Dear Georgia Physician,
As most of you are already aware, the Centers for Disease Control and Prevention (CDC) has issued a travel alert for people traveling to countries where Zika virus transmission is ongoing. I want to urgently emphasize that all pregnant women should be screened for travel history to Zika-affected areas since Zika virus infection during pregnancy may lead to poor outcomes. Zika virus infections have been confirmed in infants with microcephaly and in the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported.
Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission and who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly orintracranial calcifications, should be tested for Zika virus infection.
There is no commercially available test for Zika virus.Patients meeting these criteria should immediately be reported to DPH at 1-866-PUB-HLTH (866-782-4584). DPH will facilitate laboratory testing, and provide information about appropriate clinical samples,interpretation of test results, and next steps.
Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Women trying to become pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.
Brazilian health authorities report more than 3,500microcephaly cases in Brazil between October 2015 and January 2016. Some of the affected infants have had a severe type of microcephaly and some have died. Studies are under way to investigate the association of Zika virus infection and microcephaly.
Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito. About one in five people infected with Zika virus will develop symptoms, which include fever, rash, joint pain,and conjunctivitis (pink eye). Other commonly reported symptoms include myalgia, headache, and pain behind the eyes. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon and deaths are very rare.
No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids,and use of analgesics and antipyretics. Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or chikungunya virus infection. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. People infected with Zika, chikungunya, or dengue virus should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission.
Several cases of travel-associated Zika virus infection have been confirmed recently in the United States in Florida, Texas, Illinois,and Hawaii. In each case, the infected individual traveled outside of the country and tested positive once they got home.
As we work together to prevent the spread of Zika virus, I urge you to be alert to patients, especially pregnant women, who present with symptoms of Zika virus infection and have travel history to places where Zika virus has been reported. For more information on Zika virus and the guidelines for pregnant women, click here.
Very truly yours,
Brenda Fitzgerald, M.D.
Additional resources: http://www.cdc.gov/zika/