Is this the Summer of Zika?

Zika virus in the United States this summer, we don’t know for sure if it will happen.

For those of you who don’t know, Zika virus has taken South America by storm with increasing evidence linking it to neurologic disorders such as microcephaly in newborns and Guillain-Barre syndrome. Although the virus has been known for many decades, the disease course appears to be different as it has spread to South America.

Many more data and recommendations have become available since my previous post, so an update seems to be in order.

• The Zika virus is transmitted by the Aedes species mosquito, which can bite during the day as well as at night.
• Most infected persons will not have symptoms. Those that do may experience fever, rash, joint pain, inflamed eyes (conjunctivitis), muscle pain, and headache. These are the same symptoms one can experience with dengue and chikungunya disease (both transmitted by the same mosquito).
• Symptoms will occur anywhere from a few days to a week after exposure.
• Neurologic complications that have been described include microcephaly, Guillain-Barre syndrome, encephalitis, and facial paralysis. Onset of neurologic complications can occur 0-15 days after fever and rash syndrome.
• Zika virus is detected for 7-10 days in the blood, up to 15 days in the urine, and up to 62 days in semen. However, it is not clear how long the virus is actually infectious in the urine and semen.
• Virus has been detected in fetus brain, placenta, testes, and breast milk.
• Pregnant women experiencing Zika symptoms should be tested for the virus at the time of illness.
• Infection can be diagnosed with a blood test called the Trioplex RT-PCR Assay, which tests for Zika, dengue, and chikungunya. Blood should be tested within one week of symptom onset, while urine can be tested for 14 days after symptom onset. Testing is available through the Tarrant County Health Department. Your healthcare provider can contact the health department for guidance and general testing algorithm.
• Infection usually doesn’t require hospitalization and is managed with rest, hydration, and Tylenol. Avoid aspirin or NSAIDS until dengue is ruled out.

Prevention Recommendations

• No vaccine exists at this time to prevent Zika virus disease.
• The Tarrant County Health Department has created a Zika virus home care kit that includes a fact sheet, backyard checklist, and mosquito repellant and dunks.
• Men who live in or have traveled to an area with Zika should use a condom every time they have sexual contact.
• Couples that include a man who has been diagnosed with Zika or has had symptoms of Zika should consider using condoms for at least six months after symptoms begin.
• Couples that include a man who traveled to an area with Zika but did not develop symptoms of Zika should consider using condoms or abstaining from sex for eight weeks after their return.
• Wear long-sleeved shirts and long pants.
• Stay in places with air conditioning and window/door screens.
• Use insect repellents with one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. (However, do not use insect repellent on babies younger than two months old, and do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than three years old.)
• Consider covering crib, stroller, and baby carrier with mosquito netting.
• If you are diagnosed with Zika virus disease or have symptoms suggestive of Zika virus disease, you should take steps to prevent mosquito bites for three weeks so you do not spread Zika to mosquitoes that could spread the virus to other people.

Bryan Youree, MD, is an infectious disease physician with the Tarrant County Infectious Disease Associates in Fort Worth, Texas. He has worked in the infectious disease field for 12 years. He attended Baylor College of Medicine and completed his post-graduate training at Vanderbilt University Medical Center. He served on faculty there before joining the Fort Worth practice.