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

With Zika Incoming CDC says Protect the Unborn and the Pregnant

By Gary Evans, Senior Staff Writer

The Zika virus dramatically emerging in the Western Hemisphere is causing an unprecedented level of birth defects and a rare paralytic condition, as respective links between mosquito-borne infections and both microcephaly and Guillain-Barré syndrome are growing stronger every day, the director of the Centers for Disease Control and Prevention said in a sobering press conference today.

“Zika associated microcephaly and other fetal harm are a new phenomenon,” said Tom Frieden, MD, MPH. “It has been more than 70 years since rubella was identified as a cause of fetal malformations. We are not aware of any prior mosquito-borne disease associated with such a potentially devastating birth outcome on a scale anything like what appears to be occurring with Zika in Brazil.”

Though the exact numbers await confirmation, Brazil has reported thousands of cases of microcephaly, a birth defect that stunts brain and head development of the fetus. While speculative to this point, Frieden said in no uncertain terms today that the Zika virus infection in pregnant women is causing the devastating birth defect.

“Because this phenomenon is so new we are quite literally discovering more about it each and every day,” he said. “With each passing day, the linkage between Zika and microcephaly becomes stronger. In addition, the linkage with Zika and Guillain-Barre syndrome also appears stronger the more we learn. And because it is new and because it is so severe, it is scary -- especially for women who are pregnant or who are considering becoming pregnant.”

Guillain-Barré syndrome is an immune disorder that attacks the peripheral nervous system, causing weakness and tingling that can progress to almost total paralysis. The number of cases associated with Zika was unknown as this post was filed.

Though Zika was recently transmitted sexually in Dallas, Frieden reiterated that the primary threat is to pregnant women and their unborn children via mosquito bites. New guidelines released Friday address issues for both pregnant women and sexual transmission. With the recent confirmed sexual transmission, the Zika response narrative was shifting to questions about safe sex between couples, men who have sex with men, the blood supply and the presence and persistence of the virus in body fluids. Yet despite the potential horrific outcome in the aforementioned high risk groups, the vast majority of Zika infections are mild and self-limiting, he emphasized.

“We are prioritizing all of the work that we can do to protect pregnant women,” Frieden said when reporters asked about other potential risk groups and transmission by routes other than mosquitoes.

“We are still learning more about Zika virus and how it works in the body,” he continued. “I think it is important to emphasis that Zika is a mosquito-borne virus and the overwhelming majority of cases are spread by mosquitoes. There are unknowns – we don’t know how long that Zika virus can persist in semen. Studies are underway to look at that but it will be weeks to months before we know more. Our priority here is to prevent pregnant women from becoming infected with Zika and for that reason spread by other routes and other populations is of much less concern because, again four out of five cases of Zika are asymptomatic and those that are symptomatic are generally mild.”

First Zika birth defect in U.S.?

With Puerto Rico, the U.S. Virgin Islands and U.S. Samoa now having ongoing transmission, Frieden braced the public for the onset of Zika and announced what is possibly the first infant born in the U.S. with an unspecified birth defect caused by the virus.

“There is no doubt that over the coming months many more travelers will return to the U.S. with Zika infection,” Frieden said. “Some of them will be pregnant women and already one, a woman in a Hawaii, unfortunately did give birth to an infected infant. We hope and expect that local transmission will not become widespread. But we will have to change our guidance as we learn.”

One bleak scenario at present is that returning travelers with Zika will spark outbreaks in U.S. states where Aedes mosquitoes that carry the virus typically are found. That could certainly include many of the southern and western border states and perhaps a much broader region in the summer months. With transmission seemingly inevitable in the U.S., the CDC is marshaling its resources and honing its message to protect unborn children.

“The real problem here is the effect on the developing brain of the fetus -- that is the priority for protection,” Frieden said.

Thus pregnant women should avoid travel to areas where the virus is spreading and avoid mosquito bites through protective clothing and repellents if they are in such an area. The CDC is cranking out Zika test kits as quickly as possible and is trying to get the private sector to begin mass production. Pregnant women without symptoms of Zika virus disease can be offered testing 2 to 12 weeks after returning from areas with ongoing Zika virus transmission, the CDC recommends. Those with symptoms should of course be prioritized for testing. There is no vaccine or treatment for Zika.

The CDC recommends that men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy. Pregnant women should discuss their male partner’s potential exposures to mosquitoes and history of Zika-like illness with their health care provider.

Men with non-pregnant partners who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission “might consider” abstaining from sexual activity or using condoms consistently and correctly during sex, the CDC recommended. Couples considering this personal decision should take several factors into account. Most infections are asymptomatic, and when illness does occur, it is usually mild with symptoms lasting from several days to a week; severe disease requiring hospitalization is uncommon, the CDC added.

Updated guidelines released for women who reside in areas with ongoing Zika virus transmission, both pregnant women and women of reproductive age, include the following:

  • For pregnant women experiencing symptoms consistent with Zika virus disease, testing is recommended at the time of illness.
  • For pregnant women not experiencing symptoms consistent with Zika virus disease, testing is recommended when women begin prenatal care.
  • Follow-up testing around the middle of the second trimester of pregnancy is also recommended, because of an ongoing risk of Zika virus exposure.
  • Pregnant women should receive routine prenatal care, including an ultrasound during the second trimester of pregnancy. An additional ultrasound may be performed at the discretion of the health care provider.
  • For women of reproductive age in Zika transmission areas, healthcare providers should discuss strategies to prevent unintended pregnancy, including counseling on family planning and the correct and consistent use of effective contraceptive methods, in the context of the potential risks of Zika virus transmission, the CDC recommended.

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.