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Vol 1 | Issue 3 | Oct – Dec 2022                                                                                    Indian J Pharm Drug Studies | 97 

Review Article 

Current and Emerging Pharmacotherapies for Zika Virus: A Comprehensive 

Review 

Queeny Wilcy Noronha1, Thanshifa Fathima1, Ramdas Bhat2, A R Shabaraya3 

From 1 UG student, Department of Pharmacy Practice, 2 Assistant Professor, Department of Pharmacology, 3 Principal and Head of 

Department of Pharmaceutics, Srinivas College of Pharmacy, Valachil, Post Farangipete, Mangalore, Karnataka, India-574143 

Corresponding to: Ramdas Bhat, Assistant Professor, Department of Pharmacology, Srinivas college of Pharmacy, Valachil, 

Mangalore -574143 Karnataka, India. Email: ramdas21@gmail.com, Tel.: +91 7795772463 

ABSTRACT 

Zika virus is a single-stranded RNA virus that belongs to the Flaviviridae family and was first identified in the Zika Forest of Uganda 

in 1947. Since 2007, there have been several outbreaks of Zika virus in various countries, with the most significant outbreak occurring 

in Brazil in 2015. The virus is primarily transmitted by infected Aedes mosquitoes, but it can also be sexually transmitted, transmitted 

through blood transfusions, and from mother to child during pregnancy. While most people who become infected with Zika virus 

experience mild or no symptoms, there is a potential for severe outcomes, including neurological complications like Guillain-Barre 

syndrome and congenital birth defects like microcephaly. This article provides an overview of Zika virus, its transmission, symptoms, 

and potential impacts on public health. Despite no specific antiviral treatment available for Zika virus, there are ongoing efforts to 

develop vaccines and treatments. The potential for sexual transmission of Zika virus has also led to recommendations for safe sexual 

practices, particularly for pregnant women or women who may become pregnant. Continued research is needed to better understand 

the virus and its potential impacts on public health, including long-term effects and the potential for the virus to be transmitted 

through other routes. The emergence of Zika virus as a significant public health concern highlights the need for continued vigilance 

and research to mitigate the potential impacts of this and other emerging infectious diseases. Given the threat of Zika virus and its 

ability to spread across international borders, global collaboration and coordinated responses are essential to address emerging 

infectious disease threats. It is essential to continue investing in research and development to reduce the impact of emerging infectious 

diseases on public health. 

Key words: Zika virus (ZIKV), Mosquito, RNA, World Health Organization (WHO), Infection 

n RNA flavivirus known as the Zika virus (ZIKV) 

was first discovered in Uganda, Africa, in 1947. For 

many years, the virus was not seen as a serious threat 

to public health; nevertheless, in 2007, an epidemic was 

discovered in the Yap Islands in the Pacific [1]. Further 

breakouts occurred in French Polynesia in 2015 after which 

they expanded to other Pacific Islands and, starting in 2016, 

migrated quickly into Americas [2]. The World Health 

Organization (WHO) declared a public health emergency in 

2016 due to possibility ZIKV infection during pregnancy 

might have catastrophic consequences for the infant, such as 

microcephaly and neurological impairment [3].  

Despite a decline in transmission since 2017, the virus is 

still present and outbreaks are still a possibility [4]. The 

emergence of ZIKV in South America has been the subject of 

extensive research, with previous reviews covering this topic 

[5]. Nonetheless, the emphasis of this review is on recent 

discoveries from 2019 to 2020, including updates on 

epidemiology, transmission, immunogenicity and host 

variables, clinical characteristics, and potential therapies [6]. 

As our understanding of the virus grows, ongoing research is 

assisting in the discovery of new strategies for ZIKV 

prevention and treatment. Nonetheless, the risk of outbreaks 

and the terrible side effects caused by ZIKV infection 

highlight the ongoing need for research into this virus and the 

development of effective treatments [7].  

Epidemology  

Human infection incidents were few and uncommon before 

2007. Serological testing and viral isolation were the main 

sources of human infection reporting, which suggested 

extensive dispersion in Africa and Southeast Asia but no 

significant outbreaks [8-10]. In the island of Yap, there was an 

event in 2007, which resulted in 49 confirmed cases and          

59 probable cases over the course of a four-month period [11-

13]. With 294 confirmed cases over a 10-week period, French 

Polynesia had another significant outbreak in 2013 [14]. The 

virus entered the Americas in 2014. Cases of locally acquired 

infection were found on Easter Island, while instances in 

northeastern Brazil were discovered in 2015 [15-16]. 

A 

mailto:ramdas21@gmail.com


Bhat R et al.                                                                                                                        Zika Virus: A Comprehensive Review 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                    Indian J Pharm Drug Studies | 98 

The 2013 chikungunya virus epidemic was similar to the 

rising frequency of the Zika virus in the Americas [17]. 

Because most infected persons do not seek medical attention, 

it is challenging to assess the number of Zika cases [18].  

While Colombia has reported more than 25,000 suspected 

cases, Brazilian officials believe that there have been close to 

1.5 million infections since the outbreak started [19-22]. 

Figure 1: Areas of locally acquired Zika virus infection, June to February, 2016, Adapted from World Health Organization 

situation report,19 February 2016 [7] 

Clinical Manifestations  

The majority of Zika virus patients don't exhibit any 

symptoms. If so, symptoms are often mild (rash, fever, 

conjunctivitis, muscle and joint pain, malaise, and headache), 

start 3–14 days after infection, and last 2–7 days. Although 

other arboviral and non-arboviral conditions might also 

present with same symptoms, a laboratory confirmation of 

Zika virus infection is necessary [23]. 

Complications  

Zika virus infection during pregnancy causes microcephaly 

and other congenital deformities in the foetus, such as limb 

contractures, high muscle tone, eye abnormalities, and hearing 

loss. Congenital Zika syndrome is the umbrella term for these 

clinical features. The risk of congenital deformities following 

Zika virus infection during pregnancy is unknown; it is 

estimated that 5-15% of babies born to mothers who 

contracted the virus while pregnant show signs of Zika-related 

problems. Congenital defects can develop after an infection, 

whether it is symptomatic or not. Preterm birth, stillbirth, and 

foetal death are other complications of zika infection during 

pregnancy [24]. 

Treatment  

The current gold standard of therapy for Zika virus (ZIKV) 

infection is symptomatic treatment as there is no particular 

antiviral vaccine or medication available. It is important to 

take analgesics and antipyretics carefully to avoid side effects 

such hepatopathy, allergies, and nephropathy. As clinical 

diagnosis and serological analysis can be imprecise, aspirin 

administration should be avoided to prevent bleeding issues in 

individuals who have been incorrectly diagnosed with ZIKV 

infection [25]. A typical symptom of rashes is severe pruritus, 

which may be controlled by avoiding hot showers and 

overusing soap as well as using enough skin moisturisers. If 

these efforts are unsuccessful, calamine or menthol-based 

cooling creams can be utilised, and older antihistamine 

medications may offer comfort owing to their calming effects.  

As it is uncertain how well corticosteroids would treat this 

ailment, they should be avoided [26]. The diagnosis of 

Guillain-Barré syndrome (GBS) should be made when the 

patient exhibits areflexia, clinical progression, and progressive 

weakening affecting two or more limbs over the course of up 

to four weeks. Because there is a possibility of respiratory 

muscle paralysis, patients with suspected GBS should be 

closely watched in intensive care units. Plasmapheresis and 

hyperimmune intravenous immunoglobulin (IVIG) are two 

treatment options for GBS that, although being pricey 



Bhat R et al.                                                                                                                        Zika Virus: A Comprehensive Review 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                    Indian J Pharm Drug Studies | 99 

treatments, shorten the time it takes for a patient to recover 

[27]. 

Virology and Pathogenesis  

The Flaviviridae family, which also contains other medically 

relevant mosquito-borne viruses including DENV, WNV, and 

yellow fever virus, is home to the positive-sense, single-

stranded RNA virus known as the Zika virus [28]. A 

polyprotein that is broken down into 10 proteins, including the 

capsid, envelope, and seven nonstructural proteins, is encoded 

by its 10,794-nucleotide genome. It also includes two 

noncoding sections at its 5' and 3' ends. Both the African and 

Asian subspecies of the virus originated in East Africa in the 

late 19th or early 20th century, and both have since migrated 

to numerous regions, including the Pacific Islands and the 

Americas [29]. 

Many genomic regions were shown to be under strong 

negative selection pressure in recent research on the molecular 

evolution of the Zika virus, which might have resulted in 

recombination events and the elimination of deleterious 

polymorphisms [30]. To ascertain the effect of this discovery 

on the virus's transmission, zoonotic maintenance, and 

epidemiology, more research is required. The AXL receptor 

tyrosine kinase and other entry and adhesion factors let the 

virus invade host cells through cellular receptors and infect 

keratinocytes, immature dendritic cells, and fibroblasts [31]. 

Zika virus antigens were exclusively found in the nucleus of 

infected cells, unlike other flaviviruses, suggesting a unique 

replication location that needs more research. Cellular 

autophagy boosts Zika virus replication in skin fibroblasts 

[32]. 

Diagnosis  

The overlap with other arboviruses makes it difficult to 

reliably diagnose Zika virus infection based only on clinical 

signs. Because of this, a precise diagnosis requires laboratory 

testing. Patients with an acute fever, rash, myalgia, or 

arthralgia who have recently gone to places where the Zika 

virus is still being transmitted need to get tested for the virus 

as well as for CHIKV, DENV, and Zika virus. A PCR-based 

diagnostic and a serologic assay, both of which are 

commercially accessible and authorized for use in emergency 

situations, are both available.  

Based on the clinical data supplied by the healthcare 

practitioner, the laboratory chooses the proper test.Serologic 

testing is not advised during the acute period of sickness; 

instead, molecular amplification tests, such as RT-PCR, are 

the method of choice. Nonetheless, if samples test negative for 

the Zika virus by RT-PCR, serologic testing can be taken into 

consideration. Due to cross-reactivity with other flaviviruses, 

such as DENV, serologic testing has limits in terms of 

specificity. Thus, employing a different testing method, 

positive serologic test results should be verified. The kind of 

sample used can also alter the likelihood of detection, and 

additional specimen types, such urine and saliva, are being 

examined for their potential diagnostic value [33]. 

Viruria may last longer than viremia, and saliva and urine 

may be acceptable substitutes, particularly when drawing 

blood is difficult. According to one study, Zika virus RNA can 

be found in urine up to 20 days after viremia has been 

eliminated. As a result, when the Zika virus is clinically 

suspected, RT-PCR urine testing should be considered. 

Similarly, salivary RT-PCR testing has been shown to improve 

the rate of infection diagnosis during the acute phase, but 

blood remains the preferred sample. Large reference 

laboratories typically conduct Zika virus testing, and it is best 

to contact local public health organisations before testing to 

organise sample collection [33]. 

Prevention and Control of Zikv 

Mosquitoes pose the most risk for ZIKV infection, hence it is 

important to manage and limit their breeding grounds in order 

to stop the virus from spreading [34]. Mosquito nets, insect 

repellents, and closing cracks and gaps can all help with this. 

Larvicides should be used with insecticides that are suggested 

by the WHO Pesticide Evaluation System. Insect repellents 

should not be used to infants less than two months; however, 

mosquito nets can shield them from bites [35].  

The Centers for Disease Control and Prevention advises 

using mosquito repellents with active chemicals such 

picaridin, DEET, eucalyptus oil, IR3535, oil of lemon, and 

para-menthane-diol, which are safe for use by expectant and 

lactating moms. Nevertheless, children under three years old 

should not use repellents that include para-menthane-diol, 

lemon oil, or eucalyptus oil. Flying insect foggers with 

Tetramethrin and Cypermethrin and indoor mosquito-killing 

sprays with Imidacloprid and -Cyfluthrin can both kill 

mosquitoes [36]. 

Before receiving blood transfusions, it is advisable to get 

tested for ZIKV infection to stop blood-borne illness. 

Pregnancy should be avoided in high-risk locations until the 

virus has been completely eradicated, or increased caution 

should be used because ZIKV infection has been associated to 

microcephaly [37]. The spread of ZIKV can also be stopped 

by using a variety of vector control techniques. A technique 

that works well is giving mosquitoes a bacterium that 

regulates their number. To manage mosquito populations, 

Wolbachia, an intracellular bacterium, can be used as a 

biopesticide [38]. Toxorhynchites splendens mosquito larvae 

can be used since the adults consume honeydew, fruit, and 

nectar while the larvae do not feed on blood but rather the 



Bhat R et al.                                                                                                                        Zika Virus: A Comprehensive Review 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                    Indian J Pharm Drug Studies | 100 

larvae of other mosquito species [39]. Using sterile males to 

cause infertility in wild, fertile Aedes species mosquito 

females is another successful tactic [40]. 

CONCLUSION 

The Zika virus is a newly emerging disease that, while less 

dangerous to adults than SARS and MERS, can cause foetal 

defects if contracted during pregnancy. It is one of the 

TORCH illnesses, which can result in congenital 

abnormalities. To manage potential Zika-related problems in 

different countries, medical community knowledge must be 

increased, vector control strategies improved, and disease 

surveillance systems expanded. 

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How to cite this article: Ramdas Bhat, Queeny Wilcy 

Noronha, Thanshifa Fathima, A R Shabaraya. Current and 

Emerging Pharmacotherapies for Zika Virus: A 

Comprehensive Review. Indian J Pharm Drug Studies. 

2022;1(3) 97-101. 

Funding: None                 Conflict of Interest: None Stated 


