Page 103 - Journal of Special Operations Medicine - Spring 2016

waste is a theoretical possibility. Perinatal transmission permethrin-treated uniforms and use DEET-containing
and sexual transmission of the disease have been reported. repellents when in endemic areas. Patients who are sus-
It is unknown how long semen can remain infected, but it pected of having a Zika virus infection in the field, who
is likely a longer period than in blood. cannot be evacuated, should be cared for under bed nets
for the next 7–10 days to prevent further infections in
those around them. Patients also should be counseled
Clinical Presentation
that they can infect their sexual partners with the virus,
It is estimated that only one in five of those infected even after they have become asymptomatic.
show evidence of the disease: fever, maculopapular
rash, polyarthralgia, headache, and nonpurulent con- Guidance regarding the sexual transmission of Zika vi-
junctivitis. The incubation period following an infected rus and many other issues related to the disease are un-
mosquito bite ranges from 3 to 12 days. Symptoms can dergoing rapid change as new information is added to
last from several days to a week before resolution. what is known. Please consult http://www.cdc.gov/zika
/hc-providers/index.html for the most up-to-date guidelines.
Transmissions in urban and jungle environments have
been demonstrated. Of concern with the recent outbreaks Disclosure
in French Polynesia and Brazil are the noted increases in
the number of cases of Guillain-Barré syndrome in those
known to have been infected with the Zika virus. Also, The author has nothing to disclose.
in December 2015, the Pan American Health Organi-
zation issued an alert of a possible link to infants born Disclaimer
with microcephaly, after finding a 20-fold increase in the
number of infants born with smaller-than-expected head The views expressed in this publication are those of the
sizes in Brazil during the course of the previous year. author and do not reflect the official policy or position
of the Department of the Army, Department of Defense,
or the US Government.
Diagnosis
On 26 February 2016, the US Food and Drug Adminis- Bibliography
tration announced an Emergency Use Authorization for
the CDC Zika IgM Antibody Capture Enzyme-Linked Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on
Immunosorbent Assay (Zika MAC-ELISA). This test Yap Island, Federated States of Micronesia. N Engl J Med.
2009;360:2536–2543.
can be used for patients 5 days after illness onset and Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009;15:
for the next 12 weeks. Information regarding testing 1347–1350.
for Zika virus infections can be obtained from CDC’s Musso D, Cao-Lormeau VM, Gubler DJ. Zika virus: following the
Arbovirus Diagnostic and Reference Laboratory at 970- path of dengue and chikungunya? Lancet 2015;386:243–244.
221-6400 or found online at http://www.cdc.gov/zika Dyer O. Zika virus spreads across Americas as concerns mount
over birth defects. BMJ. 2015;351–352
/hc-providers/diagnostic.html. Musso D, Roche C, Robin E, et al. Potential sexual transmission
of Zika virus. Emerg Infect Dis. 2015;21:359–361.
Treatment
The treatment for Zika virus infection is supportive. Recommended Internet Links:
Caregivers should be careful to not come into direct con- http://www.cdc.gov/zika/hc-providers/index.html
tact with blood of patients with the virus, because it is
likely infectious. The use of aspirin and other nonsteroi- http://ecdc.europa.eu/en/healthtopics/zika_virus
dal anti-inflammatory drugs should be avoided until den- _infection/factsheet-health-professionals/Pages
gue infection has been ruled out, because this may result /factsheet_health_professionals.aspx
in worsened hemorrhagic disease in patients with dengue.

Vaccination COL Burnett is currently Chief of Pediatric Subspecialties
and Pediatric Infectious Diseases at Tripler Army Medical
No vaccine currently exists for this disease.
Center in Hawaii. He is board certified in Pediatrics and Pe-
diatric Infectious Diseases. He has served overseas in Korea,
Importance in a Deployed Setting Germany, Kosovo, Iraq, Afghanistan, and Kuwait and as the
JSOTF-P Surgeon in the Philippines. He is a graduate of the
Because of the lack of a vaccine, and an effective anti- University of Wisconsin-Madison and the Medical College of
viral treatment, prevention is key. It is important to wear Wisconsin. E-mail: mark.burnett@JSOMonline.org.

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