Zika Virus and Travel Medicine

More than 1 billion people travel every year, some on business others on vacation, visiting relatives and friends, for school projects and, many other different reasons. All this possibility of movement and communication is very beneficial but we cannot deny that it also brings an increased risk for our health when we are exposed to diseases that are prevalent in other countries. One of these diseases that have been making headlines recently is the Zika virus.

Zika virus was first discovered in 1947 and is named after the Zika forest in Uganda.  In the Western hemisphere the virus was first detected in February 2014 on Chile’s Easter Island and subsequently detected in Brazil in May 2015

Today, there is an ongoing Zika virus outbreak in the Americas, the Caribbean, and the Pacific. The World Health Organization (WHO) has declared Zika virus a Public Health Emergency of International Concern.

• The most common symptoms of Zika are fever, rash, joint pain, conjunctivitis (red eyes), muscle pain and, headache.
• Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito that bite三 mostly during the daytime, but can also bite at night and can also spread dengue and chikungunya viruses.
• The incubation period between mosquito bite and the onset of clinical manifestations is typically 2 to 14 days

The illness is usually mild with symptoms lasting for several days to a week and many people might not even realize they have been infected.

Unfortunately,  Zika virus infection has been associated with neurologic complications, including congenital microcephaly , other developmental problems among babies born to women infected during pregnancy, Guillain-Barré syndrome, myelitis, and meningoencephalitis.

Between March 2015 and April 2016, more than 5000 cases of microcephaly have been reported among newborns born to Brazilian mothers with Zika virus infection. This represents a more than 20-fold increase in microcephaly compared with previous years.

Zika infection has been associated with fetal abnormalities in all trimesters, and it should be presumed that there is risk for congenital infection at any time during pregnancy.

• Zika virus can be spread during intercourse by a man infected with Zika to his sex partners.
• To help prevent spreading Zika by  intercourse, condoms should be used. This includes vaginal, anal, and oral sex. Abstinence  is the best way to be absolutely sure that someone does not get sexually transmitted Zika virus.
  • Pregnant women should talk to a doctor or healthcare provider if they or their male sex partners recently traveled to an area with Zika, even if they don’t feel sick.
• 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.

If you have Zika, protect others from getting sick:

• During the first week of infection, Zika virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites. An infected mosquito can then spread the virus to other people.
• To help prevent others from getting sick, avoid mosquito bites during the first week of illness.

Treatment

• To date there is no vaccination or treatment for Zika. To treat the symptoms:
  • Get plenty of rest.
  • Drink fluids to prevent dehydration.
  • Take medicine such as acetaminophen (Tylenol®) or paracetamol to reduce fever and pain.
  • Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) until dengue can be ruled out to reduce the risk of bleeding.

Steps to prevent mosquito bites

When in areas with Zika and other diseases spread by mosquitoes, take the following steps:

• Wear long-sleeved shirts and long pants.
• Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside.
• Sleep under a mosquito bed net if you are outside.
• Use Environmental Protection Agency (EPA)-registered insect repellents. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women.
  • Always follow the product label instructions.
  • Reapply insect repellent as directed.
  • If you are also using sunscreen, apply sunscreen before applying insect repellent.
• Treat clothing and gear with permethrin or purchase permethrin-treated items.
• If you have a baby or child:
  • Do not use insect repellent on babies younger than 2 months of age.
  • Dress your child in clothing that covers arms and legs or cover crib, stroller, and baby carrier with mosquito netting.

• Do not apply insect repellent onto a child’s hands, eyes, mouth, and irritated or cut skin.

If you are planning to travel consider a pre travel consultation at least 1 month before traveling. The doctor will make a risk assessment based on your itinerary, season, length of the trip, activities, accommodations, past medical history, and give some advice about immunizations, chemoprophylaxis for traveller’s diarrhea and malaria and prevention of mosquito bites. And don’t forget to bring your vaccination card.

Bibliography

1. Zika virus infection, Daniel J Sexton, MD. UpToDate. This topic last updated: Apr 13, 2016.
2. http://www.cdc.gov/
3. who.int