News Flash: The Zika Virus

Immunology, Podcast 8

News Flash: Zika Virus on episode 027 of The Nurse Practitioner Show Podcast with Dr Rachel Danford NP of Accessible Healthcare Institute

Click play above to hear episode 027 of The Nurse Practitioner Show

The Beginnings of the Zika Virus

During May 2015 Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. Followed by the World Health Organization (WHO) declaring Zika virus  Public Health Emergency of International Concern (PHEIC) in February 2016. Since the first alert, the Zika virus has now been transmitted across South America, Central America, Pacific Islands, the Caribbean, and more. Although it became a worldwide concern recently, the Zika Virus was first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and subsequently primarily reported in tropical Africa, Southeast Asia, and the Pacific Islands

Transmission

The Zika virus is transmitted through:

  • Mosquitoes – primarily through the bite of an infected Aedes species mosquito which also spreads dengue and chikungunya , theA. aegypti and A. albopictus species
  • Mother to Child – it is a major concern for women of childbearing age due to the fetal anomalies associated with exposure to the virus, such as microcephaly intracranial calcifications, and brain and eye abnormalities. Detection of fetal abnormalities may not be discovered on fetal ultrasounds until the late second or early third trimester of the pregnancy.
  • Sexual Contact
  • Blood Transfusions

Preparation and Prevention

The goal is to prevent mosquito bites!

  • Take steps to control mosquitoes inside and outside your home.
  • Wear long-sleeved shirts and long pants.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites, including netting for cribs, strollers, and baby carriers
  • Use Environmental Protection Agency (EPA)-registered insect repellents (avoid on infants less than 2 months of age). Choosing an EPA-registered repellent ensures the EPA has evaluated the product for effectiveness. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women. Ensure the EPA-registered insect repellent has one of the following active ingredients:
    • DEET
    • picaridin
    • IR3535
    • oil of lemon eucalyptus (do not use on children less than 3 years of age)
    • para-menthane-diol (do not use on children less than 3 years of age)
  • Travelers returning from areas with Zika virus need to prevent mosquito bites for 3 weeks, even if they do not feel sick, to prevent transmission of virus to other individuals
  • Prevent transmission of Zika virus through sexual contact by abstaining from sexual contact, or using condoms. It is unknown how long the virus is available in the semen of men who have had Zika and how long the virus can be spread via sex. It is known that the virus is available in semen longer than in blood.

Symptoms

  • Most individuals infected with Zika virus are asymptomatic, without symptoms, and may not be aware of illness
  • Most common symptoms: fever, maculopapular rash, arthralgia (joint pain), or conjunctivitis (red eyes), which can be overlooked as they resemble symptoms of many other illnesses
  • Other symptoms can include myalgia (muscle pain) and headache
  • Severe disease requiring hospitalization is uncommon and case fatality is low.
  • Cases of Guillain-Barre syndrome have been reported in patients following suspected Zika virus infection.
  • Incubation period: unknown, likely few days to one week
  • Duration: few days to one week

Diagnosis

The U.S Federal Drug Administration (FDA) has approved two diagnostic laboratory tests to diagnose Zika Virus. These diagnostic tools are available at qualified laboratories that are certified to perform high-complexity tests.

  • Zika IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (Zika MAC-ELISA) – serum blood immunoassay test to detect antibodies that are created to fight off the Zika Virus after 4- 5 days onset of symptoms
  • Triplex Real-Time Polymerase Chain Reaction Assay (Triplex RT-PCR Assay) – serum blood test able to differentiate between chikungunya, dengue, and Zika viruses in a single test. Immunoassays tend to have cross-reactivity between these pathogens; therefore, a PCR-based assay may be the best option for early detection.

Current Centers for Disease Control (CDC) and Public Health Agency of Canada (PHAC) guidelines do not recommend testing people who have never experienced symptoms compatible with Zika virus infection or with non-pregnant patients after recovering from a self-limited illness.

The CDC has provided Tools for Healthcare Providers, including algorithms on diagnosis and treatment options for patients. In addition, Public Health Ontario in Canada has provided testing options and algorithms for patients suspected of Zika virus.

Treatment

  • There is neither a vaccine nor medication to cure the viral infection
  • As with most other viral infections, treatment is supportive care to help ease the symptoms:
    • Rest
    • Hydration
    • Acetaminophen (Tylenol®) to ease symptoms of fever and pain
    • Until dengue can be ruled out as a diagnosis, avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin®/Advil®), and naproxen (Alleve®) to decrease risk of bleeding
  • Prevent mosquito bites the 1st week of illness in order to prevent mosquitoes from becoming infected and thereby transmitting to other individuals through mosquito bites

Reportable Diagnosis

As an arboviral disease, Zika virus is a nationally notifiable condition. Healthcare providers are encouraged to report suspected cases to their state or local health departments to facilitate diagnosis and mitigate the risk of local transmission. State or local health departments are encouraged to report laboratory-confirmed cases to CDC through ArboNET, the national surveillance system for arboviral disease.

Reference

Centers for Disease Control and Prevention. (2016, February 26). Zika Virus. Retrieved April 29, 2016, from http://www.cdc.gov/zika/index.html

A special thanks to Gebauer’s Pain Ease for sponsoring this episode of The Nurse Practitioner Show™.

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