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Tropical Journal of Applied Natural Sciences

Trop. J. Appl. Nat. Sci., 2(1): 1-5 (2017)
ISSN: 2449-2043
https://doi.org/10.25240/TJANS.2017.2.1.01

Zika Virus Disease: A Review

Ezekwueche, S.N.1 , Umedum, C.U.1, Anukwonke, C.2
1Department of Microbiology, Chukwuemeka Odumegwu Ojukwu University, Anambra State, Nigeria
2Department of Environmental Sciences, Chukwuemeka Odumegwu Ojukwu University, Anambra State, Nigeria

*Corresponding author’s email: ezekwuechestephen@gmail.com

ABSTRACT
Zika virus disease is the focus of an ongoing pandemic and public health emergency. Review Article
Zika virus disease is a mosquito borne flavivirus that is caused by Zika virus. Aedes
species of mosquitoes such as Aedes aegypti and Aedes albopictus, are considered as Received: 9th Aug., 2017.
Accepted: 4th Oct., 2017.
the main vectors. The incubation period of Zika virus is 3-14 days. The disease was
Published: 23rd Oct., 2017.
previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus
in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika
Keywords:
virus infections are characterized by subclinical or mild influenza-like illness, severe Zika virus;
manifestations have been described, including fever, headache, muscle pain, joint Epidemiology;
pain, maculopapular rashes, conjunctivitis, Guillain-Barre syndrome in adults and Clinical manifestation;
microcephaly in babies born to infected mothers. Neither an effective treatment nor a Diagnosis;
vaccine is available for Zika virus; therefore, the Public Health response primarily Prevention.
focused on preventing infection, particularly in pregnant women.

INTRODUCTION Zika virus is named after the Ugandan forest where it was
first isolated from a rhesus monkey in 1947. The first

Z ika virus disease is an acute infectious disease
caused by the Zika virus (ZIKV), belonging to
family Flaviviridae, genus Flavivirus, which are
also the aetiological factors of dengue, yellow fever,
Japanese encephalitis, and West Nile fever. Zika virus is a
positive-sense single-stranded RNA virus. Zika virus is
transmitted by day-time active female Aedes mosquitoes
(mainly Aedes aegypti and Aedes albopictus), vectors of
dengue, chikungunya, yellow fever, Japanese encephalitis,
and West Nile fever (Sikka et al., 2016). The true extent of
Zika virus vectors is still unknown. The distribution of
Aedes mosquitos is now the most extensive ever recorded
due to global trade and travel. It is reported in Sub-Saharan
Africa, South and South-East Asia, North Australia,
Oceania, South and Central America, southern states of the
United States, and also in southern Europe (A. aegypti in
Georgia, southern Russia, Madeira; A. albopictus in Italy,
France, Spain, Greece, Croatia, Montenegro, Albania,
Bulgaria, southern Russia) (Kraemer et al., 2015). Zika
virus is not endemic in Poland because Aedes mosquitoes
transmitting the virus are not present in the territory of
Poland; however, there is a potential risk of importing the
disease from Zika endemic areas, e.g. South and Central
America because of a growing popularity of
transcontinental travel among Polish people (Korzeniewski
et al., 2016). The incubation period of Zika virus is 3-14
days (Krow-Lucal et al., 2017).
human cases were detected in 1952 in Uganda and
Tanzania (Plourde and Bloch, 20116).
Zika virus is primarily spread by the female Aedes aegypti
mosquito, which is active mostly in the daytime (Abushouk
et al., 2016; Ayres, 2016). The mosquitos must feed on
blood in order to lay eggs (Abushouk et al., 2016) see
Figure 1. The virus has also been isolated from a number
of arboreal mosquito species in the Aedes genus, such as A.
africanus, A. apicoargenteus, A. furcifer, A. hensilli, A.
luteocephalus and A. vittatus, with an extrinsic incubation
period in mosquitoes of about 3-14 days (Krow-Lucal et
al., 2017).
2. MODE OF TRANSMISSION
There are four ways by which Zika virus can be transmitted
namely; Transmission through the bite of an infected Aedes
species of mosquitoes such as Aedes aegypti and Aedes
albopictus (San-Juan, 2012); Vertical transmission (that is,
through the mother to the child) (Gatherer and Kohl, 2015);
Transmission through sexual contact (Oster et al., 2016);
Transmission through blood transfusion (Musso et al.,
2014).
The main transmission route of the Zika virus is via
mosquitoes of the genus, Aedes, the same vector that

1

transmits dengue or Chikungunya virus. The virus is
transmitted from human to human, by the bites of infected
female mosquitoes such as Aedes aegypti and Aedes
albopictus (San-Juan, 2012). During the first week of
infection, Zika virus can be found in the blood and passed
from an infected person to another mosquito through
mosquito bites. An infected mosquito can then spread the
virus to other people. Infected humans are the main carriers
and multipliers of the virus and serving as a source of the
virus for uninfected mosquitoes. The virus circulates in the
blood of infected human for several days at approximately
the same time that they have Zika fever. Aedes mosquitoes
may acquire the virus when they feed on an individual
during this period (San-Juan, 2012).
A mother already infected with Zika virus near the time of
delivery can pass on the virus to her newborn around the
time of birth, but this is rare. It is possible that Zika virus
could be passed from mother to the fetus during pregnancy
(Gatherer and Kohl, 2015). In 2015, Zika virus RNA was
detected in the amniotic fluid of two pregnant women
where the fetuses have microcephaly, indicating that the
virus had crossed the placenta and could have caused a
mother to child infection (Schuler-Faccini et al., 2016). As
at February 2016, the link between the Zika virus and
microcephaly was strongly suspected, but not yet
scientifically proven according to WHO (Oliveira et al.,
2016).
As of February, 2016, three reported cases indicate that
Zika virus could possibly be sexually transmitted. There
was a report of a US biologist who had been bitten many
times while studying mosquitoes in Senegal. Six days after
returning home in August 2008, he fell ill with symptoms
of Zika virus but before having unprotected intercourse
with his wife who had not been outside the US since 2008.
She subsequently developed symptoms of Zika virus, and
Zika antibodies in both the biologist and the wife’s blood
confirmed the diagnosis (Foy et al., 2011; Oster et al.,
2016). In the second case in early February 2016, the Dalles
Country Health and Human Service Department reported
that a person contracted Zika fever after sexual contact with
an ill person who had recently returned from a high risk
country. This case is still under investigation (Oster et al.,
2016).
A potential risk is suspected based on a study conducted
between November, 2013 and February, 2014 during the
Zika virus outbreak in French Polynesia in which blood
donors tested positive for Zika virus RNA and were
asymptomatic at the time of blood donation. Eleven of
these positive donors reported symptoms of Zika fever after
their donation, and only three of thirty-four samples grew
in culture (Musso et al., 2014). Since January, 2014,
nucleic acid testing of blood donors was implemented in
French Polynesia to prevent unintended transfusion (Musso
et al., 2014).
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https://doi.org/10.25240/TJANS.2017.2.1.01
3. EPIDEMIOLOGY
Zika virus was first isolated from a rhesus monkey in the
Zika forest in Uganda in 1947 (Plourde and Bloch, 20116).
In 1948, Zika virus was isolated from Aedes mosquito,
which was considered to be a vector for Zika transmission
(Altman, 2007). Over the next decades, the Zika virus was
isolated from other mosquitos of the Aedes genus: A.
aegypti, A. apicoargenteus, A. luteocephalus, A. vitattus, A.
furcifer, A. albopictus (Duffy et al., 2009). Until 2007, only
14 cases of the disease were confirmed worldwide (Duffy
et al., 2009). The first outbreak of the Zika fever occurred
in Micronesia (Yap Island) in 2007. During the outbreak,
blood samples were collected from 557 residents of Yap
Island; 414 (74%) of the tested individuals had IgM
antibody against Zika virus and 156 (38%) of the infected,
with a mean age of 36 (61% women; usually the elderly),
reported symptoms of the illness during the outbreak period
(Duffy et al., 2009). Researchers estimated that 5,005 of
the 6,892 Yap residents, who were 3 years of age or older,
became infected with Zika virus in 2007 (Duffy et al.,
2009). These were the first cases of the disease recorded
outside Africa or Asia (Hayes, 2009).
Between 2013 and 2015, further outbreaks occurred in
some Pacific islands: in French Polynesia, New Caledonia,
Cook Islands, Easter Island, and Solomon Islands. In
December, 2013 Zika virus was suspected to be responsible
for an estimated 19,000 cases of dengue-like syndrome in
French Polynesia (Cao-Lormeau et al., 2014). In 2015,
Zika fever spread to Brazil and more than 20 other
countries in South and Central America. Until February
2016, an estimated 1.6 million autochthonous cases of Zika
have been reported globally, mainly in South and Central
America (including approximately 1.5 million cases in
Brazil alone, over 30,000 cases in Columbia, more than
4,600 cases in Venezuela), less commonly in Africa (over
7,000 in Cape Verde) and on the islands of Oceania (Tonga,
American Samoa, Samoa) (Garcia et al., 2016).
On 1st February, 2016, the WHO declared the Zika virus
outbreak to be a Public Health Emergency of International
Concern. The WHO declaration may potentially reduce the
number of visitors to the Rio Olympic Games in 2016 (Ioos
et al., 2014). As of 17th February, 2016, the Centers for
Disease Control and Prevention (CDC) reported 82-travel
associated Zika fever cases in the United States, with no
locally acquired vector-borne infections (CDC, 2016).
Single cases of imported Zika infections have also been
recorded in Europe (Venturi et al., 2014; Zammarchi et al.,
2015), China (Rajagopalan and Clare, 2016), and Australia
(Barker, 2016). A continuing expansion of the infection
vector to all parts of the world may result in the occurrence
of new Zika virus outbreaks, especially in densely
populated urban areas (Oster et al., 2016).
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 https://doi.org/10.25240/TJANS.2017.2.1.01

Figure 1: Zika virus transmission/life cycle.

Source: CDC (2016).

Figure 2: Microcephaly attributed to Zika virus disease.

Source: CDC (2016).

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4. CLINICAL MANIFESTATIONS
About 75-80% of patients are asymptomatic, only 20-25%
of patients infected with Zika virus develop symptoms
(Staples et al., 2016; Dasgupta et al., 2016). The most
common signs and symptoms of Zika virus disease are;
fever, maculopapular rash, headache, muscle pain, joint
pain, conjunctivitis, Guillian bare syndrome in adults,
microcephaly in babies, see figure 2 (Foy et al., 2011;
Heang et al., 2012).
5. DIAGNOSIS
Zika virus disease can be diagnosed by carrying out the
following tests in the laboratory;
(a) Polymerase Chain Reaction (PCR): It is more useful in
the first 3-5 days after the onset of symptoms (Dhurba,
2016).
(b) Serological test: An enzyme linked immunosorbent
assay (ELISA) has been developed to detect IgM to Zika
virus only after 5 days (Dhurba, 2016).
(c) Nucleic acid amplification test (NAAT): It is used to
detect viral RNA (Dhurba, 2016).
(d) Plaque reduction neutralization assay: This assay
generally has improved specificity over immune assay, but
may still yield cross-reactive result in secondary flavivirus
infections (Dhurba, 2016).
6. MANAGEMENT AND PREVENTION
Avoidance of mosquito bite is an important element to
disease control, since the main transmission route of the
Zika virus is via mosquito bite. The US Centers for Disease
Control and Prevention (CDC) recommends the following
preventive measure; keeping the environment clean,
avoiding mosquito bites, wear long-sleeved shirts and long
pants to cover exposed skin, stay and sleep in screened-in
or air-conditioned rooms and door screens to keep
mosquitoes outside, travel restrictions to endemic areas, if
you have Zika virus disease, protect others from getting
sick by avoiding mosquito bites during the first week of
illness, taking measures to have safe sex (Dhurba, 2016).
There is currently no specific treatment for Zika virus. Care
is supportive with treatment of pain, fever and itching
(Sikka et al., 2016). Zika virus may be sensitive to
interferon treatment, which is commonly used against other
viral infections. However, these results have not been
tested in animals or humans (Hamel et al., 2015).
7. CONCLUSION
Zika virus disease has been declared a Public Health
emergency. Zika virus has the propensity to infect large
numbers of persons with severe consequences in some
cases. The epidemic has serious medical, ethical, and
economic drawbacks, particularly in countries where the
resources for early diagnosis are lacking and potential
intervention measures (e.g., contraception or termination of
pregnancy) are discouraged or illegal (Plourde and Bloch,
2016). Continued vigilance and public enlightenment are
the key towards improving our understanding,
management and prevention of this emerging pathogen.
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