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 Table of Contents  
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 50-52

Zika virus: A review with oral health implications

1 Department of Oral Medicine and Radiology, Sri Sukhmani Dental College and Hospital, Derabassi, Punjab, India
2 Officer Commanding, 1209 Dental Unit, Leh, Jammu and Kashmir, India
3 Department of Pedodontics, Sri Sukhmani Dental College and Hospital, Derabassi, Punjab, India

Date of Web Publication10-Oct-2017

Correspondence Address:
Ruchika Khanna
Department of Oral Medicine and Radiology, Sri Sukhmani Dental College and Hospital, Derabassi, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_44_17

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Zika virus was first isolated in the year 1947 from the blood of sentinel rhesus macaque of Uganda. The virus was introduced in Brazil from Pacific Islands and thereon spread rapidly. It was considered the first infectious disease to have birth defects. This review highlights the transmission, clinical aspects, clinical features, diagnosis, and possible implications of the virus for the dental team.

Keywords: Birth defects, infectious, Zika

How to cite this article:
Khanna R, Gupta MS, Jagga U. Zika virus: A review with oral health implications. J Dent Res Rev 2017;4:50-2

How to cite this URL:
Khanna R, Gupta MS, Jagga U. Zika virus: A review with oral health implications. J Dent Res Rev [serial online] 2017 [cited 2023 Mar 29];4:50-2. Available from: https://www.jdrr.org/text.asp?2017/4/2/50/216421

  Introduction Top

Zika virus is a flavivirus, belonging to the family Flaviviridae. It was first discovered in the year 1947 and was isolated from Aedes Africanus. There was no incidence of human illness earlier until a serosurvey done on people of Uganda showed 6.1% seroprevalence of antibodies against Zika Virus, suggesting human infection to be frequent.[1] Further serosurveys done showed the human spread to much broader geographic areas such as Egypt,[2] East Africa,[3] Nigeria,[4] India,[5] Thailand,[6] Vietnam,[6] the Philippines,[7] and Malaysia (near Kuala Lumpur and in East Malaysia [Sabah and Federal Territory of Labuan]).[8] The first case of human infection of Zika Virus was recognized in Nigeria in 1953. In spite being recognized, only 13 cases were recorded in next 57 years until its outbreak in 2007 on several islands in the state of Yap, Federated States of Micronesia resulting in almost 5000 infections in a total population of 6700.[9] Whereas an outbreak of Zika Virus in French Polynesia in 2013–2014 involved around 32,000 persons.[10],[11],[12] Cases of associated Guillain–Barre syndrome is also noted.[11] Investigators in Brazil in September 2015, noted a sudden increase in the cases of microcephaly in infants in same areas in which Zika Virus was reported.[13] By 2016, almost 4300 cases of microcephaly have been recorded.[14] It is speculated that due to the increasing number of microcephaly associated with Zika Virus cases there will be a significant effect on not only the general health of the patient but also dental health would too be affected.[15],[16] The common features of ZIKV infection are fever, conjunctivitis, cutaneous rash, and arthralgia but the majority of the affected patients with the clinical disease present with only mild symptoms.[17] Recent data show the presence of Zika Virus in body fluids such as blood, semen, urine, saliva suggesting the transmission of the virus through corporal fluids. [Figure 1] shows areas in the world affected by Zika Virus in the past decade.[18]
Figure 1: Areas affected by Zika Virus in the past[18]

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Mosquito virus transmission

In Africa, sylvatic transmission cycle is seen involving nonhuman primates and forest dwelling species of Aedes mosquitoes which is not seen in Asia.

Species belonging to Stegomyia, Diceromyia of Aedes and Australopithecus africanus, Aedes luteocephalus are likely vectors found in Asia and Africa.[19] Whereas, the transmission seen in urban environments is human-mosquito-human transmission cycle. Species A. Aegypti and Aedes albopictus bite mainly during the daytime and are distributed widely through the tropical and subtropical world.

Non-mosquito transmission

Significant data show that Zika Virus transmits from mother to fetus during pregnancy. Zika Virus has been found in the amniotic fluid of mothers whose fetus had cerebral abnormalities detected by ultrasonography and viral antigen and RNA have been detected in brain tissue and placentas of children born with microcephaly.[20]

Clinical aspects

Acute febrile illness

French Polynesian blood donors reported conjunctivitis, rash, arthralgia, or combination of these symptoms 3–10 days after blood donation.[21] A serosurvey from an outbreak in Yap indicated maculopapular rash in 90% of patients, fever (65%), arthritis or arthralgia (65%), nonpurulent conjunctivitis (55%), myalgia (48%), headache (45%), retro-orbital pain (39%), edema (19%), and vomiting (10%). Other symptoms reported are temporary dull metallic hearing, hand and ankle edema with subcutaneous bleeding.[22]

Neurological effects

An association has been observed between Zika Virus and Guillain–Barr syndrome (GBS) which is an acute paralytic peripheral neuropathy. GBS is characterized by nerve inflammation and demyelination secondary to the action of antibodies against myelin antigens. Zika Virus infection complicated by meningoencephalitis [23] and acute myelitis [24] have been reported in literature.

Adverse fetal outcomes

Maternal Rubella infection can cause various congenital anomalies such as sensorineural hearing loss, eye anomalies, cataracts, cardiac anomalies, neurological effects, brain damage, and microcephaly.[25]

Clinical features

The incubation period lasts from 2 to 7 days. Symptoms can last for up to a week, with a clinical presentation similar to that of other arbovirus infections such as chikungunya and dengue. Common signs of ZIKV infection are headache, and conjunctivitis rash, self-limiting acute fever, arthralgia. Rash that appears is pruritic and maculopapular. Hemorrhagic signs are uncommon (Duffy et al., 2009). Sore throat, vomiting, diarrhea, apthous ulcers, cough (Tappe et al., 2014; Foy et al., 2011).


The routine diagnosis of Zika Virus is the detection of viral nucleic acid by a real-time polymerase chain reaction and IgM antibodies by IgM capture enzyme-linked immunosorbent assay (MAC-ELISA).

Relevance to dentistry

The dental practice involves close contact to the airway and generation of aerosol sprays posing a higher risk environment to pass and catch various viral infections.[26] However, a considerable reduction of the risk can be done by use of masks and gloves, rubber dam, high volume suction, and preprocedure rinses.

Implications for dental team

With proper knowledge, it is possible to reduce the transmission of emerging infection in dental setting. The implications include:

  • Being aware of incubation periods
  • Being aware of patients' recent travel history
  • Being aware of emerging infections
  • Delaying elective treatment of those from affected areas who may have been in contact with cases until the incubation period has passed to reduce risk of transmission.

  Conclusion Top

Zikv is a new evolving viral infection with global health consequences with microcephaly, Guillain–Barre syndrome and neurological disorders to mention a few. Although the risk of transmission in health-care setting is low, it should be prevented by following standard guidelines of infection control. Additional studies and research are required for better understanding of the disease. Dental professionals too should be aware of such infection as they have a potential to spread by the generation of aerosol sprays in the oral cavity.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Dick GW. Epidemiological notes on some viruses isolated in Uganda; Yellow fever, Rift Valley fever, Bwamba fever, West Nile, Mengo, Semliki forest, Bunyamwera, Ntaya, Uganda S and Zika viruses. Trans R Soc Trop Med Hyg 1953;47:13-48.  Back to cited text no. 1
Smithburn KC, Taylor RM, Rizk F, Kader A. Immunity to certain arthropod-borne viruses among indigenous residents of Egypt. Am J Trop Med Hyg 1954;3:9-18.  Back to cited text no. 2
Smithburn KC. Neutralizing antibodies against certain recently isolated viruses in the sera of human beings residing in East Africa. J Immunol 1952;69:223-34.  Back to cited text no. 3
Macnamara FN. Zika virus: A report on three cases of human infection during an epidemic of jaundice in Nigeria. Trans R Soc Trop Med Hyg 1954;48:139-45.  Back to cited text no. 4
Smithburn KC, Kerr JA, Gatne PB. Neutralizing antibodies against certain viruses in the sera of residents of India. J Immunol 1954;72:248-57.  Back to cited text no. 5
Pond WL. Arthropod-borne virus antibodies in sera from residents of South-East Asia. Trans R Soc Trop Med Hyg 1963;57:364-71.  Back to cited text no. 6
Hammon WM, Schrack WD Jr., Sather GE. Serological survey for a arthropod-borne virus infections in the Philippines. Am J Trop Med Hyg 1958;7:323-8.  Back to cited text no. 7
Smithburn KC. Neutralizing antibodies against arthropod-borne viruses in the sera of long-time residents of Malaya and Borneo. Am J Hyg 1954;59:157-63.  Back to cited text no. 8
Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536-43.  Back to cited text no. 9
Cao-Lormeau VM, Roche C, Teissier A, Robin E, Berry AL, Mallet HP, et al. Zika virus, French Polynesia, South Pacific, 2013. Emerg Infect Dis 2014;20:1085-6.  Back to cited text no. 10
Rapid Risk Assessment: Zika Virus Infection Outbreak, French Polynesia. Stockholm: European Centre for Disease Prevention and Control; 2014. Available from: http://www.ecdc.europa.eu/en/publications/. [Last accessed 2016 Jun 23].  Back to cited text no. 11
Mallet HP, Vial AL, Musso D. Bilan de L Epidemie. A Virus Zika en Polynesie Francaise, 2013-2014. Available from: http://www.hygiene-publique.gov.pf. [Last updated on 2015 May 21].  Back to cited text no. 12
Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, et al. Possible association between Zika virus infection and microcephaly – Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65:59-62.  Back to cited text no. 13
Victora CG, Schuler-Faccini L, Matijasevich A, Ribeiro E, Pessoa A, Barros FC, et al. Microcephaly in Brazil: How to interpret reported numbers? Lancet 2016;387:621-4.  Back to cited text no. 14
Mizuno Y, Kotaki A, Harada F, Tajima S, Kurane I, Takasaki T, et al. Confirmation of dengue virus infection by detection of dengue virus type 1 genome in urine and saliva but not in plasma. Trans R Soc Trop Med Hyg 2007;101:738-9.  Back to cited text no. 15
Poloni TR, Oliveira AS, Alfonso HL, Galvão LR, Amarilla AA, Poloni DF, et al. Detection of dengue virus in saliva and urine by real time RT-PCR. Virol J 2010;7:22.  Back to cited text no. 16
Leão JC, Gueiros LA, Lodi G, Robinson NA, Scully C. Zika virus: Oral healthcare implications. Oral Dis 2017;23:12-7.  Back to cited text no. 17
Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika virus. N Engl J Med 2016;374:1552-63.  Back to cited text no. 18
Diallo D, Sall AA, Diagne CT, Faye O, Faye O, Ba Y, et al. Zika virus emergence in mosquitoes in Southeastern Senegal, 2011. PLoS One 2014;9:e109442.  Back to cited text no. 19
Calvet G, Aguiar RS, Melo ASO, Sampaio SA, de Filippis I, Fabri A, et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: A case study. Lancet Infect Dis 2016;16:653-60.  Back to cited text no. 20
Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 2014;19. pii: 20761.  Back to cited text no. 21
Karimi O, Goorhuis A, Schinkel J, Codrington J, Vreden SGS, Vermaat JS, et al. Thrombocytopenia and subcutaneous bleedings in a patient with Zika virus infection. Lancet 2016;387:939-40.  Back to cited text no. 22
Carteaux G, Maquart M, Bedet A, Contou D, Brugières P, Fourati S, et al. Zika virus associated with meningoencephalitis. N Engl J Med 2016;374:1595-6.  Back to cited text no. 23
Mécharles S, Herrmann C, Poullain P, Tran TH, Deschamps N, Mathon G, et al. Acute myelitis due to Zika virus infection. Lancet 2016;387:1481.  Back to cited text no. 24
Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982;2:781-4.  Back to cited text no. 25
Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. J Am Dent Assoc 2004;135:429-37.  Back to cited text no. 26


  [Figure 1]

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