dengue, West Nile and Japanese encephalitis First noted in central Africa in monkeys in 1947, but appeared in Pacific Islands in 2007, then noted to be spreading as a pandemic from South towards North America in 2014 Transmitted by mosquitoes mostly Ae. aegypti This mosquito found only in far N Queensland

Zika Virus Infection Causes a mild febrile illness in adults Diagnosis Begins with headache Maculopapular rash (variable) Myalgia and Arthralgia Conjunctivitis Diagnosis ELISA for IgM and IgG Some cross reactivity with dengue PCR for acute phase viral RNA Zika virus particles and RNA Found in fetal brain in mid trimester With progressive microcephaly seen after maternal infection

Zika Virus in Pregnancy Apparent transplacental with progressive fetal microcepahy and brain calcifications Transmission Risk – Emerging data Best data from a prospective study in French American territories Overall 13% 1st trimester and 5.5% 3rd trimester Microcephaly rate 5.8% of which 1.6% severe American CDC recommends that any woman who has travelled to a known endemic area and who has two or more symptoms should be tested for ZV IgG Monitor fetus with ultrasound and Refer to a Perinatal Specialist Unit for management No treatment available

Prevention Avoid mosquito bites Pregnant women should avoid travel to areas known to harbour Zika Virus Check current maps and guidelines Avoid mosquito bites Very low risk of transmission in Australia as most areas do not have the appropriate species of mosquito that would act as a vector

Sexual Transmission of Zika Virus Zika Virus can be transmitted sexually The transmission risk is LOW But it can be transmitted before a person becomes symptomatic And possibly by asymptomatic persons It has been detected in semen for quite long periods Up to 6 months after infection Mean clearance from serum was 84 days 95% cleared in 4 months Women whose partner has or may have Zika are advised to avoid pregnancy Check how long with current guidelines Women in Zika areas are advised to use condoms or avoid sex during pregnancy

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