McAfee U.S. Army Health Clinic
The U.S. Centers for Disease Control and Prevention has confirmed the first case of Zika virus infection in a non-traveler in the continental United States. A Dallas county resident has become the first Zika patient to contract the virus in the U.S.
Dallas county health officials said the patient was infected through sexual contact, not through a mosquito bite.
The Zika virus is usually spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis. The illness is usually mild with symptoms lasting from several days to weeks. Severe disease requiring hospitalization is uncommon.
The Zika Virus is a mosquito-borne virus belonging to the Flavivirus genus. Other flaviviruses include those which cause yellow fever, dengue, St. Louis encephalitis, West Nile, and Japanese encephalitis. Zika was first detected in 1947 in the Zika Forest of Uganda and subsequently detected in Asia. The host for the virus is presumed to be a primate.
The first Zika virus infection in the Americas was an outbreak on Easter Island, Chile, in 2014. A second outbreak in Natal, Brazil, was identified in early 2015. Occurring in areas with dengue and chikungunya, this Zika virus outbreak has spread to at least 18 other countries in the Caribbean and South and Central America, to include Mexico.
In October 2015, Brazil reported a twentyfold increase in incidents of microcephaly, a birth defect leading to smaller than usual head size. The Brazil Ministry of Health, the Pan American Health Organization and the US Centers for Disease Control and Prevention are investigating possible associations between Zika virus infection and microcephaly.
As a result, the CDC has issued a level 2 travel alert (Practice Enhanced Precautions) for areas where Zika virus transmission is ongoing, recommending that pregnant women in any trimester should consider postponing travel to these areas which include the following: Americas: 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, U.S. Virgin Islands, Venezuela. Pacific Islands: Samoa. Africa: Cape Verde.
Approximately one in five persons infected with Zika virus will develop symptoms, which are similar to dengue and chikungunya and include fever, rash, body aches, and conjunctivitis. Neurologic complications, including Guillain-Barre Syndrome and meningoencephalitis, have been reported in French Polynesia. The illness is usually mild with symptoms lasting for several days to a week and death is rare.
Transmission is via the Aedes aegypti and Aedes albopictus mosquitoes, which also transmit dengue and chikungunya viruses. Both species of mosquitoes are found worldwide, including in the southern portions of CONUS. These mosquitoes primarily bite during the day and prefer manmade breeding sites, such as tires, buckets, and other containers. Transmission of Zika virus is also believed to occur via exchange of body fluids, such as sexual intercourse and blood and organ donation; however, more research is needed to confirm this.
Zika should be considered in patients with acute onset of fever, rash and body aches with recent travel to areas with known virus transmission, especially if dengue and chikungunya can be ruled out, as clinically the illnesses are similar. Diagnosis of Zika virus is by PCR and viral isolation in blood, urine, or saliva collected within five days of symptom onset. Cross reaction with other flaviviruses, especially dengue virus, has been widely reported. There is currently no commercial kit available for rapid testing. While several DoD laboratories can test for Zika virus, none are approved for diagnostic testing. Suspected cases of Zika virus can be confirmed by sending specimens to the CDC. Directions can be found at http://www.cdc.gov/ncezid/dvbd/specimensub/arboviral-shipping.html.
To reduce the risk of contracting Zika virus, personnel in affected areas should avoid mosquito bites. Use DEET or picaridin repellent on exposed skin, wear long-sleeved clothing and pants properly treated with permethrin. Stay in air-conditioned quarters with screened windows, and when feasible, reduce the amount of time spent outdoors when mosquitoes are most active. Eliminating standing water where mosquitoes can breed, such as old tires, buckets and other outdoor containers, is also important.
If you have recently been to any area within the travel alert and have concern of possible symptoms please make an appointment with McAfee Health Clinic. Local mosquitos on WSMR are capable of spreading the virus from an already infected person. A greater risk will be presented during summer which is peak mosquito season. Concerns about large concentrations of mosquito activity can be reported to McAfee Preventive Medicine at (575) 674-3520.
Additional information regarding Zika virus is available at http://www.cdc.gov/zika/, including a map identifying geographic distribution. Information on the dengue, chikungunya and Zika viruses circulating in the Americas is available at: https://www.ncmi.detrick.army.mil/document.php?id=115932. Information on vector control is available at: https://tiny.army.mil/r/DxEGI/. Additional information on mosquito control around the home is available at: https://tiny.army.mil/r/OUaT/homemosqcontrol and https://www.youtube.com/watch?v=1tYQCIc3yew.
Elizabeth, H., MAJ. (2016). Zika Virus Infections. APG, MD: Public Health Command.
Zika-affected Areas. (2016). http://www.cdc.gov/zika/geo/index.html
Symptoms, Diagnosis, & Treatment. (2016). http://www.cdc.gov/zika/symptoms/index.html