(Take the continuing education module “Zika: The Pandemic Threat,” today.)
By Heather Stringer
In early February, the first case of the Zika virus infection contracted through sexual transmission was identified in the U.S. The case involved a patient in Texas who had sexual relations with a man who had recently traveled to Venezuela. Since then, at least 10 more cases of Zika contracted through sexual relations have been recorded. Also, as of June 1, more than 600 travel-associated cases have been recorded in the United States and more than 1,100 locally acquired cases of the virus in U.S. territories.
In response to the first case of Zika via sexual transmission, the CDC recommended that men who have traveled to an area with active Zika transmission take precautions if they have a pregnant partner. These men should avoid sexual activity or use a condom throughout the pregnancy. Although the Zika virus is not deadly like Ebola, this mosquito-borne virus is linked to microcephaly, as well as other fetal brain defects. In addition, the World Health Organization said Zika also causes Guillain-Barre syndrome, a disorder of the nervous system.
According to the CDC website, pregnant women who had possible exposure to Zika virus who do not reside in an area with active transmission should be evaluated for Zika virus infection and tested in accordance with CDC guidelines. Also, pregnant women who reside in an area with active Zika virus transmission should be evaluated and tested. Women can request more information on testing from their healthcare providers. “The CDC also is recommending that pregnant women be tested for the virus if they have traveled to affected areas such as Central or South America or the Caribbean,” Nancy Dirubbo, DNP, FNP, FAANP, owner of Travel Health of New Hampshire, said. “But mosquitoes don’t read maps, and some countries do not have the resources to report cases systematically. I recommend that pregnant women who recently have been in any tropical or subtropical area in the world be tested.”
While women may be tempted to forgo the test if they are asymptomatic, only one in five people who are infected experiences symptoms, which typically include acute onset of fever with maculopapular rash, headache, joint pain, fever and conjunctivitis.
The CDC also suggests that providers offer fetal ultrasounds to pregnant women who have traveled to Zika-affected areas to screen for microcephaly, although this test may not detect the condition until the late second or early third trimester, according to the CDC. “The babies born with this condition are profoundly neurologically impaired, and many do not live long,” said Dirubbo. “So much of the brain is missing that they often struggle to function.”
Questions about conception
Dirubbo recently saw a woman who was concerned because she was trying to conceive and her job occasionally included travel to countries affected by the virus. Dirubbo shared the information about the CDC warnings, and the woman decided to ask her employer if she could skip an upcoming trip. Dirubbo also suggested the woman ask her employer if the company has a policy in place for high-risk travel.
If a patient has already been to an affected area and wants to conceive, Dirubbo recommended the patient be tested for Zika. Although a negative result would be reassuring, it is still unclear exactly how long the virus lives in the body. If at all possible, she advises delaying attempts to conceive until more information is available. Currently, the CDC recommends that healthcare providers advise waiting at least 8 weeks after their possible exposure before attempting conception.
If a woman has not traveled to an affected area and wants to conceive — but her partner has traveled to a risky area — then it is best to consider delaying conception and abstain or use a condom, said Susan Dolan, RN, MS, CIC, president of the Association for Professionals in Infection Control and Epidemiology. “There have been a few cases in which the virus is present in semen longer than in the blood, from two to 10 weeks after infection,” said Dolan, an epidemiologist at Children’s Hospital Colorado. “But it is still unknown whether it could be longer.”
According to the CDC website, a man can spread the virus via sexual contact, when he has symptoms, before symptoms start and after symptoms end. It is not known if he can spread the disease while asymptomatic.
While it is strongly recommended to avoid traveling to countries affected by Zika, this is not always possible, said Debra Bingham, DrPH, RN, FAAN, vice president of nursing research, education and practice for the Association of Women’s Health, Obstetric and Neonatal Nurses. “One of the things we want women to know is how to protect themselves from mosquito bites,” Bingham said. “Most people think mosquitoes bite at dusk, but [the Aedes mosquitoes] bite during the day.”
If people travel to a Zika-affected area, she recommends they wear thick clothing which covers the body and mosquito repellent, such as DEET, IR3535 or Picaridin. Dirubbo also encourages women of childbearing age who travel to these areas to use the most effective birth control methods, such as an intrauterine device or Nexplanon.
Keeping nurses safe
While the virus is not rampant in the U.S., Dolan encourages nurses to properly use standard precautions and safe injection practices to keep themselves healthy. She cited an article in the January 2016 issue of the American Journal of Infection Control, which found that fewer than one in five nurses complies with the guidelines. For example, the study found that hand sanitization after removing gloves was one of the precautions that was more frequently forgotten by nurses.
Thus far, the Zika virus has been found in blood, semen, amniotic fluid and cerebral spinal fluid, and additional information on other body fluids is still under investigation, Dolan said. “It’s critical for nurses to prevent transmission, and if they take shortcuts, they put themselves and others at risk,” she said. “I’m passionate about hand hygiene and proper use of personal protective equipment because this is key to preventing transmission of various pathogens within the healthcare system.”
While the Zika virus outbreak has not significantly affected the U.S. compared to other countries, Dirubbo urges nurses to stay current by visiting the CDC website regularly to get updates.
In late April, for instance, for the first time during the outbreak, the virus was found in the Asian tiger mosquitoes in Mexico, according to the Washington Post. That species is very common in Connecticut, according to a CBS Evening News story. Mosquito season in Connecticut ramps up in June, which is when special traps will be set to catch the Asian tiger mosquitoes. They will be tested for Zika.
Heather Stringer is a freelancer writer.
For more information, read parts 1 and 2 of our Zika series:
Zika-Part 1: How to keep travel safe during the health threat
“Zika-Part 2:Nurses address questions about the virus”
To comment, email [email protected]