zika%20virus%20infection
ZIKA VIRUS INFECTION

Zika virus is an icosahedral, enveloped, single-stranded RNA virus that comes from the Flaviviridae family and genus Flavivirus.

It is transmitted in humans through a bite of Aedes aegypti and Aedes albopictus mosquito.

In February 2016, the Zika virus infection was declared by the World Health Organization (WHO) as an international health emergency.

Pregnant women infected by Zika virus may pass their infection to the developing fetus and may cause birth defects such as microcephaly, ventriculomegaly, intracranial calcifications, extra-axial fluid, polymicrogyria, decreased brain parenchymal volume, hypoplasia of the cerebellum, brainstem or dermis, delayed myelination, thinning or hypoplasia of the corpus callosum and cortical atrophy and malformation.

 

 

Prevention

Protection from Mosquito Bite

  • Patients are advised to:
    • Avoid being bitten by mosquito especially on the first few days of illness (viremic phase) to prevent local transmission and other mosquitoes from being infected
    • Avoid going to mosquito-infested areas or in areas with known high transmission of Zika virus
    • Wear light-colored clothing, and long sleeves and pants to avoid skin exposure
    • Use nets (with or without treated insecticide) and insect repellents when outdoors (eg DEET, IR3535 or Icaridin)
    • Use air conditioning when indoors and keep windows and door screens closed
    • Seek consultation if symptoms of dengue, chickungunya and Zika virus have been recognized or developed

Prevention from Sexual Transmission

  • It should be noted that even if the sexual partner is asymptomatic, he or she can still transmit the infection to his or her partner
  • The following measures are recommended to prevent sexual transmission of Zika virus:
    • Pregnant women are advised to abstain from sex for the remainder of her pregnancy
      • Avoid having unprotected sex for 6 months with their male partners who have traveled to a moderate- to high-risk area
    • Use condoms during sex, especially for those who have partners who lived in or have traveled to areas with active Zika virus transmission
    • Couples whose partner has been in an area with active Zika virus transmission are also advised to abstain from sex or use male or female condoms (to be used from start to finish, every time during vaginal, anal and oral sex) and use of dental dams (latex or polyurethane sheets)
  • All pregnant patients should be tested, especially those who have been exposed to Zika virus sexually and those who developed symptoms after having sexual exposure to a partner who is asymptomatic
  • For pregnant women who have traveled in an area with active transmission and who developed or did not develop symptoms within 2 weeks of traveling, testing for Zika virus should be advised
    • Ultrasound every 3-4 weeks is recommended
  • For pregnant women who lived in an area with active transmission, consultation with a healthcare professional is advised
    • Should be tested on the 1st prenatal visit and 2nd trimester of pregnancy
    • If pregnant women present with symptoms associated with Zika, they should be tested anytime during pregnancy

Prevention from Unintended Pregnancy

  • Patients are advised to seek consultation before planning on having a baby, especially those couples living in areas with high-risk of Zika virus infection
    • Reproductive life plans, pregnancy intentions and timing of pregnancy must be discussed
  • Women should have access to safe and effective contraceptive methods in case they want to delay or avoid pregnancy

Preventive Measures Among Pregnant Women and Their Partners

  • Prevent mosquito bites
  • Pregnant women should avoid traveling in areas known to have Zika virus transmission
    • If traveling cannot be delayed or prevented, consultation with a healthcare professional prior to travel is recommended
  • Consider postponing non-essential travel to places with reports of Zika virus infection (eg local transmission or traveling in countries with adjacent borders that have limited information about Zika virus and its transmission)
  • Advise preventive measures to avoid being infected with Zika virus
  • For men and women who live in areas with active viral transmission and have developed symptoms, men are advised to wait for at least 6 months and at least 8 weeks for women from the onset of symptoms before they attempt conception

Caretakers, Family Members and Visitors of a Person with Zika Virus Infection

  • Avoid touching body fluids, blood and contaminated surfaces, especially for those with exposed skin
  • Wash hands with soap and water or use an alcohol-based hand rub immediately after providing care
  • For clothes with soiled blood and body fluids, remove and wash the clothes with detergent immediately
    • Use of bleach is not necessary
  • All devices must be reprocessed using a sterilant and disinfectant

Preventive Measures in Healthcare Setting and Among Healthcare Professionals

  • Use standard precaution to protect all healthcare professionals from disease transmission
    • All body fluids, blood, secretions, excretions, mucous membranes and non-intact skin must be considered as infectious agents
      • Blood, semen and vaginal secretions are associated with the transmission of Zika virus 
  • Occupational exposure
    • Evaluation of blood, body fluids, secretions and excretions must be required in all healthcare personnel that have been exposed to Zika virus
    • If possible exposure has occurred, it should be reported immediately and personnel should be assessed for all the possible pathogens including ZIKA, HIV and hepatitis
    • Wounds that have been exposed to blood and body fluids should be washed with soap and water immediately
    • For exposed mucous membranes, flushing and cleansing with copious amounts of water must be done 
  • Labor and delivery setting
    • Presence of body fluids and other infectious materials should be assessed and based on:
      • Condition of the patient
      • Type of anticipated contact
      • Nature of the procedure or activity performed
      • Application of practices and personal protective equipment (PPE)
  • Pregnant personnel
    • May care for patients infected with Zika virus; however, all facility managers and supervisors should be advised on the potential exposure of the personnel to needle stick or cut with a sharp object, chapped or abraded skin and mucous membranes
    • Advise the personnel to adhere to the standard precautions for all patients
  • Healthcare professional with Zika virus infection
    • For asymptomatic healthcare personnel, no work restrictions are given
    • For symptomatic healthcare personnel, work restrictions may be given based on the presenting symptoms of the patient
  • Disinfection of patient's room
    • No special cleaning materials or practices are required in cleaning the rooms of patients who are suspected or known to have Zika virus
    • Daily cleaning of the surfaces and floors is advised and a hospital disinfectant should be used after cleaning
    • Bed linens, towels and wash cloths should be managed using the standard precaution for workers handling the soiled textiles
  • Reprocessing of equipments and devices
    • Instruments and devices should be cleaned, dried, sterilized and packed properly
    • All devices must be reprocessed using a sterilant and disinfectant
  • Prevention of exposure in dentistry setting
    • Protect the eyes from splashes
    • Only sterilized and disinfected devices should be used

HIV and Zika Virus Infection

  • HIV-infected adults coinfected with Zika and have severe immunosuppression should be closely monitored for all infections

Community Control Measures

  • Schools, government and health organizations, healthcare facilities, tourism and social development agencies should collaborate and participate in reducing the vector density and preventing further transmission

Vaccination

  • At present, several vaccines are being developed worldwide for the prevention of Zika virus infection
    • A DNA-based Zika vaccine being developed by the National Institute of Allergy and Infectious Diseases' Vaccine Research Center is undergoing phase II clinical trial
    • A purified inactivated vaccine called ZPIC developed by the Walter Reed Army Institute of Research, and several mRNA-based Zika vaccines are being evaluated in different phase I clinical trials
    • A live-attenuated Zika vaccine being developed by the US National Institutes of Health and the Butantan Institute is in phase I
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