• Clinical science

Zika virus infection

Abstract

Zika virus is an arbovirus transmitted by the mosquito Aedes aegypti. The infection can also be transmitted transplacentally and sexually. Since 2015, epidemic outbreaks of Zika virus infection have occurred in South America, US territories, and in certain southern US states. The infection is typically asymptomatic or results in mild flu-like symptoms. However, this infection has received a lot of attention because it can result in fetal microcephaly when the virus infects pregnant women. Much about this disease is still unknown and it is currently the subject of much study and research. The diagnosis is usually confirmed by PCR and/or serology. Currently, neither a definitive therapy nor a clinically-approved vaccine exist.

Epidemiology

  • Worldwide geographical distribution
    • Before 2015, a few cases were reported in Africa, southeast Asia, and in the Pacific islands
    • Since 2015, epidemic outbreaks have been reported in South America (especially Brazil).
  • Epidemiology in the US
    • The overwhelming majority of cases (> 25,000) are reported in US territories, most of which occured in Puerto Rico.
    • Approx. 4000 cases were reported in the continental US, most of which occur in New York; , Florida, California, and Texas.

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Pathogen: Zika virus
  • Route of transmission
    • Vector-borne transmission by the mosquito Aedes aegypti (common) and Aedes albopictus (rare)
    • Transplacental transmission from the mother to the fetus
    • Sexual transmission
    • Possibly via blood transfusion

References:[3][4]

Clinical features

  • Incubation time: 2–14 days
  • Approx. 80% of cases remain asymptomatic
  • In symptomatic patients, the manifestations are usually mild and last for 2–7 days

The symptoms of Zika virus infection in adults are usually mild and non-specific, but its complications may be devastating (see “Complications” below).

References:[5]

Diagnostics

A Zika virus infection should be considered in any patient that recently traveled to a region with an outbreak.

References:[6]

Treatment

  • Definitive therapy does not exist yet.
  • Treatment is primarily symptomatic; with rest; , oral/IV fluids; , and/or NSAIDs.

References:[5]

Complications

  • Guillain-Barre syndrome
  • Myelitis, meningoencephalitis
  • During pregnancy
    • Congenital infections can result in microcephaly (craniofacial disproportion)
    • Other congenital manifestations: spasticity (contractures), hyperreflexia, ocular abnormalities (e.g., pigmentary retinal mottling), and sensorineural hearing loss
      • BJH: This is was there in the german LK, ive translated it, but it needs to be in a different LK and discussed in detai

References:[5][7]

We list the most important complications. The selection is not exhaustive.

Prevention

  • A vaccine against Zika virus does not exist yet.
  • Vector control and safe sexual practices are the most important public health measure in endemic regions.
  • Individuals traveling to endemic regions should be told to use insect repellents, mosquito nets, and long-sleeved clothing.
  • Pregnant women should be advised against visiting endemic regions.
  • In the case of travel to an endemic region and/or a positive Zika test, the individual should use some form of contraception for the following time periods (even if asymptomatic!):
    • : at least 2 months
    • : at least 6 months

Zika virus infection is a notifiable disease!

References:[8]