Zika Virus

ZIKA VIRUS February 2016

 What is Zika?
Zika is a viral infection that is spread by the bite of an infected mosquito. Outbreaks typically occur in tropical Africa and southeast Asia. In May 2015, Brazil reported the first outbreak of Zika in the Americas. Zika is now present in tropical areas.

 What are the countries and territories that have reported ongoing transmission in the Americas Region?

Since this is an evolving situation, the list of affected countries is likely to change.  For up-to-date lists of countries please visit the CDC website at http://www.cdc.gov/zika/geo/ or the Pan American Health Organization at www.paho.org.  As of January 28, 2016 the countries and territories have reported ongoing transmission of Zika include: Barbados, Bolivia, Brazil, Cape Verde (Africa), Colombia, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa (Oceania/Pacific Islands), Suriname, U.S. Virgin Islands, and Venezuela.

 Are there any people with Zika in the US or New Jersey?  

Locally transmitted cases of Zika have not been identified in the United States, although the potential for local transmission exists, as Aedes mosquitoes (the mosquitoes that transmit Zika) are present in many states.  In late December 2015, the NJDOH identified New Jersey’s first laboratory-confirmed case of Zika in a Bergen county woman exposed in Colombia. While there is no local public health risk associated with this travel-related case of Zika, the NJDOH informed local health departments (LHDs) and health care providers to increase awareness of the risk of Zika in travelers to South and Central America and the Caribbean.

 Why has the CDC issued a travel alert for Zika if there is not transmission in the US?

Zika virus can be spread from a pregnant woman to her unborn baby. There have been reports of a serious birth defect of the brain called microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. Knowledge of the link between Zika and these outcomes is evolving, but until more is known, CDC recommends special precautions for the following groups:

Women who are pregnant (in any trimester):

-          Consider postponing travel to any area where Zika virus transmission is ongoing.

-          If you must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.

 

Women who are trying to become pregnant:

-          Before you travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection.

-          Strictly follow steps to prevent mosquito bites during your trip.

  What can we expect in the near future?

Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to change over time. As more information becomes available, travel notices will be updated.

 Is the U.S. at risk of a widespread outbreak?

While areas in the south and southcentralU.S. are home to the type of mosquito that transmits Zika virus, a widespread outbreak is not expected.  If U.S. mosquitoes become infected with the virus, it will likely result in localized outbreaks which can be controlled through good surveillance and mosquito control efforts.  Additionally, in the U.S there is widespread use of window screens and air conditioning which reduce exposure to mosquitoes.  The CDC’s assumption is based on studies of other mosquito-borne diseases, such as dengue and Chikungunya, that had localized transmission in the U.S but did not expand to large, uncontrollable outbreaks. 

 ZIKA TESTING

 Who should be tested for Zika virus?

  • Pregnant women, or women who recently delivered, who were pregnant during or within two weeks of travel to a country with current Zika transmission and who report during that time period two or more of the following symptoms:
    • Acute onset of fever
    • Rash
    • Arthralgia
    • Conjunctivitis
  • Asymptomatic pregnant women with travel to a country with current Zika transmission who have a fetal ultrasound suggestive of microcephaly or intracranial calcifications
  • Infants with microcephaly or intracranial calcifications detected prenatally or at birth, and whose mother traveled to or resided in an area with Zika transmission while pregnant
  •  Infants born to mothers who have a confirmed positive or inconclusive test result for Zika following travel to, or residence in, an area with Zika while pregnant and reported at least two symptoms during that time period.

 Pregnant women with travel to a country with current Zika transmission, but who do not present with symptoms, are not currently being recommended for testing. 

 Non-pregnant individuals with a history of travel to an area with Zika transmission are not currently being recommended for testing, even if symptoms are present.  In these individuals, Zika is typically a mild illness with no specific treatment, so while Zika should still be considered in the differential, it is not clinically important to make a definitive diagnosis.

 Considerations for follow up:  Asymptomatic pregnant women with a history of travel to an area of Zika transmission while pregnant, regardless of past symptoms, should consult with their health care providers.  Providers may refer to the CDC MMWR Interim Guidelines for Pregnant Women During a Zika Virus Outbreak:  http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1er.htm.

 Testing is not indicated for women without a recent travel history to an area with Zika transmission, or for pregnant women who traveled before becoming pregnant.

Can a pregnant woman be tested for Zika weeks or months after being in a country with Zika?

At this time, we do not recommend routine Zika virus testing in asymptomatic pregnant women who have traveled to a country with known transmission. Only pregnant women who experienced two or more symptoms during or within two weeks of travel will be tested; even if the symptoms have resolved, we will still test if the criteria is met.

 ZIKA SIGNS / SYMPTOMS / SEVERITY

 What are the signs and symptoms of this virus in people?
The most common symptoms of Zika include:

  • Fever
  • Rash
  • Joint pain
  • Conjunctivitis (red eyes)

 Other common symptoms include:

  • Muscle pain
  • Headache

 How severe is illness associated with Zika?
Most people do not develop symptoms. In the 20% of people who do get symptoms, the illness is usually mild. The biggest concern is the chance for a serious birth defect if a pregnant woman becomes infected.

Rash Type and Distribution

At this point in time we understand very little about rash. While maculopapular rash seems to be reported most often, pruritic rashes have been described as well. Additionally, rash on the trunk and face have been described, but we cannot rule out the possibility rash will distribute differently. CDC would like providers to document all rash information to learn more.

ZIKA VIRUS TRANSMISSION / INFECTIVITY

 Is Zika contagious?  How does it spread?
Most people who are infected were bitten by an infected mosquito.  There has been one report of possible spread of the virus through blood transfusion and one report of possible spread of the virus through sexual contact. 

 What is the incubation period for Zika?    

Symptoms usually begin 3-12 days after being bitten by an infected mosquito and last several days to a week.

 Who is at highest risk for getting infected with Zika?

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, this includes pregnant women.

Are you immune for life once infected?

Once a person has been infected, he or she is likely to be protected from future infections.

 

Can mothers pass Zika on to babies?

Zika virus can be passed from mother to her baby during pregnancy. This mode of transmission is being investigated. To date, there are no reports of infants getting Zika through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.

 Can Zika be spread during breastfeeding?

To date, there are no reports of infants getting Zika through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found. Mothers who are breastfeeding in areas where Zika virus is found should practice mosquito prevention measures such as using insect repellent.  

 Can Zika be sexually transmitted?

There has been one report of possible spread of the virus through blood transfusion and one report of possible transmission through sexual contact, but the primary method of transmitting Zika is through the bite of an infected mosquito.

 

Is CDC going to release recommendations about the sexual transmission of Zika virus?

CDC is aware of a few scientific papers that suggests Zika virus may be transmitted through sex. These papers point to a theoretical risk but the science to date is clear that Zika virus is primarily transmitted to people through the bite of an infected mosquito. The agency has no immediate plans to make recommendations regarding sexual transmission of Zika virus, but they continue to review and evaluate the research on potential paths of transmission as it becomes available. CDC’s immediate epidemiological studies are being designed to help scientists better understand the risk of Zika virus transmission from a pregnant woman to her unborn baby.

 Can a previous Zika virus infection cause someone who later becomes pregnant to have an infant with microcephaly?

We do not know the risk to the baby if a woman is infected with Zika virus while she is pregnant. However, Zika virus infection does not pose a risk of birth defects for future pregnancies. Zika virus usually remains in the blood of an infected person for about a week. The virus will not cause infections in a baby that is conceived after the virus is cleared from the blood.

 If a woman who is not pregnant is bitten by a mosquito and infected with Zika virus, will her future pregnancies be at risk?

No. If infected, Zika virus usually remains in the blood of an infected person for about a week. The virus will not cause infections in a baby that is conceived after the virus is cleared from the blood.

TREATMENT

 What is the treatment for people with Zika?

There is no specific treatment for Zika. Symptoms are treated by getting rest, drinking fluids to prevent dehydration and taking medicines such as acetaminophen or paracetamol to relieve fever and pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, should be avoided until dengue can be ruled out to reduce the risk of increased bleeding.

 Is there a vaccine for Zika?

No, there is currently no vaccine to prevent Zika.

 What is New Jersey doing in response to this situation?

The NJ Department of Health is communicating with local health departments and health care providers through health alert messages and conference calls to increase their awareness.  Updated information will be posted to the NJDOH website as updates become available. 

 What would we do if there was a case of Zika in New Jersey?

Travel related cases at this time of year are not a risk to the public since mosquitoes are not active in the US during the winter months.  However, if people are infected while visiting another country in months when mosquitoes are active in the US, it will be important for the Zika infected traveler to avoid being bitten by a mosquito once they return to the US for the week following illness onset.  This will help prevent the mosquitoes here in the US from getting infected by the traveler. 

ZIKA TRAVEL ISSUES AND CONCERNS

 Can I travel to countries affected by the outbreak?

Since Zika is spread by mosquitoes, CDC recommends that travelers to areas with ongoing transmission protect themselves from mosquito bites:

 Cover exposed skin by wearing long-sleeved shirts and long pants.

  • Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed.
  • Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
  • Most repellents, including DEET, can be used on children aged >2 months.
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
  • Stay and sleep in screened-in or air-conditioned rooms.

 Women who are pregnant (in any trimester) should consider postponing travel to any area where Zika virus transmission is ongoing. If you are pregnant and must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip. Women who are trying to become pregnant should talk to their doctor about plans to become pregnant and the risk of Zika virus infection before travel and strictly follow steps to prevent mosquito bites during travel. All women of child bearing age who choose to travel should follow steps to prevent mosquito bites in the event of an unplanned pregnancy.

 Is it safe to get pregnant after traveling to a country with Zika virus?

If infected, Zika virus usually remains in the blood of an infected person for about a week. The virus will not cause infections in a baby that is conceived after the virus is cleared from the blood.

 Should I avoid contact with people that have recently traveled to affected countries?

Zika is not an airborne disease and cannot be spread by coughing, sneezing or talking. However, Zika virus has been found in semen and person-to-person sexual transmission has been documented, although this is uncommon.

 What if I am elderly or have a chronic illness and have plans to travel?

There is currently no evidence that Zika causes more serious illness in the elderly or people with chronic illnesses.  It is recommended that all travelers consult with their healthcare providers to be sure they are well enough to travel. In most cases, Zika virus causes a mild illness.  Providers should consider the patient’s ability to withstand all vector-borne diseases, including but not limited to dengue, Chikungunya, and malaria, which can cause severe illness.  Other travel-related illness, such as diarrhea should also be considered. If a person chooses to travel, they should take steps to avoid mosquito bites, (read the steps from the first question in this section).

 ADDITIONAL ZIKA INFORMATION/RESOURCES

 Where can I learn more?

The CDC website has additional information about Zika and the current outbreak.    

The web address is:  http://www.cdc.gov/zika/index.html

The web address for CDC travel health notices is:

For NJ information, go to:  http://www.nj.gov/health/cd/izdp/vbi.shtml