Zika virus disease

Symptoms Of Zika Virus Disease

The incubation period (the time from exposure to symptoms) of Zika virus disease is 3 to 14 days. Symptoms are usually indistinguishable from other diseases such as dengue & chikungunya and persist for 2 to 7 days. The symptoms include: 

• Fever 
• Rash
• Conjunctivitis
• Muscle pain
• Joint pain
• Malaise
• Headache

Patients might also experience some other symptoms such as: 

• Abdominal pain
• Diarrhoea
• Constipation
• Photophobia
• Small ulcers on the oral mucosa
• Hearing impairment
• Vomiting

Causes Of Zika Virus Disease

Most people get the Zika infection through mosquito bites. It is primarily transmitted through the bite of an infected Aedes aegypti and Aedes albopictus mosquito. These mosquitoes lay eggs & breed in or near stagnant water. Standing water in coolers, buckets, flower vases, and pots provide breeding sites to these infected mosquitoes. 

A person can get the virus in his blood through the bite of an infected mosquito. The virus usually remains in the blood for one week. These mosquitoes mostly bite during the morning and early afternoon. 

The basic reproduction number (R0, a measure of transmissibility) of Zika virus has been estimated to be between 1.4 and 6.6. R0 tells you the average number of people who will contract a contagious disease from one person with that disease. For example, if a disease has an R0 of 18, a person who has the disease will transmit it to an average of 18 other people.

Note: R0 (R naught) is the basic reproduction number, also known as basic reproduction ratio or rate, which is used to measure the transmissibility of infectious agents.

The other ways through which people can get the infection include:

• Through unprotected sexual intercourse

• Through contaminated blood transfusions

• From mother to child

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Risk Factors For Zika Virus Disease

The factors that increase the risk of Zika virus disease include: 

• Unprotected sex

• Travelling to the areas where there are Zika outbreaks

• Staying in Zika-infected area

• Blood transfusion

Diagnosis Of Zika Virus Disease

Zika virus disease is usually advised to be diagnosed within a week of developing symptoms or in case you or your partner have recently travelled to a contaminated area. 

The most common testing methods includes: 

1. Reverse transcription polymerase chain reaction (RT-PCR): This method detects RNA (genetic material) of the Zika virus. It is a rapid, sensitive and specific method for early detection. The test can be done with urine, saliva & blood samples. Studies suggest that the genetic material of the Zika virus can be detected for a longer time in the urine and saliva of patients for a longer duration as compared to blood. This test can detect the virus during the first 3 to 5 days from the onset of infection. 

2. Serology: It detects the antibodies such as immunoglobulin M (IgM) in the blood produced by the virus. The method can detect the presence of antibodies after 4 days of illness. IgM levels are variable, but generally become positive starting in the first week after onset of symptoms and continuing for up to 12 weeks post symptom onset or exposure, but may persist for months to years. Generally, it is not used much as it cannot differentiate with other flaviviruses such as dengue, chikungunya, and yellow fever.

3. Plaque reduction neutralisation tests (PRNT): These are quantitative assays that measure virus-specific neutralising antibody titers. PRNTs can resolve false-positive IgM antibody results that cause non specific infections and help identify the exact virus that has caused the infection. Thus, it is a confirmatory diagnostic method.

Examination during pregnancy

During pregnancy, several tests can be done to identify congenital Zika virus infection. These include:

1. Ultrasound: For Zika infected (or suspected) pregnant women, serial ultrasounds (every 3 to 4 weeks) are recommended. The test can detect various brain related abnormalities of the foetus such as microcephaly and intracranial calcifications. Microcephaly can be detected in the late second & early third trimester of pregnancy. Early detection (18 to 20 weeks of gestation) is also possible. 

2. Amniocentesis: In this procedure, amniotic fluid (fluid that surrounds the foetus) is tested for the possible Zika virus infection of the baby. It is done after 15 weeks of gestation as early detection increases the chances of infection. 

Several tests such as anemia, diabetes, hepatitis B and C, and HIV conducted during pregnancy can minimise or prevent various health threats.

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Prevention Of Zika Virus Disease

A. Avoid mosquito bites

1. Use mosquito repellents

These are available in the form of patches, bands, creams & lotions. A mosquito repellant provides protection from mosquitoes both indoors and outdoors. They can be chemical based or natural. Commonly available mosquito repellants in the market are: 

• DEET

• Oil of lemon eucalyptus

• Picaridin

• IR3535

Tips to follow while using repellants

• Avoid spraying the repellant on the skin under clothing.

• Apply sunscreen first, if you are applying it with a repellant.

• Read complete instructions to avoid any reaction.

• Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin.

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2. Avoid stagnant water

Mosquitoes lay eggs in and around standing water. The following measures can be taken to avoid standing water.

• Drain out water from buckets and mugs after washing & bathing.

• Cover up water storage containers with tight lids.

• Remove standing water from flower pots, AC trays, and coolers. 

• Clean roof gutters, home coolers and swimming pools regularly.

• Keep native larvivorous fishes in the pools as they feed on mosquitoes.

3. Restrict entry of mosquitoes from outdoors 

The infected mosquitoes breeding eggs outside in the trash containers can enter the house. The best way is to prevent their entry. This can be done by taking following measures: 

• Use nets and screens for doors and windows.

• Keep windows and doors close.

• Fix all the holes of doors and windows, if any.

• Cover baby carriers with net.

4. Cover yourself up 

One can avoid the mosquito bite by wearing protective clothing. While you are dressing up, follow the measures such as: 

• Wear full sleeve clothes.

• Wear light colored clothes.

• Allow the clothes to dry completely before wearing.

• Treat clothes with insecticide such as permethrin.

5. Sleep under mosquito nets

It is one of the conventional and effective ways to prevent mosquito bites. These nets can be mounted on your bed. The fine mesh of the nets restricts the entry of mosquitoes. 

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B. Follow safe sexual practices

Zika virus disease can be transmitted through vaginal, oral & anal sex. Sharing of sex toys can also pass the virus to other person. The virus can stay in semen (viral persistence in testes can last upto 160 days) and vaginal secretions for a longer time than any other body fluids (urine & blood). The following preventive measures can be taken to reduce the chances of infection.

• Use condoms while having vaginal, oral and anal sex (from start to end).

• Abstain from any sort of sexual activity, if infected. 

• Avoid sharing of sex toys.

• Use dental dams while having oral sex.

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Specialist To Visit

In most cases, the symptoms of Zika infection are usually mild and often go away on their own. However, visiting a doctor and early intervention may lead to slow progression and early resolution of disease. The specialists who can help treat this infection include:

• General physician

• Infectious disease specialist

In case of pregnancy, women should visit her obstetrician-gynaecologist as the Zika infection is known to cause several complications in the foetus. 

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Treatment Of Zika Virus Disease

There is no specific treatment or vaccine available for Zika virus disease. The treatment is usually aimed to reduce the symptoms. Most of the patients usually recover on their own by taking proper rest & supportive care. 

• People are advised to take plenty of fluids such as water, fruit juices, buttermilk, and coconut water to prevent dehydration. 

• As the infection causes tiredness and fever, proper rest should be taken by the patients. 

• In case of pain and fever, paracetamol can be taken. 

• Pregnant women living in the areas of active Zika transmission or having symptoms should immediately consult their doctors. 

Note: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be avoided until your doctor confirms the absence of dengue fever.

Home-care For Zika Virus Disease

Once you have Zika virus, there are very few chances that you will experience any symptom. Symptoms are usually mild and rarely require hospitalisation. Try to take plenty of water and proper rest. Abstain from any kind of sexual activity as it may transmits the infection to your partner. Do not plan to conceive for at least 2 to 3 months after the recovery. Control mosquitoes both inside and outside your home. Pregnant women should regularly meet their gynaecologist to screen any foetal abnormality or birth defects. 

If you are taking care of a Zika infected patient, follow these precautionary measures to reduce the transmission. 

1. Do not touch blood or body fluids such as urine and vomit of infected person.

2. Wash hands properly after meeting the infected person.

3. Remove and wash clothes timely and immediately, if they are exposed to any blood or other fluids of an infected person.

4. Sanitise the person’s environment and belongings daily.

5. Take necessary steps to avoid mosquito bites such as keeping doors and windows closed and using mosquito nets. 

Complications Of Zika Virus Disease

People suffering from Zika virus disease usually recover on their own. The disease is mild and rarely requires hospitalisation. But, in some cases, the diseases can cause several complications. Pregnant women are at high risk of developing complications. 

Congenital Zika syndrome

There is a strong link between Zika virus infection during pregnancy & birth defects in children. An infected pregnant woman can pass the virus to her developing baby. It can cause a group of birth defects in the child known as congenital Zika syndrome. It can affect the growth & development of the developing baby. The possible abnormalities include: 

• Smaller brains and collapsed skull, the condition is known as microcephaly

• Decreased brain tissue

• Scarring at the back of eye

• Reduced mobility of the joints

• Reduced movement of the body immediately after the birth

• Epilepsy

• Intellectual disability

• Respiratory infection

• Dysphagia

• Neural tube defects

• Cerebral palsy

• Low birth weight

• Vision problems

Guillain-Barré syndrome (GBS)

Zika virus disease can cause GBS, which is a neurological disorder in which nerve cells are damaged by the immune system. It can lead to muscle weakness. In advanced stages, muscles that control breathing can also be affected. Usually, patients recover from GBS within several months. Rarely, it causes permanent damage. 

GBS is a rare complication of Zika virus infection. It occurs in 2-3 patients out of 10,000 affected with the infection. 

Other neurological disorders

Zika virus disease can also lead to some central nervous system related disorders such as: 

• Encephalitis
• Meningoencephalitis
• Retinopathies 
• Neuropathy
• Myelitis

Thrombocytopenia

Very rarely, Zika virus disease can cause thrombocytopenia. People with this disorder have less number of platelets which can result in bleeding, bruising and slow blood clotting.

Here’s more about thrombocytopenia or low platelet count.
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Pregnancy loss

The infection of Zika virus in pregnant women increases the chances of miscarriages, preterm birth & still birth. 

Alternative Therapies For Zika Virus Disease

Home remedies for zika virus disease

Garlic (Lehsun): It has anti-inflammatory properties which aids in fighting Zika infection. Allicin, an ingredient of garlic boosts the immunity. It helps in the reduction of muscle pain & fever. You can simply include it in your food. It can also be taken in a powdered form. 

Papaya (Papita): Papaya enhances the immunity which helps in fighting with infections. It also acts as an antioxidant. 

Note: Papaya should not be consumed during pregnancy. 

Vitamin C: Foods rich in Vitamin C such as strawberries & kiwi also enhances the immunity and may aid in faster recovery. 

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