Zika Virus Treatment & Management

Updated: Oct 12, 2017
  • Author: Bhagyashri D Navalkele, MD, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Approach Considerations

Zika virus (ZIKV) infection is usually mild and self-limited. There are no specific treatment options for Zika virus infection. [16]

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Medical Care

Supportive care with rest and adequate fluid hydration is advised. Symptoms such as fever and pain can be controlled with acetaminophen. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with unconfirmed Zika virus infection should be avoided since the use of such drugs in dengue fever is associated with hemorrhagic risk. [21]

The WHO recommends optimal supportive care in patients with Guillain-Barré syndrome, including frequent neurologic examinations, testing of vital signs, and respiratory function monitoring to decrease the likelihood of complications (eg, blood clots, respiratory failure). Patients whose symptoms are escalating rapidly or who are unable to walk should receive intravenous immunoglobulin therapy or therapeutic plasma exchange. [22]

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Consultations

Expert consultation with a maternal-fetal medicine and infectious diseases specialists is advised for management of Zika virus infection during pregnancy.

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Prevention

Avoidance of Travel to Areas of Active Zika Virus Transmission

The best method for preventing Zika virus infection is to avoid travel to areas with active Zika virus transmission.

Mosquito Control and Prevention of Mosquito Bites

Residents who live in endemic areas or travelers to endemic areas are advised to avoid mosquito bites. Different strategies to prevent mosquito bites include wearing full-sleeved shirts and long pants, sleeping under mosquito bed net, and treating clothing with permethrin. [16]

Environmental Protection Agency (EPA)–registered mosquito-repelling agents such as DEET, picaridin, IR3535, and para-menthane-diol products can be used by all age groups except those younger than 2 months for prevention of mosquito bites. Mosquito larval habitats can be controlled by appropriate handling of water-holding containers, including routinely discarding or covering stagnant water or using larvicidal agents. Certain other measures to control mosquitoes, including the use of genetically engineered Aedes aegypti mosquitoes as previously performed to prevent dengue infection by reducing the natural population of mosquitoes, is under investigation.

Caution should be exercised to prevent local transmission of Zika virus from infected patients to uninfected mosquitoes. Mosquito bites should be avoided during initial stages of Zika infection owing to high viremia. This reduces infection of mosquitoes and prevents local spread of viral illness. Various control measures have been advised since the global rise in incidence of Zika virus infections.

Preventing Other Modes of Zika Virus Transmission

Until recently, the mosquito was the only known vector for Zika virus transmission. As the infection spreads, new possible routes of transmission facilitating human-to-human spread of the virus without an intermediate vector have been discovered. The CDC has issued interim guidelines advising sexual abstinence or regular use of condoms to prevent the spread of Zika virus to sexual partners, especially during pregnancy. [24] Probable Zika virus transmission from blood transfusion has yet to be confirmed. [25] Few countries outside the United States are restricting blood transfusion from returning travelers after travel to Zika virus outbreak zones for at least 28 days after return.

The CDC advises that women with Zika virus infection should wait at least 8 weeks after any symptom onset before attempting to get pregnant. Asymptomatic women with a possible exposure (who have been in an area of active transmission) should also wait 8 weeks before attempting pregnancy. They suggest that men wait at least 6 months before attempting to conceive. [26]

Owing to high rates of microcephaly among infants born to women with Zika virus infection, South American governments (Brazil, Colombia, El Salvador) have advised women to avoid pregnancies until 2018.

A travel alert has been issued for pregnant women in any trimester to avoid or postpone travel to areas with ongoing Zika virus infection. [21] In March 2016, the CDC amended its prior recommendation that pregnant women postpone travel to Zika-affected countries, instead limiting the avoidance to elevations below 6500 feet (2000 meters), since A aegypti mosquitoes are unlikely to live above this elevation. [27]

Zika Virus Vaccine Development

Currently, no prophylactic treatment or vaccine is available for the prevention of Zika virus infection, although phase I human trials of the Zika Purified Inactivated Virus (ZPIV) vaccine have begun. [28]  

In an effort to combat the spread of Zika virus infection in the Americas, the White House recently released a statement requesting $1.8 billion in emergency funding to implement measures for vector control and vaccine development. [29] In preparing for the Olympic and Paralympic games being hosted by Rio de Janeiro, Brazil, in August 2016, the Brazilian Health Ministry has launched a “Zika Zero” campaign, which aims to raise public awareness for vector control and eradication of mosquito breeding grounds to protect local and international tourists and athletes from Zika virus infection.

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