Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

symptomatic: non-pregnant

1st line – supportive therapy

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ACUTE
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symptomatic: non-pregnant
1st line – 

supportive therapy

Treatment for symptoms includes rest, fluids, and use of analgesics and/or antipyretics (e.g., paracetamol).

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue virus infection can be ruled out to reduce the risk of haemorrhage.[130]

Calamine lotion may be used topically for the itch associated with the rash.

Primary options

paracetamol: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

pregnant: with possible mosquito-borne or sexual exposure

1st line – supportive therapy plus monitoring

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ACUTE
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pregnant: with possible mosquito-borne or sexual exposure
1st line – 

supportive therapy plus monitoring

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 antenatal visits.​[14][177]

If symptomatic, supportive therapies include rest, fluids, and use of analgesics and/or antipyretics (e.g., paracetamol). Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided. Non-drug measures may be recommended (e.g., damp cloths, lukewarm baths/showers) to reduce fever during pregnancy. However, if these measures fail, paracetamol can be used safely in pregnant women. Calamine lotion may be used for the itch associated with the rash.

Appropriate psychological support for the woman and her family is recommended.[195]​​

Primary options

paracetamol: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

congenital Zika syndrome

1st line – evaluation plus monitoring

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ACUTE
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congenital Zika syndrome
1st line – 

evaluation plus monitoring

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 physiotherapist, speech therapist, and occupational therapist.

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. CDC: interim guidance for the diagnosis, evaluation and management of infants with possible congenital Zika virus infection Opens in new window

The World Health Organization also offers specific guidance for the screening, assessment, and management of neonates and infants with congenital Zika infection. WHO: screening, assessment and management of neonates and infants with complications associated with Zika virus exposure in utero Opens in new window

A co-ordinated approach, with ongoing psychosocial support for families and caregivers, is recommended.[2]​​[178]

Breastfeeding according to normal infant feeding guidelines is still recommended in women with suspected, probable, or confirmed infection, or those who reside in or have travelled to areas of ongoing transmission. Transmission through breast milk is only a theoretical concern at this point and the benefits of breastfeeding 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.[92]​​​[196][197] One systematic review found no evidence of perinatal transmission via breastfeeding or breast milk intake based on low-certainty evidence.[93] 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 carers should receive skilled support from healthcare workers.​[196]

Zika-associated Guillain-Barre syndrome

1st line – supportive therapy plus immunotherapy

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ACUTE
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Zika-associated Guillain-Barre syndrome
1st line – 

supportive therapy plus immunotherapy

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.​[145]

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 programme.[145]​​[147]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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