The Nurse Practitioner's Guide to Zika in the U.S.
Now that the Zika virus has reared its ugly head here in the United States with cases of local transmission reported in Florida, nurse practitioners must be even more aware of how to treat patients with possible exposure to the virus. This is especially important for NPs caring for pregnant women, and women of childbearing age, as the virus can have devastating effects in pregnancy. What are the latest guidelines in patient care now that Zika transmission has occurred on U.S. soil?
The Latest on Zika Transmission
Active Zika virus transmission has been identified in the Wynwood neighborhood of Miami, FL. So far, 16 cases of individuals infected with the virus have been identified. Individuals who live in, or who have traveled to, this area any time after June 15th are at risk for having been exposed to the virus. The June 15th date is based on Zika's incubation period of up to two weeks.
While previous cases of Zika in the United States have been among individuals who acquired the virus while traveling outside of the country, or sexually, the cases in Miami are a result of local Zika virus transmission. The cases in the Wynwood outbreak were identified by door-to-door surveys of people who gave blood and urine samples that tested positive for the virus.
Stopping the Spread of Zika
Efforts are underway to stop the spread of Zika from the Wynwood neighborhood of Miami to surrounding areas and states. Ground spraying and aerial spraying efforts, as well as public education, are the primary methods being used to stop the spread of the virus. While these measures are having a positive effect in controlling the area's mosquito population, they are not proving quite as effective as officials had hoped. This means that we could see the Zika outbreak in the United States spread. As a result, nurse practitioners in all areas need to be aware of the latest testing and treatment guidelines for the virus.
Zika Testing Guidelines
In pregnant women, Zika infection may result in miscarriage or birth defects, namely microcephaly. Given the severity of the consequences of Zika infection coupled with the reality of local transmission, the CDC has recently updated the recommendations for screening in pregnancy. Here are the new Zika virus recommendations:
- Pregnant women should avoid travel to areas with active Zika transmission, including those areas in the United States.
- Healthcare providers should ask pregnant women about possible exposure to Zika at every visit.
- Sexual transmission of Zika has been documented from both men and women to their partners. Pregnant women and/or their partners who live in or who have traveled to an area with Zika transmission should use barrier protection, or abstain from sexual activity, for the duration of pregnancy.
- For symptomatic pregnant women with exposure to Zika virus, testing of serum and urine is recommended up to 2 weeks after symptom onset. Asymptomatic pregnant women who live in an area of Zika transmission should have rRT-PCR testing of serum and urine less than 2 weeks after the latest possible exposure. Testing should also occur in women who are evaluated 2-12 weeks after exposure and are found to be IgM positive.
- Asymptomatic pregnant women with possible Zika exposure may be offered screening within 2-12 weeks after the latest date of possible exposure. Asymptomatic women who live in areas with active Zika transmission should should have Zika virus IgM testing as part of routine OB care during the first and second trimesters.
- Non-pregnant women with Zika should wait at least eight weeks before trying to conceive. Men with Zika should wait at least six months before trying to conceive.
The Future of Zika
The Zika virus situation is constantly developing as we learn more about the disease. Researchers aren't sure if Zika is here for the long haul, or if we can expect the virus to disappear as quickly as it arrived. On the positive side, it appears that infected individuals acquire immunity to the virus. This means that, similar to the chickenpox or measles, if an individual is infected now, the body will clear the virus, develop antibodies, and be protected from illness or pregnancy complications in the future.
Given our developing knowledge of the Zika virus, and the presence of active Zika transmission in the United States, it is imperative that nurse practitioners stay up to date with the latest Zika recommendations.
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