Zika virus infection is a mosquito-borne viral infection that typically causes no symptoms but can cause fever, rash, joint pain, or infection of the membrane that covers the white of the eye (conjunctivitis, or pinkeye). Zika virus infection in a pregnant woman can cause microcephaly (a serious birth defect) and eye and other abnormalities in the baby.
The Zika virus is spread by mosquitoes, but it can also be spread through sexual intercourse, through blood transfusions, and from a pregnant woman to her baby before or during birth.
Symptoms of Zika virus infection, if they occur, are usually mild.
Doctors suspect Zika based on a person’s symptoms and recent travel history and confirm the diagnosis based on results of blood or urine tests.
The best ways to prevent Zika virus infection are to avoid being bitten by mosquitoes and to avoid unprotected sex with a partner who has or may have the infection.
The Zika virus, like the viruses that cause dengue, yellow fever, and chikungunya disease, is an arbovirus, spread by a certain species of mosquito, the Aedes mosquito, which breeds in areas of stagnant water. These mosquitoes prefer to bite people and live near people, indoors and outdoors. They bite aggressively during the day indoors and in shady areas outdoors. They are most active during the several hours after sunrise and before sunset. They also bite at night.
In 1947, the Zika virus was first identified in monkeys in the Zika Forest of Uganda. It was relatively unknown until 2007, when the first large-scale outbreaks occurred in the South Pacific islands. In May 2015, local transmission was reported in South America, then in Central America and in the Caribbean, reaching Mexico by late November 2015. Local transmission means that people are bitten by an infected mosquito where they live or work, as opposed to becoming infected while they were traveling.
As of May 2017, cases of locally transmitted Zika virus infection were reported in Miami-Dade County in southeastern Florida and Brownsville, Texas. As of December 2019, no new cases of locally transmitted Zika virus have been reported in the continental United States. Zika virus infection has been reported in travelers returning to the United States after travel to countries where the virus is transmitted locally.
The Centers for Disease Control and Prevention (CDC) issues travel alerts when outbreaks occur. As of December 2019, there are no areas with Zika outbreaks.
Transmission of Zika Virus
During the first week of infection, Zika virus is present in blood. When mosquitoes bite an infected person, they ingest blood containing the virus. The virus replicates in the mosquitoes and, after a few days, when the mosquitoes bite another person, they can transmit the virus to that person.
People who have traveled to areas where Zika virus infection is common may have Zika virus in their blood when they return home. If they live in an area with Aedes mosquitoes, the mosquitoes may bite them, then spread the virus to other people living in the area, resulting in local transmission of the Zika virus.
Although the Zika virus is usually spread by mosquitoes, it may be spread in other ways:
Sexual intercourse (vaginal, anal, or oral sex) and the sharing of sexual devices
An infected pregnant woman to her baby before or during birth
Blood transfusion or organ transplantation
People with Zika virus infection can transmit the virus through sexual intercourse in many circumstances:
If the infection never causes any symptoms
Before their symptoms start
While they have symptoms
After their symptoms end
Zika virus remains in semen much longer than it remains in blood and other body fluids. It can be spread by infected men to their sex partners (male or female) through unprotected (no condom) sexual intercourse, including vaginal, anal, and oral sex (see also Zika: Sexual Transmission and Prevention).
The Zika virus also remains in vaginal fluids after it disappears from blood and urine. Infected women can spread the virus to their male partner during sexual intercourse.
Transmission by blood transfusion has been reported in Brazil. However, no cases of transmission by blood transfusion have been confirmed in the United States.
The Zika virus can be spread from mother to child during pregnancy or around the time of birth.
At present, there have been no reports of infants becoming infected with Zika virus through breastfeeding. Even though the genetic material of Zika virus has been found in breast milk, risk of transmission from breast milk is outweighed by the nutritional benefits of breast milk for the infant. (See Centers for Disease Control and Prevention [CDC]: Zika Transmission and World Health Organization [WHO]: Guideline: infant feeding in areas of Zika virus transmission, 2nd edition.)
Symptoms of Zika Virus Infection
Most people who become infected with the Zika virus have no symptoms, and many do not know they are infected. If symptoms occur, they are usually mild. Infections severe enough to require hospitalization are uncommon. Death due to Zika virus infection is rare.
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Symptoms of Zika virus infection include fever, conjunctivitis (pinkeye), joint and muscle aches, pain behind the eyes, headache, and a red, bumpy rash. Symptoms last 4 to 7 days.
Rarely, Guillain-Barré syndrome develops after a Zika virus infection. Guillain-Barré syndrome is a nerve disorder that causes muscle weakness and a pins-and-needles sensation or loss of sensation that usually lasts for a limited time.
Zika virus infection in babies of infected mothers
Zika virus infection during pregnancy can cause microcephaly or other problems in the baby. Microcephaly refers to an abnormally small head. The head is small because the brain does not develop normally and is small.
Babies infected before birth can have many problems besides microcephaly, sometimes including:
Delays in development (for example, children may have problems with speech and may sit, stand, and walk later than expected)
Intellectual disability
Problems with movement and balance
Feeding problems, such as difficulty swallowing
Hearing loss
Vision problem
In the United States, several cases of microcephaly have been linked to the Zika virus. The mothers of these babies were probably infected when they traveled to a country where Zika virus infection is common. Cases are being monitored by the CDC and WHO (see CDC: Zika cases in the United States; WHO: Countries and territories with current or previous Zika virus transmission).
Image courtesy of Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.
Zika virus infection can cause other abnormalities in the brain and in the eyes (including cataracts). Infected babies may have excess skin on the scalp and, rarely, joints with a limited range of motion (such as clubfoot).
Diagnosis of Zika Virus Infection
Blood and urine tests
Doctors suspect Zika virus infection based on symptoms and on the places and dates of travel. However, symptoms of Zika virus infection resemble those of many tropical diseases (such as malaria, dengue, and other mosquito-borne viral infections), and it occurs in the same areas as these infections. Thus, tests are needed to confirm Zika virus infection.
Blood or urine tests can detect the virus if tests are done within a week or two after symptoms begin. These tests may use the polymerase chain reaction (PCR) technique, which increases the amount of the virus’s genetic material and thus makes the virus easier to detect. Tests are also done to check for Zika virus antibody in the blood.
Routine testing for Zika virus infection is not recommended for pregnant women who do not have symptoms. However, for those in or with recent travel to areas with high levels of Zika virus or who have had sex with someone with a high risk of exposure, doctors may recommend testing.
Currently, men who may have been exposed to the Zika virus are not tested to determine whether they are infected and thus at risk of transmitting the virus through sexual intercourse. Instead measures to prevent transmission (such as condoms) are recommended whenever people who may have been exposed to the Zika virus have sexual intercourse (including vaginal, anal, and oral sex).
Treatment of Zika Virus Infection
Supportive care
There is no specific antiviral medication for Zika virus infection.
Treatment of Zika virus infection is supportive. It includes the following:
Rest
Fluids to prevent dehydration
If the Zika virus is detected in pregnant women, doctors may recommend that ultrasonography be done every 3 to 4 weeks to monitor how the fetus is developing. Doctors may refer women to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management.
Doctors may monitor brain development for ≥ 2 years after birth in all infants born to mothers infected with Zika virus, whether or not the infants have symptoms.
Prevention of Zika Virus Infection
If possible, pregnant women should NOT travel to areas with ongoing Zika virus outbreaks (see also CDC: Pregnant Women and Zika). If traveling to such areas, pregnant women should talk with their doctor about the risks of infection and about the precautions to be taken to avoid mosquito bites during the trip.
Currently, there is no vaccine to prevent Zika virus infection, although research to develop a vaccine is progressing.
Prevention of transmission of Zika virus by mosquitoes
Prevention of Zika virus infection depends on control of mosquitoes in areas where Zika virus infection is common and on prevention of mosquito bites when traveling to such areas.
To prevent mosquito bites, people should take the following precautions:
Wear long-sleeved shirts and long pants.
Stay in places that have air conditioning or that use window and door screens to keep mosquitoes out.
Sleep under a mosquito bed net in places that are not adequately screened or air-conditioned.
Use Environmental Protection Agency–registered insect repellents—with ingredients such as DEET (diethyltoluamide) or other approved active ingredients—on exposed skin surfaces.
For children, the following precautions are recommended:
Do not use insect repellent on infants under 2 months old.
Do not use products containing oil of lemon eucalyptus (para-menthane-diol) on children under 3 years old.
For older children, adults should spray repellent on their own hands and then apply it to the children's skin.
Dress children in clothing that covers their arms and legs, or cover the crib, stroller, or baby carrier with mosquito netting.
Do not apply insect repellent to the hands, eyes, mouth, or cut or irritated skin of children.
Prevention of sexual transmission of Zika virus
The Zika virus can be sexually transmitted from men to their sex partner (male or female) and from women to men. The CDC has made recommendations about preventing Zika virus from being transmitted during sexual intercourse (CDC: Zika: Sexual Transmission and Prevention).
For pregnant women, precautions to prevent sexual transmission of the Zika virus are particularly important. If their partner (male or female) lives in or has traveled to an area where Zika virus infection is common, the couple should use a preventive measure for the entire duration of the pregnancy. The couple should do one of the following:
Abstain from sex (vaginal, anal, or oral)
Consistently and correctly use a barrier birth control method during sex (vaginal, anal, or oral)
This recommendation applies whether the partner has symptoms or not because most Zika virus infections do not cause symptoms, and when symptoms do develop, they are usually mild.
The CDC also provides recommendations when there is no existing pregnancy. The time periods for men and women differ because the Zika virus remains in semen longer than in other body fluids.
Men who have traveled to an area with current or past Zika virus transmission should
Use condoms or abstain from sex for at least 3 months after he returns, or from the start of symptoms or the date he was diagnosed with Zika.
Women who have traveled to an area with current or past Zika virus transmission should
Use condoms or abstain from sex for at least 2 months after she returns, or from the start of symptoms or the date she was diagnosed with Zika.
Partners who have both traveled to an area with current or past Zika virus transmission should
Use condoms or abstain from sex for at least 3 months after the later traveler returns, or from the start of symptoms or the date either was diagnosed with Zika.
Barrier methods include condoms (male and female) and dental dams (used during oral sex). These barriers can reduce the risk of getting the Zika virus during sex. To be effective, condoms and dental dams must be used correctly. They should be placed before sexual activity begins and remain until it ends (see Condoms). They should be used each time, during vaginal, anal, and oral sex.
Not sharing sex devices can also reduce the risk of sexual transmission.
See also CDC: Zika: People Trying to Conceive.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
CDC: Zika Virus: Comprehensive information on Zika virus, from prevention, travel information, and mosquito control through symptoms, testing, and treatment
