Introduction: Zika infection was declared as Public Health Emergency of International Concern since year 2015. Despite of no new reported case via National Surveillance System for flavivirus, an underestimated seroprevalence might occur as the country contributes to the Asian lineage of the virus. Methods: Systematic literature search using PICO framework and PRISMA checklist across four databases for articles published from year 2013-2018 yielded 189 results, 37 articles accepted by titles following criteria were subjected to abstract screening, leaving 8 articles with clear risk proceed to full text analysis using Cochrane checklist and GRADE assessment. Results: There were four high quality articles and four low quality articles based on biases in studies. Blood product management and vac-cination are strategies strongly recommended to be implemented as Zika response while vector control and family planning are public health measures to be proposed as policy if feasible. Successful factors to improve Zika surveil-lance and management includes developing algorithm for blood product management, anti-Zika vaccine research, algorithm for new-born screening, participation of policy makers, healthcare capacity building, raising healthcare and public awareness on the infection, international funding, utilization of technology in data management and bio-logical control of vector. Conclusion: Implementation of Zika response as policy is timely, should be evidence-based and follow guidelines from WHO / CDC / FDA US after cost-effectiveness evaluation for Malaysia setting.