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An Emerging Pathogen
Definition
Zika virus (ZIKV) is a
mild, short lasting febrile
Illness.
History
ZIKV was first discovered in April1947 when a
research rhesus monkey living in the Zika forest
Uganda developed an unknown febrile illness.
Conducted studies established that ZIKV was
endemic to Africa and Asia. It was first isolated
in humans in 1952 in Uganda and Tanzania.
Spread of ZIKV
In April - July 2007 the first outbreak of ZIKV
outside Africa and Asia was reported. This
occurred on the Yap island in the federated state
of Micronesia. It was then identified in French
Polynesia in 2013 and the most recent confirmed
outbreak outside Africa and Asia was in April
2015 in Brazil.
ZIKV Outbreaks
Since its first discovery in Uganda, ZIKV has
been detected in Nigeria, Egypt, Gabon,
Senegal, Sierra Leone, Tanzania, India, Pakistan,
New Caledonia, Easter Island, Indonesia,
Malaysia, Philippines, Thailand, Vietnam, Cook
Island, Yap Island, French Polynesia and Brazil.
Agent
ZIKV is a member of the flavivirus
genus and flaviviridae virus family. It is
closely related to Dengue, Yellow Fever,
West Nile and Japanese Encephalitis
Virus.
Vector
Aedes Africanus: ZIKA forest
Aedes Aegypti : Malaysia
Aedes Hensilii : Yap Island
ZIKV was later isolated in Aedes Vitattus,
Aedes Apicoargenteus, Aedes Furcifer and
Aedes Luteocephalus
Photo of Vector
Aedes Mosquito
Reservoir
During studies of yellow fever in the
Zika forest of Uganda, a rhesus monkey
who was tethered in a tree developed a
fever. Serologic studies later identified
the ZIKA Virus. To date the monkeys
still remain the only reservoir.
Rhesus Monkey
Mode of Transmission
Transmission is via the bite of the Aedes
Aegypti mosquitoes. However the Aedes
Hensilli was the predominant mosquito
species identified.
Clinical Presentation
Fever (Between 37.8C-38.5C)
Conjunctivitis
Arthralgia
Maculo-Papular Rash ( often starting on the face
and spreading)
Myalgia
Headaches (Retro-Ocular headaches)
Diarrhoea
Diagnosis
Incubation period is usually between 3 -12 days
with illness lasting 2-7 days. The virus can be
detected during the first five (5) days after the
establishment of the clinical picture (acute
phase). RT-PCR (the reverse transcriptionpolymerase chain reaction) test is done to detect
viral RNA.
Diagnosis Contd
Serologic Test (ELISA or Inmunofluerescence) :
to detect specific IgM or IgG against Zika Virus.
This could be positive after 5 6 days following
the onset of symptoms.
PRNT (Plaque Reduction Neutralization Test):
Confirmation of positive results.
Treatment
There is no vaccine or specific antiviral
treatment for ZIKA viral infection. Treatment
is symptomatic and supportive. This includes
rest, use paracetamol alone or with codeine for
pain and fever. Avoid Aspirins, Ibuprofen and
other anti-inflammatory drugs.
Treatment Contd
The use of antihistamines to control pruritis
is recommended in cases of maculopapular
rashes.
Drink plenty fluids to replenish lost from
sweating, vomiting and other insensible
loses.
Complication
Following the outbreak of the Zika virus a noted
increase in autoimmune and neurologic diseases
were observed. Researchers identified 73 cases
in a population of 270,000. Guillian-Barre
Syndrome accounted for 42 cases.
Prevention
Aedes Aegypti mosquitoes lay eggs in
man-made, water filled receptacles such
as water tanks, buckets, tyres, machinery,
pet water dishes and pot plant drip trays,
with mosquito eggs able to survive in
dried-out containers for up to 12 months.
Prevention Contd
Eliminate potential breeding sites
Empty and spray insecticide to any old unused
container that has held water e.g. tyres, plastic
containers, black sheet plastic, buckets or pot
plant drip trays.
Store any containers upside down and
undercover or under a domed tarpaulin in good
repair. Punch holes in tins before discarding
Prevention Contd
Avoid using saucers or drip trays under
pot plants. Let pots drain directly onto the
ground or make sure saucers are emptied
at least once/week. Wipe their inner
surface firmly with a cloth several times
or fill with sand, or spray with insecticide
or apply methoprene insecticide pellets
Prevention Contd
Empty bird baths and pet drinking water
at least weekly and spray with
insecticide, or use methoprene pellets
Cover and completely seal septic tanks,
rainwater tanks or other large water
storage containers
Prevention Contd
Use methoprene briquettes in unsealed
tanks as a temporary measure
Ensure roof gutters drain freely so that
pools of water are not left at any low
points. Throw a small amount of
methoprene pellets on to the roof above
problem gutters
Prevention Contd
NB:.
Fishponds with fish do not
breed mosquitoes. Tadpoles do not
eat mosquito larvae.
Prevention Contd
Personal Protection
To reduce the risk of mosquito bites in
ZIKV affected areas:
Wear loose, light-coloured protective
clothing in outdoor situations, covering
feet, legs and arms.
Prevention Contd
Use personal repellents containing
DEET or picaridin on areas of exposed
skin in combination with protective
clothing
Use electric insecticide impregnated
vapour pads in indoor or enclosed areas.
Prevention Contd
Avoid scents on the body, such as
perfume, deodorants and sweat, since
these can attract mosquitoes
Use electric insecticide impregnated
vapour pads in indoor or enclosed
areas
Prevention Contd
Avoid being outdoors between dusk and dawn
to avoid mosquito bites, particularly in poorly
lit areas, rural areas, or the outskirts of large
towns
If accommodation is not well screened, sleep
inside mosquito netting.
Use insecticide impregnated bed nets and
clothing in high risk areas.
Conclusion
To guarantee prevention success, it is
imperative to involve inter-sectoral
participation and collaboration at all levels of
government including: health, education,
environment, social development and
tourism sectors, among others.
Conclusion Contd
We also rely on support of non-governmental
organizations (NGOs). Communication channels
must remain open and community participation
should be mobilized. It is important to provide
clear, good quality information to the public
about this disease via communication
campaigns.
Conclusion Contd
Vigilance must be enhanced towards imported
cases of ZIKV infection in St. Vincent and the
Grenadines especially with Carnival closely
approaching. Early detection of cases is
essential to reduce the risk of transmission.