Friday, 29 January 2016

Zika Virus By Jaikumar pareta

  • Zika Virus By Jaikumar pareta

  •  Introduction :

  • Zika virus is transmitted to humans by infected mosquitoes. It causes mild fever and rash. Other symptoms include muscle pain, joint pain, headache, pain behind the eyes and conjunctivitis.
  • Zika virus disease is usually mild, with symptoms lasting only a few days.
  • The disease has similar clinical signs to dengue, and may be misdiagnosed in areas where dengue is common.
  • There is no cure for Zika virus disease. Treatment is focused on relieving the symptoms.
  • Prevention and control relies on reducing the breeding of Aedes mosquitoes and minimizing contact between mosquito vectors and people by using barriers (such as repellents, insect screens), reducing water-filled habitats supporting mosquito larvae in and close to dwellings, and reducing the adult mosquito populations around at-risk communities.







Background

Zika virus is a mosquito-borne flavivirus closely related to dengue virus. It was first isolated from a rhesus monkey in Zika forest, Uganda in 1947, in mosquitoes (Aedes africanus) in the same forest in 1948 and in humans in Nigeria in 1954. Zika virus is endemic in parts of Africa and Asia and was first identified in the South Pacific after an outbreak on Yap Island in the Federated States of Micronesia in 2007. 

Transmission

Zika virus is primarily transmitted to humans through bites from Aedes mosquitos, which often live around buildings in urban areas and are usually active during daylight hours (peak biting activity occurs in early mornings and late afternoons).
Some evidence suggests Zika virus can also be transmitted to humans through blood transfusion, perinatal transmission and sexual transmission. However, these modes are very rare.
The incubation period is typically between 2 and 7 days.

Signs and symptoms

Zika virus infection is characterized by low grade fever (less than 38.5°C) frequently accompanied by a maculopapular rash. Other common symptoms include muscle pain, joint pain with possible swelling (notably of the small joints of the hands and feet), headache, pain behind the eyes and conjunctivitis. As symptoms are often mild, infection may go unrecognized or be misdiagnosed as dengue.
A high rate of asymptomatic infection with Zika virus is expected, similar to other flaviviruses, such as dengue virus and West Nile virus. Most people fully recover without severe complications, and hospitalization rates are low. To date, there have been no reported deaths associated with Zika virus.

Diagnosis

Several methods can be used for diagnosis, such as viral nucleic acid detection, virus isolation and serological testing. Nucleic acid detection by reverse transcriptase-polymerase chain reaction targeting the non-structural protein 5 genomic region is the primary means of diagnosis, while virus isolation is largely for research purposes. Saliva or urine samples collected during the first 3 to 5 days after symptom onset, or serum collected in the first 1 to 3 days, are suitable for detection of Zika virus by these methods. Serological tests, including immunofluorescence assays and enzyme-linked immunosorbent assays may indicate the presence of anti-Zika virus IgM and IgG antibodies. Caution should be taken with serological results as IgM cross reactivity with other flaviviruses has been reported in both primary infected patients and those with a probable history of prior flavivirus infection.

Treatment

There is no commercial vaccine or specific antiviral drug treatment for Zika virus infection. Treatment is directed primarily at relieving symptoms using anti-pyretics and analgesics.

Prevention and control

The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as repellants, insect screens, closed doors and windows, and long clothing. Since the Aedes mosquitoes are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should use insecticide-treated mosquito nets to provide protection. Mosquito coils or other insecticide vaporizers may also reduce the likelihood of being bitten.
During outbreaks, space spraying of insecticides may be carried out periodically to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers.
Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering.

Disease outbreaks

The first documented outbreak of Zika virus in the South Pacific occurred on Yap Island in the Federated States of Micronesia in 2007. This outbreak affected 180 (confirmed, probable and suspected) people and was characterized by rash, conjunctivitis and joint pain.
In October 2013, French Polynesia reported its first outbreak, which was estimated to affect around 11% of the population.  This particular outbreak spread to other Pacific Islands including New Caledonia, Cook Islands, and Easter Island. As most cases of Zika virus infection present with mild illness similar to other circulating arbovirus infections, and there was limited laboratory capacity during this outbreak for the detection of Zika virus, it is likely that many cases of infection were not identified.

More about disease vectors

Both Ae. aegypti and Ae. albopictus have been implicated in large outbreaks of Zika virus. Ae. aegypti is confined to tropical and sub-tropical regions, while Ae. albopictus can be found in tropical, sub-tropical and temperate regions. Ae. albopictus has spread from Asia and become established in areas of the South Pacific, Africa, Europe and the Americas in recent decades. In the South Pacific,Ae. hensilli was implicated in the spread of Zika virus on Yap Island in 2007, while Ae. polynesiensis was suspected to spread Zika virus in French Polynesia in 2013.  Neither of these endemic species had been recognized as a Zika virus vector before, indicating that as this emerging disease spreads to previously unaffected countries, the potential exists for other endemic Aedes species to play a role in transmission.
  • Ae. aegypti is closely associated with human environments and can breed in indoor (flower vases, concrete water tanks in bathrooms), and artificial outdoor (vehicle tyres, water storage vessels, discarded containers) environments.
  • Ae. albopictus thrives in a wider range of water-filled breeding sites than Ae. aegypti, including coconut husks, cocoa pods, bamboo stumps, tree holes and rock pools, in addition to artificial containers such as vehicle tyres and plant pot saucers. This diversity of habitats explains the abundance of Ae. albopictus in rural as well as peri-urban areas and shady city parks.
  • Ae. hensilli breeds in coconut shells, tins, plastic containers, vehicle tyres, tree holes, canoes and metal drums. 
  • Ae. polynesiensis breeds in tree holes, coconut shells and crab holes.
  • WHO responds to Zika virus infection by:

  • Providing technical support and guidance to countries for the effective management of cases and outbreaks;
  • Supporting countries to improve their surveillance systems;
  • Providing training on clinical management, diagnosis and vector control including through a number of WHO Collaborating Centres;
  • Publishing guidelines for vector control; and
  • Encouraging countries to develop and maintain the capacity to detect and confirm cases, manage patients, and implement social communication strategies to reduce the presence of the mosquito vectors.
WHO Director-General, Margaret Chan, will convene an International Health Regulations Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations.
The Committee will meet on Monday 1 February in Geneva to ascertain whether the outbreak constitutes a Public Health Emergency of International Concern.
Decisions concerning the Committee’s membership and advice will be made public on WHO’s website.

Outbreak in the Americas

In May 2015, Brazil reported its first case of Zika virus disease. Since then, the disease has spread within Brazil and to 22 other countries and territories in the region.
Arrival of the virus in some countries of the Americas, notably Brazil, has been associated with a steep increase in the birth of babies with abnormally small heads and in cases of Guillain-Barré syndrome, a poorly understood condition in which the immune system attacks the nervous system, sometimes resulting in paralysis.
A causal relationship between Zika virus infection and birth defects and neurological syndromes has not been established, but is strongly suspected.






WHO action

WHO’s Regional Office for the Americas (PAHO) has been working closely with affected countries since May 2015. PAHO has mobilized staff and members of the Global Outbreak and Response Network (GOARN) to assist ministries of health in strengthening their abilities to detect the arrival and circulation of Zika virus through laboratory testing and rapid reporting. The aim has been to ensure accurate clinical diagnosis and treatment for patients, to track the spread of the virus and the mosquito that carries it, and to promote prevention, especially through mosquito control.
The Organization is supporting the scaling up and strengthening of surveillance systems in countries that have reported cases of Zika and of microcephaly and other neurological conditions that may be associated with the virus. Surveillance is also being heightened in countries to which the virus may spread. In the coming weeks, the Organization will convene experts to address critical gaps in scientific knowledge about the virus and its potential effects on fetuses, children and adults.
WHO will also prioritize the development of vaccines and new tools to control mosquito populations, as well as improving diagnostic tests.
How to Treat Pregnant Women with Diagnoses of Zika Virus Disease No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics . Fever should be treated with acetaminophen. Although aspirin and other nonsteroidal anti-inflammatory drugs are not typically used in pregnancy, these medications should specifically be avoided until dengue can be ruled out to reduce the risk for hemorrhage . In pregnant a woman with laboratory evidence of Zika virus in serum or amniotic fluid, serial ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks. Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended.







Zika virus: News and updates:

16 March 2016

First locally acquired cases are reported from Kosrae, Federated States of Micronesia; Dominica; and Cuba.

15 March 2016

A retrospective analysis of the Zika outbreak in French Polynesia, which occurred in 2013-2014, is published online in The Lancet. Using serological and surveillance data, the authors calculated the risk of microcephaly in fetuses and babies born to mothers infected with the Zika virus to be 1 in 100, or 1%. This study supports the hypothesis that Zika infection in the first trimester of pregnancy is associated with an increased risk of microcephaly

10 March 2016

Colombia reports two cases of microcephaly; both mothers and newborns tested positive for Zika virus by PCR. Results are pending for 13 more samples, among 27 cases of babies born with microcephaly in 2016.

10 March 2016

The United States reports two Guillain-Barre Syndrome (GBS) cases with confirmed Zika virus infection. The first case, an elderly man with a recent history of travel to El Salvador, died from sudden subarachnoid haemorrhage caused by a ruptured aneurysm. The second case, a male resident of Haiti in his 30s, was diagnosed after he travelled to the US for treatment. He recovered fully after 5 days of treatment in hospital.

9 March 2016

Venezuela provides an epidemiological update of the Zika outbreak in that country. A total of 16,942 suspected Zika cases have been reported. Of 801 samples tested by PCR, 352 (44%) were positive for Zika virus. Among the suspected cases are 941 pregnant women. A total of 226 samples from pregnant women were tested, and 153 (67.6%) were positive. No information is available about the outcome of these pregnancies, as the virus has not circulated long enough for these pregnancies to come to term.
Venezuela also reports 578 cases of Guillain-Barré syndrome, among which 235 have presented with symptoms of Zika virus infection. In addition, 1 case of facial paralysis and 10 cases of unspecified neurological disorders are PCR-positive for Zika virus.

9 March 2016

A letter published online in the New England Journal of Medicine describes a case in France of central nervous system infection with Zika virus associated with meningoencephalitis. The patient was an 81-year-old man who had been on a cruise in New Caledonia, Vanuatu, the Solomon Islands, and New Zealand. He was admitted to an intensive care unit and placed on a ventilator; cerebrospinal fluid tested positive for Zika virus. His neurologic condition improved without specific treatment, and he was discharged on day 17 of hospitalization.

8 March 2016

The second meeting of the Zika Emergency Committee affirms that clusters of microcephaly cases and other neurological disorders continue to constitute a Public Health Emergency of International Concern (PHEIC), and that evidence is increasing of a causal relationship of these disorders with Zika virus. WHO updates its travel recommendations to advise pregnant women not to travel to areas with ongoing Zika virus outbreaks; those whose partners live in or travel to such areas should practice safe sex or abstain for the duration of their pregnancy.

4 March 2016

The New England Journal of Medicine publishes online a study of Zika virus infection in 88 pregnant women in Rio de Janeiro, Brazil. 72 of these women (82%) tested positive for Zika virus in blood and/or urine. The most common symptoms were rash, joint pain, red eyes, and headache. Abnormalities of the fetus were detected by ultrasound in 12 Zika-positive women. These abnormalities included two fetal deaths, inability of the placenta to deliver adequate nutrients and oxygen to the fetus (placental insufficiency), poor fetal growth (fetal growth restriction), and injury to the central nervous system, including microcephaly. These findings add to the growing body of evidence linking Zika virus infection to fetal abnormalities.

3 March 2016

A case report published online in The Lancet describes a 15-year-old Zika-positive girl in Guadeloupe who developed acute myelitis (inflammation of the spinal cord), which caused severe back pain, numbness, and bladder dysfunction. This association suggests that Zika virus preferentially affects the nervous system.
  • 2 March 2016
The United States confirms an additional 5 cases of sexually transmitted Zika virus infection, bringing the total six. All cases occurred in women with partners who recently returned from an area with ongoing Zika virus circulation. These additional cases suggest that sexual transmission of the virus may be more common than previously assumed.

2 March 2016

Samoa reports 10 additional cases of PCR-confirmed Zika virus infection, none of whom reported any recent international travel.

1 March 2016

France reports a probable case of sexual transmission of Zika virus, in the partner of a patient who had travelled to Brazil. The new case tested positive for Zika virus by PCR in saliva and urine; the partner tested positive by PCR in urine.

Information for travellers visiting Zika affected countries:

Travellers to areas with Zika virus outbreaks should be provided with up-to-date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites and, upon return, should take appropriate measures, including safe sex, to reduce the risk of onward transmission.
Based on available evidence, there are no general restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission. Countries reporting sporadic Zika infections in travellers arriving from affected countries pose little, if any, risk of onward transmission.
Pregnant women should be advised not to travel to areas of ongoing Zika virus outbreaks. Zika virus is spread by mosquitoes, and not by person-to-person contact, though a small number of cases of sexual transmission have been documented.
As a precautionary measure, some national governments may make public health and travel recommendations to their own populations, based on their assessment of the available evidence and local risk factors.
Zika has been found in human semen. Two reports have described cases where Zika has been transmitted from one person to another through sexual contact.
Until more is known about the risk of sexual transmission, all men and women returning from an area where Zika is circulating - especially pregnant women and their partners - should practice safer sex, including through the correct and consistent use of condoms, or abstaining from sex for the duration of the pregnancy.
All travellers, including pregnant women, going to an area where locally acquired Zika infection is occurring should adhere closely to steps that can prevent mosquito bites during the trip. These include:
  • wearing clothes (preferably light-coloured) that cover as much of the body as possible;
  • using insect repellent: repellents may be applied to exposed skin or to clothing, and should contain DEET, (diethyltoluamide) or IR 3535 or Icaridin. Repellents must be used in strict accordance with the label instructions;
  • using physical barriers such as screens, closed doors and windows;
  • sleeping under mosquito nets, especially during the day, when Aedesmosquitoes are most active;
  • using physical barriers such mesh screens or treated netting materials on doors and windows; and
  • identifying and eliminating potential mosquito breeding sites, by emptying, cleaning or covering containers that can hold even small amounts of water, such as buckets, vases, flower pots and tyres.
Zika MAC-ELISA (CDC)
  • The Zika MAC-ELISA is a laboratory test to detect proteins the human body makes to fight a Zika virus infection.  These proteins, called antibodies, appear in the blood starting 4-5 days after the start of illness and last for up to 12 weeks.  In some people, they are present for longer than 12 weeks. 
  • The CDC Zika MAC-ELISA test has been authorized under the EUA for use by qualified laboratories in the U.S.designated by the CDC that are certified to perform high-complexity tests. 
  • Because of the possibility of false positive results in patients who were previously infected with viruses similar to the Zika virus (i.e., flaviviruses, such as dengue), under the terms of the EUA, positive and inconclusive results must be further tested by the CDC or by authorized laboratories in consultation with the CDC to confirm the presence of antibodies to Zika virus.
  • Trioplex rRT-PCR (CDC)
    • The CDC Trioplex rRT-PCR test has been authorized under the EUA for use by qualified laboratories in the U.S. designated by the CDC that are certified to perform high-complexity tests. 
    • The assay (test)  is intended for use with specimens collected from individuals meeting CDC Zika virus clinical criteria (e.g., clinical signs and symptoms associated with Zika virus infection) and/or CDC Zika virus epidemiological criteria (e.g., history of residence in or travel to a geographic region with active Zika transmission at the time of travel, or other epidemiologic criteria for which Zika virus testing may be indicated as part of a public health investigation).
  • Emergency Use Authorization (EUA)
    • While many people with Zika virus infection experience no symptoms, the virus can pose potentially serious risks to the public health. Access to a diagnostic test that can identify patients with Zika virus infections is critical to supporting response efforts and expanding domestic readiness. Potential links between Zika virus infection and neurological complications (i.e., Guillain-BarrĂ© Syndrome), as well as microcephaly and other poor pregnancy outcomes associated with Zika virus infection during pregnancy,  have also increased the importance of having a diagnostic test available for Zika virus. As there are no commercially available diagnostic tests cleared or approved by the FDA for the detection of Zika virus infection, it was determined that an EUA is crucial to ensure timely access to a diagnostic tool.
    • An EUA is a tool that FDA can use to allow the use of certain medical products for emergencies based on scientific data.  The U.S. Secretary of Health and Human Services (HHS) has declared that circumstances exist to allow the emergency use of authorized diagnostic tests for Zika virus infection, such as the Zika MAC-ELISA

Thursday, 28 January 2016

Tips for staying safe in cold weather By Jaikumar pareta

Tips for staying safe in cold weather.

BY JAIKUMAR PARETA 

Hypothermia and older adults

The cold truth about hypothermia is that Americans aged 65 years and older face this danger every winter. Older adults are especially vulnerable to hypothermia because their body's response to cold can be diminished by underlying medical conditions such as diabetes, some medicines including over-the-counter cold remedies, and aging itself. As a result, hypothermia can develop in older adults after even relatively mild exposure to cold weather or a small drop in temperature.
These tips will help older people avoid this dangerous cold-weather condition. When the temperature gets too cold or the body's heat production decreases, hypothermia occurs. Hypothermia is defined as having a core body temperature below 95 degrees.
Someone suffering from hypothermia may show one or more of the following signs: slowed or slurred speech, sleepiness or confusion, shivering or stiffness in the arms and legs, poor control over body movements or slow reactions, or a weak pulse. Older adults can lose body heat fast—faster than when they were young. A big chill can turn into a dangerous problem before an older person even knows what’s happening. Doctors call this serious problem hypothermia (hi-po-ther-mee-uh).
Hypothermia is what happens when your body temperature gets very low. For an older person, a body temperature colder than 95 degrees can cause many health problems such as a heart attackkidney problems, liver damage, or worse.
Being outside in the cold, or even being in a very cold house, can lead to hypothermia. You can take steps to lower your chance of getting hypothermia.
Read this booklet for tips on how to stay safe when it's cold outside. Share it with your family and friends.






Keep warm inside

Living in a cold house, apartment, or other building can cause hypothermia. People who are sick may have special problems keeping warm. Do not let it get too cold inside and dress warmly.











What Are The Signs Of Hypothermia?

When you think about being cold, you probably think of shivering. That is one way the body stays warm when it gets cold. But, shivering alone does not mean you have hypothermia.
How do you know if someone has hypothermia? Look for the "umbles"—stumbles, mumbles, fumbles, and grumbles—these show that the cold is a problem. Check for:
  • Confusion or sleepiness
  • Slowed, slurred speech, or shallow breathing
  • Weak pulse
  • Change in behavior or in the way a person looks
  • A lot of shivering or no shivering; stiffness in the arms or legs
  • Poor control over body movements or slow reactions

Taking Action

A normal body temperature is 98.6 °F. A few degrees lower, for example, 95 °F, can be dangerous. It may cause an irregular heartbeat leading to heart problems and death.
If you think someone could have hypothermia, use a thermometer to take his or her temperature. Make sure you shake the thermometer so it starts below its lowest point. When you take the temperature, if the reading doesn't rise above 96 °F, call for emergency help. In many areas, that means calling 911.
While you are waiting for help to arrive, keep the person warm and dry. Try and move him or her to a warmer place. Wrap the person in blankets, towels, coats—whatever is handy. Even your own body warmth will help. Lie close, but be gentle. Give the person something warm to drink but stay away from alcohol or caffeinated drinks, like regular coffee.

The Emergency Room

The only way to tell for sure that someone has hypothermia is to use a special thermometer that can read very low body temperatures. Most hospitals have these thermometers. In the emergency room, doctors will warm the person's body from inside out. For example, they may give the person warm fluids directly by using an IV. Recovery depends on how long the person was exposed to the cold and his or her general health.

How Do I Stay Safe?

  • Try to stay away from cold places. Changes in your body that come with aging can make it harder for you to be aware of getting cold.
  • You may not always be able to warm yourself. Pay attention to how cold it is where you are.
  • Check the weather forecasts for windy and cold weather. Try to stay inside or in a warm place on cold and windy days. If you have to go out, wear warm clothes including a hat and gloves. A waterproof coat or jacket can help you stay warm if it's cold and snowy.
  • Wear several layers of loose clothing when it's cold. The layers will trap warm air between them. Don't wear tight clothing because it can keep your blood from flowing freely. This can lead to loss of body heat.
  • Ask your doctor how the medicines you are taking affect body heat. Some medicines used by older people can increase the risk of accidental hypothermia. These include drugs used to treat anxiety, depression, or nausea. Some over-the-counter cold remedies can also cause problems.
  • When the temperature has dropped, drink alcohol moderately, if at all. Alcoholic drinks can make you lose body heat.
  • Make sure you eat enough food to keep up your weight. If you don't eat well, you might have less fat under your skin. Body fat helps you to stay warm.

Health Problems

Some illnesses may make it harder for your body to stay warm. These include problems with your body's hormone system such as low thyroid hormone (hypothyroidism), health problems that keep blood from flowing normally (like diabetes), and some skin problems where your body loses more heat than normal.
Some health problems may make it hard for you to put on more clothes, use a blanket, or get out of the cold. For example:
  • Severe arthritis, Parkinson's disease, or other illnesses that make it tough to move around
  • Stroke or other illnesses that can leave you paralyzed and may make clear thinking more difficult
  • Memory loss
  • A fall or other injury

Staying Warm Inside

Being in a cold building can also cause hypothermia. In fact, hypothermia can happen to someone in a nursing home or group facility if the rooms are not kept warm enough. People who are already sick may have special problems keeping warm. If someone you know is in a group facility, pay attention to the inside temperature and to whether that person is dressed warmly enough.
Even if you keep your temperature between 60 °F and 65 °F, your home or apartment may not be warm enough to keep you safe. For some people, this temperature can contribute to hypothermia. This is a special problem if you live alone because there is no one else to feel the chilliness of the house or notice if you are having symptoms of hypothermia. Set your thermostat for at least 68 °F to 70 °F. If a power outage leaves you without heat, try to stay with a relative or friend.
You may be tempted to warm your room with a space heater. But, some space heaters are fire hazards, and others can cause carbon monoxide poisoning. The Consumer Product Safety Commission has information on the use of space heaters, but here are a few things to keep in mind:
  • Make sure your space heater has been approved by a recognized testing laboratory.
  • Choose the right size heater for the space you are heating.
  • Put the heater on a flat, level surface that will not burn.
  • Keep children and pets away from the heating element.
  • Keep things that can catch fire like paint, clothing, bedding, curtains, and papers away from the heating element.
  • If your heater has a flame, keep a window open at least one-inch and doors open to the rest of your home for good air flow.
  • Turn the heater off when you leave the room or go to bed.
  • Make sure your smoke alarms are working.
  • Put a carbon monoxide detector near where people sleep.
  • Keep an approved fire extinguisher nearby







  • When going outside in the cold, it is important to wear a hat, scarf, and gloves or mittens to prevent loss of body heat through your head and hands. Also consider letting someone know you’re going outdoors and carry a fully charged cellphone.  A hat is particularly important because a large portion of body heat can be lost through the head. Wear several layers of loose clothing to help trap warm air between the layers.
  • Check with your doctor to see if any prescription or over-the-counter medications you are taking may increase your risk for hypothermia.
  • Make sure your home is warm enough. Some experts suggest that, for older people, the temperature be set to at least 68 degrees. 
  • To stay warm at home, wear long underwear under your clothes, along with socks and slippers. Use a blanket or afghan to keep your legs and shoulders warm and wear a hat or cap indoors.