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Zika Virus; An emerging threat to human health with international concerns

Leila Molaeipoor1,2, Ehsan Mostafavi1,2*

1-Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran. Iran. 2-Research Center for Emerging and Re-emerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran *Corresponding author: [email protected] (Received 23 April 2016; Accepted 30 August 2016))

Summary

Among the emerging infectious diseases, arboviruses have rung more the public health alarms. Human cases of were reported since 1952. As of June 2016, 60 countries have reported Zika virus. Zika virus-carrying mosquitoes are reported around the world and the transmission of the virus by travelers from endemic areas and the possibility of sexual transmission of the virus have added the concerns of the spread of the diseases. The main concern for Zika virus disease is probable microcephaly disease in infants and WHO declared a public health emergency of international concern for this disease. In Iran, as a result of not reporting of Aedes aegypti and Aedes albopictus, Zika virus transmission is not a big concern; however because of being in neighbor of Pakistan, with high reports of potential Zika virus vectors, possible transmission of the virus by travelers from endemic areas and the possibility of sexual transmission of the virus, continuing monitoring and vector control programs is needed.

Keywords: Zika Virus, Arbovirus, Emerging and Reemerging, Outbreak

Introduction Although more than one century has Chang, 2007). Zika virus was first isolated passed from the discovery of effective during the monitoring of yellow fever in actions to prevent and control of infectious in 1947. Human cases of Zika virus diseases, these diseases still represent were reported since 1952. Sporadic Cases of serious threats to the public health. disease in tropical regions of Africa and Outbreaks of emerging infectious diseases Asia (including India, Malaysia, Indonesia, have risen new challenges for human health. and Pakistan) were reported during 1969- Among the emerging infectious diseases, 1983 (Kindhausera et al., 2016). The global expansion of -Borne outbreak of Zika virus was reported in the viruses (Arboviruses) has rung more the remote island of the Federated States of public health alarms (Shapshak et al., 2015). Micronesia YAP in 2007 (world Health Zika virus is an enveloped, positive Organization, 2016b). With 28,000 cases, sense single-stranded RNA virus of the the largest outbreak of Zika fever occurred family Flaviviridae and the genus flavirirus in French Polynesia in 2013 and 2014. Since with 10794 kb total length of genus and two after, other outbreaks had been reported in flanking noncoding regions (Kuno and three other islands of the Pacific islands

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Molaeipoor and Mostafavi. 66 including Easter Island (Chile), Cook against possible outbreaks of Zika virus Islands, and New Caledonia. Since 2005, (Gulland, 2016). there have been reports on the circulating Although such as Dengue Fever and virus from different parts of the world, Chikungunya, Aedes aegypti and Aedes particularly from Africa, Southeast Asia, albopictus are known as Zika virus primary Oceania, and South America. As of 9 June vectors (Wong et al., 2013), recent studies 2016, 60 countries have reported Zika virus have shown that a wide range of of which 46 countries are experiencing a may be the potential vectors of Zika first outbreak of the diseases since 2015, virus. In the new reports, Zika virus has also with no previous evidence of circulation. been isolated from perfuscus and Fourteen countries reported evidence of Zika Anopheles coustani that are widely spread in virus transmission durin 2007-2014, with tropical regions of the world and may act as ongoing transmission (World Health Zika virus mechanical vectors (Marcondes Organization, 2016a; Kindhausera et al., and Ximenes, 2015). Although the detection 2016) (Table 1). of the virus in theses mosquitoes doesn’t Zika virus-carrying mosquitoes are proof the transmission of the virus; however, reported around the world and the these studies represents our unknowns about transmission of the virus by travellers from the virus and its transmission modes. endemic areas and the possibility of sexual In its urban cycle, Zika virus is served transmission of the virus has added the by human, as the role amplifying host, and concerns of the spread of the diseases Aedes mosquitoes, as the vector (Musso et (Hotez, 2016b). Evidences of the presence al., 2015). The disease is often associated of the Aedes mosquito vectors in the with either no symptoms or mild clinical countries of southern Europe with a history symptoms including fever, skin rash, of reemerging of arthropod-borne diseases, conjunctivitis, muscle pain, joint pain, and other factors accelerating spreading of weakness, and headache, lasting for 2 to 7 the virus, including the climate changes and days (Nhan and Musso, 2015). Severe recent economic downturn in Europe, made symptoms or deaths are reported in rare it more expectable to have reports of Zika cases. The scientists have reported fever outbreaks in european countries such correlation between the occurrence of as such as Portugal, Spain, southern France clinically severe signs, including progressive and Italy in the near future (Hotez, 2016a). neurological disorder and autoimmune Concerns are also considered on the diseases such as Guillain-Barré syndrome upcoming mass gatherings in Summer and Zika virus outbreaks in France and Olympics in Brazil, where the disease is Brazil in 2013 and 2015, respectively endemic (Coombes, 2016), and the Umrah (Lucey and Gostin, 2016). The main concern and Haji pilgrimages in Saudi Arabia, where for Zika virus disease is probable local mosquito populations signify the microcephaly disease in infants which is potential for the outbreaks (Hotez, 2016b; observed in northern Brazil (world Health Bhatt et al., 2013). Organization, 2016b). WHO declared a Based on the reports, the disease is Public Health Emergency of International extending into new countries and regions of Concern over the Zika virus after an increase the world (Fauci and Morens, 2016, Lucey in cases of microcephaly and Guillain-Barré and Gostin, 2016). The World Health syndrome in the Americas. Organization (WHO) has asked dengue Infected patients by Zika virus may not fever endemic countries to be more prepared need any special treatment. Indeed, adequate

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Molaeipoor and Mostafavi. 67 rest, increased fluid intake, and symptomatic disease epidemiological information treatment with conventional drugs are identifing hot spot regions, pay more common ways to treat this disease. An attention to pregnant women travelling to effective vaccine for the disease is not yet the endemic countries, make physicians and reported. Preventive controls are similar to public communities aware of the associated other preventive measures against risks with sexual transmission of the disease, Arboviruses including avoidance of the early response to the potential outbreaks, mosquito bite and vector control (Nhan and and strengthen the prevention and control Musso, 2015). strategies in parallel with other Arboviruses According to similar clinical signs to species (Nhan and Musso, 2015). other Arboviruses and lack of adequate Table 1. Countries with reports of Zika laboratories to detect the virus in many parts virus, 1947–April 2016 (World Health of the world, the incidence of the disease are Organization, 2016a). believed to be underestimated; however, the disease has high potential to spread across Year Country tropical and subtropical regions of the 1947-52 Uganda, United republic of world, according to the distribution of the Tanzania potential vectors (Nhan and Musso, 2015). 1954 1960-1983 , , In Iran, monitoring programs and vector Pakistan, , Cate control of Aedes mosquito has started years D'ivorie, , , ago to investigate the possible vectors of , Indonesia, Malaysia, dengue fever especially in eastern regions of Nigeria, Casta Rica. the country. In spite of the establishment of 2007-2009 YAP (Micronesia Federal States of Gabon). the monitoring and controlling programs for 2012-2014 French Polynesia, Chile, Cook vectors, and due to the lack of reports Islands, New Caledonia, Malaysia, regarding Aedes aegypti and Aedes Philippines, Cambodia, Indonesia, albopictus, Zika virus transmission is not a Thailand big concern in Iran. However, due to many Feb 2015 Brazil, Salomon Islands Apr 2015 Vanuatu report about the presence of potential Zika Jul 2015 Samoa, Fiji virus vectors in neighborhood countries such Oct 2015 Colombia, Cabo Verdi as Pakistan (Khan et al., 2015), continuing Nov 2015 Samoa, Solomon, El Salvador, monitoring and vector control programs are Guatemala, Mexico, Paraguay, needed especially in eastern regions of the Suriname, Venezuela Dec 2015 French Guiana, Honduras, country. Passengers who travel to endemic Martingue, Panama, Puerto Rico areas of Zika virus must be educated about Jan 2016 Bolivia, United States Virgin, the potential risks of Zika virus and Islands, Dominican Republic, Casta appropriate measures to reduce the Rica, Guadeloupe, Saint Martin, possibility of exposure to mosquito bites and Nicaragua, Barbados, Maldives, Ecuador, Guyana, Jamaica, risk of the disease. Fortunately, the Curacao, Samoa, Haiti, Tango laboratory diagnosis of Zika virus is Feb 2016 Peru, Marshall Islands, Saint established in Pasteur Institute of Iran as a Vincent and The Grenadines, Sint part of the surveillance system of the Maarten, Trinidad and Tobago, disease. Aruba, BONAIRE March –April Saint Barthelemy, Micronesia, To prevent possible threats of Zika fever 2016 Vietnam, Belize, Saint Lucia, outbreaks, consistent actions are very Cuba, Philippines essential to detect the patients, update the

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