Travelling abroad: Zika Virus

By Dr George Kassianos, President of the British Global & Travel Health Association

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WHAT IS ZIKA VIRUS?

Zika Virus (ZIKV) is a flavivirus (similar to dengue) and was first discovered in a monkey in the Zika forest, Uganda in 1947. It is found in parts of Africa, Asia and the Pacific Islands and has recently been reported in Central and South America and the Caribbean.

HOW CAN YOU GET ZIKA?

ZIKV infection is spread by day-biting mosquitoes. A small number of cases of sexual transmission of ZIKV have also been reported and there is increasing evidence of transmission from mother to foetus via the placenta.

WHAT ARE THE SYMPTOMS OF ZIKA?

ZIKV infection is usually a mild and short-lived illness; severe disease is uncommon. Symptoms include: fever, headache, red, sore eyes and conjunctivitis, joint and muscle pain, a rash, itching and swollen joints. Serious complications and deaths from ZIKV are not common. However, there is now scientific consensus that ZIKV is a cause of microcephaly (baby has a head that is much smaller than normal) and other congenital anomalies.

HOW CAN YOU TEST FOR ZIKA?

Tests are carried out only if symptomatic: serum (blood test) and if less than 21 days urine too.

HOW DOES IT AFFECT PREGNANT WOMEN?

Based on a systematic review of the literature up to 30 May 2016, WHO concluded that ZIKV infection during pregnancy is a cause of congenital brain abnormalities, including microcephaly (also referred to as congenital Zika syndrome (CZS)) and that ZIKV is a trigger of Guillain-Barré syndrome (GBS).

CAN YOU TREAT ZIKA?

There is no specific treatment; rest, fluids and pain relief are recommended to help relieve symptoms.

HOW CAN I REDUCE MY RISK OF BEING INFECTED?

It is recommended that pregnant women should postpone non-essential travel to areas designated as ‘high risk’ for ZIKV transmission until after pregnancy. They should consider postponing non-essential travel to areas designated as ‘moderate risk’ until after pregnancy.

WHICH COUNTRIES SHOULD I AVOID?

Get up-to-date information by visiting: https://travelhealthpro.org.uk/countries

NaTHNaC Advice

Summary of travel advice according to Public Health England/ NaTHNaC Zika risk rating.

HIGH AND MODERATE RISK

1. Pregnant women:

  • Should postpone non-essential travel to high risk areas until after pregnancy

  • Should consider postponing non-essential travel to moderate risk areas until a er pregnancy

  • If travel is essential, be aware of the risk, be scrupulous with insect bite avoidance, seek advice from your GP or midwife on return, even if you have not been unwell

2. All travellers:

  • Should avoid mosquito bites day and night. If you experience symptoms suggestive of ZIKV infection, seek medical advice (while the symptoms are still present)

3. Male travellers:

  • If your female partner is pregnant, consistent use of condoms or other barrier methods is advised during vaginal, anal and oral sex to reduce the risk of transmission during travel and for the duration of the pregnancy even if you did not develop symptoms compatible with ZIKV infection

  • If your female partner is planning pregnancy: effective contraception is advised to prevent pregnancy and consistent use of condoms or other barrier methods is advised during vaginal, anal and oral sex to reduce the risk of transmission during travel and for three months after return even in the absence of symptoms

4. Female travellers:

  • Avoid becoming pregnant during travel and for eight weeks after your last possible ZIKV exposure or from symptom onset. Last possible ZIKV exposure is defined as the date of leaving an area with high or moderate ZIKV risk, or the date on which unprotected sexual contact with a potentially infectious partner took place

LOW RISK

  • All travellers should avoid mosquito bites particularly between dawn and dusk

  • Pregnant women should seek medical advice if they develop ZIKV symptoms, and contact their GP on return

REFERENCES

  • https://travelhealthpro.org.uk/disease/196/zika-virus

  • https://www.gov.uk/guidance/zika-virus-sample-testing-advice

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

  • https://travelhealthpro.org.uk/news/4/zika-virus--update-and-advice-for-travellers- including-pregnant-women-and-those-planning-pregnancy

  • https://www.jwatch.org/na47546/2018/10/10/extended-analysis-zika-persistence?query=etoc_jwid&jwd=000020111096&jspc=GP


Juliana Kassianos