Zika Virus: an Emerging Global Pandemic

Monica Madvariya
WHO Recommendations
On 17 January 2016, the Pan American Health Organization (PAHO), the regional office of the United Nations' World Health Organization, considering the increased number of cases of congenital anomalies, Guillain-Barré syndrome and other neurological or autoimmune syndromes in Zika-affected areas, recommended that its member states "establish and maintain the capacity to detect and confirm Zika virus cases, prepare healthcare facilities to respond to a possible increase demand of specialized care for neurological syndromes, as well to strengthen antenatal care".[30] After WHO declared Zika virus as a global health emergency in February 2016, all countries including India are advised to take measures to contain the spread of the virus.[9]

Prevention is solely based on protection against mosquito bites. Aedes mosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore personal protection measures should be applied all day long and especially during the hours of highest mosquito activity (mid-morning, late afternoon to twilight).
Personal protection measures to avoid mosquito bites should be applied when staying in risk areas by:
• using repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535 and wearing long-sleeved shirts and long pants especially during the hours of highest mosquito activity. Repellent use must be strictly done in accordance with the instructions indicated on the product label. For newborn children under three months of age, repellents are not recommended.
• using long-lasting insecticidal treated mosquito bed nets
• keeping accommodations are adequately screened or air conditioned
• removing mosquito breeding sites in close outdoor/indoor premises by eliminating standing water, repairing septic tanks and using screens on doors and windows
• Travellers, especially children, pregnant women, and people with immune disorders or severe chronic illnesses, should consult their doctor or seek advice from a travel clinic to receive personalised recommendations on use of repellents and protection before travelling;
• Similar protective measures apply to a symptomatic patient in order to prevent transmitting the disease to non-infected mosquitoes.

• The Ministry of Health and Family Welfare has advised enhanced surveillance through the Integrated Disease Surveillance Programme (IDSP) which would involve tracking clustering of acute febrile illness if any, among those who travelled to areas with ongoing transmission in the 2 weeks preceding the onset of illness. Clustering of cases of microcephaly among newborns and reporting of Gullian Barre Syndrome would also be undertaken.
• All the International Airports will display information to travelers on Zika virus disease and would have quarantine/isolation facility for returning travellers with febrile illness.
• National Centre for Disease Control (NCDC), Delhi and National Institute of Virology (NIV), Pune, have been designated as the nodal agencies providing laboratory diagnosis of Zika virus disease. Ten additional laboratories would be strengthened to expand the scope of laboratory diagnosis.
• RT- PCR test would remain the standard test. As of now, there is no commercially available test for Zika virus disease. Serological tests are not recommended.
• The state health departments will promote increased awareness among clinicians including obstetricians, paediatricians and neurologists about Zika virus disease and its possible link with adverse pregnancy outcome (foetal loss, microcephaly)
• Augmented measures for vector control would be taken
• Travel Advisory for public
- Non-essential travel to the affected countries to be deferred/ cancelled
- Pregnant women or women who are trying to become pregnant should defer/ cancel their travel to the affected areas.
- All travelers to the affected countries/ areas should strictly follow individual protective measures, especially during day time, to prevent mosquito bites (use of mosquito repellant cream, electronic mosquito repellants, use of bed nets, and clothing that appropriately covers most of the body parts).
- Persons with co-morbid conditions (diabetes, hypertension, chronic respiratory illness, Immune disorders etc) should seek advice from the nearest health facility, prior to travel to an affected country.
- Travelers having febrile illness within two weeks of return from an affected country should report to the nearest health facility.
- Pregnant women who have travelled to areas with Zika virus transmission should mention about their travel during ante-natal visits in order to be assessed and monitored appropriately.

Zika virus disease is usually relatively mild and requires no specific treatment. People sick with Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with paracetamol. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available.
Some authorities have recommended against using Aspirin and other NSAIDs as these have been associated with hemorrhagic syndrome when used for other flaviviruses. Additionally, Aspirin use is generally avoided in children when possible due to the risk of Reye syndrome.[29]
Zika virus had been relatively little studied until the major outbreak in 2015, and no specific antiviral treatments are available as yet. Advice to pregnant women is to avoid any risk of infection so far as possible, as once infected there is little that can be done beyond supportive treatment.

Zika Virus: an Emerging Global Pandemic Zika Virus: an Emerging Global Pandemic 02/10/2016
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