Health Emergency Response (HER) Advisory: Zika Virus Outbreak

Health Emergency Response (HER) Advisory: Zika Virus Outbreak

Christopher Romero; Lina Bofill, MD, FACP; Kalai Mathee, PhD; Carlos Espinal, MD 

Zika Facts: Spanish Version | Portuguese Version

For daily updates, see PROMED-mail.   On Monday, February 1st, the World Health Organization (WHO) declared a public health emergency in response to an outbreak of Zika virus, predominantly in Central and South America. Click here for the CDC’s current travel advisories.    Zika is a virus in the Flaviviridae viral family, which places it in the same family as those that cause yellow fever and dengue fever. Zika virus (ZKV) is transmitted through infected Aedes sp. mosquitoes, especially Aedes aegypti—the same vector that transmits the dengue and chikungunya viruses, and seriously threatens urban settings with the transmission of yellow fever. Prior to 2007, ZKV infections were reported to cause only sporadic human infections in Africa and Asia along the equatorial line. In 2007, an outbreak was reported from Micronesia, which marked the first detection outside of the endemic region. ZKV has been detected in the Americas since 2014. In May 2015, the Pan-American Health Organization (PAHO), in collaboration with the Brazilian Ministry of Health, confirmed the local transmission of ZKV in the northeastern part of the country. Since then, ZKV rapidly spread to other areas of Central and South America. Until now, no locally transmitted ZKV cases have been reported through mosquito bites. However, there have been reported local cases stemming from travelers who have been infected abroad in countries under an active ZKV outbreak.   While the public has expressed great concern about the virus’ transmission rates and subsequent infection, Zika fever in itself is often asymptomatic (in 60-80% of cases). An infected patient exhibiting symptoms may experience a low-grade fever, conjunctivitis, a maculopapular rash, small-joint pain, and headache. The CDC suggests bed rest and acetaminophen to dull pain symptoms, as no vaccine or prophylactic medication is currently available to treat this condition. If you suspect a ZKV infection, do not take NSAIDs (such as ibuprofen, aspirin, diclofenac, naproxen sodium or similar drugs) until a possible dengue infection is ruled out by a medical professional.   Researchers are currently investigating links to Guillain-Barré syndrome (GBS) in cases of ZKV in French Polynesia, after the 2014 outbreak. Since the Brazilian outbreak in 2015, a dramatic increase in congenital microcephaly and an increase in cases of GBS in correlation with the current outbreak have been reported. However, a causal relationship between ZKV and these conditions have not been established as of the current day.   Prevention is the best cure: avoid mosquito bites. Mosquitoes that are likely to carry ZKV are active throughout the daytime and early evening. In areas with an active ZKV outbreak, the public is asked to wear protective clothing throughout the day, remaining indoors when possible, and using air conditioning or window and door screens to help keep mosquito exposure low. If sleeping outside is unavoidable, use mosquito nets, and use preventive measures in all cases through the use of repellents and insecticides. For pregnant women and children under 3 years of age, consult a medical professional for safe alternatives. In addition to these individual protection measures, public health intervention is based on the key components of the Integrated Management Strategy (IMS) for vector-borne disease: clinical diagnosis and management, community engagement and active participation, social communication and integrated vector control.