By Wayne Shields,
President and Chief Executive Officer,
Association of Reproductive Health Professionals,
All healthcare providers, especially family planning professionals, should integrate Zika virus prevention into their standard clinical care, according to a new health provider toolkit from the CDC and Office of Population Affairs (OPA).
This new resource has been developed to bring urgently needed, evidence-based guidance to providers to help stem the spread of the Zika virus, a mosquito-borne and sexually transmitted illness that can result in adverse fetal outcomes such as microcephaly, neurological complications, and Guillain-Barre syndrome.
The new toolkit, which is available at http://bit.ly/29Tq9LR, advises that all healthcare providers should be able to screen for the Zika virus; integrate Zika into counseling on contraception and sexual health; recommend prevention strategies to women who do not want to become pregnant; and help women understand how to reduce the risk of becoming infected with the Zika virus, including transmission through vaginal, anal, and oral sex.
Helping non-pregnant women and men of reproductive age mitigate the impact of Zika by providing contraceptive and pregnancy planning services is a critically important component of the response, says Lorrie Gavin, PhD, MPH, senior health officer at the Office of Population Affairs. “Since there are so few treatments for microcephaly and other consequences to infant health from Zika, we need to emphasize every opportunity for prevention,” Gavin states. “We are especially focused on reducing the risk of Zika to pregnant women and women of childbearing age, because of the severity of adverse pregnancy outcomes we’ve seen globally among pregnant women with Zika.”
The CDC issued two updated resources for guidance and information to prevent Zika virus transmission and its health effects.1,2 The first one is interim guidance for healthcare providers caring for pregnant women with possible exposure to the Zika virus. Because the diagnosis of Zika infections can be complicated, the updated information expands the timeframe, up to 14 days, that testing for Zika virus particles in the blood of pregnant women can be offered. This expansion will provide a definite diagnosis for more pregnant women who have become infected with the Zika virus.1
The second resource is interim guidance for the prevention of the sexually transmitted Zika virus. It expands the CDC’s definition of sexual exposure to Zika to include sex without a barrier method (including male or female condoms, among other methods) with any person — male or female — who has traveled to or lives in an area with Zika.2
As of mid-July 2016, there is only one unconfirmed report of a Zika-virus transmission by a mosquito in the United States. However, it is only a matter of time before we see many more, according to Christine Dehlendorf, MD, MAS, associate professor in residence at the Departments of Family and Community Medicine, Obstetrics, Gynecology and Reproductive Sciences, and Epidemiology and Biostatistics, University of California, San Francisco. Screening for risk should focus on travel by women and their partners to affected areas, says Dehlendorf.
“The number of travel-associated cases of Zika is growing rapidly in the U.S. As of early July, there were over 600 pregnant women in the U.S. states and territories who have evidence of Zika virus infection,” she notes. “Far less is known about Zika than other flaviviruses like the dengue virus, because implications such as length of active infection are not yet evident.”
Although the current priority is on prevention and screening in the United States, federal and state policymakers need to plan for the care and support of those who will be affected by the virus over time, especially those caring for children who are born with microcephaly, neurological complications, and Guillain-Barre syndrome, says Dehlendorf.
Helping women to maintain their sexual and reproductive autonomy is a primary consideration for health professionals, she states. “People come first in healthcare, and we need to remember to respect their decision making during this urgent time,” Dehlendorf advises.
Zika does bring an important opportunity to the family planning field, says Gavin. “Although there is a need to respond to Zika on an emergency basis, this also provides a chance to solidify and reinforce recent advances in the delivery of family planning services, so that there is a more sustained and widespread impact.”
The CDC/OPA toolkit does not address abortion services, another important consideration for healthcare related to the Zika virus. Healthcare professionals who wish to counsel on abortion services can look to information provided by the National Abortion Federation at prochoice.org and to information from the Abortion Care Network at abortioncarenetwork.org.
- Oduyebo T, Igbinosa I, Petersen EE, et al. Update: Interim guidance for health care providers caring for pregnant women with possible Zika virus exposure — United States, July 2016. MMWR Morb Mortal Wkly Rep 2016; doi: http://dx.doi.org/10.15585/mmwr.mm6529e1.
- Brooks JT, Friedman A, Kachur RE, et al. Update: Interim guidance for prevention of sexual transmission of Zika virus — United States, July 2016. MMWR Morb Mortal Wkly Rep 2016; doi: http://dx.doi.org/10.15585/mmwr.mm6529e2.