– FAQ

Due to recent cases of Zika virus in Brazil, especially in the Northeast regio n, we recommend travelers to read the fo llo wing info rmatio n provided by the Braz ilia n Ministry o f Health:

1. What is the Zika v irus fever? Answer: it is a self-limited vira l disease usually with benign evolution. The main symptoms are macular or papular rash, fever, arthralgia, non-purulent conjunctivitis/conjunctival hyperaemia, myalgia and headache. Less frequently, retro- orbital pain and gastro-intestina l signs are present.

2. What is the distribut ion of t his disease? Answer: Zika virus disease is caused by a virus from the Flavivirus genus, Flaviv iridae family, fro m the Spo ndweni gro up. It was first iso lated in 1947 from a mo nkey in the Zika forest, Uganda, then in mosquitoes ( africanus) in the same forest in 1948, and in a human in Nigeria in 1952. The Zika virus is endemic to the East and West of the African continent and sporadic circulat io n reco rd in Africa (Nigeria, Tanz ania, Egypt, Central Africa, Sierra Leone, Gabon, Senegal, Ivory Coast, Cameroon, Ethiopia, Kenya, Somalia and Burkina Faso), Asia (Malaysia, India, Pakistan, Philippines, Tha iland, Viet Nam, Cambo dia, India, Indonesia) and Oceania (Micronesia, French Polynesia, New Caledonia/France and Cook Is lands).

In the Americas, the Zika v irus was o nly ident ified o n Easter Is land, Chile’s territory in the Pacific Ocean, 3500 Km from the Mainland, at the beginning of 2014. Imported cases of Zika virus are described in Canada, Germany, Italy, Japan, United States and Australia.

3. How is it transmitted? Answer: the main route of transmission is through the vector sting and after an incubation period (time between the mosquito bite and the onset of symptoms) of about appro ximately 4 days, the patient can init iate the first signs and symptoms.

Attention: the o nly way to avo id infectio n is to prevent mosquito bites by using repellents and wearing appro priate clo thing. There is no medicine o r vaccine available that prevents Zika virus infectio n.

Due to the possible link between Zika virus infection and birth defects, pregnant women are urged to be particularly vigilant in preventing mosquito bites.

4. What are the main signs and symptoms? Answer: Zika virus fever is a litt le known disease and its descriptio n is gro unded in a limited number o f case reports and outbreak investigations. Based on these publicatio ns, signs and symptoms include maculopapular rash and acute onset (rash with white or red dots) and can be accompanied by fever, not purulent conjunctival hyperemia and no rash, arthralgia or arthritis, myalgia, headache and backache. Less frequently, there are reports also of edema, sore throat, cough and vomiting. Acco rding to the publicatio ns, o nly 18% o f peo ple infected present clinical manifestations of the disease.

5. What is the prognosis? Answer: according to the reports available, there is no record of deaths for this disease. The disease is considered benign and self-lim ited, with the signs and symptoms lasting generally from 2 to 7 days. But the disease may have serious consequences to new- borns – see item 3 above.

6. Are there any treatments or vaccine aga inst the Zika virus? Answer: treatment is symptomatic and is based on the use of acetaminophen (paracetamol) for fever and pain, as medical advice.

The use of aspirin and anti-inflammato ry drugs are not recommended due to increased risk o f bleeding co mplicat io ns. If symptoms are present, visit a health service facility for proper orientation. There is no vaccine against the Zika virus.

7. What are the measures of preventions and control? Answer: the measures of prevention and control are similar to those of dengue and . There are no specific control measures, since there is no vaccine or antiv ira l drugs. Integrated vector management program aiming to reduce mosquito vecto r density in a sustainable manner is o f primary impo rtance. Intersecto ral collaboration and efficient public communication strategy to ensure community partic ipatio n are required fo r sustainable vecto r co ntro l pro gram. Activities suppo rting the reduction of mosquito breeding sites in outdoor/indoor areas by draining or discarding sources of standing water.

Clothes that minimize skin exposure during the day, when mosquitoes are most active, provides some protection to mosquito bites, especially during outbreaks. Repellents should be applied on exposed skin or on clothes.

Sources: http://portalsaude.saude.gov .br/images/pdf/2015/maio/14/PERGUNTAS-E-RESPOSTAS-zika.pdf http://ecdc.europa.eu/en/healthtopics/zika_v irus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx