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Zika Advice for Travellers (Update)

13 June 2016

(There is a more current update posted here)

In May 2015, Brazil announced an outbreak of the mosquito-borne flavivirus Zika virus (ZIKV). Since then the virus has spread widely with transmission detected in 52 countries/territories in the past 9 months. The UK defines areas with active ZIKV transmission according to the ECDC country list. To date, 27 confirmed cases of ZIKV infection have been reported in UK travellers linked to this outbreak.

ZIKV, after an incubation of 2-12 days, produces a mild clinical illness, similar to dengue fever that resolves in 4–7 days. Symptoms may include: fever, headache, conjunctivitis, rash, myalgia and arthralgia. There is no specific treatment, or vaccine and management is supportive only.

ZIKV Infection and Microcephaly

Concern has been raised by a large increase in the number of reported cases of microcephaly and central nervous system (CNS) malformations in neonates and fetuses in Brazil that coincide with the ZIKV outbreak. Seven countries or territories with Zika outbreaks have reported similar congenital malformations potentially associated with those outbreaks. Investigations by the World Health Organisation and local health authorities are ongoing to establish the nature of the relationship between ZIKV in pregnancy and these congenital anomalies.

Sexual Transmission

ZIKV has been detected in semen two months after clinical symptoms of ZIKV; a small, but growing number of probable sexually transmitted cases of ZIKV infection (male to female) have been reported.

A recently published case report from France has detailed transmission from an asymptomatic man to his female partner between 21 and 30 days after return from a ZIKV endemic area.

The length of time after return from a ZIKV endemic area that condoms, contraception or abstinence should be practiced for has thus increased from 4 to 8 weeks. Asymptomatic male and non-pregnant female travellers should practice abstinence or use contraception including condoms during travel and for 8 weeks on return to reduce the risk of sexual transmission of ZIKV, particularly around the time of conception. Men who develop symptoms should continue to practice abstinence or use condoms for 6 months after return.

Advice for Travellers to ZIKV Affected Countries

All Travellers

  • Mosquito bite avoidance is strongly recommended.
  • Advised to seek travel advice from a healthcare provider at least 6-8 weeks in advance of travel, but particularly important if pregnant or planning pregnancy.
  • Strongly advised not to travel without adequate insurance – pregnant women should check with their travel insurance company that they are covered under the policy.
  • Male and non-pregnant female travellers should practice abstinence or use contraception, including condoms during travel and for 8 weeks on return to reduce the risk of sexual transmission of ZIKV particularly during conception or pregnancy.

Women who are Pregnant

  • Advised to postpone non-essential travel to countries with active ZIKV transmission until the proposed link between ZIKV and adverse pregnancy outcomes has been fully clarified.
  • If travel is essential, should be helped to understand the risks in order to make a fully informed decision.
  • During travel, strict bite avoidance is essential. Advise use of barrier methods to prevent potential sexual transmission of ZIKV from a male partner during travel and throughout the pregnancy.
  • On return, early obstetric review is recommended even if well.

Further Resources