Information on the Zika Virus from International SOS

The following information is only partial and taken from the member resource at International SOS: https://pandemic.internationalsos.com/zika. Use your Elizabethtown College membership number to log into the website and view the complete information on this virus and to see an interactive map on countries affected by the Zika Virus. It is not a substitute for professional medical advice

What is the Zika Virus?

• Zika is a viral illness transmitted through mosquito bites.
• Zika virus is an emerging disease rapidly spreading through many tropical countries, including the Pacific Islands and particularly in the Americas.
• It is usually a mild disease. Symptoms include fever, rash, red eyes (conjunctivitis), muscle and joint pains, like many other illnesses.
• Most people recover in a week. No specific treatment is available.
• The virus might be linked to neurological complications and birth defects.

Travel Advice

Pregnant women - discuss you risks with your doctor and consider postponing travel to any area where Zika virus transmission is ongoing. In addition to the infectious risks of any destination, it is important to consider the standard of available healthcare, and the availability of obstetric and neonatal specialist support (should it be required). Many health authorities including the United States CDC and the World Health Organization advise pregnant women not to travel to areas with active transmission of Zika virus.

If travelling to an affected area

Prevent infection by preventing mosquito bites:

• Use an effective insect repellent that contains DEET, Picaridin, PMD, or IR3535. 
• When outdoors, wear clothing that covers most of your body (long sleeves, long pants, socks). 
• Ensure windows are covered with fly-wire. 
• Consider using an insecticide-treated bed net. 
• Use "knock-down" insect spray to kill mosquitoes in your room. 
• Choose air conditioned accommodation if possible. 

Prevent sexual transmission through using condoms.

After Travel 

Pregnant women - consult your doctor. You may be advised to be tested whether or not you develop symptoms and you may also require additional monitoring or specialist care.

All travellers

• Monitor your health for two weeks.
• If you develop symptoms, ensure that you see a doctor and advise them of your travel. This is especially important if you are, or are trying to fall pregnant. 
• Note that malaria circulates in parts of some of the affected countries and you may need to be tested and/or treated for malaria. 
• Prevent sexual transmission. 
• As Zika virus may persist in semen, men who have travelled to a Zika-affected area authorities advise the use condoms for at least 28 days if their partner is not pregnant, or if their partner is pregnant - for the duration of the pregnancy. 
• The World Health Organisation advises women who have travelled to a Zika-affected area to "adopt safer sexual practices or consider abstinence for at least four weeks after return", while some .
• Consider delaying pregnancy
• Authorities differ in how long they advise delaying attempting pregnancy, ranging from 28 days (UK authorities) to two months ( Canadian and US authorities). 
• Prevent transmission to local mosquitoes.
• If you are returning to an area that has mosquitoes which can transmit Zika, continue to prevent mosquito bites for 2 to 3 weeks (e.g. using insect repellent). This will reduce the risk of infecting local mosquitoes with Zika, and therefore reduce the risk of an outbreak.

 

 

Zika FAQs

Where is there a risk of Zika?

Wherever Zika is circulating in the mosquito population, there is a risk of infection. Many areas of the Americas are experiencing a large outbreak, while other places have documented Zika but are not reporting outbreaks. See the Map for further details.

Which other areas could be affected by Zika?

Zika is spread by certain types of Aedes mosquitoes. Zika could potentially appear wherever these mosquitoes are established, which is generally in tropical and subtropical areas. Dengue and Chikungunya are spread by the same mosquito, and countries that are dealing with outbreaks of these mosquito-borne viruses are obviously at risk. The Africa Regional Office of the World Health Organisation stated "all the countries in the African Region are at risk of Zika virus transmission" while in February, the Pan American Health Organisation expected that in the Americas, Zika "will continue to spread and will likely reach all countries and territories of the region where Aedes mosquitoes are found", and that "Aedes mosquitoes—the main vector for Zika transmission—are present in all the region's countries except Canada and continental Chile." However in April, the Chilean Ministry of Health announced it had detected Aedes aegypti mosquitoes in Arica, continental Chile. Researchers have published a map of the global extent of two mosquitoes which can spread Zika.

Can Zika be fatal?

Up until 2013/14, complications and fatalities had not been described. Now the condition Guillain–Barré syndrome (GBS), a muscular weakness which can be mild or severe, has been linked to Zika infection. Severe cases of GBS can be fatal.

There have been some reports of low platelet count associated with Zika, which can lead to bleeding, which might potentially be fatal.

Can Zika spread from one person to another?

Although Zika is primarily mosquito-borne disease, meaning it is transmitted to people through the bite of infected mosquitoes, sexual transmission from men to women is increasingly being reported. A case of male to male sexual transmission of Zika virus has also been documented.

 

The first case was a man who spread Zika to his wife in 2008, with the second case in January 2016 case in Dallas, Texas. Since then, more cases have been documented, in the US, Argentina and France, and Italy (retrospective identification of a case from 2014). Zika has been identified in the semen of infected men, although it is uncertain how long the virus persists.

Zika virus has been found in urine and saliva, and researchers were able to infect cells exposed to these infected body fluids in the laboratory (see report, in Portuguese). This suggests Zika may potentially be transmissible through these body fluids, however such transmission has never been reported. It is too early to tell how significant this potential route is in the present outbreak of Zika but urgent further study is planned and/or already underway. The most important known route of transmission remains via mosquito bites.

Zika infection can be spread through blood transfusion, however many national blood transfusion services are implementing measures to reduce the risk.

Can Zika spread via sharing food?

While Zika virus has been identified in saliva, and cells exposed to infected saliva have been infected under experimental conditions in the laboratory, transmission through food or other objects contaminated with saliva has never been reported.

I'm pregnant and my partner has returned from a Zika-affected area. What precautions should I take?

All health authorities advise abstaining from sexual activity or using a condom for the duration of the pregnancy.

I'm pregnant and I was in a Zika-affected country. Should I be tested for Zika?

If you develop any Zika symptoms within two weeks of travel, see your doctor promptly and advise them of your travel. They can arrange testing. However, if you do not have any symptoms, authorities offer different recommendations. They do agree you should see your doctor and have regular monitoring.

The UK Royal College of Obstetricians & Gynaecologists,Interim clinical guidelines on Zika virus infection and pregnancy, 29 January 2016 states: "Routine testing of asymptomatic women (those who remained asymptomatic while travelling and for two weeks after their return from a ZIKV affected area) is not recommended. However, serial fetal ultrasound scans [...] should be considered".

The US CDC previously cautioned against routine testing of asymptomatic pregnant women. The 5 February Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure includes "a new recommendation to offer serologic testing to asymptomatic pregnant women (women who do not report clinical illness consistent with Zika virus disease) who have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2–12 weeks after pregnant women return from travel."

The European CDC advises women who are pregnant and those planning to become pregnant to see their healthcare provider before travelling to Zika affected areas and after they return.

I've just come back from a Zika-affected area. Should I use condoms and for how long?

To prevent sexual transmission, a number of authorities advise the use of condoms. As it is uncertain how long Zika remains in semen, recommendations on the duration of condom use differs.

The World Health Organization advises all men and women who have returned from a Zika-affected area to "adopt safer sexual practices or consider abstinence for at least four weeks after return." People who have a pregnant sexual partner should "use safer sexual practices or abstinence from sexual activity for the duration of the pregnancy."

The Public Health Agency of Canada advises men who have a pregnant partner to use condoms for the duration of the pregnancy, and men who have any partner who could become pregnant should use a condom for six months after return.

The US CDC advises couples who are pregnant partner to abstain from sex, or use condoms for the duration of the pregnancy. For men whose partner is not pregnant, they advise them to abstain from sex or use a condom for at least 8 weeks after return if they did not have symptoms of Zika, or for at least 6 months if they did have Zika symptoms. For women who have travelled to a Zika-affected area to delay trying to conceive for at least 8 weeks after return.

The United Kingdom Government advises condom use for male travellers with a female partner who might fall pregnant for 28 days if he did not have an illness, or for 6 months if he had Zika symptoms or confirmed Zika.

The European CDC advises men who have been to Zika affected areas to use condoms with a pregnant partner until the end of pregnancy, or for six months with partners who could fall pregnant.

I've been in a Zika-affected area, but I haven't been sick. How soon is it safe to get pregnant?

UK authorities advise women to wait 28 days (double the maximum incubation period).

US CDC advises women to wait at least 8 weeks. Men should wait at least 8 weeks before trying to father a child if they didn't have an illness, but at least 6 months if they did have Zika symptoms.

Canadian authorities advise women to wait at least two months.

I'm not pregnant, but had Zika and recovered. If I get pregnant in the future, is there a risk of microcephaly?

Once the Zika virus has cleared from your blood, the US CDC advises there is "no evidence that Zika virus infection poses a risk of birth defects in future pregnancies". If you have had Zika, talk to your doctor about how long you should wait before trying for pregnancy. UK authorities advise people who have returned from a Zika-affected area to wait 28 days before trying to fall pregnant.

How long does Zika virus remain in your system?

Much more research is needed to determine how long it takes the body to clear Zika. Current understanding is that Zika virus is detectable in the blood for about 3-5 days after the onset of symptoms, however one study found Zika in blood 17 days after symptom onset. Transmission via blood transfusions (donations not screened for Zika infection) is possible and The American Red Cross has advised people to defer blood donation until 28 days after leaving a Zika-affected area. The Canadian Blood Service requires returned travellers to wait 21 days before donating blood. The European CDC advises "Persons with diagnosis of Zika fever may be accepted for blood donation 28 days after cessation of symptoms". The World Health Organization advises travellers who have been to a Zika-affected area not to donate blood for at least one month.

The virus has been found in urine in several studies, up to 10 days, 15 days or 23 days after symptom onset. The virus has also been identified in saliva and breast milk. Although it is not yet known how long it may be present in saliva, one study has identified Zika virus in saliva for up to 29 days after symptom onset. Zika virus was detectable in breast milk four days after symptom onset in a case in New Caledonia. An interim guideline from WHO regarding breastfeeding states that with no known cases of transmission to breastfed infants from infected mothers, and no virus grown from breast milk samples, "in light of available evidence, the benefits of breastfeeding for the infant and mother outweigh any potential risk of Zika virus transmission through breast milk."

It is unknown how long Zika can persist in semen, however it may be at least several weeks. One report found Zika virus in semen up to 62 days after the start of symptoms. Hence authorities advise precuations against sexual transmission for differing durations (see Question above, I've just come back from a Zika affected area. Should I use condoms and for how long?)

Can people be infected with other viruses at the same time as Zika?

Yes. Co-infection (being infected at the same time) of Zika and Dengue viruses has been documented, as has coinfection with Zika, Dengue and Chikungunya. One theory is that the complications which appear to be associated with Zika (such as microcephaly, Guillain–Barré syndrome) might be more likely in people who have had a previous infection with dengue.

Should I cancel my trip?

The decision to cancel your trip should be made after weighing up your individual risks. Zika can be prevented by preventing mosquito bites. Most people who are infected have no symptoms, or have only a mild illness. The virus appears to be linked to irreversible birth defects. At this stage no one can quantify the risk for pregnant women. Many authorities including the US CDC and Public Health England, are advising pregnant women to postpone travel to the areas where Zika virus transmission is occurring.

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