Patient Safety: Be Proactive

87 countries and territories have had evidence of autochthonous mosquito-borne transmission of Zika virus (ZIKV) 

The World Health Organization (WHO) updated its advice recommending that pregnant women avoid traveling to areas with Zika virus transmission, especially during outbreaks, based on the increased risk of severe birth defects during pregnancy. They also advised all travelers to take steps to reduce the possibility of exposure to mosquitos and avoid the risk of sexual transmission. Those traveling in impacted areas should :

• cover up with light-colored clothing
• use correct insect repellents, screens and windows to protect themselves.
• practice safer sex via condoms, abstinence and other measures in high-risk areas and upon returning home.

New studies show that a combination of MRIs and ultrasounds are both critical in detecting abnormalities in babies. Critical abnormalities that were seen in babies prenatally and/or after being born to parents with Zika Virus (or likely to have Zika Virus) showed that both radiological studies are needed. Read at more at Journal of the American Medical Association here

The warm weather is here and more than a dozen cases of Zika Virus have already been reported in the U.S. this year. Zika remains a public health threat especially to pregnant women and their unborn children. There are several researchers working on vaccines, so in the future that may offer hope for pregnant women. For now, the CDC recommends that pregnant women and women trying to get pregnant or who may wish to become pregnant:

• Should not travel to any area with Zika.
• Women that must travel to, or live in an area with Zika virus, should talk with healthcare providers and strictly follow steps to prevent mosquito bites
• Women with a male partner(s) who lives in, or has traveled to an area with Zika, should abstain or properly use condoms every time they have sex
• Before women or male partner(s) travel, talk to healthcare providers about plans to become pregnant and the risk of Zika virus infection
• Women and male partner(s) should strictly follow steps to prevent mosquito bites

For more information and tools visit https://www.cdc.gov/zika/about/needtoknow.html

At this time of the year when New Yorkers may seek warmer climates for vacations, we want to share information. A new study from the U.S Centers for Disease Control and Prevention (CDC) found that two-year old children with prenatal exposure to the mosquito-borne Zika virus, now have severe health and developmental challenges. The study included 19 Zika-infected children from Brazil who now suffer microcephaly, seizures, bronchitis, pneumonia, issues with sleeping, feeding, hearing, vision, and motor functions. “Children severely affected by Zika virus are falling far behind age-appropriate developmental milestones, and their challenges are becoming more evident as they age,” CDC Director Dr. Brenda Fitzgerald said in an agency news release. We remind you:

• Zika infection during pregnancy causes serious birth defects. Pregnant women should not travel to areas with Zika.
• Talk to your doctor about what you can do to protect yourself and your baby from Zika. Take notes and follow instructions carefully. Ask questions.
• Use condoms the right way every time you have sex, or do not have sex during your pregnancy.

There is important new information and updated Zika-virus guidelines concerning pregnant women, those who may get pregnant and health care providers. Zika virus vaccines in development are seeing progress in research testing phases. Unfortunately not everyone with Zika-virus has noticeable symptoms or a confirmed case. 1 in 12 infants, who are born to mothers with confirmed Zika virus infection, come into the world with a related birth defect. The Centers for Disease Control and Prevention (CDC) believes Zika remains a large public health threat especially to pregnant women and their unborn children. Despite that cases are down compared to this time last year, Zika-virus infection cases continue to spring up in the United States and other countries across the world.

The CDC’s revised guidelines for healthcare providers include:

• Asking pediatric doctors to carefully assess infants born without birth defects to moms who had potential Zika-virus infection while pregnant.
• The importance of maintaining careful assessment of congenital Zika virus infection risks
• Asking OBGYN and Pediatric health care providers to stay in close communication

Mosquito season has begun In New York State; activity begins when the temperature reaches 50° F. The mosquito volume increases, reaching its peak during the hot summer months.  As of May 3, The CDC (Centers for Disease Control) notes there were 5,274 cases reported in the US, with the most in Florida and New York, and most often in travelers returning from affected areas. Texas and Florida reported cases gained through local mosquitos.  In the US Territories there were 36,574 Zika Virus cases reported, with the majority in Puerto Rico, and a few in the U.S. Virgin Islands American Samoa. https://www.cdc.gov/zika/geo/united-states.html

Protect yourself and your community from mosquito bites to prevent Zika virus infection:

• Use air conditioning
• Use well-fitting window and door screens. Repair holes now.
• Wear long-sleeved shirts and long pants.
• Use EPA-registered insect repellents as directed every day.
• Once a week, empty and scrub, turn over, cover, or throw out items that hold water.
• Check those areas after each rain and remove water
• Repair and seal septic systems.

Note to Women of Childbearing Age and Male Partners
Women of child-bearing age need to know about the risk Zika virus presents to them if they become pregnant. Zika infection during pregnancy causes serious birth defects. Pregnant women should not travel to areas with Zika. Talk to your doctor about what you can do to protect yourself and your baby from Zika. Take notes and follow instructions carefully. Ask questions.

Use condoms the right way every time you have sex, or do not have sex during your pregnancy.

Men: If your partner is pregnant or plans to become pregnant, either use condoms the right way every time you have vaginal, anal, and oral sex, or do not have sex if she is pregnant or plans to soon become pregnant. The CDC recommends eight-weeks after travelling to a known-infected location. Take steps to avoid mosquito bites to prevent Zika virus infection and other mosquito-borne diseases.

Note to Travelers: Many people infected with Zika don’t even know they have it. See a healthcare provider if you develop a fever, rash, joint pain, or red eyes during a trip or within 2 weeks after traveling to a place with Zika, or if you have had sexual contact with someone who has traveled. Many people don’t get sick enough to go to the hospital.  Zika is primarily spread through the bite of infected Aedes aegypti and Ae Albopictus mosquitoes. The best way to prevent Zika is to protect against mosquito bites. See a healthcare provider if you develop a fever, rash, joint pain, or red eyes during a trip or within 2 weeks after traveling to a place with Zika, or if you have had sexual contact with someone who has traveled. Source https://www.cdc.gov/zika/public-health-partners/partner-presentations.html

The CDC has updated guidelines for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection https://www.cdc.gov/zika/hc-providers/infants-children/evaluation-and-management.html

It is critical for women who are pregnant or wish to become pregnant, and for women and men who may become pregnant to get medical counseling on preventing mosquito bites, and having protected sex before and after traveling to areas affected by the Zika-virus. According to the Centers for Disease Control and Prevention (CDC) as of January 9, 2017, there are a recorded 2,842 pregnant women with lab evidence of possible Zika virus in the U.S. and its Territories. Zika Virus infection during pregnancy may cause severe brain defects including microephaly whereby a baby’s head is smaller than expected and the baby may have a smaller brain that might not have developed properly. Some infants with congenital Zika virus infection who do not have microcephaly at birth may later experience slowed head growth and develop postnatal microcephaly. The CDC has a chart entitled What to Know If Your Doctor Suspects Microcephaly During Pregnancy. 

https://www.cdc.gov/zika/pdfs/whattoknow-doctor-suspects-microcephaly.pdf

A new study noted in the Journal of the American Medical Association (JAMA) reports some people infected with Zika develop conjunctivitis, an eye infection common known as “pink eye.” Although the Zika infection had been identified in urine, semen, saliva and breast milk, the study noted Chinese travelers who had been infected in Venezuela were found to have the virus from eye swabs five to seven days after symptoms occurred. On September 7, The World Health Organization updated its assessment of the Zika virus as a cause of congenital brain abnormalities in babies and Guillain-Barre syndrome in adults, after considering months of research into the mosquito-borne disease.

We believe that women who are pregnant or planning to become pregnant should talk with your doctors about your risks in general of having or contracting the disease, and about travel to currently-known Zika infested areas, including the potential for the spread in the southern gulf states of the United States. We want to urge all pregnant women and women of child-bearing age to take every precaution possible to avoid mosquito bites, sexual transmission of the disease, and to carefully consider travel to known areas of wide-spread Zika virus. The World Health Organization and the Centers for Disease Control and Prevention currently recommend that men who have had symptoms of Zika not attempt to father a child for six months after their illness. They also suggest that men who have been ill practice safe sex or abstinence if their partner is pregnant. To date there is no vaccine or treatment for Zika. Due to these concerns, it is urged that everyone, especially women of child-bearing age, be proactive in this regard and not wait until symptoms appear.  Everyone should avoid bug bites by using insect repellents, removing any and all standing water, and scrubbing with soap any areas that mosquitoes eggs could have been laid.  Currently men who have symptoms and have contracted the Zika virus have been recommended to ensure they do not impregnate women for at least a few months. Common Zika Virus symptoms are fever, rash, joint pain, and red eyes, although some infected people do not have any Zika Virus symptoms. Zika Virus Disease is thought to be spread to people through the bite of infected mosquitoes, and through sexual transmission. Zika Virus infection in pregnant women has recently been declared a definite cause of microcephaly. That condition causes babies to be born with smaller heads and major developmental challenges that are potentially lifelong. The virus is also associated with other severe fetal brain defects, and has also been linked to Guillain-Barre syndrome, an autoimmune disorder that can cause paralysis.  Experts have begun calling the host of conditions linked to the virus in babies, Congenital Zika Syndrome, as recently some babies born with disabilities are more severe than in textbook microcephaly cases. Of the more than 3,000 U.S. pregnant women travelers tested for Zika so far this year, coming from afflicted areas, a full 28% of them had Zika, and most, but not all, had rash, fever or red eyes.

The CDC recommends that pregnant women and women trying to get pregnant or who may wish to become pregnant:

• Should not travel to any area with Zika.
• Women that must travel to, or live in an area with Zika virus, should talk with healthcare providers and strictly follow steps to prevent mosquito bites
• Women with a male partner(s) who lives in, or has traveled to an area with Zika, should abstain or properly use condoms every time they have sex
• Before women or male partner(s) travel, talk to healthcare providers about plans to become pregnant and the risk of Zika virus infection
• Women and male partner(s) should strictly follow steps to prevent mosquito bites

It was merely months ago that health officials thought the Zika virus was not transmitted through sexual activity. Now, the CDC has an excellent video available to the public about preventing the Zika virus, based on the currently known methods of transmission, including sexual transmission.  Infants affected by Zika virus may never learn to talk or walk, will have trouble seeing, and could develop epilepsy. Officials indicate that there may be a spectrum of problems with a baby’s health that don’t show up as microcephaly.