Letter to the Editor
An Overview of Zika Virus Disease
The Neurohospitalist 2016, Vol. 6(3) 93-94 ª The Author(s) 2016 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1941874416637409 nhos.sagepub.com
Daniel M. Pastula, MD, MHS1, Daniel E. Smith, MD1, J. David Beckham, MD1, and Kenneth L. Tyler, MD1 Keywords Zika virus, arbovirus, arboviral disease, flavivirus, North America
Zika virus is one of many recently emerging arthropod-borne viruses, or arboviruses, capable of causing human disease in North America. First identified in the Zika Forest of Uganda in 1947, Zika virus is a mosquito-borne flavivirus belonging to the same viral genus as the West Nile and the dengue viruses.1 Only a handful of human Zika virus disease cases had been recognized until 2007, when an outbreak Zika virus disease was reported in Yap State in the Federated States of Micronesia.2 From 2013 to 2014, Zika virus spread to other islands in the Pacific Ocean, and in 2015 local transmission was first reported in Brazil.3 Since then, Zika virus has spread throughout the region, and as of February 2016, local transmission has been reported in parts of South America, Central America, Mexico, and the Caribbean.3 Continued spread is expected throughout neighboring regions where certain Aedes species of mosquitoes are present. As of February 2016, no local transmission of Zika virus has been reported in the continental United States, but there have been imported travel-associated cases of Zika virus disease over the last few years.3,4 Clinically, approximately only 20% of Zika virus infections are symptomatic, with common symptoms including fever, rash, joint pain, conjunctivitis, muscle pain, and/or headache.2,3 Fortunately, for most people, Zika virus disease is mild and usually resolves within 1 week. However, there have been concerning preliminary reports that Zika virus infection may be associated with increased cases of Guillain-Barre´ syndrome and microcephalic birth defects.5 Public health authorities in northeastern Brazil have reported a 20fold increase in the incidence of newborn microcephaly (from *5 to *100 per 100 000 live births per year) largely concurrent with Zika virus circulation in the area.5 Furthermore, there is a report that Zika virus was detected in brain tissue of newborns diagnosed with microcepahly who died shortly after birth.4,5 Out of an abundance of caution, the US Centers for Disease Control and Prevention (CDC) issued an interim travel notice on January 15, 2016, advising pregnant women to consider postponing travel to areas with documented local Zika virus transmission.3,4 Further research is needed to better understand any possible links between Zika virus infection, neurologic syndromes, and microcephalic birth defects.
Clinicians should consider the diagnosis of Zika virus disease in febrile patients with recent travel to areas where Zika virus is currently circulating. Suspected Zika virus disease cases should be reported to local and/or state health departments. Zika virus testing is currently done at the CDC Arbovirus Diagnostic Laboratory and some state public health laboratories.3 Unfortunately, treatment of Zika virus disease is only supportive at this time, and there is no commercially available vaccine. To prevent mosquito bites that may lead to Zika virus disease, people should wear long-sleeved shirts and pants while outside when feasible, apply insect repellant when going outdoors, and use window screens or air-conditioning to keep mosquitoes outside.3 Author’s Note This article has not been submitted for publication elsewhere. All authors have contributed substantively to the conception, design, or analysis and interpretation of the data; contributed substantively to the drafting of the manuscript or critical revision for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
References 1. U.S. Centers for Disease Control and Prevention. Arbovirus Catalog. Web site. https://wwwn.cdc.gov/Arbocat/Default.aspx. Accessed January 17, 2016. 2. Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009; 360(24):2536-2543. 3. U.S. Centers for Disease Control and Prevention. Zika Virus. Web site. http://www.cdc.gov/zika. Published online February 26, 2016. Accessed January 17, 2016.
1
Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado Denver, Aurora, CO, USA Corresponding Author: Daniel M. Pastula, Department of Neurology, University of Colorado Denver, 12401 East 17th Avenue, Mailstop L950, Room 486, Aurora, CO 80045, USA. Email: [email protected]
94 4. U.S. Centers for Disease Control and Prevention. Transcript for CDC Telebriefing: Zika Virus Travel Alert. Web site. http:// www.cdc.gov/media/releases/2016/t0116-zika-virus-travel. html. Published online January 16, 2016. Accessed January 17, 2016.
The Neurohospitalist 6(3) 5. Pan American Health Organization. Epidemiological Update: Neurological syndrome, Congenital Anomalies, and Zika Virus Infection. Web site. http://www.paho.org/hq/index.php?option¼ com_docman&task¼doc_view&Itemid¼270&gid¼32879&. Published and Accessed January 17, 2016.
An Overview of Zika Virus Disease
The Neurohospitalist 2016, Vol. 6(3) 93-94 ª The Author(s) 2016 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1941874416637409 nhos.sagepub.com
Daniel M. Pastula, MD, MHS1, Daniel E. Smith, MD1, J. David Beckham, MD1, and Kenneth L. Tyler, MD1 Keywords Zika virus, arbovirus, arboviral disease, flavivirus, North America
Zika virus is one of many recently emerging arthropod-borne viruses, or arboviruses, capable of causing human disease in North America. First identified in the Zika Forest of Uganda in 1947, Zika virus is a mosquito-borne flavivirus belonging to the same viral genus as the West Nile and the dengue viruses.1 Only a handful of human Zika virus disease cases had been recognized until 2007, when an outbreak Zika virus disease was reported in Yap State in the Federated States of Micronesia.2 From 2013 to 2014, Zika virus spread to other islands in the Pacific Ocean, and in 2015 local transmission was first reported in Brazil.3 Since then, Zika virus has spread throughout the region, and as of February 2016, local transmission has been reported in parts of South America, Central America, Mexico, and the Caribbean.3 Continued spread is expected throughout neighboring regions where certain Aedes species of mosquitoes are present. As of February 2016, no local transmission of Zika virus has been reported in the continental United States, but there have been imported travel-associated cases of Zika virus disease over the last few years.3,4 Clinically, approximately only 20% of Zika virus infections are symptomatic, with common symptoms including fever, rash, joint pain, conjunctivitis, muscle pain, and/or headache.2,3 Fortunately, for most people, Zika virus disease is mild and usually resolves within 1 week. However, there have been concerning preliminary reports that Zika virus infection may be associated with increased cases of Guillain-Barre´ syndrome and microcephalic birth defects.5 Public health authorities in northeastern Brazil have reported a 20fold increase in the incidence of newborn microcephaly (from *5 to *100 per 100 000 live births per year) largely concurrent with Zika virus circulation in the area.5 Furthermore, there is a report that Zika virus was detected in brain tissue of newborns diagnosed with microcepahly who died shortly after birth.4,5 Out of an abundance of caution, the US Centers for Disease Control and Prevention (CDC) issued an interim travel notice on January 15, 2016, advising pregnant women to consider postponing travel to areas with documented local Zika virus transmission.3,4 Further research is needed to better understand any possible links between Zika virus infection, neurologic syndromes, and microcephalic birth defects.
Clinicians should consider the diagnosis of Zika virus disease in febrile patients with recent travel to areas where Zika virus is currently circulating. Suspected Zika virus disease cases should be reported to local and/or state health departments. Zika virus testing is currently done at the CDC Arbovirus Diagnostic Laboratory and some state public health laboratories.3 Unfortunately, treatment of Zika virus disease is only supportive at this time, and there is no commercially available vaccine. To prevent mosquito bites that may lead to Zika virus disease, people should wear long-sleeved shirts and pants while outside when feasible, apply insect repellant when going outdoors, and use window screens or air-conditioning to keep mosquitoes outside.3 Author’s Note This article has not been submitted for publication elsewhere. All authors have contributed substantively to the conception, design, or analysis and interpretation of the data; contributed substantively to the drafting of the manuscript or critical revision for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
References 1. U.S. Centers for Disease Control and Prevention. Arbovirus Catalog. Web site. https://wwwn.cdc.gov/Arbocat/Default.aspx. Accessed January 17, 2016. 2. Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009; 360(24):2536-2543. 3. U.S. Centers for Disease Control and Prevention. Zika Virus. Web site. http://www.cdc.gov/zika. Published online February 26, 2016. Accessed January 17, 2016.
1
Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado Denver, Aurora, CO, USA Corresponding Author: Daniel M. Pastula, Department of Neurology, University of Colorado Denver, 12401 East 17th Avenue, Mailstop L950, Room 486, Aurora, CO 80045, USA. Email: [email protected]
94 4. U.S. Centers for Disease Control and Prevention. Transcript for CDC Telebriefing: Zika Virus Travel Alert. Web site. http:// www.cdc.gov/media/releases/2016/t0116-zika-virus-travel. html. Published online January 16, 2016. Accessed January 17, 2016.
The Neurohospitalist 6(3) 5. Pan American Health Organization. Epidemiological Update: Neurological syndrome, Congenital Anomalies, and Zika Virus Infection. Web site. http://www.paho.org/hq/index.php?option¼ com_docman&task¼doc_view&Itemid¼270&gid¼32879&. Published and Accessed January 17, 2016.
