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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Puerto Rico Bracing for Possible Zika Epidemic

By Gary Evans, Senior Staff Writer

Zika is establishing a foothold in the Commonwealth of Puerto Rico, which has ongoing transmission of the virus and spread is projected to increase, the Centers for Disease Control and Prevention reports.

The CDC recently reported 30 confirmed cases in Puerto Rico, only one of which was travel-related. Because the most common mosquito vector of Zika , Aedes aegypti, is present throughout Puerto Rico, the virus is expected to continue to spread throughout the island, putting at risk the 3.5 million residents and some 43,000 pregnant women annually. Past spread of two other mosquito-borne viruses, dengue and chikungunya, do not bode well for containing Zika in Puerto Rico as well as the U.S. Virgin Islands and American Samoa.

“There have been case reports of local transmission in all three territories,” CDC director Tom Frieden, MD, MPH, said in recent Congressional testimony. “Furthermore, recent outbreaks of mosquito-borne dengue and chikungunya suggest that Zika virus may spread widely in those areas. We need to be fully prepared, especially as the spring and summer months arrive. We are particularly concerned about Puerto Rico and the U.S. territories that may experience substantial spread of Zika. For comparison, more than 80% of adults in Puerto Rico have been infected with at least one strain of dengue, and about a quarter have been infected with the more recently introduced chikungunya virus.”

The cases in Puerto Rico include one pregnant woman and a 37-year-old old man who developed Guillain-Barre syndrome after acquiring Zika. The woman was in her first trimester of pregnancy had symptoms of body and joint pain, rash, conjunctivitis, and nausea. Her obstetrician provided counseling regarding risks to her fetus and recommended clinical follow-up with CDC interim guidelines. The man developed a rash, which resolved in two days, but the next day he reported a tingling sensation in his hands and feet, followed by progressive weakness in limb muscles and uncontrolled fluctuating hypertension. He was hospitalized with ascending paralysis and responded to treatment with intravenous immunoglobulin.

Overall, three (10%) of the patients were hospitalized, a rate “higher than expected on the basis of previous reports,” the CDC reported. Most of the patients resided in eastern Puerto Rico or the San Juan metropolitan area. The most frequently reported signs and symptoms were rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Approximately 25% of patients sought healthcare, suggesting there could be more Zika infections with mild symptoms that were not captured in surveillance.

AHC Media is dedicated to covering developments in this ongoing story. In addition to breaking news on our homepage, the cover story of April ED Management outlines what hospitals need to do to prepare for a potential outbreak. The March issue of Hospital Infection Control & Prevention contains a trio of stories examining the latest Zika developments, including combating the spread of the virus via sexual transmission. Additionally, the March issue of Hospital Employee Health contains a story about protecting pregnant healthcare workers from contracting the virus.