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Monday, 8 February 2016

ZiKa Virus questions yet to be solved

ZiKa Virus questions  yet to be solved

By authors
 Rupak Bhattacharya1, Pranab Kumar Bhattacharya2, Upasana Bhattacharya3,Ritwick Bhattacharya4, Rupsa Bhattacharya5, AyisheeMukherjee5, Dalia Mukherjee5, Hindole Banerjee5  Debasis Mukherjee 5

1     BSc (Calcutta University.), MSc(Jadavpur University.) of Residence -7/51 Purbapalli, Po-Sodepur, Dist- 24 Parganas (north), Kolkata-110, West Bengal, India, Theoretical Physicist.  No Institutional attachment present

2     MBBS (Calcutta Univ.) Honours , M.D (Calcutta Univ.), FIC Path (India), Professor of Pathology, Calcutta School of Tropical Medicine, Kolkata-700073, West Bengal, India; ----now as  Professor of Pathology at Murshidabad District Medical College, Berhampore,  station Road , Murshidabad, West Bengal, India, Member of Board of Studies(UG/PG) of West Bengal University of Health Sciences, DD 36 Salt lake,  sector -1, Kolkata-64

3      Student and only daughter of Prof. Pranab kumar Bhattacharya

4 (Calcutta Univ.), of Residence 7/51 Purbapalli, PO-Sodepur, Dist 24 Parganas (north), Kolkata-110, West Bengal, India

5Residence 7/51 Purbapalli, Po-Sodepur, Dist 24 Parganas (north), Kolkata-110, West Bengal, India

E-mial  address (P. K. Bhattacharya)   mobile +91 9231510435 )   mobile +91 9231510435
This article has been published in British Medical journal As Rapid Response  under Title " Time for Global Action  on Zika Virus Epidemic : Zika Virus questions yet to be Solved" BMJ 2016; 352 Published on 11th Feb 2016  Cite this  as BMJ 2016; 352:i781//rr-0 

 Zika Virus is a flavi virus, RNA virus like other RNA virus related with Yellow fever, chikengunya( an alpha virus) Dengue, West Nile, Japanese encephalitis. Zika virus originated first in Zika forest of Uganda, Africa, and it was first discovered in 1947 in rhesus monkey of zika forest. It was subsequently identified in human in 1952 in Uganda and in Tanzania. Sporadic zika virus was then reported in Africa and in southern Asia. In 2007 Zika pandemic occurred in western pacific the America & Africa, Cape verde , West Africa in 2013[1] . From  September 2015 to  February 2016  Zika pandemic  involved more than 4000 people infected in Brazil, French Polnenesia documented a concomitants epedimeic of 73 cases of GB syndrome and other multiple conditions  in population approximately 2,70,000 which may represent complication of Zika[1]  Two cases also confirmed  in Australia  and one in Ireland ( A man and an aged woman of 70 years) who have recovered  and both cases had history of travelling in Zika Virus infected areas. Outbreak is likely  to spread to new countries. Zika now circulated the globe

Zika virus particles are 40nm in diameter with outer envelop and inner dense core.

The vector of Zika Virus is ades mosquitoes. Most Zika spreads through ades Aegypti, those do survive in cooler temperate environment and ades Albopictus which can also survive and hibernate in cooler temperature. In Africa Zika spread by ades Africans. These mosquitoes have a day bite or late evening hours bite habits. The vector for Chikungunya and Dengue (DNV) are also carried by ades Aegypti or in India by  ades Albopictus. Ades Mosquitoes breed on fresh water and household container storage water and in garbage bags

Incubation period for Zika Virus diseases is not very well known. So Zika Virus occur in Tropical areas where large mosquitoes population and thus circulate in Africa, America, South Asian and Western pacific Countries.

 In 2014 December Brazil first reported Zika virus and more than 4000 people then infected.  Now pandemic of Zika occurred through out South America, Central Africa and Caribbean sea [1]. The infection spreaded in at least 20 countries in America due to free air travelers, travelers from Brazil or where pandemic nature spread occurred like in Europe.  Asia can spread the virus. Zika is still confined to narrow belt running across Africa to Asia [1]

The infection in 80% cases remains asymptomatic in human as per old records. There may be mild illness; Fever (<38.5oC), Prostration, Skin Rash (exanthema) Arthalgia, Bone pain; Joint pain, Headache, conjunctivitis, or symptoms almost alike dengue fever or alike Chikengunya like disease. The disease is self limiting one in most cases. Severe illness may occur like GB Syndrome (so far 73 cases reported); autoimmune like illness, Neurological symptoms and in Pregnancy, pregnant women giving birth with microcephaly. However causation between microcephaly and Zika virus not yet established though evidences of Zika virus has been found in placenta, in amniotic fluid of mother and brain of fetuses and dead new born autopsy

 There are yet no commercially available diagnostic tests in field. Antibody to Zika Virus IGM can be done by Mac ELISA but it may cross react with many other Flaviviruses like Dengue, Chkengunya. Quantities RT PCR test can be done. Viral culture is confirmatory. Diagnosis is mostly clinical.

 Treatment of Zika Virus infection is complete rest; Plenty fluid and water intake; Avoidance of Aspirin and if GB syndrome occurs ventilators and other supportive care required. Broad spectrum antiviral may be tried

Prevention and awareness is the best treatment. House hold storage of water is contracting source. So control of Mosquito birth  by biological ways i.e. fishes those feed on mosquito larvae  or genetically engineered modified sterile mosquitoes  larvae  ,use of mosquito nets , strengthening public care health system  to control mosquito breeding , house screening by municipality and gram panchayet  for house debris, storage of  fresh water  etc. Wearing of light color cloths that covers maximum part of the body as much as possible

 The question remains yet to be solved-: whether Zika spreads through Sexual routes Saliva or urine, with a patient’s contact who suffered from Zika Virus. So far three cases recorded A patient was infected in Dallas, Texas in likely to have been infected by sexual contact. The patient had not travelled to infected areas but his partner had returned from Venezuela. Special attention is required for Children, young adult sick’s, elderly, travelers Center for Disease control USA provided guide line for prevention of Sexual transmission ofZika virus 2016. Men who reside in or have travelled to an area of active Zika virus transmission  and who have pregnant partner must abstain from sexual activities or consistant and correctly use condoms during sex for duration of pregnancy

Indian have warned pregnant woman not to travel to countries affected by Zika virus The two mosquitos that carry Zika Virus thrive in India and Indian  patients  have in past tested positive for antibodies to Zikka. But Prevalance of Dengue and Chikengunya will make it hard to gauge Zika’s prevalence  Indian health ministry should start screening  those who arrives on air flights from Zika affected countries like Latin America


1] Anthony S Fauci and David M Morens “ Zika virus in the America-yet another Arbovirus threat “ Nejm January-13 ;2016 Doi 10.1056/NEJMP 1600297

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