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

Zika 101: Separating Fact from Fear

January 29th, 2016

By Gary Evans, Senior Staff Writer

If you are pregnant and reading this on your cellphone as your taxi heads toward the airport and an outbound flight to Brazil, you really should reconsider whether you want to travel into Zika country. In Brazil and other countries where Zika is actively spreading via mosquitoes, the virus is the prime suspect behind increasing cases of microcephaly -- a horrific birth defect that stunts head and brain development. This is a valid and compelling concern.

If, on the other hand, you are on American soil at an outdoor cookout and are wondering if that mosquito that just fed on your leg transmitted Zika virus, consider that the risk is probably too low to be calculable at present. Four out of five people exposed to the virus by this vector-borne route don’t even get sick or have any symptoms. Thus, if you acquired the virus and became symptomatic enough to even be aware of it and get tested, you would probably need to get ready for your CNN interview as the first documented case of Zika virus acquired without leaving the country. Travel-related infections are being reported and are expected to increase.

“There are 31 travel-associated cases detected in 11 states and the District of Columbia, from the period of 2015 to the present,” the CDC’s Anne Schuchat, MD, said at a press conference yesterday, Jan. 28. “For the U.S. territories, there are 20 laboratory-confirmed cases that we are aware of, 19 from Puerto Rico, and one from the U.S. Virgin Islands. [We are] making this nationally notifiable and laboratory testing for the lab confirmation with the PCR is just increasing, so we really do expect there to be a lot more travel-associated cases. The key thing for people to know and remember is that most of these are very mild illnesses. It’s really the circumstances of pregnant women who are traveling that we want to have heightened awareness of, and we really caution pregnant women to consider postponing travel.”

If there is anything we’ve learned about infectious diseases in this 21st century age of pandemics, it is not to underestimate them. The Aedes mosquitoes that can carry the Zika virus are in the U.S. and similar tropical diseases like Dengue have been sporadically transmitted here. That will probably happen with Zika in the U.S. when a traveler returning from a country where the virus is endemic is bitten by a mosquito, who then subsequently feeds on another person and transmits the virus between them. Remember, however, that the infected person does not become a life-long chronic carrier of Zika virus and the window of transmission possibility is thought to be about one week. Thus, there is not the slightest reason – and certainly no benefit -- to rejuvenate the politicized hype and hysteria that accompanied Ebola, where fear held the day while science was trampled by lemmings.

As of today, Jan. 29, here are the answers the Centers for Disease Control and Prevention is providing to commonly asked questions about Zika:

What is Zika virus disease? Zika is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week. About 1 in 5 people infected with Zika will get sick. For people who get sick, the illness is usually mild. For this reason, many people might not realize they have been infected.

Is this a new virus? No. Outbreaks of Zika previously have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika virus likely will continue to spread to new areas. In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil.

Should we be concerned about Zika in the United States? The U.S. mainland does have Aedes species mosquitoes that can become infected with and spread Zika virus. U.S. travelers who visit a country where Zika is found could become infected if bitten by a mosquito. With the recent outbreaks, the number of Zika virus disease cases among travelers visiting or returning to the United States will likely increase. These imported cases may result in local spread of the virus in some areas of the United States. CDC has been monitoring these epidemics and is prepared to address cases imported into the United States and cases transmitted locally.

How is Zika transmitted? Zika is primarily transmitted through the bite of infected Aedes mosquitoes. It can also be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth. We do not know how often Zika is transmitted from mother to baby during pregnancy or around the time of birth. There have been reports of a serious birth defect of the brain, microcephaly (a condition in which a baby’s head is smaller than expected when compared to babies of the same sex and age) and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. Knowledge of the link between Zika and these outcomes is evolving, but until more is known, CDC recommends special precautions for the following groups:

Women who are pregnant (in any trimester):

• Consider postponing travel to any area where Zika virus transmission is ongoing.

• If you must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.

Women who are trying to become pregnant:

• Before you travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection. For more questions and answers on Zika and pregnancy, see Questions and Answers: Zika and Pregnancy

Who is at risk of being infected? Anyone who is living in or traveling to an area where Zika virus is found who has not already been infected with Zika virus is at risk for infection.

What countries have Zika? Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to change over time. Please visit the CDC Travelers' Health site [Editor’s note: Travel advisories are currently in affect for Mexico, the Caribbean and Central and South America. Check the CDC for updates.]

What can people do to prevent becoming infected with Zika? There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to avoid being bitten. Protect yourself and your family from mosquito bites. Here’s how:

• Wear long-sleeved shirts and long pants.

• Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside.

• Use Environmental Protection Agency (EPA)-registered insect repellents. All EPA-registered insect repellents are evaluated for effectiveness. Always follow the product label instructions. Reapply insect repellent as directed. Do not spray repellent on the skin under clothing. If you are also using sunscreen,apply sunscreen before applying insect repellent.

• If you have a baby or child: Do not use insect repellent on babies younger than 2 months of age. Dress your child in clothing that covers arms and legs, or a covered crib, stroller, and baby carrier with mosquito netting. Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin. Adults: Spray insect repellent onto your hands and then apply to a child’s face.

• Treat clothing and gear with permethrin or purchase permethrin-treated items. Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last. If treating items yourself, follow the product instructions carefully. Do NOT use permethrin products directly on skin. They are intended to treat clothing.

• Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.

What is the treatment for Zika? There is no vaccine or specific medicine to treat Zika virus infections. Treat the symptoms:

• Get plenty of rest.

• Drink fluids to prevent dehydration.

• Take medicine such as acetaminophen to reduce fever and pain.

• Do not take aspirin or other non-steroidal anti-inflammatory drugs.

• If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.

How is Zika diagnosed? See your healthcare provider if you develop symptoms (fever, rash, joint pain, red eyes). If you have recently traveled, tell your healthcare provider. Your healthcare provider may order blood tests to look for Zika or other similar viral diseases like dengue or chikungunya.

What should I do if I have Zika? In addition to treating the symptoms you can protect others. During the first week of infection, Zika virus can be found in the blood and passed from an infected person to another mosquito through mosquito bites. An infected mosquito can then spread the virus to other people. To help prevent others from getting sick, avoid mosquito bites during the first week of illness. See your healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within 2 weeks after traveling to a country where Zika virus cases have been reported. Be sure to tell your health care provider where you traveled.

Does Zika virus infection cause Guillain-Barre syndrome (GBS)? GBS is a rare disorder where a person’s own immune system damages the nerve cells, causing muscle weakness and sometimes, paralysis. These symptoms can last a few weeks or several months. While most people fully recover from GBS, some people have permanent damage and in rare cases, people have died. We do not know if Zika virus infection causes GBS. It is difficult to determine if any particular pathogen “caused” GBS. The Brazil Ministry of Health is reporting an increased number of people affected with GBS. CDC is working to determine if Zika and GBS are related.

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.