RESUMEN
The invasion of nerves by cancer cells, or perineural invasion (PNI), is potentiated by the nerve microenvironment and is associated with adverse clinical outcomes. However, the cancer cell characteristics that enable PNI are poorly defined. Here, we generated cell lines enriched for a rapid neuroinvasive phenotype by serially passaging pancreatic cancer cells in a murine sciatic nerve model of PNI. Cancer cells isolated from the leading edge of nerve invasion showed a progressively increasing nerve invasion velocity with higher passage number. Transcriptome analysis revealed an upregulation of proteins involving the plasma membrane, cell leading edge, and cell movement in the leading neuroinvasive cells. Leading cells progressively became round and blebbed, lost focal adhesions and filipodia, and transitioned from a mesenchymal to amoeboid phenotype. Leading cells acquired an increased ability to migrate through microchannel constrictions and associated more with dorsal root ganglia than nonleading cells. ROCK inhibition reverted leading cells from an amoeboid to mesenchymal phenotype, reduced migration through microchannel constrictions, reduced neurite association, and reduced PNI in a murine sciatic nerve model. Cancer cells with rapid PNI exhibit an amoeboid phenotype, highlighting the plasticity of cancer migration mode in enabling rapid nerve invasion.
Asunto(s)
Amoeba , Tejido Nervioso , Neoplasias Pancreáticas , Ratones , Animales , Neoplasias Pancreáticas/genética , Nervio Ciático/metabolismo , Páncreas/metabolismo , Tejido Nervioso/metabolismo , Movimiento Celular/genética , Invasividad Neoplásica , Microambiente TumoralRESUMEN
The Togaviridae family, genus, Alphavirus, includes several mosquito-borne human pathogens with the potential to spread to near pandemic proportions. Most of these are zoonotic, with spillover infections of humans and domestic animals, but a few such as chikungunya virus (CHIKV) have the ability to use humans as amplification hosts for transmission in urban settings and explosive outbreaks. Most alphaviruses cause nonspecific acute febrile illness, with pathogenesis sometimes leading to either encephalitis or arthralgic manifestations with severe and chronic morbidity and occasional mortality. The development of countermeasures, especially against CHIKV and Venezuelan equine encephalitis virus that are major threats, has included vaccines and antibody-based therapeutics that are likely to also be successful for rapid responses with other members of the family. However, further work with these prototypes and other alphavirus pathogens should target better understanding of human tropism and pathogenesis, more comprehensive identification of cellular receptors and entry, and better understanding of structural mechanisms of neutralization.
Asunto(s)
Virus Chikungunya , Culicidae , Animales , Caballos , Humanos , InvestigaciónRESUMEN
BACKGROUND: Colombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. METHODS: Using the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of microcephaly for evidence of congenital ZVD. RESULTS: By April 2, 2016, there were 65,726 cases of ZVD reported in Colombia, of which 2485 (4%) were confirmed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay. The overall reported incidence of ZVD among female patients was twice that in male patients. A total of 11,944 pregnant women with ZVD were reported in Colombia, with 1484 (12%) of these cases confirmed on RT-PCR assay. In a subgroup of 1850 pregnant women, more than 90% of women who were reportedly infected during the third trimester had given birth, and no infants with apparent abnormalities, including microcephaly, have been identified. A majority of the women who contracted ZVD in the first or second trimester were still pregnant at the time of this report. Among the cases of microcephaly investigated from January 2016 through April 2016, four patients had laboratory evidence of congenital ZVD; all were born to asymptomatic mothers who were not included in the ZVD surveillance system. CONCLUSIONS: Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing. (Funded by Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).
Asunto(s)
Brotes de Enfermedades , Infección por el Virus Zika/epidemiología , Virus Zika/aislamiento & purificación , Adolescente , Adulto , Anciano , Niño , Preescolar , Colombia/epidemiología , Femenino , Geografía Médica , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Microcefalia/epidemiología , Persona de Mediana Edad , Vigilancia de la Población , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Tercer Trimestre del Embarazo , ARN Viral/sangre , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Distribución por Sexo , Adulto Joven , Virus Zika/genéticaRESUMEN
PURPOSE OF REVIEW: The purpose of this review is to summarize the current literature on the presentation, diagnosis, and treatment options available for extramedullary (EM) manifestations of leukemia including myeloid sarcoma (MS) and leukemia cutis (LC). RECENT FINDINGS: Advanced imaging using 18FDG-PET/CT is an effective screening tool for EM manifestations of leukemia. The role of radiation therapy has been more clearly delineated in the treatment of both MS and LC. FDA-approved targeted agents have improved outcomes in patients with AML but have not demonstrated improvements specifically for EM; however, a checkpoint inhibitor, Ipilimumab, holds promise in impacting local control for the treatment of AML-related EM. EM manifestations of leukemia pose significant therapeutic challenges. Treatment of EM is predicated on multiple factors including the presence of concomitant bone marrow involvement, AML-risk classification, and timing of presentation at initial diagnosis or relapse following systemic therapy.
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Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/terapia , Sarcoma Mieloide/diagnóstico , Sarcoma Mieloide/terapia , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Humanos , Pronóstico , Sarcoma Mieloide/etiologíaRESUMEN
Beginning in 2004, chikungunya virus (CHIKV) went from an endemic pathogen limited to Africa and Asia that caused periodic outbreaks to a global pathogen. Given that outbreaks caused by CHIKV have continued and expanded, serious consideration must be given to identifying potential options for vaccines and therapeutics. Currently, there are no licensed products in this realm, and control relies completely on the use of personal protective measures and integrated vector control, which are only minimally effective. Therefore, it is prudent to urgently examine further possibilities for control. Vaccines have been shown to be highly effective against vector-borne diseases. However, as CHIKV is known to rapidly spread and generate high attack rates, therapeutics would also be highly valuable. Several candidates are currently being developed; this review describes the multiple options under consideration for future development and assesses their relative advantages and disadvantages.
Asunto(s)
Antivirales/uso terapéutico , Fiebre Chikungunya/prevención & control , Fiebre Chikungunya/terapia , Vacunas Virales , Fiebre Chikungunya/tratamiento farmacológico , Virus ChikungunyaRESUMEN
We assessed Zika virus seroprevalence among healthy 1-4-year-old children using a serum sample collection assembled in 2014 representing 30 urban sites across Indonesia. Of 662 samples, 9.1% were Zika virus seropositive, suggesting widespread recent Zika virus transmission and immunity. Larger studies are needed to better determine endemicity in Indonesia.
Asunto(s)
Brotes de Enfermedades/prevención & control , Infección por el Virus Zika/epidemiología , Virus Zika/aislamiento & purificación , Anticuerpos Antivirales/sangre , Salud Infantil , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Indonesia/epidemiología , Lactante , Masculino , Estudios Seroepidemiológicos , Virus Zika/inmunología , Infección por el Virus Zika/sangre , Infección por el Virus Zika/etiología , Infección por el Virus Zika/virologíaRESUMEN
The Togaviridae is a family of small, enveloped viruses with single-stranded, positive-sense RNA genomes of 10-12 kb. Within the family, the genus Alphavirus includes a large number of diverse species, while the genus Rubivirus includes the single species Rubella virus. Most alphaviruses are mosquito-borne and are pathogenic in their vertebrate hosts. Many are important human and veterinary pathogens (e.g. chikungunya virus and eastern equine encephalitis virus). Rubella virus is transmitted by respiratory routes among humans. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the taxonomy of the Togaviridae, which is available at www.ictv.global/report/togaviridae.
Asunto(s)
Togaviridae/clasificación , Togaviridae/genética , Animales , Virus Chikungunya/genética , Genoma Viral , Humanos , Virus de la Rubéola/genética , Togaviridae/patogenicidadRESUMEN
Cross-reactivity within flavivirus antibody assays, produced by shared epitopes in the envelope proteins, can complicate the serological diagnosis of Zika virus (ZIKAV) infection. We assessed the utility of the plaque reduction neutralization test (PRNT) to confirm recent ZIKAV infections and rule out misleading positive immunoglobulin M (IgM) results in areas with various levels of past dengue virus (DENV) infection incidence. We reviewed PRNT results of sera collected for diagnosis of ZIKAV infection from 1 January through 31 August 2016 with positive ZIKAV IgM results, and ZIKAV and DENV PRNTs were performed. PRNT result interpretations included ZIKAV, unspecified flavivirus, DENV infection, or negative. For this analysis, ZIKAV IgM was considered false positive for samples interpreted as a DENV infection or negative. In U.S. states, 208 (27%) of 759 IgM-positive results were confirmed to be ZIKAV compared to 11 (21%) of 52 in the U.S. Virgin Islands (USVI), 15 (15%) of 103 in American Samoa, and 13 (11%) of 123 in Puerto Rico. In American Samoa and Puerto Rico, more than 80% of IgM-positive results were unspecified flavivirus infections. The false-positivity rate was 27% in U.S. states, 18% in the USVI, 2% in American Samoa, and 6% in Puerto Rico. In U.S. states, the PRNT provided a virus-specific diagnosis or ruled out infection in the majority of IgM-positive samples. Almost a third of ZIKAV IgM-positive results were not confirmed; therefore, providers and patients must understand that IgM results are preliminary. In territories with historically higher rates of DENV transmission, the PRNT usually could not differentiate between ZIKAV and DENV infections.
Asunto(s)
Anticuerpos Antivirales/sangre , Virus del Dengue/inmunología , Dengue/epidemiología , Inmunoglobulina M/sangre , Infección por el Virus Zika/diagnóstico , Virus Zika/inmunología , Samoa Americana/epidemiología , Reacciones Cruzadas , Reacciones Falso Positivas , Femenino , Flavivirus/inmunología , Humanos , Incidencia , Masculino , Pruebas de Neutralización , Puerto Rico/epidemiología , Estados Unidos/epidemiología , Islas Virgenes de los Estados Unidos/epidemiología , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/virologíaRESUMEN
We report on 9 cases of male-to-female sexual transmission of Zika virus in the United States occurring January-April 2016. This report summarizes new information about both timing of exposure and symptoms of sexually transmitted Zika virus disease, and results of semen testing for Zika virus from 2 male travelers.
Asunto(s)
Enfermedades Virales de Transmisión Sexual/epidemiología , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/transmisión , Virus Zika , Adulto , Notificación de Enfermedades , Femenino , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana Edad , ARN Viral , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estaciones del Año , Enfermedades Virales de Transmisión Sexual/diagnóstico , Enfermedades Virales de Transmisión Sexual/historia , Evaluación de Síntomas , Viaje , Estados Unidos/epidemiología , Adulto Joven , Virus Zika/clasificación , Virus Zika/genética , Virus Zika/inmunología , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/historiaRESUMEN
The introduction of Zika virus into the Region of the Americas (Americas) and the subsequent increase in cases of congenital microcephaly resulted in activation of CDC's Emergency Operations Center on January 22, 2016, to ensure a coordinated response and timely dissemination of information, and led the World Health Organization to declare a Public Health Emergency of International Concern on February 1, 2016. During the past year, public health agencies and researchers worldwide have collaborated to protect pregnant women, inform clinicians and the public, and advance knowledge about Zika virus (Figure 1). This report summarizes 10 important contributions toward addressing the threat posed by Zika virus in 2016. To protect pregnant women and their fetuses and infants from the effects of Zika virus infection during pregnancy, public health activities must focus on preventing mosquito-borne transmission through vector control and personal protective practices, preventing sexual transmission by advising abstention from sex or consistent and correct use of condoms, and preventing unintended pregnancies by reducing barriers to access to highly effective reversible contraception.
Asunto(s)
Centers for Disease Control and Prevention, U.S. , Práctica de Salud Pública , Infección por el Virus Zika/prevención & control , Logro , Predicción , Prioridades en Salud/tendencias , Humanos , Estados UnidosRESUMEN
BACKGROUND: We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh. METHODS: We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC). RESULTS: Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Ten patients were identified with Coxiella. We isolated Leptospira from two patients and Bartonella from one patient. Ten patients had antibodies against Chikungunya virus. The proportion of patients who died was higher with rickettsial fever (5%) compared to those without a diagnosis of rickettsial infection (2%). None of the patients were initially diagnosed with rickettsial fever. CONCLUSIONS: Rickettsial infections are frequent yet under-recognized cause of febrile illness in Bangladesh. Clinical guidelines should be revised so that local clinicians can diagnose rickettsial infections and provide appropriate drug treatment.
Asunto(s)
Fiebre Chikungunya/virología , Fiebre/microbiología , Técnica del Anticuerpo Fluorescente Indirecta , Infecciones por Bacterias Gramnegativas/microbiología , Pacientes Internos/estadística & datos numéricos , Tifus por Ácaros/microbiología , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Bangladesh/epidemiología , Bartonella/aislamiento & purificación , Centers for Disease Control and Prevention, U.S. , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/inmunología , Niño , Preescolar , Coxiella/aislamiento & purificación , Femenino , Fiebre/epidemiología , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/inmunología , Humanos , Lactante , Recién Nacido , Leptospira/aislamiento & purificación , Masculino , Prevalencia , Rickettsia/aislamiento & purificación , Tifus por Ácaros/epidemiología , Tifus por Ácaros/inmunología , Estudios Seroepidemiológicos , Estados Unidos , Adulto JovenRESUMEN
Understanding the ability of the chikungunya virus (CHIKV) to be transmitted by Aedes vectors in the Americas is critical for assessing epidemiological risk. One element that must be considered is the minimum infectious dose of virus that can lead to transmission following the extrinsic incubation period. This study aimed to determine the minimum infection rate for the two Aedes species studied. The results revealed that doses as low as 3.9 log10 plaque-forming units per mL (pfu/mL) of an Asian genotype CHIKV strain can lead to transmission by Ae. albopictus, and doses of at least 5.3 log10 pfu/mL from the same strain are needed for transmission from Ae. aegypti. These low infecting doses suggest that infected individuals may be infectious for almost the entire period of their viremia, and therefore, to prevent further cases, measures should be taken to prevent them from getting bitten by mosquitoes during this period.
Asunto(s)
Aedes/virología , Virus Chikungunya/aislamiento & purificación , Carga Viral , AnimalesRESUMEN
Chikungunya virus has been causing a series of ongoing epidemics around the globe for the past 12 years. During that time, estimates indicate that >4 million cases occurred worldwide. Despite the magnitude of these outbreaks and the broad interest in understanding the virus and disease, significant gaps still exist in our knowledge base. An in-depth understanding of the basic virological elements that can affect the epidemiology of the agent is critical for future development of control and treatment products. This work describes how knowledge of various viral genetic and structural elements has begun to advance the development of vaccines and therapeutics and suggests that further knowledge is needed to provide additional options.
Asunto(s)
Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/virología , Virus Chikungunya/genética , Virus Chikungunya/fisiología , Fiebre Chikungunya/terapia , Fiebre Chikungunya/transmisión , Virus Chikungunya/patogenicidad , Brotes de Enfermedades/prevención & control , Epidemias/prevención & control , Genoma Viral , Humanos , Salud Pública , Vacunas ViralesRESUMEN
We report two patients that developed severe thrombocytopenia after Zika virus (ZIKV) infection. The first patient had 1000 platelets/µL and died after multiple hemorrhages. The second patient had 2000 platelets/µL, had melena and ecchymoses, and recovered after receiving intravenous immunoglobulin. ZIKV may be associated with immune-mediated severe thrombocytopenia.
Asunto(s)
Trombocitopenia/virología , Infección por el Virus Zika/fisiopatología , Adulto , Anciano , Humanos , Inmunoglobulinas Intravenosas , Masculino , Trombocitopenia/terapia , Resultado del Tratamiento , Infección por el Virus Zika/terapiaRESUMEN
Zika virus is a single-stranded RNA virus in the genus Flavivirus and is closely related to dengue, West Nile, Japanese encephalitis, and yellow fever viruses (1,2). Among flaviviruses, Zika and dengue virus share similar symptoms of infection, transmission cycles, and geographic distribution. Diagnostic testing for Zika virus infection can be accomplished using both molecular and serologic methods. For persons with suspected Zika virus disease, a positive real-time reverse transcription-polymerase chain reaction (rRT-PCR) result confirms Zika virus infection, but a negative rRT-PCR result does not exclude infection (3-7). In these cases, immunoglobulin (Ig) M and neutralizing antibody testing can identify additional recent Zika virus infections (6,7). However, Zika virus antibody test results can be difficult to interpret because of cross-reactivity with other flaviviruses, which can preclude identification of the specific infecting virus, especially when the person previously was infected with or vaccinated against a related flavivirus (8). This is important because the results of Zika and dengue virus testing will guide clinical management. Pregnant women with laboratory evidence of Zika virus infection should be evaluated and managed for possible adverse pregnancy outcomes and be reported to the U.S. Zika Pregnancy Registry or the Puerto Rico Zika Active Pregnancy Surveillance System for clinical follow-up (9,10). All patients with clinically suspected dengue should have proper management to reduce the risk for hemorrhage and shock (11). If serologic testing indicates recent flavivirus infection that could be caused by either Zika or dengue virus, patients should be clinically managed for both infections because they might have been infected with either virus.
Asunto(s)
Anticuerpos Antivirales/aislamiento & purificación , Pruebas Diagnósticas de Rutina , Guías de Práctica Clínica como Asunto , Infección por el Virus Zika/diagnóstico , Virus Zika/inmunología , Centers for Disease Control and Prevention, U.S. , Dengue/diagnóstico , Dengue/terapia , Femenino , Humanos , Embarazo , Estados Unidos , Infección por el Virus Zika/terapiaRESUMEN
CDC recommends Zika virus testing for potentially exposed persons with signs or symptoms consistent with Zika virus disease, and recommends that health care providers offer testing to asymptomatic pregnant women within 12 weeks of exposure. During January 3-March 5, 2016, Zika virus testing was performed for 4,534 persons who traveled to or moved from areas with active Zika virus transmission; 3,335 (73.6%) were pregnant women. Among persons who received testing, 1,541 (34.0%) reported at least one Zika virus-associated sign or symptom (e.g., fever, rash, arthralgia, or conjunctivitis), 436 (9.6%) reported at least one other clinical sign or symptom only, and 2,557 (56.4%) reported no signs or symptoms. Among 1,541 persons with one or more Zika virus-associated symptoms who received testing, 182 (11.8%) had confirmed Zika virus infection. Among the 2,557 asymptomatic persons who received testing, 2,425 (94.8%) were pregnant women, seven (0.3%) of whom had confirmed Zika virus infection. Although risk for Zika virus infection might vary based on exposure-related factors (e.g., location and duration of travel), in the current setting in U.S. states, where there is no local transmission, most asymptomatic pregnant women who receive testing do not have Zika virus infection.
Asunto(s)
Tamizaje Masivo/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología , Artralgia , Centers for Disease Control and Prevention, U.S. , Conjuntivitis , Exantema , Femenino , Fiebre , Humanos , Guías de Práctica Clínica como Asunto , Embarazo , Autoinforme , Viaje , Estados Unidos/epidemiología , Virus Zika/aislamiento & purificaciónRESUMEN
CDC has developed interim guidelines for health care providers in the United States who are caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy. These guidelines include recommendations for the testing and management of these infants. Guidance is subject to change as more information becomes available; the latest information, including answers to commonly asked questions, can be found online (http://www.cdc.gov/zika). Pediatric health care providers should work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission [http://wwwnc.cdc.gov/travel/notices]), and review fetal ultrasounds and maternal testing for Zika virus infection (see Interim Guidelines for Pregnant Women During a Zika Virus Outbreak*) (1). Zika virus testing is recommended for 1) infants with microcephaly or intracranial calcifications born to women who traveled to or resided in an area with Zika virus transmission while pregnant; or 2) infants born to mothers with positive or inconclusive test results for Zika virus infection. For infants with laboratory evidence of a possible congenital Zika virus infection, additional clinical evaluation and follow-up is recommended. Health care providers should contact their state or territorial health department to facilitate testing. As an arboviral disease, Zika virus disease is a nationally notifiable condition.
Asunto(s)
Guías de Práctica Clínica como Asunto , Infección por el Virus Zika/congénito , Infección por el Virus Zika/diagnóstico , Centers for Disease Control and Prevention, U.S. , Femenino , Humanos , Lactante , Embarazo , Complicaciones Infecciosas del Embarazo , Estados UnidosRESUMEN
CDC has updated its interim guidelines for U.S. health care providers caring for pregnant women during a Zika virus outbreak (1). Updated guidelines include a new recommendation to offer serologic testing to asymptomatic pregnant women (women who do not report clinical illness consistent with Zika virus disease) who have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2-12 weeks after pregnant women return from travel. This update also expands guidance to women who reside in areas with ongoing Zika virus transmission, and includes recommendations for screening, testing, and management of pregnant women and recommendations for counseling women of reproductive age (15-44 years). Pregnant women who reside in areas with ongoing Zika virus transmission have an ongoing risk for infection throughout their pregnancy. For pregnant women with clinical illness consistent with Zika virus disease,* testing is recommended during the first week of illness. For asymptomatic pregnant women residing in areas with ongoing Zika virus transmission, testing is recommended at the initiation of prenatal care with follow-up testing mid-second trimester. Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity. Health care providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection.
Asunto(s)
Brotes de Enfermedades/prevención & control , Personal de Salud , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/prevención & control , Infección por el Virus Zika/prevención & control , Adolescente , Adulto , Centers for Disease Control and Prevention, U.S. , Pruebas Diagnósticas de Rutina/normas , Femenino , Humanos , Embarazo , Características de la Residencia/estadística & datos numéricos , Viaje/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven , Infección por el Virus Zika/transmisiónRESUMEN
CDC has updated its interim guidance for U.S. health care providers caring for women of reproductive age with possible Zika virus exposure to include recommendations on counseling women and men with possible Zika virus exposure who are interested in conceiving. This guidance is based on limited available data on persistence of Zika virus RNA in blood and semen. Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception. Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission ( http://www.cdc.gov/zika/geo/active-countries.html), or sex (vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who traveled to or resided in an area of active transmission. Women and men who reside in areas of active Zika virus transmission should talk with their health care provider about attempting conception. This guidance also provides updated recommendations on testing of pregnant women with possible Zika virus exposure. These recommendations will be updated when additional data become available.
Asunto(s)
Brotes de Enfermedades/prevención & control , Personal de Salud , Guías de Práctica Clínica como Asunto , Infección por el Virus Zika/prevención & control , Adolescente , Adulto , Centers for Disease Control and Prevention, U.S. , Pruebas Diagnósticas de Rutina/normas , Consejo Dirigido/normas , Femenino , Humanos , Infertilidad Femenina/terapia , Masculino , Tamizaje Masivo/normas , Atención Preconceptiva/normas , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Características de la Residencia/estadística & datos numéricos , Viaje/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven , Infección por el Virus Zika/transmisiónRESUMEN
CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.() Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease(§) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated <2 weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated 2-12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR testing should be performed. Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated <2 weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal. This guidance also provides updated recommendations for the clinical management of pregnant women with confirmed or possible Zika virus infection. These recommendations will be updated when additional data become available.