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Before we left Qatar for Brazil on holidays, only a few news reports had reached us about a virus spreading throughout the Americas. However, after spending 2 weeks at the centre of the outbreak, we gained a unique perspective on the public health crisis affecting Central and South America. This article summarizes, up to May 2016, knowledge of the Zika virus, provides evidence-based recommendations regarding prevention of Zika infection, and provides a perspective on issues related to travel medicine for pharmacists outside of Zika-active zones. As of February 2016, the World Health Organization had declared the spread of Zika virus a public health emergency of international concern, a verdict that should prompt international action and research priorities.1 Zika virus is a flavivirus, with mosquitoes serving as the vectors of transmission, which causes effects similar to those of other well-known viruses, such as yellow fever virus, dengue virus, and West Nile virus.2Aedesmosquitos are deemed to be the primary transmitting vectors, but other vectors cannot be ruled out.3 Sexual transmission and congenital cases have also been documented. Alarmingly, this virus is spreading quickly among several countries across multiple continents, including Central America, the Caribbean, Mexico, and South America. The clinical presentation is largely asymptomatic, yet some patients experience mild, nonspecific flu-like symptoms such as fever, chills, rash, conjunctivitis, and joint pain. Treatment consists only of supportive measures.4 Available data give a high suspicion for the association of Zika virus with development of neurological disorders, including congenital microcephaly and Guillain-Barré syndrome.2 As such, pregnant women are considered a high-risk population. Few studies to date suggest causality; however, observational data associate small fetal head size and brain calcifications with Zika infection. Between October 2015 and January 2016, in Brazil alone, about 4000 babies were born with microcephaly, which represents a 20-fold increase from the number of cases occurring between 2010 and 2014.5 Effective prevention strategies are key to control of virus transmission and spread. These strategies can be divided into 2 broad categories: those affecting mosquito population control and those targeting individuals. Focusing efforts to control mosquito populations in endemic regions should be a priority; however, vector-control strategies employed to control dengue and chikungunya viruses within affected regions have failed in the past.6 Efforts must be coordinated to effectively reduce the burden of carrier mosquitos and subsequently the rates of transmission to humans. Unfortunately, no vaccine to prevent Zika transmission is available, nor will any be available in the near future. Tourists and those living within endemic regions should take precautions against mosquito bites. Currently, the US Centers for Disease Control and Prevention (CDC) recommends use of mosquito repellent containing N,N-diethyl-3-meta-toluamide (DEET), picaridin, oil of lemon eucalyptus, or IR3535.7One study showed that products with DEET were most effective for the longest duration.8 Recommendations also include wearing clothing that covers the arms and legs and/or using permethrin-treated clothing.7 Additional measures may include using insecticide-treated mosquito nets when sleeping and minimizing time in areas of high mosquito volume. Postponement of travel plans to Zika-active areas can also be considered. The advent of sexual transmission prompted the CDC to release interim guidelines for prevention in early 2016.9 These guidelines are very important from a public health perspective, as the virus may persist longer in semen than in blood.10 The CDC

Zika Virus: Facts, Prevention Strategies, and an Informed Tourist Perspective