🕷️ Crawler Inspector

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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 71 (from laksa157)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa071.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet","crawl_time":1772548260,"first_indexed_time":0,"http_code":200,"src_unparsed":"eu,europa!ecdc,www,\/en\/zika-virus-infection\/facts\/factsheet s443","src_root_hash":"8384339340669129071","history_drop_reason":null,"meta_title":"Factsheet about Zika virus disease","meta_descriptions":["Most Zika virus infections are either asymptomatic or cause a mild illness with a transient maculopapular rash. However, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome."],"attrs_boilerpipe_text":"Zika virus disease is a mosquito-borne disease caused by Zika virus. Most infections are either asymptomatic or cause a mild illness with a transient maculopapular rash. \nThe\nAedes\n \naegypti\nmosquito is the main vector but other\nAedes\nspecies can also transmit the virus. Sexual transmission via semen has been reported recently.\nViral circulation and a few outbreaks were documented in tropical Africa and in some areas in south-east Asia. Since 2007, several islands of the Pacific region have experienced outbreaks, and in 2015 outbreaks were reported in the Americas and the Caribbean. Zika virus disease is considered an emerging infectious disease [1-4].\nA significant increase of patients with Guillain–Barré syndrome was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. An unusual increase of congenital microcephaly was observed in some regions in north-eastern Brazil in 2015. According to WHO, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome [5].\nThere is no prophylactic or curative treatment or vaccine to protect against Zika virus infection. Therefore, preventive personal measures are recommended to avoid mosquito bites during the daytime.\nThe pathogen \nZika virus disease is caused by a virus from the \nFlavivirus\n genus, Flaviviridae family, from the Spondweni group. It was first isolated in 1947 from a monkey in the Zika forest, Uganda, then in mosquitoes (\nAedes africanus\n) in the same forest in 1948, and in a human in Nigeria in 1952. \nThere are two Zika virus lineages: the African lineage and the Asian lineage, which has spread recently in the Pacific and the Americas [2,6,7].\nClinical features and sequelae\nThe incubation period likely ranges between three and 12 days after the bite by an infected mosquito. Most of the infections remain asymptomatic (approximately 80%).\nDisease symptoms are usually mild, and the disease is commonly short-lasting and self-limiting. Its duration is between 2–7 days without severe complications, with no associated fatalities and a low hospitalisation rate.\nThe main symptoms are maculopapular rash (+\/-itchy), with or without mild fever, arthralgia, fatigue, non-purulent conjunctivitis\/conjunctival hyperaemia, myalgia and headache. The maculopapular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs might be present.\nDifferential diagnostic with dengue and chikungunya fever based on clinical symptoms remains challenging, and co-infection can occur. The other usual differential diagnoses are measles, rubella, parvovirus and enterovirus infections, and malaria.\nAmong women infected during pregnancy, congenital central nervous system malformations of the foetus (such as microcephaly) and foetal losses were notified during several recent Zika disease outbreaks. Unusual increases of Guillain–Barré syndrome incidence, coinciding with the Zika virus outbreaks, were reported in several countries in the Americas and French Polynesia.  \nEpidemiology \nSerological surveys in Africa and Asia indicate most likely silent Zika virus circulation, with detection of specific antibodies in various animal species (large mammals such as orang-utans, zebras, elephants, water buffaloes) and rodents.\nThe knowledge of the geographical distribution of Zika virus is based on results of serosurveys and viral isolation in mosquitoes and humans, and on reports of travel-associated cases. Before 2007, the areas with reported Zika virus circulation included tropical Africa and south-east Asia. Very few outbreaks were documented prior to a 2007 upsurge on Yap Island, Federated States of Micronesia [8], which was the first outbreak of Zika virus identified outside of Africa and Asia. Between 2013 and 2015, several significant outbreaks were notified on islands and archipelagos in the Pacific region, including a large outbreak in French Polynesia. In 2015, Zika virus emerged in South America, with further spread across the Americas [3,7].\nTransmission \nZika virus is transmitted by mosquitoes. It has been isolated from \nAedes aegypti\n mosquitoes and experimental infections show that this species is capable of transmitting Zika virus.\nOther \nAedes\n mosquito species (notably \nAe. africanus\n, \nAe. albopictus\n, \nAe. polynesiensis\n, \nAe. unilineatus, Ae. vittatus\n and \nAe. hensilli\n) are considered potential vectors of Zika virus. These species bite during the day.\nAedes albopictus\nis experimentally able to transmit Zika virus.\nAdditional modes of transmission have been identified:\nMaterno-foetal transmission can occur most probably by trans-placental transmission and during delivery when the mother is infected.\nSexual transmission has been documented in several instances, in one case from a symptomatic male to a woman as late as 5–6 weeks after onset of the man’s symptoms.\nThere is a potential risk of Zika virus transmission through blood transfusion and organ transplantation.\nMore information on\nAedes\nmosquitoes can be found here: \nAedes albopictus\n and \nAedes aegypti\n.\n \nDiagnostics \nZika virus disease diagnostics is primarily based on the detection of viral RNA from clinical specimens (blood, saliva, urine, cerebrospinal fluid, amniotic fluid, semen, and breast milk).\nThe viraemic period appears to be short, allowing for direct virus detection from blood and saliva, usually during the first 3–5 days after the onset of symptoms (sometimes up to 7–8 days). In several cases, Zika virus RNA has been detected in urine up to 2–3 weeks after onset of symptoms. Virus presence in semen has been documented up to 62 days after symptom onset.\nSerological investigations can be conducted from day 5 after the onset of disease, by detection of Zika-specific IgM antibodies and confirmation by neutralisation, seroconversion or fourfold antibody titre increase of Zika-specific antibodies in paired serum samples. Eight to 14 days after the onset of symptoms, diagnostic testing of urine with RT-PCR can be considered in addition to Zika virus serology. Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections (e.g. dengue, West Nile, Japanese encephalitis).\nCase management and treatment \nThere is no specific prophylactic treatment. \nDifferential clinical diagnostic should be considered as well as co-infection with other mosquito-borne diseases such as dengue fever, chikungunya and malaria.\nThe treatment is symptomatic and mainly based on a good hydration, pain relief, and anti-histamines for pruritic rash. Treatment with acetylsalicylic acid and no-steroidal anti-inflammatory drugs is discouraged if the diagnosis of dengue is not excluded because of a potential increased risk of haemorrhagic syndrome. Acetylsalicylic acid is also discouraged because of the risk of Reye's syndrome after viral infection in children and teenagers.\nPublic health control measures\nNo vaccine or prophylactic treatment is available.\nIntegrated vector management aiming to reduce mosquito vector density in a sustainable manner is of primary importance. Intersectoral collaboration and efficient public communication strategies to ensure community participation are required for sustainable vector control programmes.\nActivities supporting the reduction of mosquito breeding sites in outdoor\/indoor areas by draining or discarding sources of standing water at the community level include:\nremoval of all open containers with stagnant water in and surrounding houses on a regular basis (e.g. flower plates and pots, used tyres, tree holes and rock pools), or, if that is not possible, treatment with larvicides),\ntight coverage of water containers, barrels, wells and water storage tanks, and the\nwide use of physical barriers that reduce the risk of exposure to mosquitos bites (such as mosquito nets, window\/door screens and air conditioning).\nDuring an outbreak, elimination of adult mosquitoes through aerial spraying with insecticides can be considered but efficacy seems very limited.\nIn areas where the vector is active, the following is recommended:\nSymptomatic patients should strictly follow personal protection measures to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission.\nAsymptomatic individuals returning from an area with Zika virus outbreaks should follow personal protection measures against mosquito bites for three weeks after their return.\nInfection control, personal protection and prevention \nPrevention is also based on protection against mosquito bites. \nAedes \nmosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore, personal protection measures should be applied all day, especially during the hours of the highest mosquito activity (mid-morning, late afternoon to twilight). Personal protective measures against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), sleeping or resting in screened or air-conditioned rooms, the wearing of clothes that cover most of the body, and the use of mosquito repellent in accordance with the instructions indicated on the product label.\nPregnant women and women who are planning to become pregnant and planning to travel to areas with widespread transmission should postpone non-essential travel. Those who are planning to travel to areas with sporadic transmission should consult their physician or a travel clinic and consider postponing non-essential travel. Pregnant women residing in countries with active transmission (sporadic and widespread) should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites.\nTravellers with immune disorders or severe chronic illnesses should consult their doctors or seek advice from a travel clinic before travelling, particularly with regard to effective prevention measures.\nSimilar protective measures apply to a symptomatic patients in order to prevent human-to-mosquito-to-human transmission.\nSexual transmission of Zika virus through semen has been documented, therefore practicing safer sex (including the use of condoms) is recommended throughout pregnancy to protect the foetus.\nReferences  \n1.         Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50.\n2.         Faye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, et al. Molecular Evolution of Zika Virus during Its Emergence in the 20(th) Century. PLoS Negl Trop Dis. 2014;8(1):e2636.\n3.         Musso D, Gubler DJ. Zika Virus. Clin Microbiol Rev. 2016 Jul;29(3):487-524.\n4.         Plourde AR, Bloch EM. A Literature Review of Zika Virus. Emerg Infect Dis. 2016 Jul 15;22(7).\n5.         World Health Organization. WHO statement on the third meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: World Health Organization; 2016. Available from:\nhttp:\/\/www.who.int\/mediacentre\/news\/statements\/2016\/zika-third-ec\/en\/\n.\n6.         Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor Ldel C. Phylogeny of Zika Virus in Western Hemisphere, 2015. Emerg Infect Dis. 2016 May;22(5):933-5.\n7.         Faria NR, Azevedo Rdo S, Kraemer MU, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science. 2016 Apr 15;352(6283):345-9.\n8.         Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43.","attrs_markdown":"[Skip to main content](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#main-content)\n\n![](https:\/\/webtools.europa.eu\/images\/flags\/eu.svg) An official website of the European Union An official EU website\n\nHow do you know?\n\nAll official European Union website addresses are in the **europa.eu** domain.\n\n[See all EU institutions and bodies](https:\/\/european-union.europa.eu\/institutions-law-budget\/institutions-and-bodies\/search-all-eu-institutions-and-bodies_en)\n\nThis site uses cookies. 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It is seated in Stockholm, Sweden.\")\n  ### [About ECDC](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc)\n  - [Who we are](https:\/\/www.ecdc.europa.eu\/en\/about-us\/ecdcs-organisational-structure \"ECDC's mission is to identify, assess and communicate current and emerging threats to human health posed by infectious diseases.\")\n  - [What we do](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/what-we-do \"Read more about ECDC's mission and daily work\")\n  - [Partners and networks](https:\/\/www.ecdc.europa.eu\/en\/about-us\/ecdcs-partnerships-and-networks \"The main mode for ECDC to interact with the Member States on scientific and technical work is within networks linked to Competent Bodies in the countries.\")\n  - [Work with ECDC](https:\/\/www.ecdc.europa.eu\/en\/about-us\/work-with-us \"ECDC offers a wide variety of career opportunities in public health. Join our team and contribute to the strengthening of Europe’s defences against infectious diseases.\")\n  - [Procurement and grants](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/procurement-and-grants)\n  - [Media centre](https:\/\/www.ecdc.europa.eu\/en\/news-events)\n  \n  ### Spotlight\n  - [Strategic documents](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/who-we-are\/key-documents\/strategic-documents)\n  - [Annual reports of the Director](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/who-we-are\/key-documents\/annual-reports-director)\n  - [Governance](https:\/\/www.ecdc.europa.eu\/en\/about-us\/ecdcs-governance)\n  \n  ![podcast logo](https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/styles\/col_lg_4_16x9\/public\/images\/podcast%20logo%203.jpg.webp?itok=MDW3nu0X)\n  \n  ### [ECDC: On Air](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/media-centre\/ecdc-air)\n\n1. [Home](https:\/\/www.ecdc.europa.eu\/en)\n2. [Infectious disease topics](https:\/\/www.ecdc.europa.eu\/en\/all-topics)\n3. [Zika virus infection](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-disease)\n4. [Disease information](https:\/\/www.ecdc.europa.eu\/en\/infectious-disease-topics\/zika-virus-infection\/disease-information-zika-virus-infection)\n5. Facts\n\n[Disease information](https:\/\/www.ecdc.europa.eu\/en\/infectious-disease-topics\/zika-virus-infection\/disease-information-zika-virus-infection)\n\n- [Facts](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet \"Most Zika infections result in a mild illness or are asymptomatic, but there is a scientific consensus that the Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome.\")\n  - [The pathogen](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#the-pathogen)\n  - [Clinical features and sequelae](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#clinical-features-and-sequelae)\n  - [Epidemiology](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#epidemiology)\n  - [Transmission](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#transmission)\n  - [Diagnostics](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#diagnostics)\n  - [Case management and treatment](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#case-management-and-treatment)\n  - [Public health control measures](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#public-health-control-measures)\n  - [Infection control, personal protection and prevention](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#infection-control,-personal-protection-and-prevention)\n  - [References](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/facts\/factsheet#references)\n- [Case definition](https:\/\/www.ecdc.europa.eu\/en\/zika-virus-infection\/surveillance-and-disease-data\/case-definition \"An interim case definition for surveillance of Zika virus infection has been discussed with the Health Security Committee during its meeting on 17 March 2016.\")\n\n# Factsheet about Zika virus disease\nFactsheet\n\nZika virus is a member of the Flaviviridae family and is transmitted to humans by mosquitoes. It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans. Since 2007 Zika virus has caused several outbreaks in the Pacific, and since 2015 it further spread in the Americas. These were the first documented transmissions outside of its traditional endemic areas in Africa and Asia. Zika virus is considered an emerging infectious disease with the potential to spread to new areas where the Aedes mosquito vector is present. There is no evidence of transmission Zika virus in Europe to date.\n\nZika virus disease is a mosquito-borne disease caused by Zika virus. Most infections are either asymptomatic or cause a mild illness with a transient maculopapular rash.\n\nThe *Aedes* *aegypti* mosquito is the main vector but other *Aedes* species can also transmit the virus. Sexual transmission via semen has been reported recently.\n\nViral circulation and a few outbreaks were documented in tropical Africa and in some areas in south-east Asia. Since 2007, several islands of the Pacific region have experienced outbreaks, and in 2015 outbreaks were reported in the Americas and the Caribbean. Zika virus disease is considered an emerging infectious disease \\[1-4\\].\n\nA significant increase of patients with Guillain–Barré syndrome was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. An unusual increase of congenital microcephaly was observed in some regions in north-eastern Brazil in 2015. According to WHO, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome \\[5\\].  \n  \n  \n There is no prophylactic or curative treatment or vaccine to protect against Zika virus infection. Therefore, preventive personal measures are recommended to avoid mosquito bites during the daytime.\n\n## The pathogen\nZika virus disease is caused by a virus from the *Flavivirus* genus, Flaviviridae family, from the Spondweni group. It was first isolated in 1947 from a monkey in the Zika forest, Uganda, then in mosquitoes (*Aedes africanus*) in the same forest in 1948, and in a human in Nigeria in 1952.\n\nThere are two Zika virus lineages: the African lineage and the Asian lineage, which has spread recently in the Pacific and the Americas \\[2,6,7\\].\n\n## Clinical features and sequelae\nThe incubation period likely ranges between three and 12 days after the bite by an infected mosquito. Most of the infections remain asymptomatic (approximately 80%).\n\nDisease symptoms are usually mild, and the disease is commonly short-lasting and self-limiting. Its duration is between 2–7 days without severe complications, with no associated fatalities and a low hospitalisation rate.\n\nThe main symptoms are maculopapular rash (+\/-itchy), with or without mild fever, arthralgia, fatigue, non-purulent conjunctivitis\/conjunctival hyperaemia, myalgia and headache. The maculopapular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs might be present.\n\nDifferential diagnostic with dengue and chikungunya fever based on clinical symptoms remains challenging, and co-infection can occur. The other usual differential diagnoses are measles, rubella, parvovirus and enterovirus infections, and malaria.\n\nAmong women infected during pregnancy, congenital central nervous system malformations of the foetus (such as microcephaly) and foetal losses were notified during several recent Zika disease outbreaks. Unusual increases of Guillain–Barré syndrome incidence, coinciding with the Zika virus outbreaks, were reported in several countries in the Americas and French Polynesia.\n\n## Epidemiology\nSerological surveys in Africa and Asia indicate most likely silent Zika virus circulation, with detection of specific antibodies in various animal species (large mammals such as orang-utans, zebras, elephants, water buffaloes) and rodents.\n\nThe knowledge of the geographical distribution of Zika virus is based on results of serosurveys and viral isolation in mosquitoes and humans, and on reports of travel-associated cases. Before 2007, the areas with reported Zika virus circulation included tropical Africa and south-east Asia. Very few outbreaks were documented prior to a 2007 upsurge on Yap Island, Federated States of Micronesia \\[8\\], which was the first outbreak of Zika virus identified outside of Africa and Asia. Between 2013 and 2015, several significant outbreaks were notified on islands and archipelagos in the Pacific region, including a large outbreak in French Polynesia. In 2015, Zika virus emerged in South America, with further spread across the Americas \\[3,7\\].\n\n## Transmission\nZika virus is transmitted by mosquitoes. It has been isolated from *Aedes aegypti* mosquitoes and experimental infections show that this species is capable of transmitting Zika virus.\n\nOther *Aedes* mosquito species (notably *Ae. africanus*, *Ae. albopictus*, *Ae. polynesiensis*, *Ae. unilineatus, Ae. vittatus* and *Ae. hensilli*) are considered potential vectors of Zika virus. These species bite during the day. *Aedes albopictus* is experimentally able to transmit Zika virus.\n\nAdditional modes of transmission have been identified:\n\n- Materno-foetal transmission can occur most probably by trans-placental transmission and during delivery when the mother is infected.\n- Sexual transmission has been documented in several instances, in one case from a symptomatic male to a woman as late as 5–6 weeks after onset of the man’s symptoms.\n- There is a potential risk of Zika virus transmission through blood transfusion and organ transplantation.\n\nMore information on *Aedes* mosquitoes can be found here: [*Aedes albopictus*](https:\/\/www.ecdc.europa.eu\/en\/disease-vectors\/facts\/mosquito-factsheets\/aedes-albopictus \"Aedes albopictus - Factsheet for experts\") and [*Aedes aegypti*](https:\/\/www.ecdc.europa.eu\/en\/disease-vectors\/facts\/mosquito-factsheets\/aedes-aegypti \"Aedes aegypti - Factsheet for experts\")*.*\n\n## Diagnostics\nZika virus disease diagnostics is primarily based on the detection of viral RNA from clinical specimens (blood, saliva, urine, cerebrospinal fluid, amniotic fluid, semen, and breast milk).\n\nThe viraemic period appears to be short, allowing for direct virus detection from blood and saliva, usually during the first 3–5 days after the onset of symptoms (sometimes up to 7–8 days). In several cases, Zika virus RNA has been detected in urine up to 2–3 weeks after onset of symptoms. Virus presence in semen has been documented up to 62 days after symptom onset.\n\nSerological investigations can be conducted from day 5 after the onset of disease, by detection of Zika-specific IgM antibodies and confirmation by neutralisation, seroconversion or fourfold antibody titre increase of Zika-specific antibodies in paired serum samples. Eight to 14 days after the onset of symptoms, diagnostic testing of urine with RT-PCR can be considered in addition to Zika virus serology. Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections (e.g. dengue, West Nile, Japanese encephalitis).\n\n## Case management and treatment\nThere is no specific prophylactic treatment.\n\nDifferential clinical diagnostic should be considered as well as co-infection with other mosquito-borne diseases such as dengue fever, chikungunya and malaria.\n\nThe treatment is symptomatic and mainly based on a good hydration, pain relief, and anti-histamines for pruritic rash. Treatment with acetylsalicylic acid and no-steroidal anti-inflammatory drugs is discouraged if the diagnosis of dengue is not excluded because of a potential increased risk of haemorrhagic syndrome. Acetylsalicylic acid is also discouraged because of the risk of Reye's syndrome after viral infection in children and teenagers.\n\n## Public health control measures\nNo vaccine or prophylactic treatment is available.\n\nIntegrated vector management aiming to reduce mosquito vector density in a sustainable manner is of primary importance. Intersectoral collaboration and efficient public communication strategies to ensure community participation are required for sustainable vector control programmes.\n\nActivities supporting the reduction of mosquito breeding sites in outdoor\/indoor areas by draining or discarding sources of standing water at the community level include:\n\n- removal of all open containers with stagnant water in and surrounding houses on a regular basis (e.g. flower plates and pots, used tyres, tree holes and rock pools), or, if that is not possible, treatment with larvicides),\n- tight coverage of water containers, barrels, wells and water storage tanks, and the\n- wide use of physical barriers that reduce the risk of exposure to mosquitos bites (such as mosquito nets, window\/door screens and air conditioning).\n\nDuring an outbreak, elimination of adult mosquitoes through aerial spraying with insecticides can be considered but efficacy seems very limited.\n\nIn areas where the vector is active, the following is recommended:\n\n- Symptomatic patients should strictly follow personal protection measures to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission.\n- Asymptomatic individuals returning from an area with Zika virus outbreaks should follow personal protection measures against mosquito bites for three weeks after their return.\n## Infection control, personal protection and prevention\nPrevention is also based on protection against mosquito bites. *Aedes* mosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore, personal protection measures should be applied all day, especially during the hours of the highest mosquito activity (mid-morning, late afternoon to twilight). Personal protective measures against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), sleeping or resting in screened or air-conditioned rooms, the wearing of clothes that cover most of the body, and the use of mosquito repellent in accordance with the instructions indicated on the product label.\n\nPregnant women and women who are planning to become pregnant and planning to travel to areas with widespread transmission should postpone non-essential travel. Those who are planning to travel to areas with sporadic transmission should consult their physician or a travel clinic and consider postponing non-essential travel. Pregnant women residing in countries with active transmission (sporadic and widespread) should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites.\n\nTravellers with immune disorders or severe chronic illnesses should consult their doctors or seek advice from a travel clinic before travelling, particularly with regard to effective prevention measures.\n\nSimilar protective measures apply to a symptomatic patients in order to prevent human-to-mosquito-to-human transmission.\n\nSexual transmission of Zika virus through semen has been documented, therefore practicing safer sex (including the use of condoms) is recommended throughout pregnancy to protect the foetus.\n\n## References\n1\\. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50.  \n  \n 2. Faye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, et al. Molecular Evolution of Zika Virus during Its Emergence in the 20(th) Century. PLoS Negl Trop Dis. 2014;8(1):e2636.  \n  \n 3. Musso D, Gubler DJ. Zika Virus. Clin Microbiol Rev. 2016 Jul;29(3):487-524.  \n  \n 4. Plourde AR, Bloch EM. A Literature Review of Zika Virus. Emerg Infect Dis. 2016 Jul 15;22(7).  \n  \n 5. World Health Organization. WHO statement on the third meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: World Health Organization; 2016. Available from: [http:\/\/www.who.int\/mediacentre\/news\/statements\/2016\/zika-third-ec\/en\/](http:\/\/www.who.int\/mediacentre\/news\/statements\/2016\/zika-third-ec\/en\/ \"(opens in a new window)\").  \n  \n 6. Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor Ldel C. Phylogeny of Zika Virus in Western Hemisphere, 2015. Emerg Infect Dis. 2016 May;22(5):933-5.  \n  \n 7. Faria NR, Azevedo Rdo S, Kraemer MU, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science. 2016 Apr 15;352(6283):345-9.  \n  \n 8. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43.\n\n*Disclaimer: The information contained in this factsheet is intended for the purpose of general information and should not substitute individual expert advice and judgement of healthcare professionals.*\n\nPage last updated\n\n31 May 2021\n\n## Doormat menu\n### [About us](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc \"Read more about ECDC's work, organisational structure and governance\")\n- [What we do](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/what-we-do \"Read more about ECDC's mission and daily work\")\n- [Who we are](https:\/\/www.ecdc.europa.eu\/en\/about-us\/ecdcs-organisational-structure \"Overview of ECDC's organisational structure \")\n- [Governance](https:\/\/www.ecdc.europa.eu\/en\/about-us\/ecdcs-governance \"Information on the governing bodies of the Agency\")\n\n### [Work with us](https:\/\/www.ecdc.europa.eu\/en\/about-us\/work-with-us \"Information on vacancies, recruitment process, fellowship programmes, traineeships\")\n- [Vacancies](https:\/\/www.ecdc.europa.eu\/en\/vacancies?f%5B0%5D=deadline_date%3A1 \"Open and closed ECDC vacancies\")\n- [Fellowships](https:\/\/www.ecdc.europa.eu\/en\/training\/fellowships \"Information on the fellowship programmes EPIET and EUPHEM\")\n- [Procurement and grants](https:\/\/www.ecdc.europa.eu\/en\/about-us\/procurement-and-grants?deadline_date=1 \"Information on ECDC's procurement and grant procedures. List of open and closed calls for procurements and grants.\")\n\n### [Contact ECDC](https:\/\/www.ecdc.europa.eu\/en\/about-us\/contact-ecdc \"Postal address and contact details for general enquires.\")\n- [Contact us](https:\/\/www.ecdc.europa.eu\/en\/about-us\/contact-ecdc \"Visiting address and instructions for getting to ECDC\")\n- [Media centre](https:\/\/www.ecdc.europa.eu\/en\/news-events \"Information on how to contact ECDC' press office\")\n- [Social media](https:\/\/www.ecdc.europa.eu\/en\/about-ecdc\/media-centre\/ecdc-social-media \"Overview of ECDC's social media pages\")\n\n[Newsletter](https:\/\/www.ecdc.europa.eu\/en\/newsletter)\n\n[RSS](https:\/\/www.ecdc.europa.eu\/en\/rss-feeds)\n### Follow us:\n\n## Footer Menu\n- [Legal notice](https:\/\/www.ecdc.europa.eu\/en\/legal-notice)\n- [Copyright](https:\/\/www.ecdc.europa.eu\/en\/ecdc-intellectual-property-notices)\n- [Access to surveillance data](https:\/\/www.ecdc.europa.eu\/en\/about-us\/what-we-do\/surveillance\/european-surveillance-system-tessy-data-access \"Rules on direct access to data, access to subsets of data and access to aggregated published data\")\n- [Personal data protection](https:\/\/www.ecdc.europa.eu\/en\/personal-data-protection)\n- [Language policy](https:\/\/www.ecdc.europa.eu\/en\/language-policy \"The Agency's translation policy\")\n- [Cookies](https:\/\/www.ecdc.europa.eu\/en\/cookie-policy)\n- [Accessibility](https:\/\/www.ecdc.europa.eu\/en\/accessibility)\n- [Sitemap](https:\/\/www.ecdc.europa.eu\/en\/sitemap)\n\n© European Centre for Disease Prevention and Control (ECDC) 2026","attrs_readable_markdown":"Zika virus disease is a mosquito-borne disease caused by Zika virus. Most infections are either asymptomatic or cause a mild illness with a transient maculopapular rash.\n\nThe *Aedes* *aegypti* mosquito is the main vector but other *Aedes* species can also transmit the virus. Sexual transmission via semen has been reported recently.\n\nViral circulation and a few outbreaks were documented in tropical Africa and in some areas in south-east Asia. Since 2007, several islands of the Pacific region have experienced outbreaks, and in 2015 outbreaks were reported in the Americas and the Caribbean. Zika virus disease is considered an emerging infectious disease \\[1-4\\].\n\nA significant increase of patients with Guillain–Barré syndrome was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. An unusual increase of congenital microcephaly was observed in some regions in north-eastern Brazil in 2015. According to WHO, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome \\[5\\].\n\nThere is no prophylactic or curative treatment or vaccine to protect against Zika virus infection. Therefore, preventive personal measures are recommended to avoid mosquito bites during the daytime.\n## The pathogen\nZika virus disease is caused by a virus from the *Flavivirus* genus, Flaviviridae family, from the Spondweni group. It was first isolated in 1947 from a monkey in the Zika forest, Uganda, then in mosquitoes (*Aedes africanus*) in the same forest in 1948, and in a human in Nigeria in 1952.\n\nThere are two Zika virus lineages: the African lineage and the Asian lineage, which has spread recently in the Pacific and the Americas \\[2,6,7\\].\n\n## Clinical features and sequelae\nThe incubation period likely ranges between three and 12 days after the bite by an infected mosquito. Most of the infections remain asymptomatic (approximately 80%).\n\nDisease symptoms are usually mild, and the disease is commonly short-lasting and self-limiting. Its duration is between 2–7 days without severe complications, with no associated fatalities and a low hospitalisation rate.\n\nThe main symptoms are maculopapular rash (+\/-itchy), with or without mild fever, arthralgia, fatigue, non-purulent conjunctivitis\/conjunctival hyperaemia, myalgia and headache. The maculopapular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs might be present.\n\nDifferential diagnostic with dengue and chikungunya fever based on clinical symptoms remains challenging, and co-infection can occur. The other usual differential diagnoses are measles, rubella, parvovirus and enterovirus infections, and malaria.\n\nAmong women infected during pregnancy, congenital central nervous system malformations of the foetus (such as microcephaly) and foetal losses were notified during several recent Zika disease outbreaks. Unusual increases of Guillain–Barré syndrome incidence, coinciding with the Zika virus outbreaks, were reported in several countries in the Americas and French Polynesia.\n\n## Epidemiology\nSerological surveys in Africa and Asia indicate most likely silent Zika virus circulation, with detection of specific antibodies in various animal species (large mammals such as orang-utans, zebras, elephants, water buffaloes) and rodents.\n\nThe knowledge of the geographical distribution of Zika virus is based on results of serosurveys and viral isolation in mosquitoes and humans, and on reports of travel-associated cases. Before 2007, the areas with reported Zika virus circulation included tropical Africa and south-east Asia. Very few outbreaks were documented prior to a 2007 upsurge on Yap Island, Federated States of Micronesia \\[8\\], which was the first outbreak of Zika virus identified outside of Africa and Asia. Between 2013 and 2015, several significant outbreaks were notified on islands and archipelagos in the Pacific region, including a large outbreak in French Polynesia. In 2015, Zika virus emerged in South America, with further spread across the Americas \\[3,7\\].\n\n## Transmission\nZika virus is transmitted by mosquitoes. It has been isolated from *Aedes aegypti* mosquitoes and experimental infections show that this species is capable of transmitting Zika virus.\n\nOther *Aedes* mosquito species (notably *Ae. africanus*, *Ae. albopictus*, *Ae. polynesiensis*, *Ae. unilineatus, Ae. vittatus* and *Ae. hensilli*) are considered potential vectors of Zika virus. These species bite during the day. *Aedes albopictus* is experimentally able to transmit Zika virus.\n\nAdditional modes of transmission have been identified:\n\n- Materno-foetal transmission can occur most probably by trans-placental transmission and during delivery when the mother is infected.\n- Sexual transmission has been documented in several instances, in one case from a symptomatic male to a woman as late as 5–6 weeks after onset of the man’s symptoms.\n- There is a potential risk of Zika virus transmission through blood transfusion and organ transplantation.\n\nMore information on *Aedes* mosquitoes can be found here: [*Aedes albopictus*](https:\/\/www.ecdc.europa.eu\/en\/disease-vectors\/facts\/mosquito-factsheets\/aedes-albopictus \"Aedes albopictus - Factsheet for experts\") and [*Aedes aegypti*](https:\/\/www.ecdc.europa.eu\/en\/disease-vectors\/facts\/mosquito-factsheets\/aedes-aegypti \"Aedes aegypti - Factsheet for experts\")*.*\n\n## Diagnostics\nZika virus disease diagnostics is primarily based on the detection of viral RNA from clinical specimens (blood, saliva, urine, cerebrospinal fluid, amniotic fluid, semen, and breast milk).\n\nThe viraemic period appears to be short, allowing for direct virus detection from blood and saliva, usually during the first 3–5 days after the onset of symptoms (sometimes up to 7–8 days). In several cases, Zika virus RNA has been detected in urine up to 2–3 weeks after onset of symptoms. Virus presence in semen has been documented up to 62 days after symptom onset.\n\nSerological investigations can be conducted from day 5 after the onset of disease, by detection of Zika-specific IgM antibodies and confirmation by neutralisation, seroconversion or fourfold antibody titre increase of Zika-specific antibodies in paired serum samples. Eight to 14 days after the onset of symptoms, diagnostic testing of urine with RT-PCR can be considered in addition to Zika virus serology. Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections (e.g. dengue, West Nile, Japanese encephalitis).\n\n## Case management and treatment\nThere is no specific prophylactic treatment.\n\nDifferential clinical diagnostic should be considered as well as co-infection with other mosquito-borne diseases such as dengue fever, chikungunya and malaria.\n\nThe treatment is symptomatic and mainly based on a good hydration, pain relief, and anti-histamines for pruritic rash. Treatment with acetylsalicylic acid and no-steroidal anti-inflammatory drugs is discouraged if the diagnosis of dengue is not excluded because of a potential increased risk of haemorrhagic syndrome. Acetylsalicylic acid is also discouraged because of the risk of Reye's syndrome after viral infection in children and teenagers.\n\n## Public health control measures\nNo vaccine or prophylactic treatment is available.\n\nIntegrated vector management aiming to reduce mosquito vector density in a sustainable manner is of primary importance. Intersectoral collaboration and efficient public communication strategies to ensure community participation are required for sustainable vector control programmes.\n\nActivities supporting the reduction of mosquito breeding sites in outdoor\/indoor areas by draining or discarding sources of standing water at the community level include:\n\n- removal of all open containers with stagnant water in and surrounding houses on a regular basis (e.g. flower plates and pots, used tyres, tree holes and rock pools), or, if that is not possible, treatment with larvicides),\n- tight coverage of water containers, barrels, wells and water storage tanks, and the\n- wide use of physical barriers that reduce the risk of exposure to mosquitos bites (such as mosquito nets, window\/door screens and air conditioning).\n\nDuring an outbreak, elimination of adult mosquitoes through aerial spraying with insecticides can be considered but efficacy seems very limited.\n\nIn areas where the vector is active, the following is recommended:\n\n- Symptomatic patients should strictly follow personal protection measures to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission.\n- Asymptomatic individuals returning from an area with Zika virus outbreaks should follow personal protection measures against mosquito bites for three weeks after their return.\n## Infection control, personal protection and prevention\nPrevention is also based on protection against mosquito bites. *Aedes* mosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore, personal protection measures should be applied all day, especially during the hours of the highest mosquito activity (mid-morning, late afternoon to twilight). Personal protective measures against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), sleeping or resting in screened or air-conditioned rooms, the wearing of clothes that cover most of the body, and the use of mosquito repellent in accordance with the instructions indicated on the product label.\n\nPregnant women and women who are planning to become pregnant and planning to travel to areas with widespread transmission should postpone non-essential travel. Those who are planning to travel to areas with sporadic transmission should consult their physician or a travel clinic and consider postponing non-essential travel. Pregnant women residing in countries with active transmission (sporadic and widespread) should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites.\n\nTravellers with immune disorders or severe chronic illnesses should consult their doctors or seek advice from a travel clinic before travelling, particularly with regard to effective prevention measures.\n\nSimilar protective measures apply to a symptomatic patients in order to prevent human-to-mosquito-to-human transmission.\n\nSexual transmission of Zika virus through semen has been documented, therefore practicing safer sex (including the use of condoms) is recommended throughout pregnancy to protect the foetus.\n\n## References\n1\\. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50.\n\n2\\. Faye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, et al. Molecular Evolution of Zika Virus during Its Emergence in the 20(th) Century. PLoS Negl Trop Dis. 2014;8(1):e2636.\n\n3\\. Musso D, Gubler DJ. Zika Virus. Clin Microbiol Rev. 2016 Jul;29(3):487-524.\n\n4\\. Plourde AR, Bloch EM. A Literature Review of Zika Virus. Emerg Infect Dis. 2016 Jul 15;22(7).\n\n5\\. World Health Organization. WHO statement on the third meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: World Health Organization; 2016. Available from: <http:\/\/www.who.int\/mediacentre\/news\/statements\/2016\/zika-third-ec\/en\/>.\n\n6\\. Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor Ldel C. Phylogeny of Zika Virus in Western Hemisphere, 2015. Emerg Infect Dis. 2016 May;22(5):933-5.\n\n7\\. Faria NR, Azevedo Rdo S, Kraemer MU, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science. 2016 Apr 15;352(6283):345-9.\n\n8\\. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43.","meta_canonical":null}

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Boilerpipe Text	Zika virus disease is a mosquito-borne disease caused by Zika virus. Most infections are either asymptomatic or cause a mild illness with a transient maculopapular rash. The Aedes aegypti mosquito is the main vector but other Aedes species can also transmit the virus. Sexual transmission via semen has been reported recently. Viral circulation and a few outbreaks were documented in tropical Africa and in some areas in south-east Asia. Since 2007, several islands of the Pacific region have experienced outbreaks, and in 2015 outbreaks were reported in the Americas and the Caribbean. Zika virus disease is considered an emerging infectious disease [1-4]. A significant increase of patients with Guillain–Barré syndrome was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. An unusual increase of congenital microcephaly was observed in some regions in north-eastern Brazil in 2015. According to WHO, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome [5]. There is no prophylactic or curative treatment or vaccine to protect against Zika virus infection. Therefore, preventive personal measures are recommended to avoid mosquito bites during the daytime. The pathogen Zika virus disease is caused by a virus from the Flavivirus genus, Flaviviridae family, from the Spondweni group. It was first isolated in 1947 from a monkey in the Zika forest, Uganda, then in mosquitoes ( Aedes africanus ) in the same forest in 1948, and in a human in Nigeria in 1952. There are two Zika virus lineages: the African lineage and the Asian lineage, which has spread recently in the Pacific and the Americas [2,6,7]. Clinical features and sequelae The incubation period likely ranges between three and 12 days after the bite by an infected mosquito. Most of the infections remain asymptomatic (approximately 80%). Disease symptoms are usually mild, and the disease is commonly short-lasting and self-limiting. Its duration is between 2–7 days without severe complications, with no associated fatalities and a low hospitalisation rate. The main symptoms are maculopapular rash (+/-itchy), with or without mild fever, arthralgia, fatigue, non-purulent conjunctivitis/conjunctival hyperaemia, myalgia and headache. The maculopapular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs might be present. Differential diagnostic with dengue and chikungunya fever based on clinical symptoms remains challenging, and co-infection can occur. The other usual differential diagnoses are measles, rubella, parvovirus and enterovirus infections, and malaria. Among women infected during pregnancy, congenital central nervous system malformations of the foetus (such as microcephaly) and foetal losses were notified during several recent Zika disease outbreaks. Unusual increases of Guillain–Barré syndrome incidence, coinciding with the Zika virus outbreaks, were reported in several countries in the Americas and French Polynesia. Epidemiology Serological surveys in Africa and Asia indicate most likely silent Zika virus circulation, with detection of specific antibodies in various animal species (large mammals such as orang-utans, zebras, elephants, water buffaloes) and rodents. The knowledge of the geographical distribution of Zika virus is based on results of serosurveys and viral isolation in mosquitoes and humans, and on reports of travel-associated cases. Before 2007, the areas with reported Zika virus circulation included tropical Africa and south-east Asia. Very few outbreaks were documented prior to a 2007 upsurge on Yap Island, Federated States of Micronesia [8], which was the first outbreak of Zika virus identified outside of Africa and Asia. Between 2013 and 2015, several significant outbreaks were notified on islands and archipelagos in the Pacific region, including a large outbreak in French Polynesia. In 2015, Zika virus emerged in South America, with further spread across the Americas [3,7]. Transmission Zika virus is transmitted by mosquitoes. It has been isolated from Aedes aegypti mosquitoes and experimental infections show that this species is capable of transmitting Zika virus. Other Aedes mosquito species (notably Ae. africanus , Ae. albopictus , Ae. polynesiensis , Ae. unilineatus, Ae. vittatus and Ae. hensilli ) are considered potential vectors of Zika virus. These species bite during the day. Aedes albopictus is experimentally able to transmit Zika virus. Additional modes of transmission have been identified: Materno-foetal transmission can occur most probably by trans-placental transmission and during delivery when the mother is infected. Sexual transmission has been documented in several instances, in one case from a symptomatic male to a woman as late as 5–6 weeks after onset of the man’s symptoms. There is a potential risk of Zika virus transmission through blood transfusion and organ transplantation. More information on Aedes mosquitoes can be found here: Aedes albopictus and Aedes aegypti . Diagnostics Zika virus disease diagnostics is primarily based on the detection of viral RNA from clinical specimens (blood, saliva, urine, cerebrospinal fluid, amniotic fluid, semen, and breast milk). The viraemic period appears to be short, allowing for direct virus detection from blood and saliva, usually during the first 3–5 days after the onset of symptoms (sometimes up to 7–8 days). In several cases, Zika virus RNA has been detected in urine up to 2–3 weeks after onset of symptoms. Virus presence in semen has been documented up to 62 days after symptom onset. Serological investigations can be conducted from day 5 after the onset of disease, by detection of Zika-specific IgM antibodies and confirmation by neutralisation, seroconversion or fourfold antibody titre increase of Zika-specific antibodies in paired serum samples. Eight to 14 days after the onset of symptoms, diagnostic testing of urine with RT-PCR can be considered in addition to Zika virus serology. Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections (e.g. dengue, West Nile, Japanese encephalitis). Case management and treatment There is no specific prophylactic treatment. Differential clinical diagnostic should be considered as well as co-infection with other mosquito-borne diseases such as dengue fever, chikungunya and malaria. The treatment is symptomatic and mainly based on a good hydration, pain relief, and anti-histamines for pruritic rash. Treatment with acetylsalicylic acid and no-steroidal anti-inflammatory drugs is discouraged if the diagnosis of dengue is not excluded because of a potential increased risk of haemorrhagic syndrome. Acetylsalicylic acid is also discouraged because of the risk of Reye's syndrome after viral infection in children and teenagers. Public health control measures No vaccine or prophylactic treatment is available. Integrated vector management aiming to reduce mosquito vector density in a sustainable manner is of primary importance. Intersectoral collaboration and efficient public communication strategies to ensure community participation are required for sustainable vector control programmes. Activities supporting the reduction of mosquito breeding sites in outdoor/indoor areas by draining or discarding sources of standing water at the community level include: removal of all open containers with stagnant water in and surrounding houses on a regular basis (e.g. flower plates and pots, used tyres, tree holes and rock pools), or, if that is not possible, treatment with larvicides), tight coverage of water containers, barrels, wells and water storage tanks, and the wide use of physical barriers that reduce the risk of exposure to mosquitos bites (such as mosquito nets, window/door screens and air conditioning). During an outbreak, elimination of adult mosquitoes through aerial spraying with insecticides can be considered but efficacy seems very limited. In areas where the vector is active, the following is recommended: Symptomatic patients should strictly follow personal protection measures to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission. Asymptomatic individuals returning from an area with Zika virus outbreaks should follow personal protection measures against mosquito bites for three weeks after their return. Infection control, personal protection and prevention Prevention is also based on protection against mosquito bites. Aedes mosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore, personal protection measures should be applied all day, especially during the hours of the highest mosquito activity (mid-morning, late afternoon to twilight). Personal protective measures against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), sleeping or resting in screened or air-conditioned rooms, the wearing of clothes that cover most of the body, and the use of mosquito repellent in accordance with the instructions indicated on the product label. Pregnant women and women who are planning to become pregnant and planning to travel to areas with widespread transmission should postpone non-essential travel. Those who are planning to travel to areas with sporadic transmission should consult their physician or a travel clinic and consider postponing non-essential travel. Pregnant women residing in countries with active transmission (sporadic and widespread) should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites. Travellers with immune disorders or severe chronic illnesses should consult their doctors or seek advice from a travel clinic before travelling, particularly with regard to effective prevention measures. Similar protective measures apply to a symptomatic patients in order to prevent human-to-mosquito-to-human transmission. Sexual transmission of Zika virus through semen has been documented, therefore practicing safer sex (including the use of condoms) is recommended throughout pregnancy to protect the foetus. References 1. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50. 2. Faye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, et al. Molecular Evolution of Zika Virus during Its Emergence in the 20(th) Century. PLoS Negl Trop Dis. 2014;8(1):e2636. 3. Musso D, Gubler DJ. Zika Virus. Clin Microbiol Rev. 2016 Jul;29(3):487-524. 4. Plourde AR, Bloch EM. A Literature Review of Zika Virus. Emerg Infect Dis. 2016 Jul 15;22(7). 5. World Health Organization. WHO statement on the third meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: World Health Organization; 2016. Available from: http://www.who.int/mediacentre/news/statements/2016/zika-third-ec/en/ . 6. Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor Ldel C. Phylogeny of Zika Virus in Western Hemisphere, 2015. Emerg Infect Dis. 2016 May;22(5):933-5. 7. Faria NR, Azevedo Rdo S, Kraemer MU, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science. 2016 Apr 15;352(6283):345-9. 8. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43.
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Facts [Disease information](https://www.ecdc.europa.eu/en/infectious-disease-topics/zika-virus-infection/disease-information-zika-virus-infection) - [Facts](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet "Most Zika infections result in a mild illness or are asymptomatic, but there is a scientific consensus that the Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome.") - [The pathogen](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#the-pathogen) - [Clinical features and sequelae](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#clinical-features-and-sequelae) - [Epidemiology](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#epidemiology) - [Transmission](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#transmission) - [Diagnostics](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#diagnostics) - [Case management and treatment](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#case-management-and-treatment) - [Public health control measures](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#public-health-control-measures) - [Infection control, personal protection and prevention](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#infection-control,-personal-protection-and-prevention) - [References](https://www.ecdc.europa.eu/en/zika-virus-infection/facts/factsheet#references) - [Case definition](https://www.ecdc.europa.eu/en/zika-virus-infection/surveillance-and-disease-data/case-definition "An interim case definition for surveillance of Zika virus infection has been discussed with the Health Security Committee during its meeting on 17 March 2016.") # Factsheet about Zika virus disease Factsheet Zika virus is a member of the Flaviviridae family and is transmitted to humans by mosquitoes. It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans. Since 2007 Zika virus has caused several outbreaks in the Pacific, and since 2015 it further spread in the Americas. These were the first documented transmissions outside of its traditional endemic areas in Africa and Asia. Zika virus is considered an emerging infectious disease with the potential to spread to new areas where the Aedes mosquito vector is present. There is no evidence of transmission Zika virus in Europe to date. Zika virus disease is a mosquito-borne disease caused by Zika virus. Most infections are either asymptomatic or cause a mild illness with a transient maculopapular rash. The Aedes aegypti mosquito is the main vector but other Aedes species can also transmit the virus. Sexual transmission via semen has been reported recently. Viral circulation and a few outbreaks were documented in tropical Africa and in some areas in south-east Asia. Since 2007, several islands of the Pacific region have experienced outbreaks, and in 2015 outbreaks were reported in the Americas and the Caribbean. Zika virus disease is considered an emerging infectious disease \[1-4\]. A significant increase of patients with Guillain–Barré syndrome was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. An unusual increase of congenital microcephaly was observed in some regions in north-eastern Brazil in 2015. According to WHO, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome \[5\]. There is no prophylactic or curative treatment or vaccine to protect against Zika virus infection. Therefore, preventive personal measures are recommended to avoid mosquito bites during the daytime. ## The pathogen Zika virus disease is caused by a virus from the Flavivirus genus, Flaviviridae family, from the Spondweni group. It was first isolated in 1947 from a monkey in the Zika forest, Uganda, then in mosquitoes (Aedes africanus) in the same forest in 1948, and in a human in Nigeria in 1952. There are two Zika virus lineages: the African lineage and the Asian lineage, which has spread recently in the Pacific and the Americas \[2,6,7\]. ## Clinical features and sequelae The incubation period likely ranges between three and 12 days after the bite by an infected mosquito. Most of the infections remain asymptomatic (approximately 80%). Disease symptoms are usually mild, and the disease is commonly short-lasting and self-limiting. Its duration is between 2–7 days without severe complications, with no associated fatalities and a low hospitalisation rate. The main symptoms are maculopapular rash (+/-itchy), with or without mild fever, arthralgia, fatigue, non-purulent conjunctivitis/conjunctival hyperaemia, myalgia and headache. The maculopapular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs might be present. Differential diagnostic with dengue and chikungunya fever based on clinical symptoms remains challenging, and co-infection can occur. The other usual differential diagnoses are measles, rubella, parvovirus and enterovirus infections, and malaria. Among women infected during pregnancy, congenital central nervous system malformations of the foetus (such as microcephaly) and foetal losses were notified during several recent Zika disease outbreaks. Unusual increases of Guillain–Barré syndrome incidence, coinciding with the Zika virus outbreaks, were reported in several countries in the Americas and French Polynesia. ## Epidemiology Serological surveys in Africa and Asia indicate most likely silent Zika virus circulation, with detection of specific antibodies in various animal species (large mammals such as orang-utans, zebras, elephants, water buffaloes) and rodents. The knowledge of the geographical distribution of Zika virus is based on results of serosurveys and viral isolation in mosquitoes and humans, and on reports of travel-associated cases. Before 2007, the areas with reported Zika virus circulation included tropical Africa and south-east Asia. Very few outbreaks were documented prior to a 2007 upsurge on Yap Island, Federated States of Micronesia \[8\], which was the first outbreak of Zika virus identified outside of Africa and Asia. Between 2013 and 2015, several significant outbreaks were notified on islands and archipelagos in the Pacific region, including a large outbreak in French Polynesia. In 2015, Zika virus emerged in South America, with further spread across the Americas \[3,7\]. ## Transmission Zika virus is transmitted by mosquitoes. It has been isolated from Aedes aegypti mosquitoes and experimental infections show that this species is capable of transmitting Zika virus. Other Aedes mosquito species (notably Ae. africanus, Ae. albopictus, Ae. polynesiensis, Ae. unilineatus, Ae. vittatus and Ae. hensilli) are considered potential vectors of Zika virus. These species bite during the day. Aedes albopictus is experimentally able to transmit Zika virus. Additional modes of transmission have been identified: - Materno-foetal transmission can occur most probably by trans-placental transmission and during delivery when the mother is infected. - Sexual transmission has been documented in several instances, in one case from a symptomatic male to a woman as late as 5–6 weeks after onset of the man’s symptoms. - There is a potential risk of Zika virus transmission through blood transfusion and organ transplantation. More information on Aedes mosquitoes can be found here: [Aedes albopictus](https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-albopictus "Aedes albopictus - Factsheet for experts") and [Aedes aegypti](https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-aegypti "Aedes aegypti - Factsheet for experts"). ## Diagnostics Zika virus disease diagnostics is primarily based on the detection of viral RNA from clinical specimens (blood, saliva, urine, cerebrospinal fluid, amniotic fluid, semen, and breast milk). The viraemic period appears to be short, allowing for direct virus detection from blood and saliva, usually during the first 3–5 days after the onset of symptoms (sometimes up to 7–8 days). In several cases, Zika virus RNA has been detected in urine up to 2–3 weeks after onset of symptoms. Virus presence in semen has been documented up to 62 days after symptom onset. Serological investigations can be conducted from day 5 after the onset of disease, by detection of Zika-specific IgM antibodies and confirmation by neutralisation, seroconversion or fourfold antibody titre increase of Zika-specific antibodies in paired serum samples. Eight to 14 days after the onset of symptoms, diagnostic testing of urine with RT-PCR can be considered in addition to Zika virus serology. Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections (e.g. dengue, West Nile, Japanese encephalitis). ## Case management and treatment There is no specific prophylactic treatment. Differential clinical diagnostic should be considered as well as co-infection with other mosquito-borne diseases such as dengue fever, chikungunya and malaria. The treatment is symptomatic and mainly based on a good hydration, pain relief, and anti-histamines for pruritic rash. Treatment with acetylsalicylic acid and no-steroidal anti-inflammatory drugs is discouraged if the diagnosis of dengue is not excluded because of a potential increased risk of haemorrhagic syndrome. Acetylsalicylic acid is also discouraged because of the risk of Reye's syndrome after viral infection in children and teenagers. ## Public health control measures No vaccine or prophylactic treatment is available. Integrated vector management aiming to reduce mosquito vector density in a sustainable manner is of primary importance. Intersectoral collaboration and efficient public communication strategies to ensure community participation are required for sustainable vector control programmes. Activities supporting the reduction of mosquito breeding sites in outdoor/indoor areas by draining or discarding sources of standing water at the community level include: - removal of all open containers with stagnant water in and surrounding houses on a regular basis (e.g. flower plates and pots, used tyres, tree holes and rock pools), or, if that is not possible, treatment with larvicides), - tight coverage of water containers, barrels, wells and water storage tanks, and the - wide use of physical barriers that reduce the risk of exposure to mosquitos bites (such as mosquito nets, window/door screens and air conditioning). During an outbreak, elimination of adult mosquitoes through aerial spraying with insecticides can be considered but efficacy seems very limited. In areas where the vector is active, the following is recommended: - Symptomatic patients should strictly follow personal protection measures to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission. - Asymptomatic individuals returning from an area with Zika virus outbreaks should follow personal protection measures against mosquito bites for three weeks after their return. ## Infection control, personal protection and prevention Prevention is also based on protection against mosquito bites. Aedes mosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore, personal protection measures should be applied all day, especially during the hours of the highest mosquito activity (mid-morning, late afternoon to twilight). Personal protective measures against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), sleeping or resting in screened or air-conditioned rooms, the wearing of clothes that cover most of the body, and the use of mosquito repellent in accordance with the instructions indicated on the product label. Pregnant women and women who are planning to become pregnant and planning to travel to areas with widespread transmission should postpone non-essential travel. Those who are planning to travel to areas with sporadic transmission should consult their physician or a travel clinic and consider postponing non-essential travel. Pregnant women residing in countries with active transmission (sporadic and widespread) should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites. Travellers with immune disorders or severe chronic illnesses should consult their doctors or seek advice from a travel clinic before travelling, particularly with regard to effective prevention measures. Similar protective measures apply to a symptomatic patients in order to prevent human-to-mosquito-to-human transmission. Sexual transmission of Zika virus through semen has been documented, therefore practicing safer sex (including the use of condoms) is recommended throughout pregnancy to protect the foetus. ## References 1\. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50. 2. Faye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, et al. Molecular Evolution of Zika Virus during Its Emergence in the 20(th) Century. PLoS Negl Trop Dis. 2014;8(1):e2636. 3. Musso D, Gubler DJ. Zika Virus. Clin Microbiol Rev. 2016 Jul;29(3):487-524. 4. Plourde AR, Bloch EM. A Literature Review of Zika Virus. Emerg Infect Dis. 2016 Jul 15;22(7). 5. World Health Organization. WHO statement on the third meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: World Health Organization; 2016. Available from: [http://www.who.int/mediacentre/news/statements/2016/zika-third-ec/en/](http://www.who.int/mediacentre/news/statements/2016/zika-third-ec/en/ "(opens in a new window)"). 6. Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor Ldel C. Phylogeny of Zika Virus in Western Hemisphere, 2015. Emerg Infect Dis. 2016 May;22(5):933-5. 7. Faria NR, Azevedo Rdo S, Kraemer MU, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science. 2016 Apr 15;352(6283):345-9. 8. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43. Disclaimer: The information contained in this factsheet is intended for the purpose of general information and should not substitute individual expert advice and judgement of healthcare professionals. 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Readable Markdown	Zika virus disease is a mosquito-borne disease caused by Zika virus. Most infections are either asymptomatic or cause a mild illness with a transient maculopapular rash. The Aedes aegypti mosquito is the main vector but other Aedes species can also transmit the virus. Sexual transmission via semen has been reported recently. Viral circulation and a few outbreaks were documented in tropical Africa and in some areas in south-east Asia. Since 2007, several islands of the Pacific region have experienced outbreaks, and in 2015 outbreaks were reported in the Americas and the Caribbean. Zika virus disease is considered an emerging infectious disease \[1-4\]. A significant increase of patients with Guillain–Barré syndrome was reported during the 2014 outbreak in French Polynesia and the Americas since 2015. An unusual increase of congenital microcephaly was observed in some regions in north-eastern Brazil in 2015. According to WHO, there is scientific consensus that Zika virus is a cause of microcephaly, congenital nervous system malformations and Guillain-Barré syndrome \[5\]. There is no prophylactic or curative treatment or vaccine to protect against Zika virus infection. Therefore, preventive personal measures are recommended to avoid mosquito bites during the daytime. ## The pathogen Zika virus disease is caused by a virus from the Flavivirus genus, Flaviviridae family, from the Spondweni group. It was first isolated in 1947 from a monkey in the Zika forest, Uganda, then in mosquitoes (Aedes africanus) in the same forest in 1948, and in a human in Nigeria in 1952. There are two Zika virus lineages: the African lineage and the Asian lineage, which has spread recently in the Pacific and the Americas \[2,6,7\]. ## Clinical features and sequelae The incubation period likely ranges between three and 12 days after the bite by an infected mosquito. Most of the infections remain asymptomatic (approximately 80%). Disease symptoms are usually mild, and the disease is commonly short-lasting and self-limiting. Its duration is between 2–7 days without severe complications, with no associated fatalities and a low hospitalisation rate. The main symptoms are maculopapular rash (+/-itchy), with or without mild fever, arthralgia, fatigue, non-purulent conjunctivitis/conjunctival hyperaemia, myalgia and headache. The maculopapular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs might be present. Differential diagnostic with dengue and chikungunya fever based on clinical symptoms remains challenging, and co-infection can occur. The other usual differential diagnoses are measles, rubella, parvovirus and enterovirus infections, and malaria. Among women infected during pregnancy, congenital central nervous system malformations of the foetus (such as microcephaly) and foetal losses were notified during several recent Zika disease outbreaks. Unusual increases of Guillain–Barré syndrome incidence, coinciding with the Zika virus outbreaks, were reported in several countries in the Americas and French Polynesia. ## Epidemiology Serological surveys in Africa and Asia indicate most likely silent Zika virus circulation, with detection of specific antibodies in various animal species (large mammals such as orang-utans, zebras, elephants, water buffaloes) and rodents. The knowledge of the geographical distribution of Zika virus is based on results of serosurveys and viral isolation in mosquitoes and humans, and on reports of travel-associated cases. Before 2007, the areas with reported Zika virus circulation included tropical Africa and south-east Asia. Very few outbreaks were documented prior to a 2007 upsurge on Yap Island, Federated States of Micronesia \[8\], which was the first outbreak of Zika virus identified outside of Africa and Asia. Between 2013 and 2015, several significant outbreaks were notified on islands and archipelagos in the Pacific region, including a large outbreak in French Polynesia. In 2015, Zika virus emerged in South America, with further spread across the Americas \[3,7\]. ## Transmission Zika virus is transmitted by mosquitoes. It has been isolated from Aedes aegypti mosquitoes and experimental infections show that this species is capable of transmitting Zika virus. Other Aedes mosquito species (notably Ae. africanus, Ae. albopictus, Ae. polynesiensis, Ae. unilineatus, Ae. vittatus and Ae. hensilli) are considered potential vectors of Zika virus. These species bite during the day. Aedes albopictus is experimentally able to transmit Zika virus. Additional modes of transmission have been identified: - Materno-foetal transmission can occur most probably by trans-placental transmission and during delivery when the mother is infected. - Sexual transmission has been documented in several instances, in one case from a symptomatic male to a woman as late as 5–6 weeks after onset of the man’s symptoms. - There is a potential risk of Zika virus transmission through blood transfusion and organ transplantation. More information on Aedes mosquitoes can be found here: [Aedes albopictus](https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-albopictus "Aedes albopictus - Factsheet for experts") and [Aedes aegypti](https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-aegypti "Aedes aegypti - Factsheet for experts"). ## Diagnostics Zika virus disease diagnostics is primarily based on the detection of viral RNA from clinical specimens (blood, saliva, urine, cerebrospinal fluid, amniotic fluid, semen, and breast milk). The viraemic period appears to be short, allowing for direct virus detection from blood and saliva, usually during the first 3–5 days after the onset of symptoms (sometimes up to 7–8 days). In several cases, Zika virus RNA has been detected in urine up to 2–3 weeks after onset of symptoms. Virus presence in semen has been documented up to 62 days after symptom onset. Serological investigations can be conducted from day 5 after the onset of disease, by detection of Zika-specific IgM antibodies and confirmation by neutralisation, seroconversion or fourfold antibody titre increase of Zika-specific antibodies in paired serum samples. Eight to 14 days after the onset of symptoms, diagnostic testing of urine with RT-PCR can be considered in addition to Zika virus serology. Serological results should be interpreted according to the vaccination status and previous exposure to other flaviviral infections (e.g. dengue, West Nile, Japanese encephalitis). ## Case management and treatment There is no specific prophylactic treatment. Differential clinical diagnostic should be considered as well as co-infection with other mosquito-borne diseases such as dengue fever, chikungunya and malaria. The treatment is symptomatic and mainly based on a good hydration, pain relief, and anti-histamines for pruritic rash. Treatment with acetylsalicylic acid and no-steroidal anti-inflammatory drugs is discouraged if the diagnosis of dengue is not excluded because of a potential increased risk of haemorrhagic syndrome. Acetylsalicylic acid is also discouraged because of the risk of Reye's syndrome after viral infection in children and teenagers. ## Public health control measures No vaccine or prophylactic treatment is available. Integrated vector management aiming to reduce mosquito vector density in a sustainable manner is of primary importance. Intersectoral collaboration and efficient public communication strategies to ensure community participation are required for sustainable vector control programmes. Activities supporting the reduction of mosquito breeding sites in outdoor/indoor areas by draining or discarding sources of standing water at the community level include: - removal of all open containers with stagnant water in and surrounding houses on a regular basis (e.g. flower plates and pots, used tyres, tree holes and rock pools), or, if that is not possible, treatment with larvicides), - tight coverage of water containers, barrels, wells and water storage tanks, and the - wide use of physical barriers that reduce the risk of exposure to mosquitos bites (such as mosquito nets, window/door screens and air conditioning). During an outbreak, elimination of adult mosquitoes through aerial spraying with insecticides can be considered but efficacy seems very limited. In areas where the vector is active, the following is recommended: - Symptomatic patients should strictly follow personal protection measures to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission. - Asymptomatic individuals returning from an area with Zika virus outbreaks should follow personal protection measures against mosquito bites for three weeks after their return. ## Infection control, personal protection and prevention Prevention is also based on protection against mosquito bites. Aedes mosquitoes have diurnal biting activities in both indoor and outdoor environments. Therefore, personal protection measures should be applied all day, especially during the hours of the highest mosquito activity (mid-morning, late afternoon to twilight). Personal protective measures against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), sleeping or resting in screened or air-conditioned rooms, the wearing of clothes that cover most of the body, and the use of mosquito repellent in accordance with the instructions indicated on the product label. Pregnant women and women who are planning to become pregnant and planning to travel to areas with widespread transmission should postpone non-essential travel. Those who are planning to travel to areas with sporadic transmission should consult their physician or a travel clinic and consider postponing non-essential travel. Pregnant women residing in countries with active transmission (sporadic and widespread) should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites. Travellers with immune disorders or severe chronic illnesses should consult their doctors or seek advice from a travel clinic before travelling, particularly with regard to effective prevention measures. Similar protective measures apply to a symptomatic patients in order to prevent human-to-mosquito-to-human transmission. Sexual transmission of Zika virus through semen has been documented, therefore practicing safer sex (including the use of condoms) is recommended throughout pregnancy to protect the foetus. ## References 1\. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50. 2\. Faye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, et al. Molecular Evolution of Zika Virus during Its Emergence in the 20(th) Century. PLoS Negl Trop Dis. 2014;8(1):e2636. 3\. Musso D, Gubler DJ. Zika Virus. Clin Microbiol Rev. 2016 Jul;29(3):487-524. 4\. Plourde AR, Bloch EM. A Literature Review of Zika Virus. Emerg Infect Dis. 2016 Jul 15;22(7). 5\. World Health Organization. WHO statement on the third meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: World Health Organization; 2016. Available from: <http://www.who.int/mediacentre/news/statements/2016/zika-third-ec/en/>. 6\. Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor Ldel C. Phylogeny of Zika Virus in Western Hemisphere, 2015. Emerg Infect Dis. 2016 May;22(5):933-5. 7\. Faria NR, Azevedo Rdo S, Kraemer MU, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science. 2016 Apr 15;352(6283):345-9. 8\. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43.
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