Zika Virus Disease
exp date isn't null, but text field is
Zika virus is a flavivirus that is transmitted primarily through the bite of an infected mosquito, primarily Aedes aegypti, and also Aedes albopictus, the same mosquitoes that transmit dengue, chikungunya, and yellow fever. Zika virus can also be transmitted in-utero from mother to fetus, and through sexual contact, blood transfusion, and organ transplantation. Zika virus infections are usually asymptomatic. When symptoms occur, they tend to be mild and include mild fever, rash, conjunctivitis, and muscle and joint pain that last for 2 to 7 days. There is no specific treatment but symptoms can be treated with common fever medicines, rest and drinking fluids.
Zika virus infection during pregnancy can result in preterm birth, fetal loss, stillbirth, and congenital malformations including microcephaly, limb contractures, eye abnormalities, brain calcifications, and other manifestations of Congenital Zika Syndrome.
Zika virus is also associated with an increased risk of Guillain-Barré syndrome, and other neurological complications requiring close medical management and possibly intensive care and mechanical ventilation.
Case Definition
Suspected Case: Any person presenting with rash and/or fever and at least one of the following signs or symptoms:
- arthralgia; or
- arthritis; or
- conjunctivitis (non-purulent/hyperaemic)
Probable case: A suspected case with presence of IgM antibody against Zika virus and an epidemiological link (with no evidence of infection with other flaviviruses).
Confirmed case: Any person with laboratory confirmation of recent Zika virus infection presence of Zika virus RNA or antigen in serum or other samples (e.g. saliva, urine, tissue, whole blood); or IgM antibody against Zika virus positive and Plague Reduction Neutralizing Test (PRNT90) for Zika virus with titre ≥20 and Zika virus PRNT90 titre ratio ≥ 4 compared to other flaviviruses; and exclusion of other flaviviruses.
Clinical Diagnostic Criteria:
- Fever, skin rashes, conjunctivitis
- Joint pain, malaise, headache - usually mild and last for 2–7 days
- Neurological and auto-immune complications of Zika virus disease, babies born with microcephaly (observed in northeast Brazil)
Laboratory Investigations
- Reverse transcriptase-polymerase chain reaction (RT-PCR) for viral RNA
- Serology for IgM detection
- Plaque reduction neutralization test (PRNT)
Non-Pharmacological TreatmentThe mainstay treatment for Zika Virus is the supportive symptomatic treatment.
A: Assure plenty of rest to patients
Pharmacological Treatment
A: Maintain body fluids Sodium Lactate Compound (Ringers Lactate) intravenously
A: Control Fever and Pain by giving Acetaminophen or Paracetamol 15mg/kg (PO/IV) 8hourly for 3 days
Note:
- No antibiotics are of proven value.
- Steroids should not be used.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and aspirin should be avoided. These anti-inflammatory drugs act by thinning the blood, and in a disease with risk of hemorrhage, blood thinners may exacerbate the prognosis.
- Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under 3 years old.
- Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin
Prevention
- Vector control: removal and modification of breeding sites and reducing contact between mosquitoes and people;
- Wearing clothing (preferably light-coloured) that covers as much of the body as possible;
- Using physical barriers such as window screens and closed doors and windows;
- Applying insect repellent to skin or clothing that contains DEET, IR3535 or icaridin
Public Health Control Measures
- Strengthen event-based surveillance to detect the emergence of clusters of cases presenting with rash and febrile syndrome of unknown aetiology.
- Actively engage other sectors (e.g., environment, agriculture, tourism) to respond to Zika virus through a multi-sectoral approach (One Health approach).
- Enhance surveillance of Zika virus disease and of the conditions that may be associated with it, including microcephaly and congenital Zika syndrome and Guillain-Barré syndrome (GBS).
- Enhance surveillance at prenatal and postnatal clinics to monitor possible congenital infections and complications.
- Conduct community-based assessments to determine the abundance of vector mosquitoes, identify the most productive larval habitats, promote and implement plans for appropriate vector control.
- Report any identified unusual increase in the incidence of congenital neurological malformations including microcephaly in neonates and adverse pregnancy outcomes not explained through alternate causes, to the relevant public health authorities using IDSR framework.
- Intensify efforts to reduce mosquito populations including elimination of potential breeding sites (e.g., removal of trash and standing water sites around homes, covering home water storage containers, and use of larvicides) and adult mosquito control methods.
- Promotion of personal protection measures such as use of light-coloured protective clothing (long sleeves and pants), insect repellent, and physical barriers such as screens, closed doors and windows, and sleeping under mosquito nets including during the day when Aedes mosquitoes are most active.
- Develop risk communication messages to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures targeting reduction of contact with the vector.
- Provide women of childbearing age and particularly pregnant women with the necessary information and materials on family planning and reducing risk of exposure.
- Provide clinical and psychosocial support services for affected children and families.
- Zika can be transmitted through blood and blood products. Precautions already in place for ensuring safe blood donations, transfusions, and prevention of bloodborne pathogens should be followed.
- Zika can be transmitted sexually. Men and women need to get counselling on safer sexual practices, and be offered condoms and full range of contraceptive methods.
- Ensure that pregnant women who have been exposed to Zika virus be counselled and followed for birth outcomes based on the best available information and national practice and policies.
- Refer most severe cases with complication to hospitalized cares.