What Is Zika Virus?

The Zika virus, first identified in Uganda in 1947, is transmitted by Aedes mosquitoes, the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific.

Zika has “never been thought of as a severe infectious disease until now,” says Amesh Adalja, MD, a spokesman for the Infectious Diseases Society of America.

The CDC has confirmed Zika can spread through sex, usually after a person traveled to an area where Zika has broken out, got the virus, and gave the virus to a sex partner who did not travel. Infected women and men can both pass the virus to sex partners — even if they haven’t shown symptoms of infection, the CDC says. In addition, infected pregnant women can pass the virus on to their fetus.

Some studies have also shown the virus can be found in blood, semen, urine, and saliva of infected people, as well as in fluids in the eye.

In Utah, a person got the virus without traveling or having sexual contact. The person was a relative and caregiver of an elderly Zika patient who died in late June — the first Zika-linked death in the U.S. The deceased man had traveled to an area where Zika is spreading, and lab tests showed high amounts of the virus in his blood — more than 100,000 times higher than that seen in other samples of infected people, the CDC says. He also had an underlying medical condition that has not been disclosed.

Zika virus (ZIKV) is a member of the virus family Flaviviridae. It is spread by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus. Its name comes from the Ziika Forest of Uganda, where the virus was first isolated in 1947. Zika virus is related to the dengue, yellow fever, Japanese encephalitis, and West Nile viruses. Since the 1950s, it has been known to occur within a narrow equatorial belt from Africa to Asia. From 2007 to 2016, the virus spread eastward, across the Pacific Ocean to the Americas, leading to the 2015–16 Zika virus epidemic.

The infection, known as Zika fever or Zika virus disease, often causes no or only mild symptoms, similar to a very mild form of dengue fever. While there is no specific treatment, paracetamol (acetaminophen) and rest may help with the symptoms. As of 2016, the illness cannot be prevented by medications or vaccines.  Zika can spread from a pregnant woman to her baby. This can result in microcephaly, severe brain malformations, and other birth defects. Zika infections in adults may result rarely in Guillain–Barré syndrome.

In January 2016, the United States Centers for Disease Control and Prevention (CDC) issued travel guidance on affected countries, including the use of enhanced precautions, and guidelines for pregnant women including considering postponing travel.[10][11] Other governments or health agencies also issued similar travel warnings,[12][13][14] while Colombia, the Dominican Republic, Puerto Rico, Ecuador, El Salvador, and Jamaica advised women to postpone getting pregnant until more is known about the risks

Symptoms

Most people don’t have any symptoms. If symptoms do occur, they are usually mild and last around two to seven days.

Commonly reported symptoms include:

• rash
• itching all over the body
• fever
• headache
• joint pain (with possible swelling, mainly in the smaller joints of the hands and feet)
• muscle pain
• conjunctivitis (red eyes)
• lower back pain
• pain behind the eyes

Most people experience a very mild infection without any complications. However, it is now known that Zika virus may be passed from a woman to her unborn baby. This can cause potentially serious consequences for the baby, in particular a condition called microcephaly (a small head and brain). Microcephaly is just one of the signs and symptoms of congenital Zika virus syndrome (CZVS) that can be present at birth or appear later in infancy such as seizures (fits), irritability, swallowing problems, hearing and sight abnormalities.

There is also strong scientific agreement that Zika virus can cause a rare paralysing condition called Guillain-Barré Syndrome (GBS). This condition has been found in areas where Zika virus outbreaks are occurring and in cases of individual travellers returning from affected countries. GBS is known to be caused by other viruses and bacteria as well.

Diagnosis

Infection with Zika virus may be suspected based on symptoms and recent history of travel (e.g. residence in or travel to an area with active Zika virus transmission). A diagnosis of Zika virus infection can only be confirmed through laboratory tests on blood or other body fluids, such as urine, saliva or semen.

Zika pregnant

Pregnant women who experience Zika symptoms should seek immediate medical attention.

Symptoms of Zika resemble those of flu, and they can be so mild that they go unnoticed. Most people will not visit a doctor or go to the hospital.

However, a pregnant woman who experiences symptoms should see a doctor for blood or urine testing.

Several rapid detection tests are available for qualified laboratories. These are distributed by the CDC.

These tests can confirm an infection.

How it spreads

Zika virus is spread by the bite of a mosquito that is carrying the virus. Not all types of mosquito can spread it. Some types of Aedes mosquito can spread Zika virus, particularly Aedes aegypti but also possibly Aedes albopictus. Both are daytime biting mosquitoes, with increased activity around sunrise and sunset. Aedes aegypti mosquitoes often live in and around buildings in urban areas.

Most areas of Australia do not have the Aedes aegypti mosquito that can spread the virus. This mosquito is currently found in parts of Northern, Central and Southwest Queensland. Aedes albopictus is found in the Torres Strait Islands. Therefore, in most parts of Australia, there is no risk of Zika virus being spread by mosquitoes. Currently, all cases of Zika virus diagnosed in Australia were caught overseas.

Zika virus can also spread through sexual activity (vaginal, oral, or anal) particularly from a man to a woman, but male to male and female to male transmission have also been reported. However, the main way that Zika virus spreads is still by mosquitoes.

Reducing your risk of Zika virus infection

Before travelling, seek travel health advice from your GP/practice nurse or a travel clinic ideally four to six weeks before you go.

You can use this A to Z guide to check if the country you are visiting has a high, moderate or low risk for Zika virus transmission.

Detailed travel health advice for your destination is also available from the TravelHealthPro website or the Scottish travel health service fitfortravel.

To reduce your risk of infection, you should avoid being bitten by an Aedes mosquito. The most effective bite prevention methods, which should be used during daytime and night-time hours, include:

• Using insect repellent that contains DEET (N, N-diethyl-meta-toluamide) on exposed skin, after sunscreen has been applied. DEET can be used by pregnant or breastfeeding women in concentrations up to 50%, and in infants and children older than two months. It should not be used on babies younger than two months.
• Wearing loose clothing that covers your arms and legs.
• Sleeping under a mosquito net in areas where malaria is also a risk.

Advice for pregnant women

Scientists have concluded that there is enough evidence to show that Zika virus infection is a cause of birth defects, including microcephaly (this means the baby will have an abnormally small head and can be associated with abnormal brain development). This is also known as congenital Zika syndrome.

It is therefore recommended that pregnant women should:

• postpone non-essential travel to areas at high risk of Zika virus transmission
• consider postponing non-essential travel to areas at moderate risk of Zika virus transmission until after pregnancy

Discuss your travel plans with your GP, practice nurse or a travel clinic. If travel is unavoidable, then you should take extra care to avoid being bitten by mosquitoes.

If you and your partner are currently in an area with high or moderate risk of Zika virus transmission, make sure you use condoms during vaginal, anal and oral sex while travelling and for the duration of your pregnancy.

If you are pregnant and have recently returned from an area with high or moderate risk of Zika virus transmission, see your GP or midwife and mention where you have been, even if you have not been unwell.

Your midwife or hospital doctor will discuss the risk with you and can arrange an ultrasound scan of your baby to monitor growth. If there are any issues, you will be referred to a specialist foetal medicine service for further monitoring.

Zika virus is most likely to be detected by currently available tests when symptoms are present. If you are currently experiencing Zika symptoms, contact your GP, who will decide whether investigations are necessary. Investigations might include a blood test and/or an ultrasound test if you are pregnant.

Screening tests for Zika for those without symptoms are not available.

Advice for women trying to get pregnant

If you are trying to get pregnant, discuss your travel plans with your GP, practice nurse or travel clinic. You should take extra care to avoid being bitten by mosquitoes.

It is recommended that you avoid becoming pregnant while travelling to an area with high or moderate risk of Zika virus transmission, and for eight weeks after you return home. It is also recommended that you take folic acid supplements for 28 days before trying to get pregnant.

If you have experienced Zika symptoms within two weeks of returning home, it is recommended that you wait eight weeks after full recovery before you try to get pregnant.

If your male partner has travelled to an area with high or moderate risk of Zika virus transmission, you should use effective contraception to prevent pregnancy and  condoms during vaginal, anal and oral sex to reduce the risk of sexual transmission.

These measures should be taken during travel and for six months:

after start of symptoms (if he does experience Zika symptoms or a Zika virus infection has been confirmed by a doctor)

following his return home (if he has no Zika symptoms)

Treatment

Zika virus disease is usually mild and requires no specific treatment. People sick with Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available.

A person with symptoms should:

• rest
• increase fluid intake to prevent dehydration
• take over-the-counter (OTC) pain killers to relieve pain and fever

The CDC advise against using aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) until a diagnosis of dengue has been ruled out in those at risk due to the risk of hemorrhage.

The CDC also advise that pregnant women who are diagnosed with Zika should be considered for the monitoring of fetal growth and anatomy program every 3 to 4 weeks.

They also recommend seeing a doctor who specializes in pregnancy management and either infectious disease or maternal-fetal medicine.

Prevention

Mosquito bites

Protection against mosquito bites is a key measure to prevent Zika virus infection. This can be done by wearing clothes (preferably light-coloured) that cover as much of the body as possible; using physical barriers such as window screens or closing doors and windows; sleeping under mosquito nets; and using insect repellent containing DEET, IR3535 or icaridin according to the product label instructions. Special attention and help should be given to those who may not be able to protect themselves adequately, such as young children, the sick or elderly. Travellers and those living in affected areas should take the basic precautions described above to protect themselves from mosquito bites.

It is important to cover, empty or clean potential mosquito breeding sites in and around houses such as buckets, drums, pots, gutters, and used tyres. Communities should support local government efforts to reduce mosquitoes in their locality. Health authorities may also advise that spraying of insecticides be carried out.

Sexual transmission

Zika virus can be transmitted through sexual intercourse. This is of concern due to an association between Zika virus infection and adverse pregnancy and fetal outcomes.

For regions with active transmission of Zika virus, all people with Zika virus infection and their sexual partners (particularly pregnant women) should receive information about the risks of sexual transmission of Zika virus. WHO recommends that sexually active men and women be correctly counselled and offered a full range of contraceptive methods to be able to make an informed choice about whether and when to become pregnant in order to prevent possible adverse pregnancy and fetal outcomes. Women who have had unprotected sex and do not wish to become pregnant due to concerns about Zika virus infection should have ready access to emergency contraceptive services and counselling. Pregnant women should practice safer sex (including correct and consistent use of condoms) or abstain from sexual activity for at least the whole duration of the pregnancy.

For regions with no active transmission of Zika virus, WHO recommends practising safer sex or abstinence for a period of six months for men and women who are returning from areas of active transmission to prevent Zika virus infection through sexual intercourse. Sexual partners of pregnant women, living in or returning from areas where local transmission of Zika virus occurs should practice safer sex or abstain from sexual activity throughout the pregnancy.

Summary

Zika is a virus that is spread mostly by mosquitoes. A pregnant mother can pass it to her baby during pregnancy or around the time of birth. It can spread through sexual contact. There have also been reports that the virus has spread through blood transfusions. There have been outbreaks of Zika virus in the United States, Africa, Southeast Asia, the Pacific Islands, parts of the Caribbean, and Central and South America.

Most people who get the virus do not get sick. One in five people do get symptoms, which can include a fever, rash, joint pain, and conjunctivitis (pinkeye). Symptoms are usually mild, and start 2 to 7 days after being bitten by an infected mosquito.

A blood test can tell whether you have the infection. There are no vaccines or medicines to treat it. Drinking lots of fluids, resting, and taking acetaminophen might help.

Zika can cause microcephaly (a serious birth defect of the brain) and other problems in babies whose mothers were infected while pregnant. The Centers for Disease Control and Prevention recommends that pregnant women do not travel to areas where there is a Zika virus outbreak. If you do decide to travel, first talk to your doctor.

You should also be careful to prevent mosquito bites:

Use insect repellent

Wear clothes that cover your arms, legs, and feet

Stay in places that have air conditioning or that use window and door screens

Avoid spreading the virus

A person who is infected with Zika should do everything possible to avoid being bitten by a mosquito for 3 weeks after symptoms appear, because the mosquito can pass the virus to the next person. This includes people who have returned from a trip with the disease.

The person must also be careful to avoid unprotected sex, as this, too, can pass on the virus. The CDC recommend using condoms during and after traveling to regions affected by the virus.

In some countries, including the U.S., health authorities recommend that men who visit an at-risk area but do not develop symptoms should use condoms for up to 6 months if they do not have symptoms and up to 6 months from the time of symptom onset. If their partner is pregnant, they should use condoms for the duration of the pregnancy.

A person who has had the Zika virus is normally protected, and unlikely to have it again.

After the virus leaves the body, a woman can safely conceive without the risk of her child being born with microcephaly.

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