Zika Virus: Information for Travellers

Zika Virus Advice

What is the Zika Virus?

Zika belongs to the same family of viruses as dengue, West Nile, yellow fever and Japanese encephalitis, and also to a much larger category (the arboviruses), capable of spreading from one human (or animal host) to another via biting insects.

The Current Outbreak: Where Does Zika Occur?

Since the beginning of 2015, Zika transmission has been reported in 60 countries, mostly in Latin America and the Caribbean. Brazil has seen the largest number of cases, 97% of its cases occurring in the north east of the country. The second highest number of cases has been in Colombia.

Since the Aedes mosquitoes are widely present through hot countries, the major underlying fear is that Zika will spread unchecked to other parts of the world, particularly Asia and Africa (in the same way that two other infections, dengue and chikungunya, have recently done through Latin America and the Caribbean).

What Illness Does Zika Virus Cause?

After an incubation period of 3 to 14 days following exposure, the commonest Zika virus symptoms are:

  • Rash (lasting 5 to 6 days)
  • Itching
  • Headache
  • Joint and muscle aches
  • Conjunctivitis
  • Mild fever (occurs in only 36% of cases, often lasting less than a day)

Only 20% of people infected with Zika virus develop symptoms. In early stages, the Zika illness is indistinguishable from dengue and chikungunya (two other arbovirus infections that occur in exactly the same parts of the world, and that are currently more frequent than Zika).

What Should I do if I Suspect Zika Virus Infection?

No specific anti-viral treatment is available. Most symptoms are mild. People with symptoms of Zika should:

  • Get plenty of rest
  • Drink sufficiently
  • Treat any pain and/or fever with paracetamol
  • Seek medical advice if symptoms worsen
  • For conjunctivitis, apply in-eye lubricants, stop wearing contact lenses, and seek ophthalmological advice if symptoms are severe

It may be helpful to document infection. RT-PCR blood and urine testing for Zika (and other arboviruses) is available in many of the places where Zika occurs, so seek local medical advice if you think you have been infected. Testing at the time (or shortly after) infection is more likely to yield conclusive results.

Can the Fleet Street Clinic Test for the Zika Virus?

Yes, the Fleet Street Clinic can help with Zika blood or urine testing: click here for more information.

What Complications can follow Infection?

Fetal harm

Damage to the developing nervous system of the fetus during pregnancy is the greatest concern, especially: microcephaly, calcification, structural abnormalities of grey and white matter, and enlargement of the brain’s ventricles (internal fluid-filled spaces). The risk is highest during the first trimester (three months) of pregnancy, remains present during the middle trimester, and appears to be minimal during the third.

Post-infection syndromes

Zika infection has also been associated with Guillain-Barré syndrome, also called GBS. This is a rare autoimmune condition that can follow a variety of viral infections, perhaps weeks later. It consists of weakness, paralysis and a spectrum of neurological complications ranging from mild and transient to life threatening. Despite the increase in cases in Zika-affected countries, GBS remains rare. In the current outbreak, no deaths from GBS been reported.

How does the Zika Virus Spread?

By mosquitoes: The virus is spread by bites of mosquitoes from two species: Aedes albopictus and Aedes aegypti which are most active and bite during the day.

By blood, body fluids and sex: Zika can also behave as a blood-borne virus, spread by blood and body fluids. Male-to-female as well as male-to-male sexual transmission can occur. Infectious virus has so far been detected in semen for as long as 69 days following infection.

How can Zika Infection be Prevented?

Preventing insect bites

  • Unlike night-biting malaria mosquitoes, the Aedes mosquitoes that transmit Zika bite during the day
  • On sunny days, their peak biting times are:
    • during the first 2 to 3 hours after dawn
    • during mid to late afternoon
  • On overcast days and indoors, they bite all day long

Bite prevention is the key to personal protection: use insect repellent during daytime hours. Insect repellent containing DEET is most effective and should be used.

Insect bites cannot be avoided completely, but travellers should do everything possible to reduce the numbers of bites.

  • Cover up as much of the body as possible – preferably with light-coloured clothes
  • Using plenty of DEET insect repellent
  • Wear clothing impregnated with permethrin when working in the open
  • Using mosquito nets or plug-in killers in your room at night
  • Choose screened, air-conditioned accommodation if available and keep windows and doors closed
  • Ensure any obvious mosquito breeding sites close to your work or accommodation are reported and properly dealt with.

Public health authorities should take steps to control local mosquito populations and remove stagnant water and other possible breeding sites for mosquitoes.

Preventing sexual transmission

Any traveller who develops symptoms of Zika infection should seek medical advice, ask for testing, and abstain from sex in the meantime. Men who have travelled to risk areas should abstain from sex or use a condom on returning for at least 6 months afterwards, or for the duration of pregnancy if their partner is pregnant. Note: this recommendation is subject to change in the light of evolving evidence.

Concerns about Pregnancy and Conception:

Zika virus remains present in the blood of an infected person for about 10 days. There is no evidence that the virus can cause infection in a baby conceived after the virus has been cleared from the blood.

Advice for women

  • Avoid travel to affected areas if you are pregnant or actively trying to conceive, or obtain expert medical advice.
  • If you have travelled to a risk area but have been symptom-free, wait at least 6 months before trying to conceive.
  • If you have travelled to a risk area and have had symptoms, or a confirmed Zika infection, wait at least 6 months from the onset of symptoms before trying to conceive.
  • If your (male) partner has travelled to a risk area or had symptoms, or confirmed Zika infection, avoid pregnancy and use barrier contraception as below.

Advice for men

  • If you have travelled to a risk area, use condoms and wait at least 6 months before attempting to conceive.
  • If you have travelled to a risk area, use condoms/ barrier contraception for at least 6 months.
  • If you have travelled to a risk area and your partner is pregnant, you should abstain from sex or use a condom on returning for the remainder of the pregnancy.

IMPORTANT NOTE: Different authorities issue varying national guidelines, all of which will undoubtedly change as the situation evolves. 

Staying up to date

  • All travellers to regions with Zika should seek up-to-date, specialist travel health advice before they go.
  • News, recommendations, and health advice are constantly changing, and vary according to international / political perspectives and sensitivities.

Contact Fleet Street Clinic

Fleet Street Clinic is a leading multi-disciplinary medical clinic in London, with particular expertise in Travel Medicine. The clinic has been established for over 20 years and is led by Dr Richard Dawood, an expert in Travel Health and author of  bestselling travel health guide: “Travellers’ Health: How to Stay Healthy Abroad”.

For further advice about travel health, to book vaccines or other travel-related appointments, please call us on 020 7353 5678 or email us at info@fleetstreetclinic.com. Alternatively, you can book an appointment through our online booking system here.

News on Zika

World Health Organisation: www.who.int/ith

Pan American Health Organization (PAHO): www.paho.org

Centers for Disease Control & Prevention (US advice): www.cdc.gov

National Travel Health Network & Centre (NATHNAC) UK: travelhealthpro.org.uk

Health Protection Scotland: www.fitfortravel.scot.nhs.uk

European Centre for Disease Prevention and Control: www.ecdc.europa.eu

Public Health England: https://www.gov.uk/guidance/zika-virus

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