Approach
Treatment for symptomatic infection is generally supportive as there is no specific antiviral treatment available. Because of similar geographic 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).
Physicians in areas where there is local transmission should consult with local health authorities for current guidance.
Supportive therapies for symptomatic patients
Supportive therapies include rest, fluids, and use of analgesics and/or antipyretics (e.g., acetaminophen). Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue virus infection can be ruled out to reduce the risk of hemorrhage.[128] Calamine lotion may be used topically for the itch associated with the rash.
The same general advice is given for symptoms in pregnant and nonpregnant women. Nondrug measures may be recommended (e.g., damp cloths, lukewarm baths/showers) to reduce fever during pregnancy. However, if these measures fail, acetaminophen 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 pants.
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 labor and delivery settings. These precautions are recommended regardless of whether the infection is suspected or confirmed.[92]
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 (e.g., every 3-4 weeks) to assess the fetus for the presence of microcephaly or other abnormalities. All pregnant women should be encouraged to attend scheduled prenatal visits.[14][175] Appropriate psychological support for the woman and her family is recommended.[196]
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 physical therapist, speech therapist, and occupational therapist. A coordinated approach, with ongoing psychosocial support for families and caregivers, is recommended.[2][176]
The Centers for Disease Control and Prevention 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.
The World Health Organization also offers specific guidance for the screening, assessment, and management of neonates and infants with congenital Zika infection.
Breast-feeding according to normal infant feeding guidelines is still recommended in women with suspected, probable, or confirmed infection, or those who reside in or have traveled to areas of ongoing transmission. Transmission through breast milk is only a theoretical concern at this point and the benefits of breast-feeding outweigh the risk of transmission. It is unclear whether breast milk from infected women has enough viral load or infectivity to lead to infection among infants.[90][197][198] One systematic review found no evidence of perinatal transmission via breast-feeding or breast milk intake based on low-certainty evidence.[91] Among infants ages 0 to 12 months who are affected by complications associated with Zika virus infection, infant feeding practices should be modified (e.g., postural correction, thickening feeds, adjusting the environment) to achieve and maintain optimal possible infant growth and development. Mothers and caregivers should receive skilled support from healthcare workers.[197]
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 intensive care unit (e.g., patients with rapid progression of motor weakness, respiratory distress, bulbar symptoms, or autonomic dysfunction). Patients should be monitored closely for complications.[143]
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 program.[143][145]
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