Zika virus: Mumbai doctors reveal insights about the mosquito-borne virus

The number of Zika virus cases is on the rise in India, as Maharashtra reports eight cases, out of which six are in Pune, in the last 15 days, with the newest two being pregnant women in Erandwane. Taking note of the situation, the Union Health Ministry has issued an advisory to states to maintain a constant state of vigilance through screening of pregnant women for Zika virus infection and monitoring the growth of the foetus of expecting mothers who have tested positive, according to an ANI report.

The report further states that the health facilities and hospitals have been assigned a nodal officer to monitor and act to keep the premises Aedes mosquito-free. Additionally, states have been instructed to strengthen their entomological surveillance and intensify their vector control activities in residential areas, workplaces, schools, construction sites, institutions and health facilities.

With the growing number of cases, mid-day.com spoke to Mumbai health experts Dr. Leepika Parulekar, MBBS, MD, General Medicine, Holy Family Hospital in Bandra and Dr Mala Kaneria, consultant, Infectious Diseases - Jaslok Hospital & Research Centre in Tardeo to dissect the virus to know the causes, effects and treatment. They not only share why it is important to take the virus seriously but also why people need to be careful.

What is Zika virus and how does it affect people?
Parulekar: Zika virus (or Zika fever) is a disease you get from the bite of specific kinds of mosquitoes (Aedes aegypti and Aedes albopictus). A mosquito becomes infected when it bites a person already infected with Zika. That mosquito can then spread the virus by biting more people.

It is prompted by a virus, an organism that utilises your cells to make more duplicates of itself. Many people don't realise they have it or have extremely mild symptoms. If an individual who is pregnant gets infected, the virus can keep the foetus's brain from growing normally. These mosquitoes bite throughout the day and night. The virus can also be sexually transmitted.

Kaneria: Zika virus is a mosquito-borne virus, that is carried by a vector, the Aedes aegypti mosquito (which also transmits dengue and chikungunya). This virus is transmitted to the individual when bitten by the Aedes aegypti mosquito, which bites mainly in the daytime.

Maharashtra has reported 8 Zika virus cases already. How quickly does the virus spread and why should people worry about it?
Parulekar: In light of the rising number of Zika virus cases in Maharashtra, the central government issued an advisory on July 3. All states have been told to keep up with consistent cautiousness over the circumstance in the nation, focusing on screening pregnant women for the Zika virus and checking the development of foetuses in expecting mothers who test positive for the disease.

Zika outbreaks are currently happening in many countries.

Kaneria: This virus is like other vector-borne viruses such as dengue and chikungunya virus, which are transmitted by a mosquito bite. Zika virus does not spread from person to person either directly or indirectly (through objects or secretions/body fluids).

Which age group/group of people are most vulnerable to the virus and why?
Parulekar: Pregnant women and foetus are at a higher risk of complications.

How does Zika spread:
1. During sex with a person who has Zika his or her sex partners.
2. From a pregnant woman to her foetus during pregnancy or around the time of birth.
3. Through blood transfusion.

Kaneria: This virus can affect people of any age group who are exposed to mosquito bites.

Why is the disease particularly bad for pregnant women?
Parulekar: Zika infection during pregnancy can cause foetuses to have a birth defect of the brain called microcephaly. Other problems have been detected among foetuses and infants infected with Zika virus before birth, such as defects of the eye, hearing deficits, and impaired growth.

There have also been increased reports of Guillain-Barré syndrome, an uncommon sickness of the nervous system, in areas affected by Zika.

Kaneria: After being bitten by a mosquito (which is carrying the virus), the individual develops symptoms such as fever, malaise, body ache, joint pains, rash, and conjunctivitis after 3-14 days. These symptoms are usually mild, and it is even possible that the person may be asymptomatic, even though there is a laboratory confirmation of the infection. An uneventful recovery occurs in 4-7 days usually.

Though most of the affected individuals recover uneventfully, pregnant women may suffer adverse outcomes related to the foetus. Zika infection during pregnancy can give rise to transmission of the virus to the foetus through the placenta, leading to microcephaly in the foetus (which means a smaller size head of the foetus compared to the body) and other congenital abnormalities.

Since symptoms related to Zika are usually mild and self-limiting, the patient should visit a doctor if the high fever does not resolve, as there may be coinfections.

However, any pregnant woman who tests positive for Zika, should visit the doctor even if asymptomatic because of the adverse effects on the baby.

What symptoms do people with the virus present upon being infected by it? When should one approach the doctor?
Parulekar: Many people infected with Zika won't have symptoms or will only have mild symptoms. The most common symptoms are fever, rash, joint pain, or red eyes. Other common symptoms include muscle pain and headache. Symptoms can last for several days to a week. People usually don't get sick enough to go to the hospital, and they very rarely die of Zika. Once a person has been infected with Zika, they are likely to be protected from future infections.

Kaneria: Usually, the symptoms are mild, and patients make a complete recovery in a week. Pregnant women may have adverse foetal outcomes like microcephaly.

Sometimes, both adults and children may suffer from Guillain-Barre syndrome and other neurological complications after recovery from Zika.

What are the short-term effects and long-term effects of the virus?
Parulekar: According to some studies, sexual contact can spread Zika for up to six weeks after the start of symptoms. The Center for Disease Control and Prevention (CDC) recommends using condoms while having sex or not having sex for three months after travelling to an area where Zika is common, because you can have the virus without experiencing any major symptoms.

What is the treatment for Zika virus for common individuals and pregnant women respectively?
Parulekar: There is no specific medicine to treat Zika. Involve your doctor in the treatment of Zika infection.

Treat the symptoms:
1. By getting plenty of rest.
2. Drink fluids to prevent dehydration. Nutritious home-cooked meals which include seasonal fruits and vegetables.
3. Take medicine such as acetaminophen to reduce fever and pain.
4. Do not take aspirin or other non-steroidal anti-inflammatory drugs.
5If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication. To help prevent others from getting sick, strictly follow steps to prevent mosquito bites during the first week of illness.
5. Protect yourself from mosquito bites during the day as well as night, whether you are inside or outside.

Kaneria: There is no specific anti-viral medicine to treat Zika virus infection and symptomatic treatment should be administered (fever-reducing medicines, plenty of oral liquids, pain killers).

Pregnant women should be screened regularly by doing sonography, to detect microcephaly at the earliest.

What are the common misconceptions about the Zika virus?
Kaneria: A common myth about the Zika virus is that it can be transmitted from person to person, which is untrue.

What are the foods that people who are infected by the Zika virus can eat to help cure them?
Kaneria: There are no specific foods that help cure Zika. A light, nutritious meal should be had during the infection.

What are the general precautions that people can take to avoid getting infected by Zika virus?
Parulekar: The CDC recommends that all residents of and visitors to areas where Zika virus is spreading take the following steps to prevent mosquito bites:
1. Cover exposed skin by wearing long-sleeved shirts and long pants.
2. Use insect repellents that are registered with the Environmental Protection Agency (EPA) and contain DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, or IR3535.
3. Use permethrin-treated clothing and gear (boots, pants, socks, tents).
4. Stay and sleep in screened-in or air-conditioned rooms.
5. Sleep under a mosquito bed net if air-conditioned or screened rooms are not available or if sleeping outdoors.
6. Mosquito netting can be used to cover babies younger than 2 months in carriers, strollers, or cribs to protect them from mosquito bites.
7. Prevention of sexual transmission.
8. The CDC recommends the following for the prevention of sexual transmission of Zika virus
9. Pregnant individuals with male sex partners who live in or have travelled to an area with active Zika virus transmission should use barriers against infection during sex or abstain from sex for the duration of the pregnancy.

For couples
Couples planning to conceive in which a partner has confirmed Zika virus infection or clinical illness consistent with Zika virus disease or travels to an area with risk for Zika virus transmission should consider using barrier methods against infection or abstain from sex, as follows:
1. Men with Zika virus infection/travel, for at least 3 months after the onset of illness (symptomatic) or last possible exposure (asymptomatic or travel)
2. Women with Zika virus infection/travel, for at least 2 months after onset of illness or last possible exposure (asymptomatic or travel)
3. Both partners with Zika virus infection/travel, for at least 3 months after the onset of illness in the male partner (symptomatic) or last possible exposure (asymptomatic or travel)
4. Couples planning to conceive who travel to an area with risk for Zika virus transmission should Discuss with a healthcare provider on risks and possible health effects of Zika on the baby and protection strategies from Zika virus.

Kaneria: Since Zika is transmitted by Aedes aegypti, the same mosquito that also transmits dengue and chikungunya, avoiding the accumulation of stagnant water, preventing mosquito bites by wearing full-sleeved clothes, using mosquito repellents and mosquito nets are important preventive measures.

Pregnant women should visit a doctor if they test positive for Zika, even if asymptomatic.

Zika virus is present in the semen of affected males for many weeks and can be transmitted to the sexual partner. Hence, contraceptive measures should be used for a few weeks to months after infection.

How is Zika virus different from all other mosquito-related diseases?
Kaneria: Zika virus disease is different from all other mosquito-related infections as the symptoms are usually mild with complete recovery and no long-lasting consequences except in pregnant women. It is probably the only mosquito-borne infection that can be transmitted sexually.