- Zika virus infection
Action requested: Implement practices to prevent spread of influenza.
Background & Recommendations:
The influenza season is upon us in earnest. As of 1/9/16, the Health District had received reports of only four influenza-related hospitalizations and no influenza-related deaths, heightened school absenteeism, or outbreaks in long term care facilities. However, Providence Regional Medical Center Everett has reported more influenza-related hospitalizations in the past week and The Everett Clinic has reported marked increase in testing and positive results for influenza. Nationally, rates remained low as of last week, but reports are increasing. Public health laboratories have most frequently reported influenza A, with influenza A (H1N1) viruses predominating.
All health care facilities should implement practices to prevent the spread of influenza. All health care providers and ancillary staff who come in direct contact with patients should be vaccinated against influenza; health care providers who become ill should remain out of work until at least 24 hours after fever has resolved. Minimize exposure potential by screening and triage of symptomatic patients, then assuring good respiratory and hand hygiene (e.g., cough etiquette, masking). Health care providers should always practice hand hygiene frequently and should adhere to droplet precautions when caring for patients with respiratory symptoms. Detailed guidance can be found at http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm.
Zika virus infection
Action requested: Consider Zika virus infection in patients with acute fever, rash, arthralgia, or conjunctivitis, and who have traveled to areas with ongoing transmission in the two weeks prior to illness onset.
Background: Zika virus is a mosquito-borne flavivirus. Outbreaks of Zika virus disease have been reported previously in Africa, Asia, and some Pacific islands. As of 15 JAN 2016, local transmission of Zika virus had been identified in at least 14 countries or territories in the Americas, including Puerto Rico, other Caribbean islands, and Mexico. (see http://www.paho.org/hq/index.php?option=com_topics&view=article&id=427&Itemid=41484&lang=en). Spread to other countries in the region is expected. Although local transmission of Zika virus has not been documented in the continental US, Zika infections have been reported in travelers returning to the US and the number will likely increase. Imported cases may result in local spread of the virus in the continental US via human-to-mosquito-to-human transmission.
About one in five people infected with Zika become symptomatic. Clinical illness usually is mild with symptoms lasting for several days to a week; severe disease requiring hospitalization is uncommon and fatalities are rare. During the current outbreak in Brazil, Zika virus RNA has been identified in tissues from infants with microcephaly and from fetal losses in women infected during pregnancy, and Brazil has reported a marked increase in the number of babies born with microcephaly. However, it is not known how many of the microcephaly cases are associated with Zika infection and what factors increase risk to the fetus. Guillain-Barré syndrome also has been reported following suspected Zika virus infection.
- Consider Zika virus infection in patients with acute fever, rash, arthralgia, or conjunctivitis and who have traveled to areas with ongoing transmission in the two weeks prior to illness onset.
- Patients with suspected Zika infections also should be evaluated for possible dengue or chikungunya infection (symptoms and geographic distribution are similar).
- There is no commercially available lab test for Zika infection; PCR and serologic testing can be arranged by Public Health; report suspected cases to the Health District at 425-339-5278.
- Because no specific antiviral treatment is available for Zika disease, treatment is supportive (rest, fluids, and use of analgesics and antipyretics). Aspirin and other NSAIDs should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. In particular, pregnant women who have a fever should be treated with acetaminophen.
- Evaluate fetuses and infants of women infected with Zika during pregnancy for possible congenital infection and neurologic abnormalities.
- Advise pregnant women and women and women who may become pregnant during travel to consider postponing travel to areas with Zika transmission.
- Advise all travelers to take steps to avoid mosquito bites to prevent Zika infection and other mosquito-borne diseases. In particular, pregnant women and women trying to become pregnant who travel to areas with Zika transmission should adhere to steps to avoid mosquito bites.
For additional information, see http://www.cdc.gov/zika/.