With 29 persons tested positive for Zika virus in Rajasthan’s Jaipur by Monday, October 8, neighbouring states have been put on alert.

Zika virus infection in pregnant women can cause fetus loss or birth defects like microcephaly and, in adults and children, neurological problems, Guillain-Barré syndrome, neuropathy and myelitis. There is no cure or vaccine available against it and prevention is the only way. Spread through Aedes mosquito bite, preventing mosquito breeding and protection against mosquito bite is the only way.

A central team is monitoring the situation and Prime Minister Narendra Modi’s Office has sought a detailed report from the union health ministry. There is no need to panic and everything is under control, the ministry said.

Bihar has also issued advisories to all its 38 districts as one of those affected in Jaipur, a student, visited his home in Bihar’s Siwan in August, reported NDTV. The student visited Bihar between August 28 and September 12 for an exam. His family members have been put under surveillance.

Authorities in Jaipur are closely monitoring the condition of pregnant women; the zika virus disease can cause severe birth defects in unborn children. Sources in Rajasthan’s health department said the people who have tested positive have been kept in an isolation ward at Jaipur’s SMS Hospital.

Seven people infected with the virus live in the same neighbourhood. The first case in the city was confirmed on September 24.

“Our surveillance is very robust. All such cases get detected. We’ve standard protocols. Indian Council of Medical Research, National Centre for Disease Control and Directorate General of Health Services are monitoring this. I assure people that everything is under control. There’s no need to panic,” Union Health Minister JP Nadda said.

A seven-member high-level central team is already in Jaipur to assist the state government in containing the spread. A control room has been set up at the National Centre for Disease Control to undertake regular monitoring of the situation.

Medical teams have been deployed in Jaipur’s Shastri Nagar area from where several cases were detected. 179 medical teams are working in six wards in the neighbourhood to watch out for any symptoms with extra attention on pregnant women.

A mass drive to contain the spread of the infection has begun in Jaipur. Veenu Gupta, Rajasthan Additional Chief Secretary (Health), said that all cases of fever have been listed. The officer said 26,000 houses in Jaipur have been surveyed by 150 to 22 teams. Officials have treated over 2,000 containers with a chemical called temephos.

She added that among the 29 people tested positive, three are women, who were expecting children, and one gave birth on Monday night.

“More than 26,000 homes have been surveyed by officials with the help of teams from the health department along with 29,000 breeding places for the mosquito that carries this virus. We have dedicated all our machinery to contain the disease,” said Gupta. She added that five laboratories have been set up in the state in Jaipur, Jodhpur, Jhalawar, Udaipur, and Kota for testing of samples.

“So far, no cases have been reported from outside Jaipur. In the state capital, all the cases have been reported from Shastri Nagar area. We have started awareness campaigns to educate people about the disease. Although we are facing difficulties, at times, because some people are not allowing us to check their homes or are reluctant to provide their blood samples for testing,” said Gupta.

With the outbreak happening at the start of the tourist season and the pink city being part of India’s ‘golden triangle’ tourist circuit along with the national capital and Agra, authorities said strict surveillance was required in the region.

“A few cases of Zika virus have been reported in Jaipur. We have alerted neighbouring states, including Haryana, Uttar Pradesh, Delhi, Punjab, Madhya Pradesh and Gujarat, to keep strict vigil on Zika virus. Given that the festive season is round the corner, many people travel to popular tourist destinations for year-end holidays. Since there is seamless travel between these states, the health authorities will have to be careful,” said Sunil Gupta, additional director, National Centre for Disease Control (NCDC).

Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in 1947 in monkeys. It was later identified in humans in 1952 in Uganda and the United Republic of Tanzania.

Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific. From the 1960s to 1980s, rare sporadic cases of human infections were found across Africa and Asia, typically accompanied by mild illness.

The first recorded outbreak of Zika virus disease was reported from the Island of Yap (Federated States of Micronesia) in 2007. Zika virus disease is an emerging disease currently being reported by 86 countries worldwide.

Symptoms of Zika virus infection are similar to other viral infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache.

In India, the first outbreak was reported in Ahmedabad in January and February 2017 and second outbreak in July, 2017 from Krishnagiri District in Tamil Nadu. Both these outbreaks were successfully contained through intensive surveillance and vector management, the ministry said.

World Health Organisation (WHO)

Signs and symptoms

The incubation period (the time from exposure to symptoms) of Zika virus disease is estimated to be 3–14 days. The majority of people infected with Zika virus do not develop symptoms. Symptoms are generally mild including fever, rash, conjunctivitis, muscle and joint pain, malaise, and headache, and usually last for 2–7 days.

Complications of Zika virus disease

Zika virus infection during pregnancy is a cause of microcephaly and other congenital abnormalities in the developing fetus and newborn. Zika infection in pregnancy also results in pregnancy complications such as fetal loss, stillbirth, and preterm birth.

Zika virus infection is also a trigger of Guillain-Barré syndrome, neuropathy and myelitis, particularly in adults and older children.

Transmission

Zika virus is primarily transmitted by the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti, in tropical and subtropical regions. Aedes mosquitoes usually bite during the day, peaking during early morning and late afternoon/evening. This is the same mosquito that transmits dengue, chikungunya and yellow fever.

Zika virus is also transmitted from mother to fetus during pregnancy, through sexual contact, transfusion of blood and blood products, and organ transplantation.

Diagnosis

Infection with Zika virus may be suspected based on symptoms of persons living in or visiting areas with Zika virus transmission and/or Aedes mosquito vectors. A diagnosis of Zika virus infection can only be confirmed by laboratory tests of blood or other body fluids, such as urine or semen.

Treatment

There is no treatment available for Zika virus infection or its associated diseases.

Symptoms of Zika virus infection are usually mild. People with  symptoms such as fever, rash, or arthralgia should get plenty of rest, drink fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice.

Prevention

Protection against mosquito bites during the day and early evening is a key measure to prevent Zika virus infection. Special attention should be given to prevention of mosquito bites among pregnant women, women of reproductive age, and young children.

Aedes mosquitoes breed in small collections of water around homes, schools, and work sites. It is important to eliminate these mosquito breeding sites, including: covering water storage containers, removing standing water in flower pots, and cleaning up trash and used tires. Community initiatives are essential to support local government and public health programs to reduce mosquito breeding sites.  Health authorities may also advise use of larvicides and insecticides to reduce mosquito populations and disease spread.

No vaccine is yet available for the prevention or treatment of Zika virus infection.