How to Detect the Signs of Zika Virus Infection
The Zika virus is a member of the Flaviviridae family. It is an arbovirus—one of the hundreds of RNA viruses transmitted by arthropods such as mosquitoes and ticks.
Virus Family Tree
The Zika virus is a member of the Flaviviridae family. It is an arbovirus—one of the hundreds of RNA viruses transmitted by arthropods such as mosquitoes and ticks. The Zika virus originated in the Zika forest in Uganda and was first isolated from a rhesus monkey in 1947. Similar to most arboviruses, Zika is transmitted to humans through the bite of infected Aedes mosquitoes, specifically Aedes aegypti. This species lives predominantly in equatorial climates, although there is a possibility that the virus may adapt to transmission by the more widely distributed mosquito A. albopictus found in at least 32 US states.
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Signs and Symptoms
Zika is characterized as an asymptomatic or mild dengue-like disease with fever, muscle and joint aches, conjunctivitis, and maculopapular rash with an incubation period of 3 days to 12 days. Only about 20% of cases are symptomatic. There is no specific anti-viral treatment; management of symptoms may include the use of analgesics and antipyretics. Nonsteroidal anti-inflammatory drugs and aspirin should not be used due to a heightened risk of hemorrhage, at least until dengue is ruled out. Acetaminophen is recommended as an alternative. However, in more than 60 years of observation, the Zika virus has not been reported to cause hemorrhagic fever or death.
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Protecting Pregnant Women
The most significant public health concern is the recently confirmed association between Zika infection during pregnancy and microcephaly or other severe fetal brain defects. The relationship between Zika infection and microcephaly has long been suspected based on detection of Zika viral RNA in mothers and amniotic fluid samples from fetuses, which demonstrates Zika virus’ potential to infect fetuses. An otherwise unexplained 20-fold increase in the incidence of microcephaly in Brazil occurred between 2014 and 2015, which prompted health authorities in the affected regions to develop recommendations for pregnant women.
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Standard precautions are designed to protect health care providers, including dentists, dental hygienists, and auxiliary dental professionals, from exposure to these pathogens. Although the effort to prevent transmission in the dental office has primarily focused on bloodborne pathogens, saliva is also a potential route of transmission for many pathogens. Infection control protocols are determined by the clinical procedures performed, not the patient’s health status. As such, all patients must be treated as if they are potentially infectious.
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Transmission-based precautions may be necessary when patients have a documented infection, may have been exposed to a highly transferrable pathogen, and when standard precautions may be insufficient to prevent disease transmission via airborne, droplet, or dry skin contact. Transmission-based precautions are specific to anticipated contact routes and are, by definition, limited in duration—typically to the contagious period of the disease in question. Enhanced precautions in the dental setting were implemented in 2009 during an H1N1 influenza pandemic. The CDC recommendations included rescheduling symptomatic patients’ nonurgent dental treatment, waiting 24 hours to treat such patients after fever had subsided, using respiratory/cough etiquette protocols, wearing appropriate PPE, and providing care—when urgent—with operatory doors closed.
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While the Zika virus has been detected in a number of body fluids, including blood and saliva, there are no reports of transmission from infected patients to health care providers. At this time, the CDC recommends all health care personnel practice standard precautions. The use of transmission-based precautions has not been recommended, even in instances when there is a potential for exposure to large volumes of blood, such as during labor and delivery.