Introduction

Zika

virus is an

arthropod-borne flavivirus transmitted

by

mosquitoes. The virus is related to other flaviviruses including
dengue virus, yellow fever virus, and West Nile virus. Clinical
manifestations of Zika virus infection occur in approximately 20
percent of patients and include acute onset of low-grade fever
with maculopapular rash, arthralgia, or conjunctivitis (nonpurulent). Neonatal infection has also been associated with
congenital microcephaly and fetal losses among women infected
during pregnancy [1,2].
Zika virus transmission is caused by a mosquito bite (from an
Aedes genus) [3] Anti-Zika antibody has been detected in around
6% of population of residents in Uganda [4]. The virus has also
been isolated from mosquitoes collected both in Africa and in
Asia, leading to conclude that species such as Aedes africanus,
Aedes aegypti and Aedes hensilli have a role in ZIKA enzootic
maintenance (within a sylvatic environment). [5-6] Sexual,
perinatal and blood transfusion-transmitted Zika infection has
been described, although less frequently and the magnitude of
the epidemiological significance of these mechanisms has not yet
been established [7]
Zika virus infection becomes symptomatic in only 20 to 25% of
patients.. Symptoms and signs of Zika virus infection typically
include acute onset of low-grade fever (37.8 to 38.5°C) with
maculopapular rash, arthralgia (notably the small joints of hands

and feet), and conjunctivitis (nonpurulent); clinical illness is
consistent with Zika virus disease if two or more of these
symptoms are present [1,2]. Other commonly reported clinical
manifestations include myalgia, headache, retro-orbital pain, and
asthenia. More rarely observed symptoms and signs include
abdominal pain, nausea, diarrhea, mucus membrane ulcerations,
and pruritus [8]. Zika virus infection becomes symptomatic in only
20 to 25% of patients.
Clinical manifestations in infants and children with postnatal
infection (eg, transmitted via mosquito bites) are similar to the
findings seen in adults with Zika virus infection. Arthralgia can be
difficult to detect in infants and young children and can manifest
as irritability, walking with a limp, difficulty moving or refusing to
move an extremity, pain on palpation, or pain with active or
passive movement of the affected joint [9].
The incubation period between mosquito bite and onset of clinical
manifestations is typically 2 to 14 days. The illness is usually mild;
symptoms resolve within two to seven days. Zika virus may be
detectable in the blood of an infected person for a few days to a
week. Once a person has been infected, he or she is likely to be
protected from future infections [10]. Severe disease requiring
hospitalization is uncommon, and case-fatality rates are low [8].
Zika virus infection has been associated with complications
including congenital microcephaly and fetal losses among women
infected during pregnancy and Guillain-Barré syndrome. [8]

The diagnosis of Zika virus infection is definitively established via
reverse-transcription polymerase chain reaction (RT-PCR) for Zika
viral RNA or Zika virus serology [1,2,11]
There

is

no

Management
including

specific
consists

drinking

treatment
of

fluids

rest
to

for

and

Zika

virus

symptomatic

prevent

infection.
treatment

dehydration

and

administration of acetaminophen to relieve fever and pain [12].
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS)
should be avoided until dengue infection has been ruled out, to
reduce the risk of hemorrhage. NSAIDS should also be avoided in
pregnant women at ≥32 weeks of gestation to minimize risk for
premature closure of ductus arteriosus. Aspirin should not be used
in children with acute viral illness because of its association with
Reye syndrome.
A subset of infected fetuses may be at risk for stillbirth. If
antenatal testing is performed (eg, nonstress test, biophysical
profile)

and results are abnormal,

early delivery

appropriate, depending on the clinical scenario. [12]

may

be

References:
1.

Centers for Disease Control and Prevention. Emergency

Preparedness

and

Response:

Recognizing,

Managing,

and

Reporting Zika Virus Infections in Travelers Returning from Central
America,

South

America,

the

Caribbean,

http://emergency.cdc.gov/han/han00385.asp

and

Mexico.

(Accessed

on

January 18, 2016).
2.

Petersen EE, Staples JE, Meaney-Delman D, et al. Interim

Guidelines for Pregnant Women During a Zika Virus Outbreak United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:30.
3. Grard G, Caron M, Mombo IM, Nkoghe D, Mboui Ondo S, Jiolle D,
et al. Zika virus in Gabon (Central Africa)--2007: a new threat from
Aedes albopictus? PLoS Negl Trop Dis. 2014;8:e2681.
4. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D.
Evidence of perinatal transmission of Zika virus, French Polynesia,
December 2013 and February 2014. Euro Surveill. 2014;19.

5. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau
VM. Potential sexual transmission of Zika virus. Emerg Infect Dis.
2015;21:359-61.
6. Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al.
Potential for Zika virus transmission through blood transfusion
demonstrated during an outbreak in French Polynesia, November
2013 to February 2014. Euro Surveill. 2014;19.
7. Ioos S, Mallet HP, Leparc Goffart I, Gauthier V, Cardoso T,
Herida M. Current Zika virus epidemiology and recent epidemics.
Med Mal Infect. 2014;44:302-7
8.

Ministry of Health - Manuatu Hauora. Zika virus.

http://www.health.govt.nz/our-work/diseases-and-conditions/zikavirus (Accessed on January 13, 2016).
9.

Fleming-Dutra KE, Nelson JM, Fischer M, et al. Update:

Interim Guidelines for Health Care Providers Caring for Infants and
Children with Possible Zika Virus Infection — United States,
February 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6507e1er.htm
(Accessed on February 20, 2016)
10. Centers for Disease Control and Prevention. Zika Virus
Disease Q & A. http://www.cdc.gov/zika/disease-qa.html (Accessed
on February 03, 2016).
11. Oduyebo T, Petersen EE, Rasmussen SA, et al. Update:
Interim Guidelines for Health Care Providers Caring for Pregnant

Women and Women of Reproductive Age with Possible Zika Virus
Exposure - United States, 2016. MMWR Morb Mortal Wkly Rep
2016; 65:122.
12. Centers for Disease Control and Prevention. Zika Virus:
Symptoms, Diagnosis, & Treatment.
http://www.cdc.gov/zika/symptoms/index.html (Accessed on
January 13, 2016).