20 May 2015

Zika virus outbreak: Brazil

Cases have been confirmed in Rio Grande do Norte and Bahia states

As of 15 May 2015, the Ministry of Health, Brazil confirmed Zika virus (ZIKV) to be circulating in the country. Cases have been confirmed in Rio Grande do Norte and Bahia states. Enhanced surveillance and public health measures are underway [1].

In February 2014, one case of locally acquired ZIKV infection was reported in Easter Island (Chile) [2]. Previous large outbreaks have occurred in French Polynesia (2013) and New Caledonia and the Cook Islands (2014). On 7 May 2015, the Pan American Health Organization issued an alert recommending that member states, vulnerable to the introduction of ZIKV, establish and maintain appropriate measures for surveillance, control and clinical management of ZIKV infection [3].

ZIKV infection is an emerging disease in regions outside Africa and Asia [4]. Symptoms of ZIKV infection include fever, headache, a maculo-papular rash, conjunctivitis and pain in the smaller joints of the hands and feet. The illness is usually mild and short lived [5].

Advice for travellers

There are no vaccines to protect against ZIKV, which is transmitted by the Aedes mosquito.

This mosquito also transmits dengue which is endemic (regularly found) in Brazil and yellow fever (endemic in some states of Brazil) as well as chikungunya, which has recently been introduced. Aedes mosquitoes bite in the day, particularly around dawn and dusk. You should take insect bite avoidance measures to reduce the risk of infection with ZIKV and other mosquito borne diseases.

Advice for health professionals

Health professionals should include ZIKV among the differential diagnoses of dengue, yellow fever, West Nile virus and chikungunya in febrile travellers who have recently visited Brazil. If a case is suspected, appropriate samples for testing (together with a full travel and clinical history with relevant dates) should be sent as early as possible to the Public Health England, Rare and Imported Pathogens Laboratory.

The Imported Fever Service: Public Health England is available to local infectious disease physicians or microbiologists should specialist advice be needed on 0844 7788990.

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