Zika

Tai-Ho Chen, Ronnie Henry, Marc Fischer

INFECTIOUS AGENT
Zika virus (ZIKV) is a single-stranded RNA virus of the Flaviviridae family, genus Flavivirus.

TRANSMISSION
Transmission occurs through the bite of an infected Aedes mosquito. Perinatal transmission and
possible person-to-person transmission have also been reported.

EPIDEMIOLOGY
Serologic evidence and case reports of human ZIKV infection have been documented in Africa
(including Central African Republic, Egypt, Gabon, Nigeria, Senegal, Sierra Leone, and
Tanzania) and Asia (including India, Indonesia, Malaysia, the Philippines, Thailand, and
Vietnam). In addition, larger sporadic outbreaks caused by ZIKV have been documented in the
Pacific Islands in Yap State (Micronesia), French Polynesia, New Caledonia, the Cook Islands,
and Easter Island. Cases have been detected in travelers returning from countries with suspected
ZIKV activity.

CLINICAL PRESENTATION
Commonly reported signs and symptoms include fever, maculopapular rash, arthralgia, arthritis,
myalgia, headache, retroorbital pain, and conjunctivitis. Other symptoms may include fatigue,
edema, sore throat, cough, vomiting, and loose stools. Unlike in dengue infection, hemorrhagic
manifestations have rarely been reported among people infected with ZIKV. The proportion of
asymptomatic cases among people infected with ZIKV has not been established.

DIAGNOSIS
Because of the typical clinical features of fever, rash, and arthralgia, the differential diagnosis of
ZIKV infection is broad. Preliminary diagnosis should be based on clinical findings and
epidemiologic characteristics, including travel history and activities, although ZIKV infection may
share these with other arboviral infections, including dengue and chikungunya.

Diagnostic testing can include nucleic acid testing (RT-PCR), virus isolation, or antibody
detection; cross-reactivity with antibodies for other flaviviruses has been noted. Clinicians are
encouraged to report suspected ZIKV infections to state or local health departments to determine
if confirmatory testing is indicated and to reduce the risk of local transmission.
TREATMENT
No specific antiviral treatment is available for ZIKV infection. Treatment of symptoms may include
rest, fluids, antipyretics, and analgesics. As in other arboviral diseases, infected people should
avoid mosquitoes while they are sick to reduce the risk of ongoing transmission.

PREVENTION
Avoiding mosquito bites can protect against ZIKV infection (see Chapter 2, Protection against
Mosquitoes, Ticks, & Other Arthropods). Avoiding exposure to bodily fluids (including unprotected
sexual contact) of people with suspected ZIKV infection may also reduce transmission risk.

BIBLIOGRAPHY

1. 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(13).

2. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus
outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun
11;360(24):253643.

3. Foy BD, Kobylinski KC, Chilson Foy JL, Blitvich BJ, Travassos da Rosa A, Haddow AD,
et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect
Dis. 2011 May;17(5):8802.

4. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):134750.

5. Tappe D, Rissland J, Gabriel M, Emmerich P, Gunther S, Held G, et al. First case of

laboratory-confirmed Zika virus infection imported into Europe, November 2013. Euro
Surveill. 2014;19(4).