Zika Virus

Abstract

Zika virus (ZIKV) infections are the latest global public health emergency. Occupational health nurses can protect society by educating workers, women of childbearing age, and others traveling in ZIKV-infected areas about prevention strategies.

Zika virus (ZIKV) disease is spread primarily through the bite of infected Aedes-species mosquitoes that are also responsible for dengue and chikungunya viruses. First diagnosed in the mid-20th century, most ZIKV outbreaks were reported in tropical Africa until 2015 when increased infection rates in regions of the Americas surfaced. A new virus to the Americas such as ZIKV increases susceptibility for the entire population. The mosquito vector is widespread in the region, and climatic conditions, temperature, and humidity in tropical countries and U.S. Gulf coast states increase exposure risk (Pan American Health Organization [PAHO], n.d.). The World Health Organization (WHO; 2016) declared ZIKV a public health emergency of international concern in early 2016, but the United States has only confirmed international travel-related cases (Centers for Disease Control and Prevention [CDC], 2016).

Preliminary observations indicated a link between ZIKV and miscarriages, neurological birth defects including microcephaly, and Guillain-Barré syndrome (CDC, 2016). No specific antiviral treatment exists to protect against ZIKV. Two to 7 days after vector exposure, symptoms of fever, joint pain, headache, myalgia, conjunctivitis, or widespread maculopapular rash appear. An infected individual’s blood harbors the virus generally for 1 week, and sexual contact or contamination with infected body fluids may spread the virus (PAHO, n.d.). Maternal infection close to delivery can transmit ZIKV to the newborn during childbirth. In early pregnancy, the virus crosses the placenta and can cause microcephaly, absent or poorly developed brain structures, vision and hearing defects, and impaired fetal growth (CDC, 2016). ZIKV-infected individuals rarely die; infection provides lifelong immunity.

The United States now classifies ZIKV and ZIKV-congenital infection as nationally notifiable conditions, and pregnant women should avoid travel to ZIKV-prominent areas (CDC, 2016). If travel is unavoidable, recommendations include sleeping in screened or air conditioned rooms, covering exposed skin with long sleeves or pants, and using DEET-containing insect repellant. Pregnant women who become ill within 2 weeks of traveling to ZIKV areas should be screened and, if positive for ZIKV, have fetal ultrasounds approximately every 4 weeks (CDC, 2016).

Health care workers are also at risk from the bloodborne virus as well as individuals who work outdoors because the mosquito vectors are aggressive day-feeders. Occupational health nurses can educate workers and the community about strategies to prevent the spread of ZIKV (e.g., eliminating standing waters to control mosquito breeding, avoiding mosquito contact during initial infection phase to halt local transmission, preventing exposure to blood and body fluids of infected individuals, applying insect repellent after sunscreen, and wearing permethrin-treated clothing outdoors). Individuals with suspected ZIKV also require evaluation for dengue and chikungunya virus. In addition, occupational health nurses should document when employees travel to high-risk areas and assess them after return for evidence of infection. Primary prevention is imperative because ZIKV has no cure; treatment includes rest, hydration, and symptom management. To avoid hemorrhage, non-steroidal anti-inflammatory drugs should be withheld for fever management until a diagnosis of dengue is ruled out.

ZIKV’s rapid spread and adverse outcomes require occupational health nurses to remain vigilant sharing public health updates with workers. The websites for relevant information and health education resources are as follows: CDC (http://www.cdc.gov/zika/index.html), WHO (http://www.who.int/topics/zika/en), and Hesperian Health Education (http://en.hesperian.org/hhg/Zika?utm_source=OCC&utm_medium=LS&utm_campaign=Zika_en); these websites should be reviewed periodically for the latest information.