Zika virus: Colorado Medical Society guidance to physician members
The World Health Organization (WHO) rang a global alarm over the Zika virus at the end of January 2016. WHO indicates the disease is spreading explosively in the Americas and as many as four million people could be infected by the end of the year. The group plans declared the Zika virus outbreak a public health emergency on Feb. 1. Since last spring, more than 20 countries have reported locally acquired cases of Zika. Global health authorities face the delicate task of alerting the world to the dangers of Zika without provoking panic. The growing concern is infections in pregnant women and the subsequent risk of an infant born with microcephaly.
Health officials at the Centers for Disease Control and Prevention (CDC) have taken a lead in the U.S. in terms of research on Zika virus, its spread, and guidelines for prevention, testing, and diagnosis.
The Colorado Medical Society (CMS) will be assisting physicians with information and guidance as this situation progresses both here in the U.S. and internationally. Currently, the CDC recommends reassuring patients that the vast majority of those who are exposed to the virus never have symptoms and that the risk of a homegrown outbreak is very low, largely because of more effective mosquito control and the type of mosquito that transmits the virus. For the average American who is not traveling to the affected area, there is nothing to worry about. The greatest danger is risk of infection in pregnant women, especially in the first trimester, and this is a difficult task for physicians to explain to their patients.
Below are specific guidelines and facts for physicians:
- Zika virus is a mosquito-borne flavivirus transmitted primarily by the Aedes aegypti mosquitoes, which are the same vectors that transmit dengue and chikungunya virus and are found throughout much of the Americas, including parts of the U.S.
- It is estimated that 80% of persons infected with Zika virus are asymptomatic. Symptomatic disease is generally mild and characterized by acute onset of fever, maculopapular rash, arthralgia, and nonpurulent conjunctivitis. These symptoms last from several days to one week. Severe disease requiring hospitalization is uncommon, and fatalities are rare. Guillain-Barré syndrome has been reported in patients with suspected infection.
- Affected areas include 22 countries and territories in Central and South America and the Caribbean: Barbados, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, U.S. Virgin Islands and Venezuela.
General international travel guidance
- All travelers to affected areas should receive general information about the virus in order to make informed decisions.
- This is very important when families are traveling together where at-risk members are included. This includes infants, at-risk fertile women, pregnant women, children, and those who have immunosuppressive conditions.
- Vector control education and guidance should be included, including avoidance of outdoor activities during high-risk times, long sleeve and pant use, bed nets, and insect repellent during the day in affected areas.
International travel guidance for pregnant women
- Pregnant women should avoid all travel to affected areas and delay travel plans
- It is reported that airlines and cruise lines are working with pregnant women in order to cancel, delay, or reschedule travel until a later time.
Guidance for women who are fertile during travel
- This is a potentially very high risk group who may be traveling or planning to travel to affected areas, including adolescents and adult women who are sexually active during travel to affected areas.
- Detailed reproductive histories, pregnancy tests, and contraceptive guidance, including regarding abstinence and birth control prescriptions, are critical. Hormonal forms of birth control (long-acting reversible contraceptives are most effective) are recommended, along with condoms.