Zika virus – All BMJ resources are freely available

On 1 February 2016 the World Health Organization declared an international public health emergency after Zika virus was linked to thousands of birth defects in Brazil.

This page is a collection of free resources from across BMJ and elsewhere. It aims to inform clinicians about the global threat posed by the virus, and will be continuously updated as new information comes to light. It includes content in Chinese, Spanish, and Brazilian Portugese.

Countries experiencing Zika virus outbreaks

Updated 15th July 2016

Data source (countries affected): http://ecdc.europa.eu/

Data source (observed mosquitos): http://datadryad.org/

American Samoa

Argentina

Aruba

Barbados

Belize

Bolivia

Bonaire

Brazil

Cape Verde

Colombia

Costa Rica

Curaçao

Dominica

Dominican Republic

Ecuador

El Salvador

Fiji

French Guiana

Guadeloupe

Guatemala

Haiti

Honduras

Jamaica

Martinique

Mexico

Micronesia

Nicaragua

Panama

Paraguay

Peru

Puerto Rico

Saint Lucia

Saint Martin

Saint Vincent and the Grenadines

Saint-Barthélemy

Samoa

Sint Maarten

Suriname

Thailand

Tonga

Trinidad and Tobago

US Virgin Islands

Venezuela

Sporadic transmission

Anguilla

Grenada

Guinea-Bissau

Indonesia

Philippines

Sint Eustatius

What's new from BMJ

  • Feature: Mosquitoes and Zika: time to harness genetic modification?
  • Research: Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly
  • Feature: Convicting Zika SEE ALSO Brazilian Portugese translation
  • Blog: Zika virus and neurological disease: is there evidence for causality?
  • Zika virus infection: evidence-based diagnosis and treatments of the virus (from BMJ Best Practice)
  • Zika virus: management of infection and risk SEE ALSO Brazilian Portugese translation AND linked BMJ Learning module
  • Clinical Review: Zika virus SEE ALSO Brazilian Portugese translation AND linked BMJ Learning module
  • Feature: Brazil struggles to cope with Zika epidemic SEE ALSO Brazilian Portugese translation
  • Visión general del virus del Zika/Zika virus topic in Spanish (from BMJ Best Practice)
  • 寨卡 (Zika) 病毒概述 Zika virus topic in Chinese (from BMJ Best Practice)
  • Chikungunya virus (from BMJ Best Practice)
  • Zika: A clinical guide

    See a quick overview of the key facts, including countries affected, and advice on prevention, diagnosis and management of patients returning from outbreak areas.

    Questions your patients may have about Zika virus

    I’m pregnant and have a holiday planned to Guadeloupe next month. Should I go?

    Public Health England and the National Travel Health Network and Centre advise that women who are pregnant (any trimester) or who plan to become pregnant should consider avoiding travel to any area where active transmission of Zika virus is being reported (box).2 They say that if you can’t avoid travelling to one of these countries you should take great care to avoid mosquito bites.

    What anti-mosquito measures should I use?

    The US Centers for Disease Control advises pregnant women to wear clothing that covers up as much of their body as possible (long sleeves, trousers, hat).3 It also advises travellers to use a good repellent on exposed skin during the day as well as at night and particularly during mid-morning and late afternoon to dusk, when the mosquito that transmits Zika is most active. Repellents that contain N, N-diethylmetatoluamide (DEET), picaridin, and IR3535 are all safe for pregnant women, provided that they follow the instructions, says the CDC.3 It says that if you need sunscreen you should apply repellent after sunscreen and should stay or sleep in a screened or air conditioned room or use a bed net.

    What are the symptoms of Zika virus infection?

    Most people infected with the Zika virus will not get symptoms, and if they do these are usually mild. Symptoms can include fever, rash, itching, joint pain, headache, muscle pain, eye pain, and conjunctivitis.2 There is no specific treatment, but you can take paracetamol for a fever and to ease any joint pain. However, if you’re pregnant avoid aspirin and other non-steroidal anti-inflammatory drugs.3 If you’re pregnant and think you have been infected with the Zika virus you can be tested.

    I’m a man and have just returned from a business trip to Mexico. My wife is pregnant. Is it safe to have sex?

    Most cases of Zika are acquired by mosquito bites, but the virus has been shown to be present in semen. The risk of sexual transmission of Zika is thought to be very low, but Public Health England advises men who have been in a country with Zika virus transmission to use a condom for 28 days.4 Men who have had an unexplained fever and rash that could have been caused by the Zika virus or have been told that they have Zika infection are advised to use a condom for six months.

    I’m pregnant and have recently returned from the Caribbean and I’m worried my baby could have microcephaly

    The Royal College of Obstetricians and Gynaecologists advises that women who’ve had no symptoms or whose symptoms have resolved should be referred for ultrasonography, which can be repeated every four weeks.5 Women with symptoms indicating Zika virus infection should have samples sent to the Rare and Imported Pathogens Laboratory (clotted blood, an EDTA “purple top” blood, and a small volume of urine without preservative). Women who test negative should be referred for ultrasonography, which can be repeated every four weeks. Women who test positive should be referred for ultrasonography and to fetal medicine for follow-up.

    Is it true that you can get the Zika virus by kissing someone?

    There have been reports of the Zika virus being detected in the urine and saliva of two patients in Brazil. But experts in the UK have emphasised that the Zika virus is spread by mosquitoes and that it is found mainly in the blood. This means that avoiding mosquito bites is the most important way of preventing infection with the Zika virus. Although some of the virus may find its way into other body fluids, such as urine and saliva, this will be in such small amounts that the chance of any of the virus finding its way into the bloodstream of another person is extremely low, said the experts.

    Does Zika virus infection cause Guillain-Barré syndrome (GBS)?

    On 1 March 2016 a study in The Lancet of patients who developed Guillain-Barré syndrome during an outbreak of Zika virus in French Polynesia provided the first compelling evidence of a causative link between the virus and the syndrome.
    The researchers said that Zika virus should be added to the list of infectious pathogens that can cause Guillain-Barré syndrome. They warned that countries in Latin America affected by the current Zika epidemic should be prepared for an increase in the incidence of Guillain-Barré syndrome and ensure that they have enough intensive care beds. Find out more at this link.

    Dúvidas que seus pacientes podem ter sobre o vírus da Zika

    Change pageEstou grávida e já tinha marcado para passar férias em Guadalupe no mês que vem. Devo manter os planos?

    Segundo orientações da Public Health England e da National Travel Health Network and Centre, gestantes (em qualquer trimestre) e mulheres que planejam engravidar devem evitar viagens para qualquer área onde existam relatos de transmissão ativa da Zika. E, se não for possível evitar a viagem para um desses países, é necessário tomar um cuidado maior para evitar picadas de mosquito.

    Como posso me proteger do mosquito?

    Os Centros de Controle e Prevenção de Doenças dos EUA orientam as gestantes a usarem roupas que cubram a maior parte possível do corpo (mangas longas, calça, chapéu). Outro conselho aos viajantes é usar um bom repelente na pele exposta tanto durante o dia quanto à noite – e especialmente no meio da manhã e do fim da tarde até o anoitecer, quando o mosquito que transmite a Zika está mais ativo. Segundo a agência, repelentes que contêm N, N-dimetil-meta-toluamida (DEET), picaridina e IR3535 são seguros para gestantes, desde que as instruções sejam seguidas. Além disso, se você precisar de proteção solar, aplique o repelente após o protetor. Permaneça ou durma em um quarto telado ou com ar condicionado ou, ainda, use um mosquiteiro.

    Quais são os sintomas da infecção pelo vírus da Zika?

    A maioria das pessoas infectadas com o vírus da Zika é assintomática. Quando os sintomas aparecem, eles costumam ser muito leves. Entre os sintomas estão febre, erupção cutânea, coceira, dor nas articulações (artralgia), dor de cabeça, dores musculares, dores nos olhos e conjuntivite. Não existe tratamento específico, mas você pode tomar paracetamol para febre e para aliviar a dor nas articulações. Gestantes devem evitar aspirina e outros anti-inflamatórios não esteroidais. Se você estiver grávida e achar que foi infectada pelo vírus da Zika, poderá fazer um teste.

    Sou homem e acabei de voltar de uma viagem de negócios ao México. Minha esposa está grávida. É seguro ter relações sexuais?

    A maioria dos casos de Zika é adquirida por picada de mosquito, mas já se observou presença do vírus no sêmen. Acredita-se que o risco de transmissão sexual da doença seja muito baixo, mas a Public Health England aconselha os homens que estiveram nos países onde a Zika está ativa a usar preservativos por 28 dias. Para homens que tiverem febre e erupção cutânea sem explicação (que poderiam ter sido causados pelo vírus da Zika) ou que tiverem recebido diagnóstico de vírus da Zika, a orientação é usar preservativo por seis meses.

    Estou grávida e acabei de voltar do Caribe. Estou com medo de o meu bebê ter microcefalia.

    O Royal College of Obstetrics and Gynaecology, do Reino Unido, orienta que mulheres que não tiveram sintomas ou cujos sintomas tenham sido resolvidos façam uma ultrassonografia, repetida a cada quatro semanas. As amostras coletadas de mulheres com sintomas que sugiram infecção por Zika devem ser enviadas ao laboratório de patógenos raros e importados (sangue coagulado, tubo [de tampa roxa] com EDTA e um pequeno volume de urina sem conservantes). Caso o resultado do teste seja negativo, as mulheres deverão ser encaminhadas para uma ultrassonografia, que pode ser repetida a cada quatro semanas. Caso o resultado do teste seja positivo, as mulheres deverão ser encaminhadas para uma ultrassonografia e para acompanhamento pela medicina fetal.

    É verdade que o vírus da Zika é transmissível pelo beijo?

    Houve relatos de detecção do vírus da Zika na urina e na saliva de dois pacientes no Brasil. Mas especialistas do Reino Unido enfatizaram que o vírus da Zika é transmitido por mosquitos e é encontrado principalmente no sangue. Isso significa que evitar picadas de mosquito é a principal forma de evitar infecção pelo vírus da Zika. Segundo os especialistas, embora alguns vírus possam ser transmitidos por outros fluidos corporais, como urina e saliva, a quantidade deles é tão pequena que a chance de algum vírus conseguir entrar na corrente sanguínea de outra pessoa é extremamente baixa.

    A infecção pelo vírus da Zika causa a síndrome de Guillain-Barré (SGB)?

    No dia 1º de março, um estudo no Lancet com pacientes que desenvolveram a síndrome de Guillain-Barré durante um surto de vírus da Zika na Polinésia Francesa apresentou a primeira evidência convincente de uma relação causal entre o vírus e a síndrome.
    Os pesquisadores afirmaram que o vírus da Zika devia ser adicionado à lista de patógenos infecciosos que causam a síndrome de Guillain-Barré. Eles alertaram que os países da América Latina afetados pela atual epidemia de Zika devem estar preparados para um aumento na incidência da síndrome de Guillain-Barré, garantindo leitos suficientes na unidade de tratamento intensivo. http://www.bmj.com/content/352/bmj.i1242

    Zika virus news timeline from The BMJ

    See also:

    Free publication for all Zika virus research in BMJ Journals

    BMJ wants to support the fast development of research around the Zika virus by enabling researchers to share their findings as quickly as possible. Until the end of July 2016, all of our specialty journals will waive the article processing charge on open access articles investigating the Zika virus. If you wish to submit a manuscript about the Zika virus, please quote ZIKA2016. For full information on our author submission policies, visit our How to submit your paper section.

    External links to resources in English

    External links to resources in Spanish/Enlaces externos a recursos en Español

    External links to resources in Portugese/Ligações externas para recursos em Português

    Zika virus articles from other medical journals

    About Zika virus

    Zika virus was first discovered in the Zika Forest, Uganda, in 1947, and until recently was largely confined to Africa and Asia.

    The first locally acquired case in the western hemisphere was reported on Easter Island in 2014. Since then it has spread rapidly, and locally acquired cases have now been reported in South America, Central America, the Caribbean, Mexico, and the US territory of Puerto Rico.

    The virus is spread by the bite of a mosquito that has acquired the virus, usually by feeding on an infected person.

    The US Centers for Disease Control and Prevention estimates that one in five people infected with the virus becomes ill. Symptoms include fever, rash, joint pain, and conjunctivitis, as well as myalgia, headache, and vomiting. There is currently no vaccine to prevent Zika infection and no specific medicine to treat it. Treatment is symptomatic.

    Symptoms

    The illness is usually mild, and symptoms last for only about a week. Severe disease is uncommon, and reports of death are rare. In October, however, Brazilian health officials reported an unusual increase in cases of newborns with microcephaly in northeastern Brazil, and by 30 November 2015 more than 1200 cases of microcephaly, including seven deaths, had been reported. This represents a 20-fold increase in microcephaly rates, from 5.7 in 100 000 live births in 2010 to 99.7 in 100 000 live births.

    In a number of these cases the virus was detected in blood and tissue samples from the newborn or in the amniotic fluid of pregnant women whose fetus had a diagnosis of microcephaly by ultrasound. Cases of neurological syndromes, including Guillain-Barré, have also been reported to be associated with Zika virus infection. The link between the infections and instances of microcephaly and neurological syndromes is currently under investigation.

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