ZIKA Fever (ZIKA Virus Infection) Clinical Management Protocol

BACKGROUND
Zika virus (ZIKV) is an emerging arbovirus that causes an acute febrile illness. The virus was first isolated in 1947 from a febrile rhesus monkey in the Zika forest of Uganda during a research project on the transmission of jungle yellow fever. The virus was first isolated in humans in 1952 in Uganda and Tanzania. ZIKV belongs to the Flavivirus genus, family Flaviviridae the same as Dengue, Yellow Fever, Japanese encephalitis and West Nile virus.

The virus is transmitted from human to human by the bites of infected mosquitoes. The mosquitoes involved are Aedes species, typically Aedes aegypti, Aedes albopictus and Aedes polynesiensis which also transmit other mosquito-borne viruses, including Dengue. There have been reports of non vector borne transmission of the virus through perinatal transmission and sexual intercourse. Blood transfusion has been identified as a potential route for transmission.

Outbreaks of Zika fever beyond Africa have been described, inclusive of Asia. However these infections had been limited to sporadic cases or small outbreaks until 2007 when the first major outbreak of ZIKV occurred in the island of Yap (Micronesia). ZIKV has spread widely since 2013, causing outbreaks in French Polynesia and other South Pacific islands. ZIKV infections have been reported in returning travelers from Thailand, Cambodia, Indonesia, Cook Islands and New Caledonia.

In 2014 Chile reported cases of autochthonous transmission of ZIKV in the Easter Island. In May 2015, Brazil confirmed autochthonous transmission of ZIKV. In October 2015, Colombia reported the first autochthonous case of ZIKV infection.

Since January 2016, Barbados, Bolivia, Brazil, Colombia, Curacao, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, US Virgin Islands and Venezuela have reported autochthonous transmission of ZIKV.

Brazil has reported an increase in Microcephaly and other congenital anomalies in neonates during the Zika virus outbreak, raising concerns about the effects of Zika virus infection in fetuses and its implications for delivery of health care.

Due to the wide distribution of the mosquito vector capable of transmitting ZIKV and the high mobility of persons in and outside the region of the Americas and worldwide, future transmission could occur in Jamaica.

It should be noted that the description of the clinical presentation of Zika virus is based on a limited number of case reports and outbreak investigations. The body of knowledge continues to grow and updates will be made accordingly.

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