Zika

Background

Zika virus (ZIKV) is a flavivirus that results in either asymptomatic infection or mild disease. It was first identified in Uganda in 1947 and sporadic cases of disease were reported in Africa and Asia. It is transmitted by mosquitoes of the genus Aedes. Sexual transmission of ZIKV is rare but has been documented.

In 2007 ZIKV was recorded outside Africa and Asia for the first time: an outbreak occurred on Yap Island in the Federated States of Micronesia. It was during a subsequent outbreak in 2013-14 in French Polynesia that the first cases of possible perinatal transmission and Gullain-Barré syndrome were reported. In 2014 and 2015, further outbreaks in the Pacific Islands occurred.

In 2015 to 2016, ZIKV spread throughout South and Central America, the Caribbean and parts of North America. Due to an increase in microcephaly and developmental defects in newborn children being noted in the outbreak a Public Health Emergency of International Concern (PHEIC) was declared by the World Health Organisation (WHO) between February and November 2016. The PHEIC has now been replaced by the WHO's longer term Zika Strategic Response Plan.

Since 2016, ZIKV infection in pregnancy has been established as the cause of Congenital Zika syndrome which may have severe and fatal consequences for the fetus.

Guidance

Published 29 January 2016
Previous update 27 February 2019
Last updated 5 August 2019

Risk assessment

The risk to Scotland is considered very low due to the absence of the Aedes mosquito and the low risk of sexual transmission associated with imported cases.

For travellers to affected countries there is a low risk of infection which may result in mild symptoms in the majority of cases.

For pregnant travellers or women who may become pregnant during or soon after travel, the risk of infection is considered higher due to Congenital Zika Syndrome.

There is a low risk of sexual transmission of ZIKV.

Our recommendations for travellers to countries where ZIKV is circulating

Travellers should seek travel advice from a healthcare provider at least six to eight weeks in advance of travel, this is particularly important if pregnant or planning pregnancy.

Advice for the travelling public can be found on our fitfortravel website.

Specific advice on Zika virus prevention and management and county-by country advice for health professionals advising travellers can be found on our TRAVAX website.

Travellers who develop illness during travel should seek medical attention at their destination.

Those diagnosed with ZIKV when travelling

Pregnant women who are diagnosed with ZIKV should seek early obstetric review on return. They should use condoms during travel and for eight weeks afterwards to reduce the risk of sexual transmission.

All other individuals should follow contraception advice and ways of preventing onward sexual transmission as we've detailed on the fitfortravel and TRAVAX websites.

Diagnosis and reporting

Clinicians are advised to consider the possibility of ZIKV in patients presenting with a febrile illness on return from countries with a risk of ZIKV or whose sexual partner has returned from these countries, in the last two months if it's a female partner or three months if it's a male partner. This is particularly important for women of childbearing age who are, or may be pregnant. The risk of ZIKV is detailed on the individual country pages of TRAVAX.

Any requests for testing have to be directed to PHE's Rare and imported pathogens laboratory (RIPL).

Sample testing advice can be found on the PHE website. Testing should only be undertaken in those with current or a history of, symptoms. Clinicians ordering tests for patients with a relevant travel history should be explicit in requesting ZIKV testing and should indicate the country and region of travel on the RIPL request form P1 and whether pregnant, partner pregnant and gestation. Clinicians should send samples to the local laboratory who will carry out appropriate procedures and forward samples.

Clinicians should liaise with obstetric colleagues to raise awareness and ensure appropriate investigations and counselling are in place for pregnant patients with a relevant travel history. Negative serology taken four weeks after the last possible exposure to ZIKV, excludes infection. Negative antibody results indicate they do not require extra fetal ultrasound follow-up, unless there are additional concerns. This is arranged through obstetric services.

If help is required with the risk assessment and diagnosis of ZIKV in an individual in Scotland advice should be sought from the local infectious disease consultant.

Reporting of ZIKV in Scotland is through our organisation. For the rest of the UK this is directly through PHE.

Public health implications

Until further evidence is available, a precautionary approach to the risk posed by ZIKV, in particular during pregnancy, is being adopted by public health authorities worldwide.

ZIKV has been detected in semen some months after symptoms of ZIKV, and for some weeks in the female genital tract. A small, but growing number, of sexually transmitted cases of ZIKV infection have been reported worldwide.

The International Health Regulations Emergency Committee on ZIKV has advised that standard WHO recommendations should be implemented in order to control Aedes sp mosquitoes in flights from affected countries.

Further advice for clinicians

Updates on countries

An updated list of countries with risk of ZIKV transmission is available on the PHE website.

Country-by-country advice for health professionals advising travellers can be found on our TRAVAX website.

Clinical pre-travel and post-travel scenario based frequently asked questions are also on our TRAVAX website.


Pregnancy

Read the guidance for healthcare professionals on Zika virus infection in pregnancy, developed by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM), PHE and ourselves:


Other guidelines and publications

Read other guidelines and publications on Zika, below:

  • Zika virus information including rapid risk assessments on the European Centre for Disease Prevention and Control (ECDC) website.
  • Zika virus weekly situation reports, February 2016 to March 2017 on the WHO website.
  • Zika Open is a platform for the fast-track publication of new research on ZIKV and can also be found on the WHO website.
  • Alongside PHE, we've produced a leaflet on mosquito bite avoidance for travellers, updated in August 2017.
  • PHE algorithm and interim guidance for neonatologists and paediatricians for management of confirmed and potentially infected infants born to parents who travelled to areas with active Zika virus transmission, updated in February 2019, is also available on the PHE website.
  • PHE, the Royal College of Nursing (RCN), the RCM and the RCOG have published a leaflet on health advice for pregnant women returning from areas with active Zika virus transmission, updated in February 2019, and available on the PHE website.