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On Nov. 24, 2015, the National IHR Focal Point of El Salvador notified the Pan-American Health Organization (PAHO) and the World Health Organization (WHO) of three laboratory-confirmed autochthonous cases of Zika virus infection. The preliminary confirmation was provided by the national reference laboratory and has since been confirmed by the Centers for Disease Control and Prevention (CDC) in Fort Collins, Colo. Salvadoran health authorities are implementing the corresponding prevention and control activities.
PAHO/WHO also received notification of a laboratory-confirmed autochthonous case of Zika virus infection in Guatemala. The case, who is a resident of the Zacapa department, developed symptoms on Nov. 11, 2015 An investigation is being carried out to detect further cases. The confirmatory testing was performed at the CDC in Fort Collins. Guatemalan health authorities are implementing the corresponding prevention and control activities.
Given the increased transmission of Zika virus in the Region of the Americas, PAHO/WHO recommends that its member states establish and maintain the capacity to detect and confirm cases of Zika virus infection, prepare their health services for a potential additional burden at all levels of healthcare, and implement an effective public communications strategy to reduce the mosquitoes that transmit this disease, particularly in areas where this vector is present.
WHO provides the following Frequently Asked Questions (FAQs) about Zika Fever:
Q: What is Zika fever?
A: It is a mosquito-borne viral disease caused by Zika virus (ZIKV), consisting of mild fever, rash, conjunctivitis, headaches and arthralgia, which appears between three and 12 days after the mosquito vector bite. One out of four people may not develop symptoms, but among those who are affected, the disease is usually mild with symptoms that can last between two and seven days. Its clinical manifestation is often similar to dengue, another mosquito-borne illness.
Q: How is Zika virus transmitted?
A: It is transmitted by mosquitoes of the genus Aedes-the same vector that transmits dengue or chikungunya-which is present in the tropics and sub-tropics of the Americas. After an infected mosquito bite, disease symptoms usually appear following an incubation period of three to 12 days.
Q: What are the symptoms of Zika virus infection?
A: Zika virus infection presents with a moderate clinical picture, including mild fever; rashes that tend to begin in the face and spread to the rest of the body; joint pain, particularly in the hands and feet; muscle pain; headaches; and conjunctivitis, among other symptoms. Infected people may not develop symptoms. Among those who do get symptoms, onset tends to be three to twelve days after the mosquito bite. Symptoms can last between two and seven days, and people rarely require hospitalization. The symptomatology tends to be very similar to that of dengue or chikungunya, which means that it can be easily mistaken for one of those illnesses. Complications (neurological, autoimmune) are rare, but have been described in the outbreaks in Polynesia.
Q: How is it treated?
A: Treatment consists of relieving pain, fever, and any other symptom causing the patient discomfort. There is no specific vaccine against the virus.
Q: Can I be infected repeatedly with Zika virus?
A: There are no documented cases of anyone getting Zika virus infection more than once. The immune response is believed to give lifelong immunity.
Q: What does “indigenous” (or “autochthonous”) transmission of Zika virus mean? What are “imported” cases of Zika?
A: Indigenous (autochthonous) transmission means that mosquito populations residing in a specific area are infected with the virus and begin to transmit it to the people in that area. When there is indigenous transmission, patients do not have a history of travel to endemic areas. People who contract the disease by traveling to countries where Zika virus is circulating, are considered “imported” cases; that is, they were bitten by infected mosquitoes during trips to places where the virus is present.
Q: What measures should be taken to prevent Zika virus infection?
A: The elimination and control of Ae. aegypti mosquito breeding sites reduces the chances for transmission of Zika, chikungunya, and dengue. As is true of dengue and chigunkunya, this virus requires a comprehensive approach involving several areas of action, from health, to education, to the environment. Those measures include the elimination or destruction of mosquito breeding sites:
• Avoid the accumulation of water in outside containers (flower pots, bottles, and other containers that can hold water) to prevent them from becoming mosquito breeding grounds.
• Cover household water storage tanks so that mosquitoes cannot get into them.
• Do not allow trash to accumulate, and throw it away in closed plastic bags kept in covered trash receptacles.
• Unclog drains that can cause standing water.
• Also, use mosquito nets and screens on windows and doors to reduce contact between mosquitoes and people.
Q: Is it safe to travel to countries where Zika virus is circulating?
A: Yes. PAHO/WHO does not recommend any restrictions on travel or international trade due to Zika virus outbreaks.
Q: What can I do to protect myself if I travel to a place where Zika virus is circulating?
A: If you travel to a country that has Zika virus, follow these recommendations to prevent mosquito bites and reduce the risk of infection:
• Cover exposed skin with long-sleeved shirts, trousers, and hats.
• Use repellent as indicated and reapply as suggested.
• Sleep in places protected by mosquito netting.
Q: What is PAHO/WHO’s response?
A: For countries that have the vector mosquito, PAHO/WHO recommends the following: establish and maintain the capacity to detect and confirm cases; diagnose and treat patients; and implement an effective public awareness campaign to reduce the presence of the mosquito. It also recommends that countries strengthen their laboratory capacity to detect the virus in timely fashion.
Actions taken by PAHO/WHO regarding Zika fever include:
•Early warning and dissemination of information: PAHO disseminates information on public health events of international concern by publishing alerts, interactive maps, and reports. The Epidemiological Alerts provide information on international public health events that have been confirmed with the Member States, along with the recommendations the Pan American Health Organization makes regarding the event.
•Continuous communication and coordination with the WHO Collaborating Center, CDC Fort Collins, regarding the disease.
•Preparation of algorithms and technical recommendations for laboratory detection
•Materials for clinical case management in development
•Communication on the disease to answer frequently asked questions and conduct risk communication during outbreaks.
More information is available at: www.paho.org/zikavirus