West Virginia Nurse - May 2018

Page 12 West Virginia Nurse • From a pregnant woman to her fetus during pregnancy May, June, July 2018
Zika ou
or around the time of birth.
Zika: Is it Still • Through a Concern blood transfusion (likely for but Travelers?
happen
not confirmed).
territor
Shauna Lively, EdD, RN, LCCE &
Ellen King, MSN, RNC-OB, CCE
can be
The Zika virus (or ZIKV) is a concern to travelers
including health care workers, students on summer
recess and service trips, and immigrants, as well as
couples on honeymoons or “babymoons.” Often
causing no symptoms or only mild ones, ZIKV infection
during pregnancy has been linked to adverse outcomes
including pregnancy loss and microcephaly, absent or
poorly developed brain structures, defects of the eye,
and impaired growth in fetuses and infants (1). The
definition of possible Zika virus exposure includes travel
to, or residence in, an area with risk for mosquito-borne
Zika virus transmission or sex with a partner who has
traveled to or resides in an area with risk for mosquitoborne
Zika virus transmission (Oduyebo et al., 2017). The
“Zika Travel Information” CDC webpage has a map of
countries in which the virus is endemic (CDC, 2018).
In West Virginia, the common species of mosquito,
Aedes albopictus, can carry the Zika virus. The virus can
then spread via mosquito to human, from human to
human, or human to mosquito to human. We do know
that so far, there has been no evidence of mosquitoborne
Zika transmission in our state, but there has been
travel-associated ZIKV in WV travelers who had traveled to
an area where the disease is endemic (WV DHHR, 2016).
Pregnancy Risks and Surveillance
Although information on Zika virus is constantly
improving, little is known about the risks of Zika virus
infection during pregnancy. During pregnancy, 5-15% of
babies exposed to Zika in utero are affected. Information
about the timing of exposure and clinical manifestations
during pre-conception and pregnancy, as well as after
birth in the newborn, the absolute risk, and spectrum of
outcomes associated with ZIKV infection, is needed. A
Zika Pregnancy and Infant Registry has been established
and will serve to inform public health action and guide
assessment, diagnosis, intervention, and long term
follow-up. The WV Perinatal Partnership and the WV
Department of Health and Human Resources (DHHR)
have teamed up with the Centers for Disease Control to
abstract data from the birth certificate and the patient
records for the Zika Pregnancy and Infant Registry. The
U.S. Zika Pregnancy and Infant Registry includes the U.S.
Zika Pregnancy Registry and the Zika Active Pregnancy
Surveillance System, which together collect information
about pregnancy and infant outcomes among women
with laboratory evidence of ZIKV infection during
pregnancy in the 50 states, the District of Columbia,
and the U.S. territories, until at least two years of age
(Delaney et al., 2018).
• During sex with a person who has Zika to his or her sex partners.
Red eyes
Fever
Joint pain
Headache
Rash
Muscle pain
Symptoms and Recommended Treatment
Common symptoms lasting for several days to a week
include fever, rash, headache, joint pain, conjunctivitis,
and muscle www.cdc.gov/zika
pain. Although uncommon, ZIKV in adults
may result in Guillain–Barré syndrome. Once a person
has been infected with the virus, some immunity may
occur (CDC, 2018). There is no vaccination and no
treatment
CS265799A
for the
June
disease.
27, 2017Treating the exposed and
symptomatic patient with acetaminophen, rest, and
hydration will help alleviate symptoms. Reporting a
possible exposure to a health care provider is essential,
since Zika is a reportable disease and must be reported
to the local health department within 24 hours.
Counseling Patients on Prevention
1. Prevent mosquito bites
A woman who is pregnant, or who may conceive
while the Zika virus is still in her body or that of her
partner, should be advised to avoid traveling in
areas where Zika is endemic. If that is not possible,
enhanced precautions should be used: bed net
if the room is not well screened; EPA-registered
insect repellent containing DEET, picaridin IR3535
oil of lemon eucalyptus, paramenthane-diol, or
2-undecanone. When used as directed, the insect
repellents are safe and effective for pregnant and
breastfeeding women and used on children older
than two months of age. Permethrin spray can be
used on clothing and gear, but not on skin. Long
sleeves, long pants, and above the ankle socks can
help protect against ZIKV (CDC, 2016a, 2017; March of
Dimes, 2016).
Zika Symptoms
Zika Symptoms
Curr
Outb
spread
the wo
Many people infected with Zika
Many people infected with Zika won’t have United
won’t symptoms have symptoms or will only or have will mild only symptoms.
have The mild most symptoms. common The symptoms most are fever, Visit ou
common rash, headache, symptoms joint are pain, fever, red rash, eyes, and
headache, muscle pain. joint Symptoms pain, red eyes, can last for several
webpa
and days muscle to a week. pain. People Symptoms usually can don’t get sick spread
last enough for several to go days to the to hospital, a week. and they very
People rarely die usually of Zika. don’t Once get sick a person enough has been
to infected go to the with hospital, Zika, and they they are very likely to be
protected from future infections.
rarely die of Zika. Once a person
has been infected with Zika, they
www.cdc.gov/zika
are likely to be protected from
future infections.
By surveying the community, emptying standing
water, and enlisting the help of everyone to be
vigilant about eliminating mosquito breeding pools,
the mosquito population will decline. Larvicide, or
“dunks” (to be placed in standing water in gutters
and ponds), are available on Amazon and at some
home-improvement stores. They work by killing the
mosquito larvae, and have been shown to be safe for
birds and fish (CDC, 2016b).
2. Preventing human to human exposure
The Zika virus can be transmitted during pregnancy,
via blood transfusion, and through sex. It has been
found in women for up to eight weeks after exposure
and in semen for up to six months afterwards. If the
couple has been exposed or has traveled to an area
endemic with the Zika virus, not having sex – or using
condoms for the duration of pregnancy – will limit
exposure. Waiting until the virus has cleared before
attempting conception is necessary, as every sexual
encounter represents an exposure.
Zika virus has been found in breast milk, and
there have been reports of ZIKV infection among
babies who are breastfed. However, there have been
no reports of health problems in babies resulting
from breastmilk from a mother with ZIKV infection.
Evidence shows that the benefits of breastfeeding
outweigh the risk of ZIKV virus spreading and CDC
continues to encourage mothers to breastfeed, even
in areas with risk of Zika. The relationship between
Zika and breastfeeding continues to be studied
(Blohm et al., 2017; Colt et al., 2017).
Zika: Is it still a concern for travelers?
continued on page 13