1. Zika Virus in Pregnancy
Max Brinsmead MB BS PhD
October 2018

2. 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

3. 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

4. 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

5. 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

6. 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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