Zika Virus Disease

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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.