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Most reported Zika-associated microcephaly cases are from intrauterine first trimester infection. Among perinatal, specifically third trimester and immediate post-birth, Zika cases, there are only a few case reports of brain development issues.Reported Outcomes Of Perinatal Zika InfectionThough a mouse model of Zika infection (1), where embryos were infected in utero at embryonic age 14.5 days (mouse gestation is ~21 days), reported post-natal microcephaly, only a handful of human perinatally infected Zika-associated brain development or neurologic issues have been reported in the biomedical literature so far.Reported Brain And/Or Neurologic AbnormalitiesTwo infants with laboratory-confirmed Zika infection from third trimester exposure during the 2016-16 Brazil Zika outbreak showed not microcephaly but other brain abnormalities such as subependymal cysts in both and lenticulostriate vasculopathy in one (2).Paraguay reported Guillain–Barré syndrome - Wikipedia in one child after post-natal Zika in 2016 (3).No Reported Brain And/Or Neurologic AbnormalitiesOf two cases of perinatal Zika transmission from mothers infected close to delivery during the 2013-14 French Polynesia Zika outbreak, one infant remained asymptomatic while the other was diagnosed with Thrombocytopenia - Wikipedia and diffuse rash but not microcephaly (4).A study (5) of 1501 live births of Zika-infected mothers during the 2015-16 Brazil Zika outbreak found first trimester infection to be most severely affected, based on head circumference z score.Similarly, no apparent anomalies were reported (6) among children born to 1850 pregnant women in Colombia, >90% of them reportedly Zika infected during the third trimester.Reported Outcomes Of Postnatal Zika Infection In Infants & ChildrenThe CDC collated and analyzed (7) previously published data (8, 9, 10, 11, 12, 13) on ten 3 to 16 year old Zika-infected children from Africa, Asia, South America and the Pacific. Though none of them developed rash, all had fever, 2 each had conjunctivitis, vomiting or diarrhea while 3 had joint pain (Arthralgia - Wikipedia). No microcephaly.All eight cases of travel-related Zika cases among American children as of February 2016 (7) had rash with at least one other symptom (fever, arthralgia, nonpurulent conjunctivitis). Again no microcephaly.The 2007 Yap Island, Micronesia Zika virus outbreak included several infants and children. While their symptoms were similar to those in adults, namely, fever, maculopapular rash, arthralgia, Conjunctivitis - Wikipedia, 0 to 19 year olds had fewer probable and confirmed cases of Zika compared to 20 to 59 year olds (14). No microcephaly.No single case of microcephaly reported to CDC from US states among 150 probable or confirmed Zika cases among children <18 years of age (15). Ranging from 1 month to 17 years in age with median age of 14 years, all infections were travel-associated.129 (82%) had rash.87 (55%) had fever.45 (29%) had conjunctivitis.44 (28%) had arthralgia.Bibliography1. Shao, Qiang, et al. "Zika virus infection disrupts neurovascular development and results in postnatal microcephaly with brain damage." Development 143.22 (2016): 4127-4136.2. de Souza, Antonio Soares, et al. "Fetal infection by Zika virus in the third trimester: report of 2 cases." Clinical Infectious Diseases 63.12 (2016): 1622-1625.3. Lovera, Dolores, et al. "Neurologic syndrome associated with Zika postnatal acquisition. With regard to the first case in Paraguay." Revista del Instituto de Medicina Tropical 11.2 (2016): 36-41.4. Besnard, M., et al. "Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014." Euro surveill 19.13 (2014): 20751. http://www.eurosurveillance.org/images/dynamic/EE/V19N13/art20751.pdf5. França, Giovanny VA, et al. "Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation." The Lancet 388.10047 (2016): 891-897. https://www.researchgate.net/profile/Wanderson_Oliveira2/publication/304712927_Congenital_Zika_virus_syndrome_in_Brazil_A_case_series_of_the_first_1501_livebirths_with_complete_investigation/links/5789f77b08ae7a588eebbc61/Congenital-Zika-virus-syndrome-in-Brazil-A-case-series-of-the-first-1501-livebirths-with-complete-investigation.pdf6. Pacheco, Oscar, et al. "Zika virus disease in Colombia—preliminary report." New England Journal of Medicine (2016). http://www.nejm.org/doi/pdf/10.1056/NEJMoa16040377. Fleming-Dutra, Katherine E. "Update: interim guidelines for health care providers caring for infants and children with possible Zika virus infection—United States, February 2016." MMWR. Morbidity and mortality weekly report 65 (2016). https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6507e1.pdf8. Macnamara, F. N. "Zika virus: a report on three cases of human infection during an epidemic of jaundice in Nigeria." Transactions of the royal society of tropical medicine and hygiene 48.2 (1954): 139-145. http://icmr.nic.in/zika/publications/Zika%20Virus_A%20REPORT.pdf9. Olson, J. G., and T. G. Ksiazek. "Zika virus, a cause of fever in Central Java, Indonesia." Transactions of the Royal Society of Tropical Medicine and Hygiene 75.3 (1981): 389-393. http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA11796510. Heang, Vireak. "Zika Virus Infection, Cambodia, 2010-Volume 18, Number 2—February 2012-Emerging Infectious Disease journal-CDC." (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310457/pdf/11-1224_finalL.pdf11. Alera, Maria Theresa, et al. "Zika virus infection, Philippines, 2012." Emerging infectious diseases 21.4 (2015): 722. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378478/pdf/14-1707.pdf12. Dupont-Rouzeyrol, Myrielle. "Co-infection with Zika and Dengue Viruses in 2 Patients, New Caledonia, 2014-Volume 21, Number 2—February 2015-Emerging Infectious Disease journal-CDC." (2015). https://www.researchgate.net/profile/Elodie_Calvez/publication/271600742_Co-infection_with_Zika_and_Dengue_Viruses_in_2_Patients_New_Caledonia_2014/links/5505fd900cf2d60c0e6c8289.pdf13. Arzuza-Ortega, Laura, et al. "Fatal sickle cell disease and Zika virus infection in girl from Colombia." Emerging infectious diseases 22.5 (2016): 925. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861530/pdf/15-1934.pdf14. Duffy, Mark R., et al. "Zika virus outbreak on Yap Island, federated states of Micronesia." N Engl J Med 2009.360 (2009): 2536-2543. http://www.nejm.org/doi/pdf/10.1056/NEJMoa080571515. Goodman, Alyson B. "Characteristics of Children Aged< 18 Years with Zika Virus Disease Acquired Postnatally—US States, January 2015–July 2016." MMWR. Morbidity and Mortality Weekly Report 65 (2016). https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6539e2.pdfThanks for the R2A, Oliver Zahn.

Recent data suggest blood transfusions could transmit Zika so yes, blood banks in Zika-endemic areas should test for it. The link between maternal Zika infection and baby microcephaly (1) and other serious birth defects (2) is now compelling. Were Zika-infected blood transfused to pregnant women, risk could be unacceptably high for fetuses.Though Zika fever is a Vector (epidemiology) -borne disease spread by the bite of infected Aedes mosquitoes, a steady drumbeat of data shows it can also spread by other routes.Zika persists in semen (3, 4), vaginal tract (5, 6) and in circulation of pregnant women (7) for surprisingly long periods of time, and can be transmitted sexually (8, 9, 10, 11). Since Zika's asymptomatic in ~80% of those infected, Zika-infected blood transfusions could be a risk factor to fetuses not just if given to pregnant women but also if given to their sexual partners.Preliminary data suggest blood transfusion could transmit ZikaDuring the 2013-2014 French Polynesia Zika virus outbreak it was detected by Reverse transcription polymerase chain reaction (RT-PCR) in 42 of 1505 (2.8%) blood donors who were asymptomatic when they donated (12). 11 of these 14 reported having Zika fever-like syndrome about 3 to 10 days later.In the US territory of Puerto Rico, a total of 68 of 12777 (~0.5%) blood donations from April 3 to June 11, 2016 were identified as presumptive Zika viremic based on Nucleic acid test (NAT) with rates rising by ~2.2 over a 9 week period during the summer (see figure below from 13).These studies revealed Zika's potential for spreading through blood transfusion.More recently, a couple of case reports suggest blood transfusions could indeed transmit ZikaIn Brazil (14), concentrated Platelet from the blood of an asymptomatic 54 year old man was transfused into a 55 year old liver cancer patient undergoing liver transplant.Four days post-transplant, the transfused recipient was serum Zika virus positive by RT-PCR.Suspicion fell on the platelet donor after he contacted the blood donor facility 3 days after his donation to report he'd just developed dengue-like symptoms. His stored serum sample was then tested and found positive not for Dengue but for Zika virus by RT-PCR.Though source of recipient's Zika could have been other transplant related tissues and blood products, sequence analysis of 10 partial nucleotide sequences of the Zika virus isolated from the donor compared with the complete genome sequence of that isolated from the recipient matched 99.8%, strongly suggesting Zika transmission through transfusion.Recipient coming from a Zika non-epidemic area and being hospitalized in a mosquito-free area for 5 days before his Zika positive test further increased the likelihood he got Zika from his platelet transfusion.In Brazil again (15), an asymptomatic person donated platelets through Apheresis on January 16, 2016. These were transfused into two different patients on January 19.On January 21, the donor called the blood bank to report Zika symptoms (skin rash, eye pain, pain in both knees) starting on January 18.Donor samples before and after donation were negative for related Dengue virus and Chikungunya by RT-PCR. However, donor's plasma and urine samples were Zika positive 14 days after initial blood donation.Plasma samples from both recipients were Zika positive, 6 and 23 days post-transfusion, respectively.Given the high risk of newborn microcephaly from maternal Zika infection, far better to err on the side of caution and start screening blood donations for Zika. This may be why on August 26, 2016, the US FDA (16, emphasis mine)'issued a revised guidance recommending universal testing of donated Whole Blood and blood components for Zika virus in the U.S. and its territories'.Based on the available evidence the FDA concluded (17)'ZIKV meets the conditions for an RTTI [relevant transfusion-transmitted infection ] as described in 21 CFR 630.3(h)(2)'Specifically (17, emphasis mine),'FDA has determined that ZIKV meets the criteria in 21 CFR 630.3(h)(2) for an RTTI because of the sufficient incidence and prevalence of ZIKV to affect the potential donor population in the United States and because of the availability of appropriate screening tests for ZIKV' .Bibliography1. Johansson, Michael A., et al. "Zika and the Risk of Microcephaly." New England Journal of Medicine (2016). http://www.nejm.org/doi/pdf/10.1056/NEJMp16053672. Rasmussen, Sonja A., et al. "Zika virus and birth defects—reviewing the evidence for causality." New England Journal of Medicine 374.20 (2016): 1981-1987. http://www.nejm.org/doi/pdf/10.1056/NEJMsr16043383. Mansuy, Jean Michel, et al. "Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen." Lancet Infect Dis 16.405 (2016): 00138-9. https://www.researchgate.net/profile/Akshaya_Bhagavathula/publication/299346081_Extensively_drug-resistant_tuberculosis_in_a_young_child/links/56f3bd8a08ae38d7109b6d07.pdf4. Barzon, L., et al. "Infection dynamics in a traveller with persistent shedding of Zika virus RNA in semen for six months after returning from Haiti to Italy, January 2016." Euro surveillance: bulletin Européen sur les maladies transmissibles= European communicable disease bulletin 21.32 (2016). http://www.eurosurveillance.org/images/dynamic/EE/V21N32/art22556.pdf5. Davidson, Alexander. "Suspected female-to-male sexual transmission of Zika virus—New York City, 2016." MMWR. Morbidity and Mortality Weekly Report 65 (2016). http://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6528e2.pdf6. Prisant, N. et al. Zika virus in the female genital tract. Lancet Infectious Diseases, 2016, July 11. http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(16)30193-1.pdf7. Meaney-Delman, Dana, et al. "Prolonged Detection of Zika Virus RNA in Pregnant Women." Obstetrics & Gynecology (2016). Prolonged Detection of Zika Virus RNA in Pregnant Women. : Obstetrics & Gynecology8. Foy, Brian D., et al. "Probable non-vector-borne transmission of Zika virus, Colorado, USA." Emerg Infect Dis 17.5 (2011): 880-2. https://www.researchgate.net/profile/Andrew_Haddow/publication/51085888_Probable_NonVector-borne_Transmission_of_Zika_Virus_Colorado_USA/links/0c960515ad328e1ac4000000.pdf9. Coelho, Flávio Codeço, et al. "Sexual transmission causes a marked increase in the incidence of Zika in women in Rio de Janeiro, Brazil." bioRxiv (2016): 055459. http://www.biorxiv.org/content/biorxiv/early/2016/05/26/055459.full.pdf10. D’Ortenzio, Eric, et al. "Evidence of sexual transmission of Zika virus." New England Journal of Medicine 374.22 (2016): 2195-2198. http://www.nejm.org/doi/pdf/10.1056/NEJMc160444911. Fréour, Thomas, et al. "Sexual transmission of Zika virus in an entirely asymptomatic couple returning from a Zika epidemic area, France, April 2016." Eurosurveillance 21.23 (2016). http://www.e-sciencecentral.org/upload/eurosurv/pdf/eurosurv-21-23-22500.pdf12. Musso, D., et al. "Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014." Euro Surveill 19.14 (2014): 20761. http://www.eurosurveillance.org/images/dynamic/EE/V19N14/art20761.pdf13. Kuehnert, Matthew J. "Screening of blood donations for Zika virus infection—Puerto Rico, April 3–June 11, 2016." MMWR. Morbidity and Mortality Weekly Report 65 (2016). https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6524e2.pdf14. Barjas‐Castro, Maria L., et al. "Probable transfusion‐transmitted Zika virus in Brazil." Transfusion 56.7 (2016): 1684-1688. http://onlinelibrary.wiley.com/doi/10.1111/trf.13681/epdf15. Motta, Iara JF, et al. "Evidence for Transmission of Zika Virus by Platelet Transfusion." New England Journal of Medicine (2016). http://www.nejm.org/doi/pdf/10.1056/NEJMc160726216. FDA advises testing for Zika virus in all donated blood and blood components in the US17. http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM518213.pdfThanks for the R2A, Jonathan Brill.

Integrated Disease surveillance program or IDSP is an initiative started by The Ministry of Health and family welfare of the Government of India with the assistance of The World Bank to detect and respond to outbreaks quickly in November 2004.It was started with a purpose of strengthening the disease surveillance in the country by establishing a decentralized State-based surveillance system for epidemic prone diseases to detect the early warning signals, so that timely and effective public health actions can be initiated in response to health challenges in the country at the Districts, State and National level.Program Components:• Integration and decentralization of surveillance activities through the establishment of surveillance units at Centre, State, and District level.• Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team, and other Medical and Paramedical staff on principles of disease surveillance.• Use of Information Communication Technology for collection, collation, compilation, analysis, and dissemination of data.• Strengthening of public health laboratories.• Inter sectoral Co-ordination for zoonotic diseases.Outbreak Surveillance and Response:IDSP receives disease outbreak reports from the States/UTs on a weekly basis. Even NIL weekly reporting is mandated and compilation of disease outbreaks/alerts is done on a weekly basis. On an average 30- 35 outbreaks are reported to IDSP weekly. A total of 553 outbreaks were reported in 2008, 799 outbreaks in 2009, 990 outbreaks in 2010, 1675 outbreaks in 2011 and 1584 outbreaks in 2012, 1964 outbreaks in 2013, 1562 outbreaks in 2014, 1935 outbreaks in 2015, 2679 outbreaks reported in 2016 and 1714 outbreaks reported in 2017.Majority of outbreaks reported in 2018 were of Measles (28%), Chickenpox (23%), Food Poisoning (14%), Acute Diarrheal Disease (12%), Chikungunya (5%), Influenza-B (3%), Scrub typhus (3%), and Dengue (2%).Considering the non-availability of health professionals in the field of Epidemiology, microbiology, and Entomology at district and state levels, MOHFW approved the recruitment of trained professionals under NHM in order to strengthen the disease surveillance and response system by placing one Epidemiologist each at state/district headquarters, one Microbiologist and Entomologist each at the state headquarters. The post of a Veterinary Consultant at State Surveillance Unit has been approved by the MOHFW recognizing the Mission Statement of One Health Initiative.That’s All, Do upvote if you liked the answer.Have a beautiful day….Credit:- Wikipedia & Official website of Ministry of Health and Family welfare Affairs