Current knowledge and facts on Zika virus
| Recent outbreaks and epidemics of Zika virus suggest there may be a link between Zika virus and other neurological abnormalities such as-myelitis, congenital microcephaly, foetal loss and Guillain-Barre’ syndrome. Check out recent updates and latest research news on ZIKV. |
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What is Zika?
Zika virus (ZIKV) infection has become an emerging concern of global public health; it is an arthropod – borne Flavivirus transmitted by mosquitoes.
This virus was first isolated in 1947 from a rhesus monkey in the Zika forest of Uganda. Zika means – “overgrown” in the Luganda language. In addition to ZIKV, The Flavivirusgenus comprises – dengue, yellow fever, Japanese encephalitis, and Chikungunya and West Nile viruses.
ZIKV Disease Outbreak
Outbreaks of ZIKV have occurred in Africa, Southeast Asia and the Pacific Islands. In 2007 a major outbreak was reported on Yap Island, Micronesia. This was the first documented outbreak of ZIKV disease outside of Africa and Asia.
Another major outbreak of ZIKV disease occurred in French Polynesia in 2013. Since 2015, there is an ongoing ZIKV outbreak in South America which is now penetrating the Caribbean, and the Pacific.
Both Aedes aegypti and Aedes albopictus have been implicated in the major outbreaks of Zika virus. In the South Pacific, Aedes hensilli was responsible for the spread of Zika virus on Yap Island in 2007, while Aedes. Polynesiensis was suspected to spread Zika virus in French Polynesia in 2013.
On 1 February 2016 the World Health Organization (WHO) declared an international public health emergency after Zika virus was linked to thousands of birth defects in Brazil.
Transmission
The transmission of ZIKV typically occurs through the bite of an infected Aedes mosquito. Zika infection is also possible through blood transfusion or organ transplantation. ZIKV RNA has been found in blood, urine, semen, saliva, cerebrospinal fluid, amniotic fluid, and breast milk. This virus can be transmitted to humans through blood transfusion, perinatal transmission and sexual transmission.
Clinical Signs & Symptoms
Most people infected with ZIKV are asymptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. However, the recent rise in the spread of ZIKV in Brazil has been accompanied by an unprecedented rise in the number of children being born with unusually small heads-identified as microcephaly. In addition, several countries, including Brazil, reported a steep increase in Guillain-Barre syndrome-a neurological disorder that could lead to paralysis and death. There is scientific consensus that ZIKV is a cause of microcephaly and Guillain-Barre’ syndrome.
Diagnosis & Reporting
Based on the typical clinical features, the differential diagnosis for ZIKV infection is broad. In addition to dengue, other considerations include leptospirosis, malaria, and rickettsia, group A streptococcus, rubella, measles, parvovirus, enterovirus, adenovirus, and alphavirus infections (e.g., Chikungunya, Mayaro, Ross River, Barmah Forest, O’nyong-nyong, and Sindbis viruses).
ZIKV infection can be misdiagnosed; thus, the differential laboratory diagnosis is important. It can be accomplished by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin M and neutralizing antibodies. The results of serological tests have to be interpreted carefully as false-positive results can occur due to cross-reactivity with other flaviviruses.
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No specific antiviral treatment is available for ZIKV disease. Treatment is generally supportive and can include rest, plenty of fluids, and use of analgesics and antipyretics.
Because of similar geographic distribution and symptoms, patients with suspected ZIKV infections also should be evaluated and managed for possible dengue or Chikungunya virus infection. Acetaminophen or Dipyrone are recommended to control fever and pain management. Aspirin and other non-steroidal, anti-inflammatory drugs should be avoided until dengue can be ruled out to reduce the risk of haemorrhage. People infected with ZIKV, Chikungunya, or dengue virus should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission.
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Updates on ZIKV can be viewed at the following websites:
Australian Government Department of Health website
European Centre for Disease Prevention website
Pan American Health Organization (PAHO/WHO) website
United States Centre for Disease Control and Prevention (CDC) website
Set of recommendations for prevention of ZIKV infection for individuals planning to travel to Brazil can be checked from the WHO website.
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Broutet, N. et al. (2016) Zika virus as a cause of neurologic disorders. N. Engl. J. Med. 374, 1506–1509.
Cao-Lormean et al. (2016) Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. The Lancet 387(10027), 1531-1539.
Carteaux G et al.(2016) Zika virus associated with meningoencephalitis. N. Engl. J. Med. 374, 1595-1596.
Chen H, Tang R. (2016) Why zika virus infection has become a public health concern? Journal of the Chinese Medical Association 79(4), 174-78.
Daniel R. Lucey, MD, MPH; Lawrence O. Gostin, JD. (2016) The emerging ZIKA pandemic: enhancing preparedness. JAMA 315(9), 865-866.
Duffy,M.R. et al. (2009) Zika virus outbreak on Yap Island, Federated States of Micronesia. N. Engl. J. Med. 360, 2536 – 2543.
Faria,N.R. et al. (2016) Zika virus in the Americas: Early epidemiological and genetic findings. Science 352, 345–359.
Gatherer D, Kohl A. (2016) Zika virus: a previously slow pandemic spreads rapidly through the Americas. J. Gen. Virol. 97(2), 269-273.
Olagnier, D. et al. (2016) Dengue virus immunopathogenesis: lessons applicable to the emergence of Zika virus. J. Mol. Biol. (In Press).
Wang, L. et al. (2016) From mosquitos to humans: genetic evolution of Zika virus. Cell Host Microbe 19(5), 561–565.
Wolters Kluwer Clinical Drug Information: Writing scripts for bug spray? Zika and CMS change game. Rxperts Newsletter (Internet), 2016, August.
Ingredient name changes from the Australian Therapeutic Goods Administration (TGA)
The TGA maintains terminology for ingredients used in Australian medicines. The TGA has begun a four-year transition to standardise ingredient names with drug names used internationally as part of the International Harmonisation of Ingredient Names (International Harmonisation of Ingredient Names) initiative.
Some changes are minor but others are more significant and require drug manufacturers to carry both old and new names of ingredients on their labels and packaging.
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| The Therapeutic Goods Administration (TGA) is updating ingredient names to align with those used internationally. From April 2016, new ingredient names will start to appear on medicine labels, in product information and consumer medicine information leaflets and within medication information/software systems.
Some of these changes are minor, such as a changing a ‘y’ to an ‘i’, while other changes will feature the old and new names on a label. For example, ‘lignocaine’ will become ‘lidocaine (lignocaine)’. After 2023, labels will use the new name ‘lidocaine’ only.
Patients may be unfamiliar with the new ingredient names, and it’s important that healthcare professionals are prepared to have conversations with them. |
Adrenaline auto injector labels
Of particular significance will be the changes to adrenaline. During 2016, adrenaline medicine labels will start to show ‘adrenaline (epinephrine)’ as the ingredient name. It’s important to remember that it’s only the label of the auto injector that will change to include this new information, the ingredients inside including dose amounts will stay the same.
In Australia, adrenaline is the approved name of the ingredient used in auto injector devices used for the emergency treatment of anaphylaxis. Currently, the only available auto injector to treat anaphylaxis in Australia is supplied under the brand name EpiPen®.
Adrenaline auto injectors are designed to be used by anyone in an emergency, including people who are not medically trained such as friends, bystanders, passers-by, school and childcare staff.
In some countries, adrenaline is known as epinephrine. Using different names for the same ingredient can be confusing for Australians travelling overseas, visitors to Australia and health professionals trained internationally.
Including both adrenaline and epinephrine on Australian medicines should help make it clear that these are the same ingredient. Both names will also be used in the CMI leaflet available with the medicine.
Changes to CHC medicines information resources
Some of the key medicines information platforms provided to CHC users have now aligned to accommodate the new updates from the TGA.
- MIMS Online
- Aligns with the TGA’s nomenclature harmonisation.
- Includes International Non-proprietary Names (INNs) as well as Australian Approved Names (AANs).
- AusDI
- Aligns with the TGA’s nomenclature harmonisation and includes a look up table of all name changes.
- Optimised product search, interactions and safety and browse functions displaying both International Non-proprietary Names (INNs) as well as Australian Approved Names (AANs).
- Optimised Independent Drug Monographs and Product Summary documents.
- These documents now include display of both old (AAN) and new (INN) ingredient names.
In addition, both these platforms will be supporting the International Harmonisation of Ingredient Names initiative throughout its transition period. As sponsors update their Product Information (PI) and Consumer Medicine Information (CMI) documents to use the new names, users will start to see these new documents appear in both AusDI and MIMS Online.
For further information from the TGA visit https://www.tga.gov.au/updating-medicine-ingredient-names.
Recent government initiatives to combat family violence
The State Government of Victoria announced the massive budget commitment of $572 million to combat family violence after Australia’s first Royal Commission into Family Violence delivered its report in March 2016.
This report contains the commission’s recommendations about how Victoria should prevent and respond to family violence.
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| The Victorian Royal Commission’s recommendations have focused on breaking down a siloed system to increase cooperation between organisations and systems preventing and responding to domestic violence.
The Royal Commission into family violence made 227 recommendations. They have also integrated existing services, counsellors, prevention programs, Aboriginal services, justice services and housing. Reports and recommendations of the Royal Commission into family violence can be viewed at http://www.rcfv.com.au/Report-Recommendations.
The state government has launched high-impact Risk Assessment and Management Panels (RAMPs), which will operate in 18 locations across Victoria. RAMPs will bring together professionals from specialist women’s family violence services, Victoria Police, Corrections Victoria, housing, mental health, alcohol and drug services, men’s family violence services, Child FIRST and child protection. Browse recent publications and resources on violence against women, Referral options booklet includes – contact details and information on family violence and related support services from Domestic Violence Resource Centre, Victoria. Make the Link, Gippsland Women’s Health provides information resources to support – health professionals, individuals and communities to understand violence against women and family violence and act to prevent it. |
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Batty, Rosie. (2015) MJA Careers- Family violence. Med J Aust. 203(5),C1-C2.
Brown, Jac; , James, Kerrie (2014) Therapeutic responses to domestic violence in Australia: A history of controversies Australian and New Zealand Journal of Family Therapy 35 (2), 169-184.
Domestic Violence Resource Centre (2013) http://www.dvrcv.org.au/.
Joseph B, Khalil M, Zangbar B, et al. (2015) Prevalence of Domestic Violence among Trauma Patients. JAMA Surg. 150(12), 1177-1183.
O’Connor M, Cox J, Castle D.J.( 2015) What can psychiatrists do to better support victims of family violence? Australasian psychiatry. 23(1), 59-62.
Ranson, D. Williams, A., Thorne, B. and Ryan J. (2016) Family violence and clinical forensic medicine – the forgotten service? Journal of Law and Medicine. 23, 780-781.
Ray N Moynihan (2012) Domestic violence: can doctors do more to help? Med. J. Aust. 197 (2): 75.
| Content Updates on CHC Portal |
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Additional contents on Medline(Ovid)
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Wolters Kluwer enhanced database contents on Medline (Ovid) platform; it includes Epub Ahead of Print citations (also known as-publisher) supplied citations.
This new enhancement brings Ovid Medline to content parity with Medline via PubMed, so there will no longer be any need for users to search PubMed to obtain the most recent Medline citations separately.
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Discontinuation of Paediatric Pharmacopoeia
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The Pharmacy Department of The Royal Children’s Hospital Melbourne (RCH) has decided to discontinue publishing of Paediatric Pharmacopoeia. The current edition, published in 2002, is the final edition; see the official notification published on The Royal Children’s Hospital website.
Clinicians Health Channel users will continue to get up to date Australian paediatric dosing information from the Australian Medicines Handbook Children’s Dosing Companion (AMH-CDC) through Clinicians Health channel portal. The AMH – CDC is the most recent, evidence-based dosing guide for prescribing and administering medicines to children from birth to 18 years. This is the recommended paediatric drug reference to be used for prescribing medications for children.
Marketing/Promotional materials on CHC Knowledge Hub
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