Journal of Tropical Pediatrics, 2016, 62, 12

doi: 10.1093/tropej/fmw006
Editorial

EDITORIAL

Zika Virus
Chikungunya infections, though conjunctivitis appears to be more of a feature of Zika infection and
lasts 56 days, and there is more of a rash, leading, at
times, to screening to exclude measles. There is no
specific vaccine or medication, and treatment is
largely symptomatic. To date, there is no evidence
that the virus causes death, except in patients with
pre-existing conditions. Nonetheless, the arrival of
new viruses from other regions of the world does
complicate clinical care. Until recently, clinical staff
in health centres would make a clinical diagnosis of
Dengue in a patient with high fever and malaise, but
now, there are three arbovirus diseases presenting
with similar clinical pictures.
The Pan-American Health Organization and the
World Health Organization are not recommending
any travel restrictions because of Zika virus outbreaks. Action is focussed on reducing mosquito
populations and avoiding bites, which occur mainly
during the day.
There has recently been an increase in congenital
anomalies, particularly microcephaly, and Guillan
Barre syndrome and other neurological and autoimmune conditions in areas known to have Zika virus,
including documented increases in GuillanBarre
syndrome in Bahia state, Brazil and El Salvador. The
epidemiology is more striking in relation to microcephaly; between 2010 and 2014, the whole of Brazil
reported an average of 163 children with microcephaly, whereas in 2015, there were 3530 cases reported
from 20 states and the federal district, with a particular clustering in Pernambuco state, northeast Brazil
[3]. Clearly, association does not prove causation,

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Zika virus has been in the news in recent weeks following a cluster of children born with microcephaly in
Brazil, but what are the facts about this infection [1, 2]?
Zika virus was first identified in 1947 in the Zika
forest of Uganda and remained largely an African infection, with occasional outbreaks in Asia for the
next 60 years. Then in 2007, there was a major epidemic on the island of Yap in Micronesia, with almost three quarters of the population infected. Chile
reported indigenous transmission on Easter Island in
2014, and then in May 2015, the public health
authorities in Brazil confirmed the transmission of
Zika virus in the northeastern part of the country. By
January 2016, Barbados, Bolivia, Brazil, Colombia,
Dominican Republic, Ecuador, El Salvador, French
Guiana, Guadeloupe, Guatemala, Guyana, Haiti,
Honduras, Martinique, Mexico, Panama, Paraguay,
Puerto Rico, Saint Martin, Suriname and Venezuela
had all confirmed cases of Zika virus transmission, so
the virus has spread across central America, the
Caribbean and much of the northern half of south
America.
Dengue has been in the Americas for 35 years,
and Chikungunya was identified in 2013. Zika virus
is also a flavivirus. Like Dengue and Chikungunya,
Zika virus is transmitted by the Aedes aegypti mosquito and is thought to cause no symptoms at all in
75% of infections. When an infected person is symptomatic, the features are usually a mild fever,
a maculopapular rash, headache, arthralgia, myalgia,
asthenia and non-purulent conjunctivitis beginning
27 days after the bite of an infected mosquito.
These symptoms are similar to Dengue and

Editorial

D. Simkiss
University of Warwick

REFERENCES
1. Pan American Health Organisation/World Health
Organisation. Zika Virus Infection. www.who.int/media
centre/factsheets/zika/en/ (24 January 2016, date last
accessed).
2. Centers for Disease Control and Prevention, Zika Virus.
www.cdc.gov/zika/index.html. (24 January 2016, date last
accessed).
3. Pan American Health Organisation/World Health
Organisation. Epidemiological Update: Neurological
Syndrome, Congenital Anomalies and Zika Virus Infection.
Washington, DC: PAHO/WHO, 2016.

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and the Pan-American Health Association and

World Health Organization are recommending improved surveillance to investigate the association
further.
It is 500 years since the arrival of a number of diseases with sailors from Europe wreaked havoc in
central and south America. Globalization continues
to accelerate and brings many advantages, but the
introduction of new infections to nave communities
is a considerable concern. The human cost of Zika
virus has yet to emerge.