The global spread of Zika virus: is public and media concern justified in regions currently unaffected?

BACKGROUND: Zika virus, an Aedes mosquito-borne flavivirus, is fast becoming a worldwide public health concern following its suspected association with over 4000 recent cases of microcephaly among newborn infants in Brazil.

DISCUSSION: Prior to its emergence in Latin America in 2015-2016, Zika was known to exist at a relatively low prevalence in parts of Africa, Asia and the Pacific islands. An extension of its apparent global dispersion may be enabled by climate conditions suitable to support the population growth of A. aegypti and A. albopictus mosquitoes over an expanding geographical range. In addition, increased globalisation continues to pose a risk for the spread of infection. Further, suspicions of alternative modes of virus transmission (sexual and vertical), if proven, provide a platform for outbreaks in mosquito non-endemic regions as well. Since a vaccine or anti-viral therapy is not yet available, current means of disease prevention involve protection from mosquito bites, excluding pregnant females from travelling to Zika-endemic territories, and practicing safe sex in those countries. Importantly, in countries where Zika is reported as endemic, caution is advised in planning to conceive a baby until such time as the apparent association between infection with the virus and microcephaly is either confirmed or refuted. The question arises as to what advice is appropriate to give in more economically developed countries distant to the current epidemic and in which Zika has not yet been reported. Despite understandable concern among the general public that has been fuelled by the media, in regions where Zika is not present, such as North America, Europe and Australia, at this time any outbreak (initiated by an infected traveler returning from an endemic area) would very probably be contained locally. Since Aedes spp. has very limited spatial dispersal, overlapping high population densities of mosquitoes and humans would be needed to sustain a focus of infection. However, as A. aegypti is distinctly anthropophilic, future control strategies for Zika should be considered in tandem with the continuing threat to human wellbeing that is presented by dengue, yellow fever and Japanese encephalitis, all of which are transmitted by the same vector species.