Zika virus infection and Zika fever: Frequently asked questions

Updated: 6 January 2016

What is Zika virus infection?
Zika virus infection is caused by the bite of an infected Aedes mosquito, usually causing mild fever, rash, conjunctivitis,
and muscle pain.
The virus was isolated for the first time in 1947 in the Zika forest in Uganda. Since then, it has remained mainly in
Africa, with small and sporadic outbreaks in Asia. In 2007, a major epidemic was reported on the island of Yap
(Micronesia), where nearly 75% of the population was infected.
On 3 March 2014, Chile notified PAHO/WHO that it had confirmed a case of indigenous transmission of Zika virus on
Easter Island, where the virus continued to be detected until June 2014.
In May 2015, the public health authorities of Brazil confirmed the transmission of Zika virus in the northeast of the
country. Since October 2015, other countries and territories of the Americas have reported the presence of the virus.
See updated list at: www.paho.org/zikavirus.
What are the symptoms?
The most common symptoms of Zika virus infection are mild fever and exanthema (skin rash), usually accompanied by
conjunctivitis, muscle or joint pain, and general malaise that begins 2-7 days after the bite of an infected mosquito.
One out of four infected people develops symptoms of the disease. Among those who do, the disease is usually mild and
can last 2-7 days. Symptoms are similar to those of dengue or chikungunya, which are transmitted by the same type of
mosquito. Neurological and autoimmune complications are infrequent, but have been described in the outbreaks in
Polynesia and, more recently, in Brazil. As the virus spreads in the Americas, giving us more experience with its symptoms
and complications, it will be possible to characterize the disease better.
How is Zika virus transmitted?
Zika virus is transmitted to people through the bite of an infected Aedes mosquito. This is the same mosquito that
transmits dengue and chikungunya.
Can it be transmitted through blood or sexual contact?
In general, the Zika virus needs a vector (a means of transportation) to infect people. That vector is the mosquito. The
virus has also been isolated in semen, and one case of possible person-to-person sexual transmission has been described,
but not confirmed.
Zika can be transmitted through blood, but this is an infrequent mechanism. The usual recommendations for safe
transfusions should be followed (e.g., healthy volunteer donors).
Can it be transmitted from mother to child?
There is little information on transmission from mother to baby during pregnancy or childbirth. Perinatal transmission
has been reported with other vector-borne viruses, such as dengue and chikungunya. Studies are now being conducted on
possible mother-to-child transmission of the virus and its possible effects on the baby. More information.
What treatment is there?
Treatment consists of relieving pain, fever, and any other symptom that inconveniences the patient. To prevent
dehydration, it is recommended to control the fever, rest, and drink plenty of water. There is no vaccine or specific drug
for this virus.
Can it cause death?
In this Region, it is a new virus that up until now has had a very limited geographical and demographic distribution, and
there is no evidence that it can cause death. However, sporadic cases have been reported of more serious manifestations
and complications in patients with preexisting diseases or conditions, causing death.
Who is at risk of Zika infection?
Anyone not previously exposed to the virus and who lives in an area where the mosquito is present, and where imported or
local cases have been reported, may be infected. Since the Aedes mosquito is found throughout the Region (except in
continental Chile and Canada), it is likely that outbreaks will occur in other countries that have not yet reported any
cases.

How is Zika diagnosed?

In most people, diagnosis is based on clinical symptoms and epidemiological circumstances (such as Zika outbreak in the
patients area or trips to areas where the virus is circulating).
Blood tests can help to confirm the diagnosis. Some (virological PCR tests) are useful in the first 3-5 days after the
onset of symptoms, while others (serological tests) detect the presence of antibodies but are useful only after five
days.
Once it has been demonstrated that the virus is present in a given area or territory, confirmation of all cases is not
necessary, and laboratory testing will be adjusted to routine virological surveillance of the disease.
Which is the difference between Zika, dengue, and chikungunya?
All these diseases present similar symptoms, but certain symptoms suggest one disease or another:
Dengue usually presents with higher fever and more severe muscle pain. There can be complications when the fever
breaks: attention should be paid to warning signs such as bleeding.
Chikungunya presents with higher fever and more intense joint pain, affecting the hands, feet, knees, and back. It can
disable people, bending them over so that they cannot walk or perform simple actions such as opening a water bottle.
Zika does not have clearly characteristic features, but most patients have skin rashes and some have conjunctivitis.
Is there a relationship between Guillain-Barr syndrome and Zika virus?
An increase in Guillain-Barr syndrome (GBS) has been observed in areas where a Zika virus epidemic has been
documented (e.g., in French Polynesia and Brazil).
However, a direct causal relationship has not been established between Zika virus infection and GBS. Prior infection with
dengue or genetic factors could contribute to or increase cases of GBS. Several studies are underway to better establish
the relationship between Zika and GBS.
GBS occurs when a persons immune system attacks itself, in particular affecting the cells of the nervous system. This
process can be initiated by infection with various viruses or bacteria. The main symptoms include muscular weakness and
tingling (paresthesia) in the arms and legs, and severe complications can occur if the respiratory muscles are affected.
The most seriously ill patients need attention in intensive care units.
CIRCULATION OF ZIKA VIRUS
Which countries have reported cases of Zika in the Americas?
On 3 March 2014, Chile notified PAHO/WHO that it had confirmed a case of indigenous transmission of Zika virus on
Easter Island, where the virus continued to be detected until June 2014.
In May 2015, the public health authorities of Brazil confirmed the transmission of Zika virus in the northeast of the
country. Since October 2015, other countries and territories of the Americas have reported the presence of the virus.
(See updated list at: www.paho.org/zikavirus.
What causes rapid transmission in an area?
There are two factors for rapid transmission (documented in other countries): (1) Since this is a new virus to the
Americas, the entire population is susceptible, lacking defenses to Zika virus; and (2) The Aedes mosquito is widespread
in the Region, given the climatic conditions, temperature, and humidity in tropical countries.
Is it advisable to travel to countries where Zika virus is circulating?
PAHO/WHO does not recommend any travel or international trade restrictions related to Zika virus outbreaks.
Travelers are advised to take the suggested precautions to prevent mosquito bites.
How many Zika cases have been reported in the Region of the Americas?
Countries begin reporting when they detect the circulation of the virus in their territories. However, maintaining a case
count is difficult because symptoms of the disease tend to be mild and not everyone affected is seen by health services.
What is most important is to detect the circulation of the virus, strengthen the response of health services, and step up
surveillance of serious cases and complications.

PREVENTION
What measures should be taken to prevent Zika virus infection?
Prevention involves reducing mosquito populations and avoiding bites, which occur mainly during the day. Eliminating and
controlling Aedes aegypti mosquito breeding sites reduces the chances that Zika, chikungunya, and dengue will be
transmitted. An integrated response is required, involving action in several areas, including health, education, and the
environment.
To eliminate and control the mosquito, it is recommended to:

Avoid allowing standing water in outdoor containers (flower pots, bottles, and containers that collect water) so
that they do not become mosquito breeding sites.

Cover domestic water tanks so that mosquitoes cannot get in.

Avoid accumulating garbage: Put it in closed plastic bags and keep it in closed containers.

Unblock drains that could accumulate standing water.

Use screens and mosquito nets in windows and doors to reduce contact between mosquitoes and people.

To prevent mosquito bites, it is recommended that people who live in areas where there are cases of the disease, as well
as travelers and, especially, pregnant women should:

Cover exposed skin with long-sleeved shirts, trousers, and hats

Use repellents recommended by the health authorities (and apply them as indicated on the label)

Sleep under mosquito nets.

People with symptoms of Zika, dengue, or chikungunya should visit a health center.
What is PAHO/WHOs response in the Americas?
PAHO/WHO is working actively with the countries of the Americas to develop or maintain their ability to detect and
confirm cases of Zika virus infection, treat people affected by the disease, and implement effective strategies to reduce
the presence of the mosquito and minimize the likelihood of an outbreak. PAHO/WHOs support involves:

Building the capacity of laboratories to detect the virus in a timely fashion (together with other collaborating
centers and strategic partners).

Advising on risk communication to respond to the introduction of the virus in the country.

Controlling the vector by working actively with the populace to eliminate mosquito populations.

Preparing recommendations for the clinical care and monitoring of persons with Zika virus infection, in
collaboration with professional associations and experts from the countries.

Monitoring the geographic expansion of the virus and the emergence of complications and serious cases through
surveillance of events and country reporting through the International Health Regulations channel.

Supporting health ministry initiatives aimed at learning more about the characteristics of the virus, its impact on
health, and the possible consequences of infection.

Last Updated on Saturday, 23 January 2016 18:46

http://www.paho.org/hq/index.php?option=com_content&view=article&id=9183&Itemid=41463&lang=en

Zika virus
January 2016
Key Facts

Zika virus is transmitted to humans by infected mosquitoes. It causes mild fever and rash. Other symptoms include
muscle pain, joint pain, headache, pain behind the eyes and conjunctivitis.
Zika virus disease is usually mild, with symptoms lasting only a few days.
The disease has similar clinical signs to dengue, and may be misdiagnosed in areas where dengue is common.
There is no cure for Zika virus disease. Treatment is focused on relieving the symptoms.
Prevention and control relies on reducing the breeding of Aedes mosquitoes and minimizing contact between mosquito
vectors and people by using barriers (such as repellents, insect screens), reducing water-filled habitats supporting
mosquito larvae in and close to dwellings, and reducing the adult mosquito populations around at-risk communities.

Background
Zika virus is a mosquito-borne flavivirus closely related to dengue virus. It was first isolated from a rhesus monkey in
Zika forest, Uganda in 1947, in mosquitoes ( Aedes africanus) in the same forest in 1948 and in humans in Nigeria in 1954.
Zika virus is endemic in parts of Africa and Asia and was first identified in the South Pacific after an outbreak on Yap
Island in the Federated States of Micronesia in 2007. (1)
Transmission
Zika virus is primarily transmitted to humans through bites from Aedes mosquitos, which often live around buildings in
urban areas and are usually active during daylight hours (peak biting activity occurs in early mornings and late
afternoons).
Some evidence suggests Zika virus can also be transmitted to humans through blood transfusion, perinatal transmission
and sexual transmission. However, these modes are very rare.
The incubation period is typically between 2 and 7 days.
Signs and symptoms
Zika virus infection is characterized by low grade fever (less than 38.5C) frequently accompanied by a maculopapular
rash. Other common symptoms include muscle pain, joint pain with possible swelling (notably of the small joints of the
hands and feet), headache, pain behind the eyes and conjunctivitis. As symptoms are often mild, infection may go
unrecognized or be misdiagnosed as dengue.
A high rate of asymptomatic infection with Zika virus is expected, similar to other flaviviruses, such as dengue virus and
West Nile virus. Most people fully recover without severe complications, and hospitalization rates are low. To date, there
have been no reported deaths associated with Zika virus.
Diagnosis
Several methods can be used for diagnosis, such as viral nucleic acid detection, virus isolation and serological testing.
Nucleic acid detection by reverse transcriptase-polymerase chain reaction targeting the non-structural protein 5
genomic region is the primary means of diagnosis, while virus isolation is largely for research purposes. Saliva or urine
samples collected during the first 3 to 5 days after symptom onset, or serum collected in the first 1 to 3 days, are
suitable for detection of Zika virus by these methods. Serological tests, including immunofluorescence assays and
enzyme-linked immunosorbent assays may indicate the presence of anti-Zika virus IgM and IgG antibodies. Caution should
be taken with serological results as IgM cross reactivity with other flaviviruses has been reported in both primary
infected patients and those with a probable history of prior flavivirus infection.
Treatment
There is no commercial vaccine or specific antiviral drug treatment for Zika virus infection. Treatment is directed
primarily at relieving symptoms using anti-pyretics and analgesics.
Prevention and control
The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection.
Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification
of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of
natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around
at-risk communities and by using barriers such as repellants, insect screens, closed doors and windows, and long clothing.
Since the Aedesmosquitoes are day-biting mosquitoes, it is recommended that those who sleep during the daytime,
particularly young children, the sick or elderly, should use insecticide-treated mosquito nets to provide protection.
Mosquito coils or other insecticide vaporizers may also reduce the likelihood of being bitten.
During outbreaks, space spraying of insecticides may be carried out periodically to kill flying mosquitoes. Suitable
insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively
large water containers.

Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas. These include
use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to
prevent mosquitoes from entering.
Disease outbreaks
The first documented outbreak of Zika virus in the South Pacific occurred on Yap Island in the Federated States of
Micronesia in 2007. (1) This outbreak affected 180 (confirmed, probable and suspected) people and was characterized by
rash, conjunctivitis and joint pain.
In October 2013, French Polynesia reported its first outbreak, which was estimated to affect around 11% of the
population. (2) This particular outbreak spread to other Pacific Islands including New Caledonia, Cook Islands, and Easter
Island. As most cases of Zika virus infection present with mild illness similar to other circulating arbovirus infections,
and there was limited laboratory capacity during this outbreak for the detection of Zika virus, it is likely that many cases
of infection were not identified.
More about disease vectors
Both Ae. aegypti and Ae. albopictus have been implicated in large outbreaks of Zika virus. Ae. aegypti is confined to
tropical and sub-tropical regions, while Ae. albopictus can be found in tropical, sub-tropical and temperate regions. Ae.
albopictus has spread from Asia and become established in areas of the South Pacific, Africa, Europe and the Americas
in recent decades. In the South Pacific, Ae. hensilli was implicated in the spread of Zika virus on Yap Island in
2007, (1,3)while Ae. polynesiensis was suspected to spread Zika virus in French Polynesia in 2013. (2) Neither of these
endemic species had been recognized as a Zika virus vector before, indicating that as this emerging disease spreads to
previously unaffected countries, the potential exists for other endemic Aedes species to play a role in transmission.
Ae. aegypti is closely associated with human environments and can breed in indoor (flower vases, concrete water
tanks in bathrooms), and artificial outdoor (vehicle tyres, water storage vessels, discarded containers)
environments.
Ae. albopictus thrives in a wider range of water-filled breeding sites than Ae. aegypti, including coconut husks,
cocoa pods, bamboo stumps, tree holes and rock pools, in addition to artificial containers such as vehicle tyres and
plant pot saucers. This diversity of habitats explains the abundance of Ae. albopictus in rural as well as periurban areas and shady city parks.
Ae. hensilli breeds in coconut shells, tins, plastic containers, vehicle tyres, tree holes, canoes and metal drums. (4)
Ae. polynesiensis breeds in tree holes, coconut shells and crab holes.
WHO response
WHO responds to Zika virus infection by:
Providing technical support and guidance to countries for the effective management of cases and outbreaks;
Supporting countries to improve their surveillance systems;
Providing training on clinical management, diagnosis and vector control including through a number of WHO
Collaborating Centres;
Publishing guidelines for vector control; and
Encouraging countries to develop and maintain the capacity to detect and confirm cases, manage patients, and
implement social communication strategies to reduce the presence of the mosquito vectors.

http://www.wpro.who.int/mediacentre/factsheets/fs_05182015_zika/en/
Zika virus
Fact
Updated January 2016

sheet

Key facts

Zika virus disease is caused by a virus transmitted by Aedes mosquitoes.

People with Zika virus disease usually have a mild fever, skin rash (exanthema) and conjunctivitis. These
symptoms normally last for 2-7 days.
There is no specific treatment or vaccine currently available.
The best form of prevention is protection against mosquito bites.
The virus is known to circulate in Africa, the Americas, Asia and the Pacific.

Introduction
Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a
monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the

United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and
the Pacific.
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: Unknown
Signs and Symptoms
The incubation period (the time from exposure to symptoms) of Zika virus disease is not clear, but is likely to be a
few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes,
conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days.
During large outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, national health authorities
reported potential neurological and auto-immune complications of Zika virus disease. Recently in Brazil, local health
authorities have observed an increase in Zika virus infections in the general public as well as an increase in babies born
with microcephaly in northeast Brazil. Agencies investigating the Zika outbreaks are finding an increasing body of
evidence about the link between Zika virus and microcephaly. However, more investigation is needed before we
understand the relationship between microcephaly in babies and the Zika virus. Other potential causes are also being
investigated.
Transmission
Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes
aegypti in tropical regions. This is the same mosquito that transmits dengue, chikungunya and yellow fever.
Zika virus disease outbreaks were reported for the first time from the Pacific in 2007 and 2013 (Yap and French
Polynesia, respectively), and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde). In addition,
more than 13 countries in the Americas have reported sporadic Zika virus infections indicating rapid geographic
expansion of Zika virus.
Diagnosis
Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Diagnosis by
serology can be difficult as the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow
fever.
Prevention
Mosquitoes and their breeding sites pose a significant risk factor for Zika virus infection. Prevention and control
relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing
contact between mosquitoes and people.
This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body
as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is
also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that
places where mosquitoes can breed are removed.
Special attention and help should be given to those who may not be able to protect themselves adequately, such as
young children, the sick or elderly.
During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides
recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water
containers.
Travellers should take the basic precautions described above to protect themselves from mosquito bites.
Treatment
Zika virus disease is usually relatively mild and requires no specific treatment. People sick with Zika virus should get
plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, they should
seek medical care and advice. There is currently no vaccine available.
WHO Response
WHO is supporting countries to control Zika virus disease through:
strengthening surveillance;
building the capacity of laboratories to detect the virus;
working with countries to eliminate mosquito populations;
preparing recommendations for the clinical care and monitoring of persons with Zika virus infection; and
defining and supporting priority areas of research into Zika virus disease and possible complications.

http://www.who.int/mediacentre/factsheets/zika/en/

Zika virus disease: Questions and answers

Online
20 January 2016

Q&A

Where does Zika virus occur?

Zika virus occurs in tropical areas with large mosquito populations, and is known to circulate in Africa, the Americas,
Southern Asia and Western Pacific.
Zika virus was discovered in 1947, but for many years only sporadic human cases were detected in Africa and
Southern Asia. In 2007, the first documented outbreak of Zika virus disease occurred in the Pacific. Since 2013,
cases and outbreaks of the disease have been reported from the Western Pacific, the Americas and Africa. Given the
expansion of environments where mosquitoes can live and breed, facilitated by urbanisation and globalisation, there is
potential for major urban epidemics of Zika virus disease to occur globally.
How do people catch Zika virus?
People catch Zika virus by being bitten by an infected Aedes mosquito the same type of mosquito that spreads
dengue, chikungunya and yellow fever.
What are the symptoms of Zika virus disease?
Zika virus usually causes mild illness; with symptoms appearing a few days after a person is bitten by an infected
mosquito. Most people with Zika virus disease will get a slight fever and rash. Others may also get conjunctivitis,
muscle and joint pain, and feel tired. The symptoms usually finish in 2 to 7 days.
What might be the potential complications of Zika virus?
Because no large outbreaks of Zika virus were recorded before 2007, little is currently known about the complications
of the disease.
During the first outbreak of Zika from 2013 - 2014 in French Polynesia, which also coincided with an ongoing outbreak
of dengue, national health authorities reported an unusual increase in Guillain-Barr syndrome. Retrospective
investigations into this effect are ongoing, including the potential role of Zika virus and other possible factors. A
similar observation of increased Guillain-Barr syndrome was also made in 2015 in the context of the first Zika virus
outbreak in Brazil.
In 2015, local health authorities in Brazil also observed an increase in babies born with microcephaly at the same time
of an outbreak of Zika virus. Health authorities and agencies are now investigating the potential connection between
microcephaly and Zika virus, in addition to other possible causes. However more investigation and research is needed
before we will be able to better understand any possible link.
Should pregnant women be concerned about Zika?
Health authorities are currently investigating a potential link between Zika virus in pregnant women and microcephaly
in their babies. Until more is known, women who are pregnant or planning to become pregnant should take extra care
to protect themselves from mosquito bites.
If you are pregnant and suspect that you may have Zika virus disease, consult your doctor for close monitoring during
your pregnancy.
What is microcephaly?
Microcephaly is a rare condition where a baby has an abnormally small head. This is due to abnormal brain development
of the baby in the womb or during infancy. Babies and children with microcephaly often have challenges with their
brain development as they grow older.
Microcephaly can be caused by a variety of environmental and genetic factors such as Downs syndrome; exposure to
drugs, alcohol or other toxins in the womb; and rubella infection during pregnancy.

How is Zika virus disease treated?

The symptoms of Zika virus disease can be treated with common pain and fever medicines, rest and plenty of water.
If symptoms worsen, people should seek medical advice. There is currently no cure or vaccine for the disease itself.
How is Zika virus disease diagnosed?
For most people diagnosed with Zika virus disease, diagnosis is based on their symptoms and recent history (e.g.
mosquito bites, or travel to an area where Zika virus is known to be present). A laboratory can confirm the diagnosis
by blood tests.
What can I do to protect myself?
The best protection from Zika virus is preventing mosquito bites. Preventing mosquito bites will protect people from
Zika virus, as well as other diseases that are transmitted by mosquitoes such as dengue, chikungunya and yellow fever.
This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body
as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is
also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that
places where mosquitoes can breed are removed.
Should I avoid travelling to areas where Zika virus is occurring?
Travellers should stay informed about Zika virus and other mosquito-borne diseases and consult their local health or
travel authorities if they are concerned.
To protect against Zika virus and other mosquito-borne diseases, everyone should avoid being bitten by mosquitoes by
taking the measures described above. Women who are pregnant or planning to become pregnant should follow this
advice, and may also consult their local health authorities if travelling to an area with an ongoing Zika virus outbreak.
Based on available evidence, WHO is not recommending any travel or trade restrictions related to Zika virus disease.
As a precautionary measure, some national governments may make public health and travel recommendations to their
own populations, based on their assessments of the available evidence and local risk factors.
What is WHO doing?
To help countries prepare for and respond to Zika, WHO is working with ministries of health to improve laboratory
capacity to detect the virus, providing recommendations for clinical care and follow-up of infected patients (in
collaboration with national professional associations and experts), and encouraging monitoring and reporting on the
viruss spread and the emergence of complications.
WHO is also coordinating with countries that have reported outbreaks of Zika virus and other partners to investigate
the potential relationships between Zika and microcephaly and other issues.

http://www.who.int/features/qa/zika/en/