Approach

Treatment for symptomatic infection is generally supportive as there is no specific antiviral treatment available. Because of similar geographical distribution and symptoms, patients with suspected Zika virus infections should also be evaluated and managed for possible dengue or chikungunya virus infection. It is also important to rule out other serious, but potentially treatable, infections (e.g., malaria, leptospirosis, yellow fever, West Nile virus).

Advice for women possibly exposed to Zika virus infection during pregnancy, or for possibly affected infants, is evolving but generally includes serological testing where warranted, plus antenatal and postnatal monitoring.

Physicians in areas where there is local transmission should consult with local health authorities for up-to-date guidance.

Supportive therapies for symptomatic patients

These include rest, fluids, and use of analgesics and/or antipyretics (e.g., paracetamol). Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue virus infection can be ruled out to reduce the risk of haemorrhage. Calamine lotion may be used for the itch associated with the rash.

The same general advice is given for symptoms in pregnant and non-pregnant women. Non-drug measures may be recommended (e.g., damp cloths, lukewarm baths/showers) to reduce fever during pregnancy. However, if these measures fail, paracetamol can be used safely in pregnant women.

Infection prevention and control

In order to prevent transmission of infection, contact between an infected person and mosquitoes should be avoided. Mosquito bite prevention strategies should be instituted, particularly during the first week of infection. [14] Healthcare workers caring for patients should protect themselves from mosquito bites by using repellents and wearing long sleeves and long trousers.

Standard precautions (e.g., hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe injection practices, safe handling of potentially contaminated equipment or surfaces) are recommended for the protection of healthcare professionals and patients in healthcare settings and labour and delivery settings. These precautions are recommended regardless of whether the infection is suspected or confirmed. [145]

Pregnant women with possible mosquito-borne or sexual exposure

Pregnant women who may have been exposed to Zika virus should have recommended laboratory testing and regular fetal ultrasounds to assess the fetus for the presence of microcephaly or other abnormalities. All pregnant women should be encouraged to attend scheduled antenatal visits. [14] Appropriate psychological support for the woman and her family is recommended. [192]

CDC: updated interim guidance for health care providers caring for pregnant women with possible Zika virus exposure - United States (including US territories), July 2017

Congenital Zika syndrome

There is no specific treatment, and management will depend on the individual and the presence of specific symptoms and neurodevelopmental problems (e.g., seizures, intellectual disability, cerebral palsy, hearing/vision problems). Supportive therapies should be started. Children should start rehabilitation as soon as possible. This rehabilitation process must include multidisciplinary support with a physiotherapist, speech therapist, and occupational therapist. A co-ordinated approach, with ongoing psychosocial support for families and caregivers, is recommended. [2] [177]

The Centers for Disease Control and Prevention (CDC) has produced detailed guidance for the initial evaluation and outpatient management of infants with possible congenital Zika virus infection during the first 12 months of life.

CDC: interim guidance for the diagnosis, evaluation and management of infants with possible congenital Zika virus infection

The WHO also offers specific guidance for the screening, assessment, and management of neonates and infants with congenital Zika infection.

WHO: screening, assessment and management of neonates and infants with complications associated with Zika virus exposure in utero

Breastfeeding is still recommended, even in areas where a Zika virus infection outbreak is occurring as transmission through breast milk is only a theoretical concern at this point and the benefits of breastfeeding outweigh the risk of transmission. [193] [194] [195] [88]

Guillain-Barre syndrome

There are few data on the treatment of Guillain-Barre syndrome (GBS) in the context of Zika virus infection.

All patients should be admitted to hospital and monitored closely for at least 5 days or until clinically stable. Some patients may require a higher level of care in the ICU (e.g., patients with rapid progression of motor weakness, respiratory distress, bulbar symptoms, or autonomic dysfunction). Patients should be monitored closely for complications. [149]

Management should be based on symptoms according to usual treatment protocols for GBS and involves supportive therapy (e.g., airway management, cardiovascular management, pain management, plasma exchange, intravenous immunoglobulin, rehabilitation, deep vein thrombosis prophylaxis, nutritional support, bowel and bladder care, prevention of bed sores, prevention of corneal ulceration if facial weakness present) as well as psychosocial support and early initiation of a rehabilitation programme. [149] [151]

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