Zika Virus Infection - Situation Update and Latest Advice
02 Feb 2016
(There is a more current update posted here)
Following an emergency meeting yesterday (1st Feb 2016), the World Health Organisation (WHO) has declared that the ongoing Zika virus (ZIKV) outbreak in Latin America, and its association with birth defects, constitutes a Public Health Emergency of International Concern (PHEIC). This means a worldwide effort is being called for, including a united response to research and assistance in order to tackle the disease.
Zika virus (ZIKV) infection has spread rapidly in the Americas during late 2015, early 2016. Locally acquired cases have been identified in the Americas and elsewhere in the past nine months: Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, Fiji, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Maldives, Martinique, Mexico, New Caledonia, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Solomon Islands, Suriname, Thailand and Venezuela.
Some countries are experiencing widespread ZIKV transmission, others only reporting sporadic cases. ECDC are producing a regularly updated ZIKV Country List
ZIKV infection in pregnancy has been proposed as the cause of an ongoing sharp increase in congenital neurodevelopmental defects in Brazil, notably babies being born with microcephaly. The evidence for the involvement of ZIKV infection in microcephaly is circumstantial, but continues to give cause for concern. While the number of cases of microcephaly can be identified, there is no indication of how many of these are linked to ZIKV, or indeed how many cases of ZIKV there have been.
Additionally, an unusual increase in cases of Guillain-Barré syndrome (GBS) associated with exanthematous illness and ZIKV infection has been reported from south and central America. This link is not an unusual possibility as this syndrome is known to occur as a sequel to clinically similar viral infections.
Whilst a causal link between ZIKV infection occurring during pregnancy and severe birth defects has not been proven, a precautionary approach to the risk is being adopted by public health authorities worldwide until further evidence becomes available. The main risk is in Latin America, notably Brazil, and particularly during the first two trimesters of pregnancy.
Recommendations from Health Protection Scotland
Mosquito bite avoidance is strongly recommended for all travellers to ZIKV affected countries. Check the outbreak section of individual country records for information on extent of ZIKV infection, for example, widespread, ongoing transmission or sporadic cases only reported.
Women who are pregnant, or have plans to become pregnant, and who are considering travel to a country where ZIKV is circulating, are strongly urged to seek pre-travel advice from their health care provider:
They should be helped to understand the risks and to make an informed decision on whether to change their travel plans.
They should be reminded that malaria and other travel related hazards may pose a risk during pregnancy.
If the decision is made to travel, rigorous measures to avoid mosquito bites during both daytime and night time hours should be emphasised. It is not sufficient to assume that the mosquitoes that transmit ZIKV will only bite in daytime.
The mosquitoes that transmit ZIKV are particularly persistent and aggressive biters. Health Protection Scotland strongly recommends DEET- based insect repellents at a concentration of 50%, which should be applied regularly. DEET is appropriate for use in pregnancy. If DEET is unsuitable then another, proven alternative should be used.
Wearing loose, cover-up clothing is recommended. Insecticide-impregnated bed nets and air conditioning should be used in bedrooms. Reduction of mosquito breeding sites around hotel rooms/homes is advised for longer-term stays.
A vaccine against ZIKV is not available.
Women who have visited a Zika affected area whilst pregnant should arrange to have their next antenatal check promptly on return home, even if feeling well. This is not intended to cause undue anxiety, but merely as a precaution. In addition, medical attention must be sought quickly for any feverish illness experienced whilst travelling or on return.