Zika outbreak: What you need to know
By James Gallagher
Health editor, BBC News website
13 April 2016 Health
The World Health Organization has declared the
Zika virus a global public health emergency.
The infection is suspected of leading to
thousands of babies being born with
underdeveloped brains.
Some areas have declared a state of emergency,
doctors have described it as "a pandemic in
progress" and some are even advising women in
affected countries to delay getting pregnant.
But there is much we do not know in this
emerging infection.
What are the symptoms?
Deaths are rare and only one-in-five people
infected is thought to develop symptoms.
These include:
mild fever
conjunctivitis (red, sore eyes)
headache
joint pain
a rash
A rare nervous system disorder, Guillain-Barre
syndrome, that can cause temporary paralysis has
been linked to the infection.
There is no vaccine or drug treatment so patients
are advised to rest and drink plenty of fluids.
But the biggest concern is the impact it could
have on babies developing in the womb and the
surge in microcephaly.
Zika virus: Special report
What is microcephaly?
It is when a baby is born with an abnormally
small head, as their brain has not developed
properly.
The severity varies, but it can be deadly if the
brain is so underdeveloped that it cannot regulate
the functions vital to life.
Children that do survive face intellectual disability
and development delays.
It can be caused by infections such as rubella,
substance abuse during pregnancy or genetic
abnormalities.
Case study: 'It's not the end of the world'
Brazil had fewer than 150 cases of microcephaly
in the whole of 2014.
But more than 4,700 cases have been reported
since 22 October 2015, with 404 confirmed and
3,670 still being investigated.
The link with Zika has not been confirmed, but
the WHO says it is "strongly suspected".
Some babies who died had the virus in their brain
and it has been detected in placenta and amniotic
fluid too.
Why hasn't microcephaly been seen in other
countries?
Cases of microcephaly have been centred in
north-east Brazil, but the outbreak has affected
more than 20 countries.
So where are the other cases of microcephaly?
The outbreak started in Brazil before spreading
elsewhere, and the World Health Organization
says there will be a lag of several months to
know if pregnant women in these newly affected
countries are affected too.
There have been suggestions that Zika led to a
rise in birth defects after the 2013 outbreak in
French Polynesia.
The race to understand link to microcephaly
Is it safe to try for a baby?
The link to microcephaly is not certain, but some
governments have advised women to delay
getting pregnant until more is known.
Experts now believe the virus is linked to a
broader set of complications in pregnancy,
including miscarriage, stillbirth, premature birth
and eye problems.
The US Centres for Disease Control says Zika
lingers in the blood for about a week and can be
spread by sexual intercourse.
"The virus will not cause infections in a baby that
is conceived after the virus is cleared from the
blood," it says.
"There is currently no evidence that Zika-virus
infection poses a risk of birth defects in future
pregnancies."
Why is it a public health emergency?
The World Health Organization is worried that
Zika is spreading far and fast, with devastating
consequences.
Declaring Zika as a "public health emergency of
international concern" singles the disease out as
a serious global threat. It puts it in the same
category of importance as Ebola.
Unlike Ebola, where the focus was on boots on
the ground, with Zika the attention will be on
understanding the link with microcephaly.
The WHO will coordinate countries' health
agencies to conduct trials to determine the risk.
It will also encourage efforts to stop the mosquito
that spreads the disease as well as finding a
treatment or a vaccine to stop the virus.
The work will depend on money donated by
countries.
Where did Zika come from?
It was first identified in monkeys in Uganda in
1947.
The first human case was detected in Nigeria in
1954 and there have been further outbreaks in
Africa, South East Asia and the Pacific Islands.
Most were small and Zika has not previously
been considered a major threat to human health.
But in May 2015 it was reported in Brazil and has
spread rapidly.
It has since also been reported in: Barbados,
Bolivia, Colombia, the Dominican Republic,
Ecuador, El Salvador, French Guiana, Guatemala,
Guadeloupe, Guyana, Haiti, Honduras, Martinique,
Mexico, Panama, Paraguay, Puerto Rico, Saint
Martin, Suriname and Venezuela.
"Its current explosive pandemic re-emergence is,
therefore, truly remarkable," the US National
Institutes of Health said .
How does it spread?
It is spread by Aedes mosquitoes.
They are found throughout the Americas except
for Canada and Chile where it is too cold for
them to survive.
If they drink the blood of an infected person they
can then infect subsequent people they bite.
It is unclear for how long someone can transmit
the virus after being infected.
They are the same insects that spread dengue
and chikungunya virus.
And, unlike the mosquitoes that spread malaria,
they are mostly active during the day, so bed nets
offer limited protection.
The WHO expects Zika to spread throughout the
Americas , but other scientists have warned that
countries in Asia could face large outbreaks too.
Can it be spread through sex?
There have been reported cases of sexual
transmission with the virus spreading to people
who have not visited affected countries.
This seems to be a very rare event, but it means
Zika has a limited potential to spread in any
country - not just those with the Aedes mosquito.
Some countries advise men returning home from
affected countries to use condoms if their partner
is pregnant or might become pregnant.
This should be done for 28 days after coming
home if you have no symptoms, and for six
months if Zika symptoms do develop.
Zika virus has also been found in other bodily
fluids including saliva and urine, but it is unknown
whether the virus can spread through these
routes.
How long are people infectious?
The best evidence so far suggests that people can
spread the virus via mosquitoes for a week after
being infected.
In semen it may persist for two weeks.
Countries have advised safe sex and a ban on
blood donations for a month after just visiting
such countries and for longer if they developed
symptoms.
What can people do?
As there is no treatment, the only option is to
reduce the risk of being bitten.
Health officials advise people to:
use insect repellents
cover up with long-sleeved clothes
keep windows and doors closed
The mosquitoes lay their eggs in standing water,
so people are also being told to empty buckets
and flower pots.
The US Centers for Disease Control has advised
pregnant women not to travel to affected areas.
What is being done?
The Brazilian Health Minister, Marcelo Castro, has
said a new testing kit is being developed to
identify infections quickly.
He also said more money was being put into the
development of a vaccine.
Some scientists are also trialling the use of
genetically modified sterile mosquitoes that
appear to reduce mosquito populations by 90%.
Meanwhile, efforts are under way to kill the
mosquitoes with insecticide.
Zika vaccine
US experts from the National Institutes of Health
say trials of a Zika vaccine will likely start in
September this year. Depending on the results,
larger trials could begin at the start of 2017.
"The very, very best scenario" would be a vaccine
ready for the general public by the beginning of
2018, they say.
Are the Olympic Games under threat?
Rio de Janeiro is the host city for the 2016
Olympic Games from 5 to 21 August.
The Brazilian authorities will be targeting the
mosquitoes' breeding grounds in the run-up to
the Games.
The International Olympic Committee says it is in
"close contact" with the Rio organisers and that
Olympic venues will be inspected daily in the
lead-up to and during this summer's Games.
It will be to ensure puddles of stagnant water,
where mosquitoes breed, are removed to minimise
the risk of athletes and visitors coming into
contact with the insects.
There is also some hope there will be fewer
mosquitoes in August as the month is both cooler
and drier.


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