Zika Virus Update
Elizabeth D. Barnett, MD
June 21, 2016
Zika Virus Update
What is zika virus?
Why are we concerned about it?
What can we do to protect
ourselves and our family from
zika virus infection?
Zika Virus
Arthropod-borne virus (arbovirus)
similar to West Nile virus, dengue virus,
yellow fever virus
Transmitted by mosquitoes
Generally causes a mild illness but is
associated with some severe problems
Recently arrived in the Americas
Discovered in Zika Forest, Uganda 1947
39 countries and territories
have reported local vectorborne Zika cases
Mosquito Vectors
Aedes aegypti main vector
Ae. albopictus potential vector
Aedes spp. Distribution in
the United States
How Do You Get Zika Virus
Infection?
Mosquito bites
Sexual transmission: possible from
incubation period up to 62 days (or
longer?)
Blood product transfusion
Breast milk?
Saliva?
What are the symptoms of
zika virus infection?
About 80% of cases have no symptoms
Typical symptoms are:
– Fever (65%)
– Rash (lasting an average of 6 days,
ranging from 2-14 days)
– Muscle aches (lasting an average of 3.5
days, ranging from 1-14 days)
– Conjunctivitis
Symptom
Clinical symptoms and signs in 93 patients with Zika
virus disease acquired in the Americas
Rash
82
Fever/sweats
71
Arthralgia
67
Headache
57
Myalgia
56
Other*
46
Fatigue
44
Conjunctivitis
37
Pruritus
21
Guillain-Barré syndrome
2
0
10
20
30
40
50
Number of patients
60
70
80
90
Chen LH. Zika virus infection in a
Rash post
travel
totravel
Haitito Costa
Massachusetts
resident
after
Rica: a case report. Ann Int Med 2016
Clinical Features of ZIKV
Brasil P et al. NEJM 2016
Complications of zika virus
infection
Congenital infection: microcephaly
and other neurologic abnormalities in
babies
– Risk of fetal infection may be greatest if
mother infected in first trimester; lowest if
mother infected in third trimester
Guillain Barre syndrome
Bleeding problems (low platelets)
Complications of Zika
How is Zika Virus Infection
Diagnosed?
History of travel to an affected area
Signs and symptoms typical of zika virus
infection
Blood and urine can be tested for the virus
during the first 1-2 weeks after symptoms
appear
Blood can be tested for viral antibody
beginning ~ 1 week after symptoms appear
Management of Zika Virus
Disease
No specific treatment is available
Supportive treatment with
acetaminophen, hydration, and rest
Avoid aspirin and non-steroidal antiinflammatory drugs (NSAIDs) until
dengue virus infection has been ruled out
Avoid mosquito bites for a week after
infection to avoid transmitting to others
Dengue, Chikungunya, and Zika
Options for Prevention
Wear long-sleeved shirts and long
pants as weather permits
Air conditioning or window/door
screens to keep mosquitoes outside
– If no screens, sleep under a mosquito
bed net or in a tent (can treat with
permethrin)
Mosquito repellents!
Permethrin treating of clothing
Insect Repellents
These provide long lasting protection:
– DEET (20-30%)
– Picaridin (icaridin) (20%)
– IR3535
– Oil of lemon eucalyptus, para-menthane-diol
If you use sunscreen and insect repellent,
apply sunscreen first and then repellent
Dark colors, strong smells, CO, pregnant
women attract mosquitoes
Permethrin insectide treatment of clothing
Travel Precautions –
Pregnant Women
Women who are pregnant should
avoid travel to areas with ongoing
Zika transmission
– Modified (based on epidemiological
data on Ae. aegypti distribution and
dengue risk) to: Avoid travel to
elevations <2000 m
Pregnant women who have been in
Zika-infected areas can be screened
for infection
Prevention of Sexual
Transmission of Zika
Sexual partners of pregnant women, after visiting
areas with local Zika transmission, should practice
safe sex or abstain from sexual activity for duration
of pregnancy
Men with Zika virus-like symptoms after returning
from Zika areas should wait at least 6 months before
attempting conception
Asymptomatic men returning from areas with Zika
circulation should wait at least 8 weeks before
attempting conception
Asymptomatic and symptomatic women returning
from areas with Zika circulation should wait at least
8 weeks before attempting conception
Sources of Information
about Zika Virus
Centers for Disease Control and
Prevention (CDC) Website:
– http://www.cdc.gov/zika/index.html
WHO and PAHO (Pan-American Health
Organization) website:
– http://www.paho.org/hq/index.php?option=
com_content&view=article&id=11585&Item
id=41688&lang=en