July 2015
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Zika Virus Disease

Patient Experience
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Did You Know?

Zika Virus Disease

A few months ago, virtually no one had heard of Zika, but today it is a major concern around the world. To date, travelers have brought over 500 cases of the Zika virus to the continental U.S. with infections reported in almost all 50 states. Health officials say we should expect more cases and outbreaks now that the weather is getting warmer and mosquitoes are becoming more active. Preventing the spread of Zika is critical, especially for women who are pregnant; in January, the CDC posted a travel alert advising pregnant women to delay travel to areas where Zika is active.

Workers who are exposed to mosquitoes on the job or the blood and other body fluids of infected individuals may be at risk for Zika virus infection. The Occupational Safety and Health Administration (OSHA) and the National Institute Occupational Safety and Health (NIOSH) recently issued Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus. Because the virus is so new to the U.S. and recent reports tell us it has been transmitted through sex, healthcare workers and others who come in contact with blood and other body fluids on the job may have a number of questions about the disease.

What is Zika?

Zika is an infectious disease caused by the Zika virus, which is spread primarily through the bite of an infected Aedes mosquito. The illness is usually mild and lasts up to a week after being bitten. Most people do not realize they have been infected, and therefore will not seek medical attention. However, Zika during pregnancy can cause a serious birth defect called microcephaly – an abnormally small head and brain and other serious brain abnormalities in newborns.

What are the symptoms of Zika?

One out of every five infected experience mild flu-like symptoms, which are:

  • Low-grade fever
  • Rash
  • Joint pain – most often in the small joints of the hands and feet
  • Eye redness
  • Muscle aches
  • Mild headache
How can a person become infected with Zika?

To date, there has been no evidence of transmission to healthcare personnel during routine care; however, workers should follow standard precautions to protect against exposure to all blood and body fluids. Zika remains in an individual’s blood stream from 10 days to 2 weeks.

Zika has been transmitted to humans by the following:

  • The bite of an infected mosquito. This is the most common means of transmission. A mosquito becomes infected when it feeds on a person infected with the virus. It then spreads it to another person when it bites them.
  • From a pregnant woman to her fetus. A pregnant woman can pass the virus to her fetus during pregnancy or around the time of birth. There have been no reports of Zika transmission through breastfeeding.
  • From a man to a female or male partner through sexual contact, including vaginal, anal, and oral sex. It can be transmitted by an infected man before, during, or after symptoms resolve. The virus remains present in semen longer than in blood.
  • Blood transfusion. No cases of transmission through transfusion have been confirmed in the U.S., but several have occurred in Brazil.

Zika virus is not transmitted by casual contact such as talking to or hugging an infected person.

What are the symptoms of Zika when infected as a newborn or infant?

Newborns, infants, and children who become infected with Zika experience the same symptoms as adults.

Is there a vaccine or treatment for Zika?

There are currently no approved vaccines to prevent Zika infection. Management of infected persons consists of rest and symptomatic treatment, including fluids to prevent dehydration and acetaminophen for fever and pain.

If you get Zika, do you become immune to it afterward?

Yes – but experts do not know if immunity is lifelong.

Is there a risk to a fetus if a mother gets the virus, but does not become pregnant until much later?

Given what officials know so far, an infection in a woman who is not pregnant would not pose a risk of birth defects in future pregnancies after the virus has cleared from her blood.

Has Zika been linked to any other diseases or complications?

Although other diseases and complications are rare, several countries in the Americas have reported an unusual increase in the number of cases of Guillain-Barre Syndrome (GBS) in parallel with the ongoing Zika virus outbreak. GBS is a rare autoimmune disease that affects the nervous system leading to muscle weakness and possible paralysis. Most people recover from GBS, but some people experience permanent damage. In rare cases, death may occur.

In April, a man from Puerto Rico died shortly after a Zika illness when he developed immune thrombocytopenic purpura, or ITP, an autoimmune bleeding disorder that has been linked to the virus.

Who is at the greatest risk of becoming infected?

Those living or traveling to an area with active Zika transmission are at the greatest risk. Travelers returning from an area with Zika should take steps to prevent mosquito bites for 3 weeks to prevent spreading it to mosquitoes that could then spread it to other people. A map and list of countries and territories with active Zika virus transmission can be found on the CDC website at www.cdc.gov/zika/geo/active-countries.html. To date, there have been no confirmed cases of local mosquito-borne Zika infections within the continental U.S. However, as weather becomes warmer and mosquitos become more active, those in areas within range of the Aedes mosquito species could be at greater risk, although the CDC has currently made no predictions about this risk. For a complete map of these areas, go to www.cdc.gov/zika/vector/range.html.

How can you avoid becoming infected?
  • Avoid travel to an area with active Zika transmission. This is especially important for women who are pregnant or may become pregnant.
  • Prevent mosquito bites. This is especially important when traveling to active Zika areas.
    • Wear long-sleeved shirts and long pants
    • Stay in places with air conditioning and screens that keep mosquitoes outside
    • Control mosquitos inside and outside your home
    • Use mosquito netting when sleeping if you are overseas or outside
    • Stay away from mosquito breeding sites, like containers with standing water
    • Use as directed an EPA registered insect repellent
    • Cover cribs, strollers, and baby carriers with mosquito netting
  • Prevent sexual transmission:
    • Pregnant women with a male sex partner who has lived in or traveled to an area with active Zika transmission should either use a condom or not have sex during the pregnancy.
    • Women who have Zika virus should wait at least 8 weeks after symptom onset to attempt conception and men should wait at least 6 months.
    • Men with possible exposure but no clinical illness should wait 8 weeks to attempt conception. See the CDC website for more information at www.cdc.gov/mmwr/volumes/65/wr/mm6512e2.htm.
  • Healthcare workers should follow standard infection control and biosafety practices, such as hand hygiene and the use of PPE to avoid direct contact with blood or other potentially infectious materials. For more information, visit www.osha.gov/zika/index.html#!tab4.
    • Employers should consider enhanced precautions in situations where workers are at increased risk of exposure to Zika virus or other hazards.
    • While there is no evidence of Zika transmission through aerosol exposure, minimizing the aerosolization of blood or body fluids as much as possible during patient care or laboratory tests may be necessary. Engineering controls and enhanced PPE to prevent or reduce exposure may be necessary during any aerosol-generating procedures.
How is Zika diagnosed?

Preliminary diagnosis is based on clinical features, places and dates of travel, and activities. Lab diagnosis is done by serum or plasma testing. Clinicians should contact their state or local health department for testing information.

Do Zika cases need to be reported?

Yes – Zika is a nationally notifiable condition. Healthcare providers should report suspected Zika cases to their state or local health department to facilitate diagnosis and to mitigate risk of local transmission. Health departments must report lab-confirmed and probable cases to the CDC. For more information see the CDC website.


The Patient Experience

Good communication is critical for a positive patient experience. When patients feel their healthcare team is dedicated to communicating respectfully, accurately, and in a way they can understand, they are more likely to be highly satisfied with their experience. Nine of the HCAHPS survey questions are related to communication and ask patients to rate how often nurses and doctors listened to them, explained things in a way that could be understood, talked to them about medicines, and whether they would have the help they needed when they left the hospital.

When patients have a clinic or hospital visit, they often have questions and concerns about important health topics, whether or not it is the reason for their visit. When new issues, such as the Zika virus, become prevalent in the media and are frequently discussed in social circles, it can be difficult to keep the facts straight. Patients value trusted information from healthcare professionals, so talk to them about concerns and, when possible, provide written materials.

Here are some questions your patients may have about Zika.

Should I be concerned about Zika?

To date, cases of Zika in the continental U.S. have only been confirmed in persons who have contracted the disease while traveling to an active Zika area or through unprotected sexual contact with a person who recently traveled to one of the active areas. Most people who contract the disease have mild flu-like symptoms that last only a few days; however, it is an increased concern for pregnant women because it has been linked to birth defects.

Can mosquitoes spread Zika in the U.S.?

The species of mosquitoes that spread Zika are present in some parts of the U.S. (predominately Southern states along the border such as Texas and Florida), but to date, no cases of mosquito transmission in the U.S. have been confirmed. For mosquito-transmission to occur, a mosquito must bite a Zika-infected person and then pass it to another person through biting. Health officials say this type of Zika transmission is possible in the U.S. but have not determined the likelihood.

What can I do to reduce my chances of being infected?

The best way to protect yourself is by preventing mosquito bites and avoiding travel to areas with active Zika transmission.

Should I be concerned about travel?

The CDC has issued a travel advisory for numerous countries regarding the Zika virus. Pregnant women in any trimester should consider postponing travel to any area where the Zika virus is active. If you must travel to an active region, it is important to follow steps to prevent mosquito bites during your trip. Because the virus can be spread by men to women or other men through sexual contact (oral, anal, or vaginal), men should consider this risk before traveling. Pregnant women or those who may become pregnant should discuss their male sex partner’s history of travel to areas with active Zika virus transmission. Condoms are an effective method for preventing infection.

Areas with Zika Virus (source: CDC)
Is it safe to consider pregnancy right now?

Decisions about pregnancy timing are personal and complex, and discussions between patients and healthcare providers should be individualized. Some factors to consider are level of risk for Zika virus exposure and reproductive life plans.

Women with Zika virus disease should wait at least 8 weeks after symptom onset before attempting conception. Men who have had a diagnosis of Zika virus disease should wait at least 6 months after symptom onset before attempting conception.

Should I be tested for Zika?

Patients with recent travel to an active Zika region who develop symptoms consistent with Zika virus disease and those with symptoms who have had sexual contact without a condom with a man with recent travel to an active Zika region should be tested.

Where should I look for more information?

The CDC is a trusted source for information. Visit their Zika website.


Recommended Readings


Now Trending

See how well you score on these trivia questions about Zika virus.

Where did Zika get its name?

A. Zika is the last name of the scientist who first discovered it.
B. The first person with confirmed infection was from the Zika tribe in Africa.
C. It was first discovered in the Zika Forest in Uganda.
D. It was first discovered in the Zika monkey species.

Like Zika, all of the following are mosquito-borne diseases except _____.

A. West Nile
B. Chikungunya
C. Dengue Fever
D. Hanta Virus

How many people has WHO estimated could get Zika by the end of this year?

A. 500,000 to 750,000
B. 1 million to 2 million
C. 2 million to 2.5 million
D. 3 million to 4 million


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Answer

C. – It was first discovered in 1947 in the Zika Forest in Uganda.

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Answer

D. – Hanta Virus is transmitted through exposure to a rodent’s urine, feces, or saliva.

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Answer

D – 3 million to 4 million worldwide.

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