Introduction
Zika virus also termed as ZIKV is a known to have gained worldwide attention, especially in the USA, South East Asia, and Australia. The Zika belongs to the Flaviviridae family which comes under the genus Flavivirus (Wikan & Smith. 2016). The Zika virus is spread though day time mosquitoes belonging to the Aedes family. Some of the most common mosquitoes to contain and spread Zika include A. aegypti and A. albopictus. The name of Zika originated in 1947 where it was first isolated from the Zika forest in Uganda. Based on evidence, the Zika virus was associated with varying viral infections such as Yellow fever, West Nile infection, Japanese encephalitis and Dengue. A team of researchers reported that Zika is known to have spread from the equatorial areas to Africa and to Asia since the early 1950s. Based on recent evidence by the WHO, the Zika virus has spread from the Pacific Ocean to the Americas between 2007 and 2006 which lead to the 2015 Zika virus epidemic (Petersen, et al. 2016).
Most patients infected with the Zika virus are asymptomatic and the most common symptom is mild to moderate fever. Zika fever is associated with no symptoms and is often related to Dengue fever in most cases. Most healthcare professionals would recommend the use of acetaminophen for the treatment and management of Zika fever at the early stages. Acetaminophen is known to reduce the symptoms and provide relief to patients. Till date, there is no medication or vaccine available to cure or prevent Zika fever. (Slavov, et al. 2016). Zika virus is also known to spread to the foetus in pregnant women which has raised significant concern among health authorities around the globe. Some of the most common effects of Zika infection in pregnant women include severe brain malformations, microcephaly, and birth defects. (Heymann, et al. 2016). Zika virus in adults is associated with Guillain–Barré syndrome. In a recent report by the US issued warnings for travel guidance in a bid to prevent and control Zika virus infections across countries. This paper provides an overview of the Zika virus epidemic, the major health concern in Australia and its association with pregnant women.
The Zika virus was first isolated from monkeys and mosquitoes in the Zika forest of Uganda by a team of researchers and scientists of the Yellow Fever Research Institute in April 1947. (Wikan & Smith. 2016). The first isolation was from a rhesus macaque monkey kept in captivity for research purposes near Lake Victoria in the Zika forest of Uganda (Faye O, et al. 2014). The second isolation was observed in January 1948 from the mosquito A. africanus at the same site. The researchers isolated serum from the infected monkey with a ‘filterable transmissible medium’ that was termed as Zika in 1948 (Wikan & Smith. 2016).
The first evidence of Zika infection in humans: The first official report of Zika virus infection in humans was published by a team of researchers in Uganda and Nigeria through a serological survey from the local community in 1952 (Kaddumukasa, et al. 2014). In the report, a total of 85 patients were assessed of all age groups with 50 individuals having antibodies for Zika. The same report also provided information on individuals with immunity to Zika above 40 years. The spread of Zika was also established and reported in India based on a 1952 research study. The reports suggested that Zika has known to have spread among the human population since long term. Many Indians were known to have developed immune responses to the Zika virus confirming its spread across the globe from a long term (Slavov, et al. 2016). The first outbreak research for Zika was reported in 1952 on a 10 year old Nigerain Female suspected to have jaundice or malaria. The clinical symptoms included mild ferver and headache which ceased after 3 days. The researchers examined the sera of the female into laboratory mice and compared to a neutralization testes with the rhesus monkey sera immune to Zika. However, the clinical examinations of the neutralization tests revealed negative results and suspected of no Zika infection (Petersen, et al. 2016). The researchers examined the blood of infected adults with and confirmed Zika-specific serum antibodies. All infected patients had mild fever, headache and complained of joint pain and eye irritation.
Zika Virus in Australia
The Zika virus epidemic in 2015-16 had spread worldwide affecting more than a dozen countries with major case reports from Americas, Pacific, Brazil, and South America. Based on current evidence, Australia has also been affected with a few cases of Zika owing to international travel and exposure to Zika virus from affected countries.
The first case of Zika virus infection in Australia was reported in 2012 based on a 52 year old women returning back from Jakarta, Indonesia. The Australian citizen reported to have travelled for a 9 day vacation to Indonesia and felt sick while returning. Most common symptoms included fatigue, prominent headache, maculopapular rash near trunk which spread to her limbs, and rash accompanied with myalgia (Kwong, Druce, & Leder, 2013). Based on a recent case report in 2015, an Australian was confirmed to have been infected with Zika virus after a monkey bite from his travel in Bali, Indonesia (Leung, et al. 2015). The traveller was subject to clinical examination by health authorities and researchers. Initial screening with help of a nasopharyngeal swab was sequenced. The use of PCR confirmed the presence of Zika virus with the presence of Flavivirus RNA sequence. It is unlikely that the transmission may have taken place after the monkey bite; researchers suggest the possible mosquito-borne transmission as a plausible route of transmission. It is one of the few cases in Australia that may confirm the non-vector transmissions of Zika virus (Leung, et al. 2015). North America, Australia, and Europe have low rates of Zika virus infections. Researchers have also stated that the incidence and prevalence of Zika virus in Australia is low and that new cases are based on foreign travellers returning from endemic countries (Gyawali, et al. 2016). The only threat to Australia from the Zika epidemic is its foreign travellers (Taylor & Paterson. 2016). Since there is no vaccination for Zika virus, the Australian health authorities have made stringent travel polices to prevent inbound Zika infections Health authorities are concerned on the new cases in North Australia owing to local transmission from infected travellers (Saiz, et al. 2016).
Zika Virus in Queensland, Australia
Researchers have claimed that Zika virus is mainly spread through vector transmission, i.e. mosquitoes of the genus Aedes. (Sikka et al. 2016). The first case of Zika virus was reported to have been isolated from A. aegypti followed by the second case from A. africanus species in Uganda. Based on a recent report, a new vector, i.e. A. albopictus species is known to have spread Zika virus in Central Africa (Grard, et al. 2014). In Australia, the Aedes albopictus is prevalent in Northern Queensland and can act as a vector for Zika virus. Queensland which is part of North Australia is known to have many foreign travellers from endemic zones which increases the risk of a possible Zika epidemic in Queensland (Plourde, & Bloch 2016). Based on a recent study, researchers have also confirmed that the main Zika virus vector, A. aegypti, is prevalent in Queensland which increases the chances of an epidemic (Saiz, et al. 2016). The rate of Zika virus infection is estimated to increase by 2016 in Queensland owing to increased rate of foreign travellers, high prevalence rate of zika virus vectors such A. aegypti and Aedes albopictus, and low level of awareness among the general public (Monaghan, et al. 2016). Due to the exposure of Queensland locals to foreign travellers from the tropical endemic regions for Zika virus and absence of any vaccination or medication, makes it the most vulnerable state for Zika infection in Australia (Steele. 2016 and Nah, et al. 2016).
The first case of Zika virus infection in Queensland was report in March 2014 based on a female resident in Townsville who returned from Cooks Island. Researchers confirmed the female to be positive for Zika virus with the help of serum analysis with TaqMan real-time RT-PCRs and a pan-Flavivirus RT-PCR. (Pyke, et al. 2014). Based on a recent report by the WHO, a total of 14 cases of Zika virus infection have been reported in Queensland owing to favourable vector environment and inflow of foreign immigrants from endemic regions (Messina, et al. 2016). In a recent report, travellers from Brazil, Africa, and Southeast Asia are most vulnerable to spread Zika virus in Queensland (Nah, et al. 2016 and Sikka et al. 2016)
Zika Virus and Pregnant Women
Zika virus is known to affect pregnant women who are considered to be the most vulnerable by health authorities around the globe. The presence of Zika virus in foetuses of pregnant women has been confirmed in a number of case reports and studies (Besnard, et al. 2014; Boeuf, et al. 2016; Meaney-Delman, et al. 2016; and Citil Dogan, et al. 2016). In a recent case report by a team of researchers, perinatal transmission of Zika virus was confirmed in 2013. (Besnard, et al. 2014). The researchers confirmed the presence of Zika virus with the help of serum analysis with ZIKAV RT-PCR with 4 days of the delivery of the new born. The infection of the new born was a result of trans-placental transmission at the stage of delivery. The researchers also suggested that ZIKAV could be transmitted through breast milk but not confirmed from either of the two cases; however they have stated a possible risk for breast milk transmission (Besnard, et al. 2014). In a recent review on the global impact of Zika virus and its close association to pregnancy, researchers confirmed a series of complications in pregnancy such as Microcephaly, foetal mal-formation, and congenital complications (Boeuf, et al. 2016). There is strong evidence the Zika virus in pregnancy is associated with microcephaly, wherein a team of researchers reported that nearly 8165 cases of microcephaly were observed in Brazil as of June 2016 (Kleber de Oliveira, et al. 2016). There is growing evidence on major birth defects in new born and pre mature abortion due to foetal abnormalities in pregnant women confirmed with Zika virus infection (Rasmussen, et al. 2016). A systematic review, Zika virus in pregnant women are susceptible to have microcephaly with calcifications in the foetal brain and placenta (Mlakar, et al. 2016). Zika virus has profound effect on human placental barrier which is known to be associated with fetal neurotropism (De Noronha, et al. 2016). Some of the other complications include long-term neurologic sequelae, brain and brain-stem defects (Citil Dogan, et al. 2016). Lastly, zika virus is also known to impair growth in human neurospheres and brain organoids (Garcez, et al. 2016).
Zika Virus and Pregnant Women in Queensland, Australia
There is strong evidence on congenital birth defects and Zika virus in pregnant women. The Australian Health authorities are concerned on the health status of pregnant women in Northern Australia which is estimated to be the most vulnerable state for Zika infections. The first case of Zika virus infection in a pregnant women was reported in February 2016 in Queensland (Wahlquist, 2016). The women had restored from a 14 day stay in Brazil where she had contracted the virus. Based on this case, the Australian Government had issued a travel warning for pregnant women outside Australia. Since Zika infections are associated with a high rate of microcephaly, healthcare agencies in Queensland have reformed travel policies on outbound and inbound travel from susceptible endemic regions (Abbasi, et al. 2016).
A second case of Zika virus infection in a pregnant women was reported in March 2016 at the Royal Brisbane and Women's Hospital. The women reported to the general physician that she was confirmed to have Flavivirus in December 2015 and suspected to have dengue, yellow fever or Zika. Dr Jeanette Young, the chief health officer at Brisbane Hospital reported concerns on the health risk the women could pose to the foetus and the public. Based on a recent survey, health authorities stated that Queensland is the most susceptible for pregnant women and also a major health risk which could be the next epidemic (Australian Press, 2016). The Australian Health Department has reported a total of 3 pregnant Zika virus cases as of June 2016 with a risk of more cases by December 2016. Dr Jeanette Young has also stated that women from other parts of Australia refrain from travelling to Queensland and other countries susceptible to Zika infection. The Queensland Health Department has also initiated several strategies to control the spread of Zika infection, especially among women and children (Queensland Health. 2016). In the same month a child was also reported to have been infected with Zika infection. The cause of infection was not identified but the patient was treated immediately and discharged with no major health issues (Australian Press, 2016).
As per the WHO and CDC, 1 in 5 people infected with Zika virus become ill and often suffer from common symptoms such as fever, headache, and joint pain. Most pregnant women often fall ill with Zika infection and pose a threat to the foetus. Researchers claim that it is very unlikely for Zika to spread in Queensland owing to its environment and low rate of vector species for disease transmission (Meaney-Delma, et al. 2016). However, in a recent report researchers suggest that there could be a possible threat to pregnant women and the public in Queensland since it is a natural habitat for Aedes aegypti, a well-known vector species for the transmission of Zika virus in humans (Powell, & Tabachnick, 2013). Due to the recent confirmation of a pregnant women infected with Zika in Queensland, local health authorities have developed different strategies for faster and feasible tests for Zika infections. A new conventional centre for diagnosis and assessment of Zika infections at Townsville was opened in order to control and prevent infections among pregnant women (Knapton, 2016). The Queensland Health department has also issued public warning and notices to avoid popular tourist destinations such as Florida, Brazil, South Africa, and Queensland itself to prevent and control Zika infection among pregnant women (Australian Health Department, 2016). In a systematic review, researchers stated that pregnant women infected with Zika had a higher frequency of lymphadenopathy and conjunctival injections. In rare cases, the researchers also reported Guillain-Barré syndrome in women at 28 weeks gestation (Chibueze, et al. 2016). After the first case of pregnant women infected with Zika, many researchers and experts from Oxford University and the London School of Hygiene and Tropical Medicine suggested that pregnant women should not travel overseas unless required (Knapton, 2016). As per the interim RCOG/RCM/PHE/HPS clinical guidelines, women who are planning pregnancy are required to take precautions while travelling overseas and undergo clinical assessment for Zika infection when traveling to or from Queensland (RCOG, 2016). Thus, early diagnosis and avoidance to endemic regions are the best preventive ways to control Zika infection in Queensland.
Awareness of Zika Virus: Prevention and Control
Based on current evidence, Zika virus infection has become a serious global health issue and can pose as a possible threat to global economy. Some of the key reasons for the rapid spread of the disease according to the Pan American Health Organization (PAHO) include (a) No prior history of ZIKV in the Americas due to which the population lacks specific immunity against the disease and (b) The widespread of the main vector, Aedes mosquitoes along the Americas since ages other than Chile and Canada. The PAHO recommended the following to prevent and control Zika infections: (a) Reduction in the mosquito population by insecticide control (b) Prevention of potential breeding sites for mosquitoes and (c) Personal hygiene and protection. In mosquito bred zones, it is recommended that people wear ling sleeved clothes or appropriate clothing that covers maximum body surface along with the use of insect repellents (Barrera-Cruz, et al. 2016). Based on current evidence, there is no link between transmission of Zika infection and breastfeeding and thus the WHO and Queensland Health Department provide no restriction even in cases where ZIKV RNA was obtained (Barrera-Cruz, et al. 2016). Due to the alarming rate of Zika in the Americas and Southeast Asia, the CDC has developed an interim clinical guidelines for the awareness and prevention of Zika infections along with the treatment and management for pregnant women infected with Zika (Hajra, Bandyopadhyay, & Hajra, 2016). The CDC recommends that pregnant women with symptoms of Zika infection should report to their consulting physician and get examined for Zika to avoid complications to the foetus (Bell, Boyle, & Petersen. 2016). It is recommended that all pregnant women exposed to endemic regions for Zika infection should be examined within 2 weeks of their travel to avoid possible local transmission and avoidance of foetal abnormalities (Olson, et al. 2016). Researchers have reported that ZIKV remains in the semen for 14 days and in the blood for 7 days in an infected individual. It is also reported that babies born after the clearance of ZIKV from the blood or semen have no birth defects (Hafiz, et al. 2016).
The CDC has provided a comprehensive guideline for the prevention and control of Zika infection for pregnant women in February 2016. The guidelines has specifications for infants and the prevention and control of abnormalities such as microcephaly. It is recommended that mothers infected with Zika should be treated immediately to relieve symptoms and prevent foetal complications (Vouga, et al. 2016). It is also recommended that infants born with congenital abnormalities should also be treated with best available evident medications (Petersen, et al. 2016). The interim guidelines developed by the CDC also states that infants with no abnormalities born from infected mothers should undergo examination for neurological disorders while mothers are subject to a full clinical examination (Vouga, et al. 2016). It is estimated that most infants born from infected mothers have a high rate of acquiring the virus through prenatal transmission (Petersen, et al. 2016). The CDC has also provided specific recommendations for the prevention of sexual transmission of Zika infection which are as follows; (a) The use of condoms by men irrespective of their location during sex with pregnant women (b) It is advisable to use condoms to prevent cross transmission and STD and (c) Both partners should consult a healthcare provider in order to discuss the possible transmission of Zika infection (Oster, et al. 2016).
Zika virus infection has a global outreach and Australia is considered to be its recent target. Due to the favourable environmental conditions and the influx of foreign travellers to Northern Australia, there has been a significant rise in Zika infections in Queensland. Lastly, the Assistant Director General, WHO stated that “countries in the dengue belt with Aedes aegypti should look for ZIKV and take measures to detect neurological conditions” (Hajra, Bandyopadhyay, & Hajra, 2016).
References
Abbasi AU. (2016). ZIKA VIRUS INFECTION; VERTICAL TRANSMISSION AND FOETAL CONGENITAL ANOMALIES. J Ayub Med Coll Abbottabad. 28(1):1-2.
Australian Health Department. (2016). Zika virus – information for clinicians and public health practitioners Web. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/ohp-zika-health-practitioners.htm [Accessed 01 September 2016]
Australian Press (2016). Woman and child in Queensland confirmed as having Zika virus The Guardian. Web. Available at: https://www.theguardian.com/world/2016/feb/06/first-zika-case-confirmed-in-queensland-woman-who-returned-from-el-salvador [Accessed 01 September 2016]
Barrera-Cruz A, et al. (2016). [Technical guidelines for the prevention, diagnosis and treatment of Zika virus infection]. Rev Med Inst Mex Seguro Soc. 54(2):211-24.
Besnard M, et al. (2014). Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill.;19(13). pii: 20751.
Bell BP, Boyle CA, Petersen LR. (2016). Preventing Zika Virus Infections in Pregnant Women: An Urgent Public Health Priority. Am J Public Health. 106(4):589-90.
Boeuf, P., Drummer, H. E., Richards, J. S., Scoullar, M. J. L., & Beeson, J. G. (2016). The global threat of Zika virus to pregnancy: epidemiology, clinical perspectives, mechanisms, and impact. BMC Medicine, 14, 112.
Citil Dogan A, et al. (2016). The Zika virus and pregnancy: evidence, management, and prevention. J Matern Fetal Neonatal Med. 17:1-11.
De Noronha, L., Zanluca, C., Azevedo, M. L. V., Luz, K. G., & dos Santos, C. N. D. (2016). Zika virus damages the human placental barrier and presents marked fetal neurotropism. Memórias Do Instituto Oswaldo Cruz, 111(5), 287–293.
Faye O, et al. (2014) Molecular Evolution of Zika Virus during Its Emergence in the 20th Century. PLoS Negl Trop Dis 8(1): e2636.
Garcez PP, et al. (2016). Zika virus impairs growth in human neurospheres and brain organoids. Science. 352(6287):816-8
Grard, G., Caron, M., Mombo, I. M., Nkoghe, D., Mboui Ondo, S., Jiolle, D., Leroy, E. M. (2014). Zika Virus in Gabon (Central Africa) – 2007: A New Threat from Aedes albopictus? PLoS Neglected Tropical Diseases, 8(2), e2681.
Gyawali, N., Bradbury, R. S., & Taylor-Robinson, A. W. (2016). The global spread of Zika virus: is public and media concern justified in regions currently unaffected? Infectious Diseases of Poverty, 5, 37.
Hajra, A., Bandyopadhyay, D., & Hajra, S. K. (2016). Zika Virus: A Global Threat to Humanity: A Comprehensive Review and Current Developments. North American Journal of Medical Sciences, 8(3), 123–128.
Hafiz, M. Y., Mahmood, S. U., Shoaib, M., & Yusuf, F. H. (2016). Concern over Zika virus outbreak: another alarming global threat. Infection and Drug Resistance, 9, 149–151.
Heymann DL, et al. (2016). Zika virus and microcephaly: why is this situation a PHEIC? Lancet. 387(10020):719-21.
Interim RCOG/RCM/PHE/HPS clinical guidelines. Zika Virus Infection and Pregnancy. Information for Healthcare Professionals. Royal College of Obstetricians and Gynaecologists. Pdf. Available at: https://www.rcog.org.uk/globalassets/documents/news/zika-virus-interim-guidelines.pdf [Accessed 01 September 2016]
Kaddumukasa MA, et al. (2014). Mosquitoes of Zika Forest, Uganda: species composition and relative abundance. J Med Entomol. 51(1):104-13.
Kleber de Oliveira, et al. (2016). Increase in Reported Prevalence of Microcephaly in Infants Born to Women Living in Areas with Confirmed Zika Virus Transmission During the First Trimester of Pregnancy - Brazil, 2015. MMWR Morb Mortal Wkly Rep. 65(9):242-7.
Knapton, S. (2016). Zika outbreak: pregnant women warned to avoid Florida and Queensland if virus spreads Science. The Telegraph. Web. Available at: http://www.telegraph.co.uk/science/2016/03/12/zika-outbreak-pregnant-women-warned-to-avoid-florida-and-queensl/ [Accessed 01 September 2016]
Kwong, J. C., Druce, J. D., & Leder, K. (2013). Zika Virus Infection Acquired During Brief Travel to Indonesia. The American Journal of Tropical Medicine and Hygiene, 89(3), 516–517.
Leung GH, Baird RW, Druce J, Anstey NM. (2015). ZIKA VIRUS INFECTION IN AUSTRALIA FOLLOWING A MONKEY BITE IN INDONESIA. Southeast Asian J Trop Med Public Health. 46(3):460-4.
Monaghan, A. J., Morin, C. W., Steinhoff, D. F., Wilhelmi, O., Hayden, M., Quattrochi, D. A., Ernst, K. (2016). On the Seasonal Occurrence and Abundance of the Zika Virus Vector Mosquito Aedes Aegypti in the Contiguous United States. PLoS Currents, 8, ecurrents.
Meaney-Delman, et al. (2016). Zika Virus and Pregnancy: What Obstetric Health Care Providers Need to Know. Obstet Gynecol. 127(4):642-8.
Meaney-Delman, et al. (2016). Prolonged Detection of Zika Virus RNA in Pregnant Women. Obstet Gynecol. Print.
Messina, J. P., Kraemer, M. U., Brady, O. J., Pigott, D. M., Shearer, F. M., Weiss, D. J. Hay, S. I. (2016). Mapping global environmental suitability for Zika virus. eLife, 5, e15272.
Mlakar J, Korva M, Tul N, Popovic M, Poljsak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodusek V, et al. (2016). Zika virus associated with microcephaly. N Engl J Med. 374(10):951–8.
Nah, K., Mizumoto, K., Miyamatsu, Y., Yasuda, Y., Kinoshita, R., & Nishiura, H. (2016). Estimating risks of importation and local transmission of Zika virus infection. PeerJ, 4, e1904.
Olson CK, et al. (2016). Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions - United States, 2016. MMWR Morb Mortal Wkly Rep. 65(11):290-2
Oster AM, et al. (2016). Interim Guidelines for Prevention of Sexual Transmission of Zika Virus - United States, 2016. MMWR Morb Mortal Wkly Rep. 65(5):120-1.
Petersen LR, et al. (2016). Zika Virus. N Engl J Med. 374(16):1552-63.
Petersen EE, et al. (2016). Interim Guidelines for Pregnant Women During a Zika Virus Outbreak--United States, 2016. MMWR Morb Mortal Wkly Rep. 65(2):30-3.
Plourde, A. R., & Bloch, E. M. (2016). A Literature Review of Zika Virus. Emerging Infectious Diseases, 22(7), 1185–1192.
Pyke, A. T., Daly, M. T., Cameron, J. N., Moore, P. R., Taylor, C. T., Hewitson, G. R., Gair, R. (2014). Imported Zika Virus Infection from the Cook Islands into Australia, 2014. PLoS Currents, 6, ecurrents.outbreaks.
Powell, J. R., & Tabachnick, W. J. (2013). History of domestication and spread of Aedes aegypti - A Review. Memórias Do Instituto Oswaldo Cruz, 108(Suppl 1), 11–17.
Queensland Health (2016). Zika Virus. Health Alerts. Web. Availabe at: https://www.health.qld.gov.au/news-alerts/health-alerts/zika/ [Accessed 01 September 2016]
Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. (2016). Zika virus and birth defects - reviewing the evidence for causality. New Engl J Med. 374(20):1981–7.
Saiz, J.-C., Vázquez-Calvo, Á., Blázquez, A. B., Merino-Ramos, T., Escribano-Romero, E., & Martín-Acebes, M. A. (2016). Zika Virus: the Latest Newcomer. Frontiers in Microbiology, 7, 496.
Slavov, S. N., Otaguiri, K. K., Kashima, S., & Covas, D. T. (2016). Overview of Zika virus (ZIKV) infection in regards to the Brazilian epidemic. Brazilian Journal of Medical and Biological Research, 49(5), e5420.
Steele RW (2016). Zika Virus: An Explosive Pandemic and a New TORCH Agent. Clin Pediatr (Phila). 55(8):698-700.
Sikka, V., Chattu, V. K., Popli, R. K., Galwankar, S. C., Kelkar, D., Sawicki, S. G., Papadimos, T. J. (2016). The Emergence of Zika Virus as a Global Health Security Threat: A Review and a Consensus Statement of the INDUSEM Joint working Group (JWG). Journal of Global Infectious Diseases, 8(1), 3–15.
Taylor KA & Paterson BJ (2016). Zika virus from a Pacific perspective: What are the risks to Australians? Travel Med Infect Dis. 14(2):159-61.
Vouga M, et al. (2016). CDC guidelines for pregnant women during the Zika virus outbreak. Lancet. 387(10021):843-4.
Wahlquist, C (2016). Pregnant woman diagnosed with Zika virus in Australia. The Guardian. Web. Available at: https://www.theguardian.com/world/2016/feb/10/pregnant-woman-diagnosed-with-zika-virus-in-queensland [Accessed 01 September 2016]
Wikan N & Smith DR. (2016). Zika virus: history of a newly emerging arbovirus. Lancet Infect Dis. 16(7):e119-26.
