Primary prevention
There are currently no vaccines available for prevention.[128]
Primary prevention currently relies on mosquito bite prevention and mosquito population control (e.g., removing or modifying breeding sites), as well as the prevention of non-vector transmission (e.g., sexual, transfusion, nosocomial).[128]
Mosquito bite prevention and population control
The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend the following bite prevention measures:[129][130]
Wearing clothes that cover as much of the body as possible (e.g., long-sleeved shirts and long trousers); clothes may be treated with permethrin
Staying in places with air conditioning or that use window and door screens to keep mosquitoes outside
Sleeping under a mosquito net (possibly impregnated with insecticide)
Using approved insect repellent (if ≥2 months of age); DEET, picaridin, IR3535, oil of eucalyptus, para-menthane-diol (PMD), and 2-undecanone can be safely used in pregnant and breastfeeding women when used as directed (oil of eucalyptus and PMD should not be used on children <3 years of age)
Covering cribs, strollers, or baby carriers with a mosquito net
Emptying, cleaning, or covering containers that can hold water to reduce areas where mosquitoes can breed including in and around households.
The main way to prevent congenital Zika virus infection is to prevent maternal infection using mosquito bite prevention measures.
Travellers returning from areas of ongoing transmission should use mosquito bite prevention measures for 3 weeks after returning to prevent spread to uninfected mosquitoes.[131]
During outbreaks, insecticide spraying (using an insecticide recommended by the WHO) may be carried out.
The development of Aedes aegypti mosquitoes that are resistant to arbovirus infection is a preventive approach that shows promise.[132]
Prevention of sexual transmission
Recommendations for pregnant couples: the CDC recommends that pregnant women with male or female sex partners who live in or have travelled to an area with active transmission should abstain from sex (vaginal, anal, oral) or use barriers against infection (e.g., condoms) during sex for the duration of the pregnancy. Additionally, the CDC recommends that pregnant women talk with their healthcare providers about their sex partner’s potential exposures to Zika virus and symptoms of Zika-like illness.[133]
Recommendations for non-pregnant couples: the CDC recommends that if only the female partner travels to an area with risk for transmission, the couple should use condoms and abstain from sex for at least 2 months after the female partner's symptom onset (if symptomatic) or last possible exposure (if asymptomatic). However, if the male partner (or both partners) travel to an area with risk for transmission, the couple should use condoms and abstain from sex for at least 3 months after the male partner's symptom onset (if symptomatic) or last possible exposure (if asymptomatic).[133]
The WHO now supports the 2-month and 3-month timeframes for women and men, respectively. They also offer specific recommendations for people who live in areas of active transmission.[75]
Pregnancy prevention
Healthcare providers should discuss reproductive life plans (including intention of pregnancy and timing of pregnancy) with women of reproductive age in the context of the potential risks associated with Zika virus infection.
Women living in endemic areas should consult local health authorities for advice before becoming pregnant.
Family planning services, including access to contraception to prevent unplanned pregnancy, is important to prevent Zika-related congenital abnormalities. Access to adequate contraception may be an issue in some countries.[134]
In Brazil, there are no formal recommendations to avoid pregnancy; the choice to get pregnant is regarded as a personal decision.[135]
Prevention while travelling
Advice varies internationally and travellers should stay informed about Zika virus outbreaks.
The WHO recommends that pregnant women, women who may become pregnant within 2 months of travel, and male travellers whose partner may become pregnant within 3 months of travel consult their healthcare provider and consider the risks and consequences of Zika infection before travelling to areas where there may be transmission.[136]
The CDC recommends that pregnant women should avoid travel to areas with Zika travel health notices, and follow recommendations to prevent mosquito bites and sexual transmission during and after travel if travel is unavoidable.[131]
To help pregnant women and others identify areas of Zika risk, the CDC has produced an interactive map that allows people to search for location-specific information. CDC: countries and territories at risk for Zika Opens in new window The CDC Yellow Book: health information for international travel includes the most current travel health guidelines from the US government. CDC: Yellow Book Opens in new window
Mosquito bite and sexual transmission prevention measures are recommended when travelling to areas of ongoing transmission.
Prevention of transfusion transmission
Blood donation is not recommended for 1 month following Zika infection or exposure.[126]
Prevention of nosocomial transmission
Transmission in a healthcare setting has not been described as yet; however, 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.[92]
There is currently no post-exposure prophylaxis or vaccination available.
Secondary prevention
People infected with Zika virus should be protected from further mosquito exposure during the first week of illness (i.e., the viraemic stage) to prevent other mosquitoes from becoming infected and therefore reduce the risk of local transmission.[163]
Zika virus infection (and Zika virus congenital infection) is a notifiable disease in many countries. Healthcare providers should report suspected and confirmed cases to their state or local health department. In the US, these departments should report laboratory-confirmed cases to the CDC through Arbonet. In other countries, cases should be reported to the relevant national public health authorities who are then encouraged to inform the WHO and Pan American Health Organization through established International Health Regulations channel.
Pregnancy and infant registries and surveillance systems may be available in some countries to collect data on adverse outcomes during pregnancy, birth, and early childhood.
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