ZIKA VIRUS

Maj. Gen.(Retd.) Prof. Dr. A S M

Matiur Rahman
MBBS (Dhaka) MCPS (BD) D. Bact (Manchester,UK)
M.Sc (Manchester), FCPS (BD), FICS (USA) FCPS
(Pak), FRCP (EDIN), FRCP (Glasgow), FAS (BD)
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 HISTORY OF ZIKA VIRUS

Zika virus is an emerging mosquito-borne

virus that was first identified in Uganda in
1947 in rhesus monkeys through a monitoring
network of sylvatic yellow fever. It was
subsequently identified in humans in 1952 in
Uganda and the United Republic of Tanzania.
Outbreaks of Zika virus disease have been
recorded in Africa, the Americas, Asia and
the Pacific.
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 HISTORY CONT…
• Prior to 2015, Zika virus outbreaks have
occurred in areas of Africa, Southeast Asia,
and the Pacific Islands.
• In May 2015, the Pan American Health
Organization (PAHO) issued an alert
regarding the first confirmed Zika virus
infections in Brazil.
• Currently, outbreaks are occurring in many
countries.
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 ZIKA-AFFECTED COUNTRIES
23 countries in the Americas have active Zika virus transmission

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 OUTBREAK OF ZIKA

• Zika virus disease outbreaks were reported

for the first time from the Pacific in 2007
and 2013 (Yap and French Polynesia,
respectively), and in 2015 from the
Americas (Brazil and Colombia) and Africa
(Cape Verde). In addition, more than 13
countries in the Americas have reported
sporadic Zika virus infections indicating
rapid geographic expansion of Zika virus. 
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 OUTBREAK CONT..
• Recently in Brazil, local health authorities have
observed an increase in Zika virus infections in the
general public as well as an increase in babies born
with microcephaly in northeast Brazil.
• Brazil has recorded nearly 4,000 cases of
microcephaly, a serious and normally rare birth defect
that may be linked to Zika, since the start of 2015.
Around a third of these have been in the state of
Pernambuco.

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 VIROLOGY
 Species: Zika virus
 Virus family Flaviviridae
 Virus genus Flavivirus
 Group: Group IV ((+) ssRNA)
 Common size (40–65 nm)
 Symmetry (enveloped,
icosahedral nucleocapsid)
 Nucleic acid (positive-sense, single-
stranded RNA around 10,000–11,000 bases)
 Reservoir: Unknown

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Zika Virus
 Principal vector
 Aedes aegypti
(usually bite during the morning and late
afternoon/evening hours)

Zika virus is transmitted to people primarily through the bite of an infected Aedes species

mosquito. These are the same mosquitoes that spread dengue and chikungunya
 viruses.

Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito. These are the same mosquitoes that spread dengue and chikungunya  viruses.

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 Aedes aegypti
• Zika transmitted by infected female mosquito

• Primarily a daytime feeder

• Lives around human habitation

• Lays eggs and produces larvae preferentially in

artificial containers

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 WHY ZIKA VIRUS?
In humans, the virus causes a mild illness known
as Zika fever, Zika, or Zika disease, which since
the 1950s has been known to occur within a
narrow equatorial belt from Africa to Asia. In
2014, the virus spread eastward across the Pacific
Ocean to French Polynesia, then to Easter Island
and in 2015 to Mexico, Central America, the
Caribbean, and South America, where the Zika
outbreak has reached pandemic levels.

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WHAT IS ZIKA VIRUS DISEASE (ZIKA)?

• Zika is a disease caused by Zika virus that

is spread to people primarily through the
bite of an infected Aedes species mosquito.
The most common symptoms of Zika are
fever, rash, joint pain, and conjunctivitis
(red eyes). The illness is usually mild with
symptoms lasting for several days to a
week.
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 SYMPTOMS OF ZIKA
• About 1 in 5 people infected with Zika virus
become ill (i.e., develop Zika).
• The most common symptoms of Zika are
fever, rash, joint pain, or conjunctivitis (red
eyes). Other common symptoms include
muscle pain and headache. The incubation
period (the time from exposure to symptoms)
for Zika virus disease is not known, but is
likely to be a few days to a week.
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 SYMPTOMS CONT….
• The illness is usually mild with symptoms
lasting for several days to a week.
• Zika virus usually remains in the blood of
an infected person for a few days but it can
be found longer in some people.
• Severe disease requiring hospitalization is
uncommon.
• Deaths are rare.

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Symptoms of Zika …
TRANSMISSION
• Zika virus is
transmitted to people
through the bite of an
infected mosquito
from the Aedes genus,
mainly  Aedes
aegypti in tropical
regions.
• This is the same
mosquito that
transmits dengue,
chikungunya and
yellow fever.
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 TRANSMISSION CONT….

• These mosquitoes typically lay eggs in and

near standing water in things like buckets,
bowls, animal dishes, flower pots and vases.
 They prefer to bite people, and live indoors
and outdoors near people.
• These mosquitoes are aggressive daytime
biters and they can also bite at night.

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TRANSMISSION CONT…
• Mosquitoes become infected when they bite
a person already infected with the virus.
Infected mosquitoes can then spread the
virus to other people through bites.
• A mother already infected with Zika virus
near the time of delivery can pass on the
virus to her newborn around the time of
birth, but this is rare.

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TRANSMISSION CONT….
• To date, there are no reports of infants
getting Zika virus through breastfeeding.
Because of the benefits of breastfeeding,
mothers are encouraged to breastfeed even
in areas where Zika virus is found.
• Spread of the virus through blood
transfusion and sexual contact have been
reported.

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 WHO IS AT RISK OF BEING
INFECTED?
• Anyone who is living in or traveling to an
area where Zika virus is found who has not
already been infected with Zika virus is at
risk for infection, including pregnant
women.

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 ZIKA VIRUS IS LINKED TO THOUSANDS
OF CASES OF MICROCEPHALY IN BRAZIL
• Brazil has declared war on mosquitoes  • The WHO alert puts Zika in the same
responsible for spreading the Zika virus category of concern as Ebola.

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DIAGNOSIS
Zika virus is diagnosed
through PCR
(polymerase chain
reaction) and virus
isolation from blood
samples. Diagnosis by
serology can be difficult
as the virus can cross-
react with other
flaviviruses such as
dengue, West Nile and
yellow fever.
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DIAGNOSIS CONT..
Sample collection and shipment
•Virological diagnosis:
– Type of sample: serum (collected on dry tube)
– Symptoms due to ZIKV infections are usually
mild tends to be mild, the initial symptoms can
escape notice, lessening the opportunity to take
a sample.
– it is recommended that the serum sample be
taken during the first 5 days after the onset of
symptoms.
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DIAGNOSIS CONT..
• Serological Diagnosis:
– ZIKV-specific IgM antibodies can be detected
by ELISA or immunofluorescence assays in
serum specimens from day 5 after the onset of
symptoms. Since a single serum in the acute
phase is presumptive, it is recommended that a
second sample be taken 1–2 weeks after the first
sample to demonstrate seroconversion (negative
to positive) or a fourfold increase on the
antibody titer (with a quantitative test).
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DIAGNOSIS CONT..
• Sample preservation:
– Keep refrigerated (2-8 oC) if it is to be
processed (or sent to a reference laboratory)
within 48 hours.
– Keep frozen (-10 to -20 oC) if it is to be
processed after the first 48 hours or within 7
days.
– Keep frozen (-70 oC) if it is to be processed
after a week. The sample can be preserved for
extended periods.
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DIAGNOSIS CONT..
• Shipping the sample by air to the reference
laboratory:
– Ship (insofar as possible) with dry ice; at the
very least, maintain the cold chain with cooling
gels. Always use triple packaging.
– Ship within 48 hours.
– The original samples should be packed, labeled
and marked (if dry ice is used), and
documented as Category B.
– Always include the completely filled out
clinical and epidemiological record. 33
 TREATMENT
• There is no vaccine to prevent or specific
medicine to treat Zika infections.
• Treat the symptoms:
– Get plenty of rest.
– Drink fluids to prevent dehydration.
– Take medicine such as acetaminophen
(Tylenol®) to relieve fever and pain.
– Do not take aspirin and other non-steroidal anti-
inflammatory drugs

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 TREATMENT CONT…

– If you are taking medicine for another medical

condition, talk to your healthcare provider
before taking additional medication.
– If you have Zika, prevent mosquito bites for the
first week of your illness.
– An infected mosquito can then spread the virus
to other people.

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 PREVENTION

Personal:
– clothing to reduce exposed skin
– insect repellent especially in early morning, late
afternoon. Bed netting is of little utility.
Environmental:
– reduced vector breeding sites
– solid waste management
– public education

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 PREVENTION CONT….

Biological:
– Target larval stage of Aedes in large water
storage containers
– Larvivorous fish (Gambusia), endotoxin
producing bacteria (Bacillus), copepod
crustaceans (mesocyclops)
Chemical:
– Insecticide treatment of water containers
– Space spraying (thermal fogs)

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WHO response
WHO is supporting countries to control Zika
virus disease through:
•Define and prioritize research into Zika virus
disease by convening experts and partners.
•Enhance surveillance of Zika virus and
potential complications
•Strengthen the capacity of laboratories to
detect the virus.

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WHO response cont…

• Strengthen capacity in risk communication

to help countries meet their commitments
under the International Health Regulations.
• Provide training on clinical management,
diagnosis and vector control including
through a number of WHO Collaborating
Centers.

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WHO response cont…
• Support health authorities to implement vector
control strategies aimed at
reducing Aedes mosquito populations such as
providing larvicide to treat standing water sites
that cannot be treated in other ways, such as
cleaning, emptying, and covering them.
• Prepare recommendations for clinical care and
follow-up of people with Zika virus, in
collaboration with experts and other health
agencies.
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PRECAUTIONARY MEASURES

• Pregnant women who have been exposed to Zika

virus should be counselled and followed for birth
outcomes based on the best available information
and national practice and policies.
• Travelers to areas with Zika virus transmission
should be provided with up to date advice on
potential risks and appropriate measures to reduce
the possibility of exposure to mosquito bites

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 PROTECT YOURSELF, YOUR FAMILY,
AND COMMUNITY FROM MOSQUITOES
• Eliminate standing water in and around
your home:
– Once a week, empty and scrub, turn over,
cover, or throw out items that hold water, such
as tires, buckets, planters, toys, pools,
birdbaths, flowerpots, or trash containers.
Check inside and outside your home.

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PROTECT YOURSELF, YOUR FAMILY, AND
COMMUNITY FROM MOSQUITOES

– Tightly cover water storage containers

(buckets, cisterns, rain barrels) so that
mosquitoes cannot get inside to lay eggs.
– For containers without lids, use wire mesh with
holes smaller than an adult mosquito

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PROTECT YOURSELF, YOUR FAMILY, AND
COMMUNITY FROM MOSQUITOES

• If you have a septic tank, follow these steps:

– Repair cracks or gaps.
– Cover open vent or plumbing pipes. Use wire
mesh with holes smaller than an adult
mosquito.

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 PROTECT YOURSELF, YOUR FAMILY, AND
COMMUNITY FROM MOSQUITOES

• Keep mosquitoes out of your home:

– Use screens on windows and doors.
– Repair holes in screens.
– Use air conditioning when available.

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PROTECT YOURSELF, YOUR FAMILY, AND
COMMUNITY FROM MOSQUITOES

• Prevent mosquito bites:

– Use an Environmental Protection Agency
(EPA)-registered insect repellent with one of
the following active ingredients. All EPA-
registered insect repellents are evaluated to
make sure they are safe and effective.
– Always follow the product label instructions.
– Wear long-sleeved shirts and long pants.

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PROGRAMS TO MINIMIZE THE IMPACT
OF ZIKA VIRUS EPIDEMICS

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• Education of the medical community

• Implementation of emergency contingency

plan

• Education of the general population

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 RECAP
• Zika virus disease is caused by a virus transmitted
by Aedes mosquitoes.
• People with Zika virus disease usually have a mild
fever, skin rash (exanthema) and conjunctivitis.
These symptoms normally last for 2-7 days.
• There is no specific treatment or vaccine currently
available.
• The best form of prevention is protection against
mosquito bites.
• The virus is known to circulate in Africa, the
Americas, Asia and the Pacific.
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 THANK YOU
Reference:
http://www.cdc.gov/zika/prevention/index.html
http://www.who.int/mediacentre/factsheets/zika/en/
http://www.cdc.gov/zika/geo/index.html
http://www.bbc.com/news/world-latin-america-35489388
Zika virus (ZIKV) Surveillance in the Americas: Interim
guidance for laboratory detection and diagnosis-29 June 2015
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