CDC Medical Officer Updates Physician Assistants on Zika as Virus Goes into its Second Year

Romeo Galang, MD, MPH, medical officer with the Centers for Disease Control and Prevention (CDC), delivered a CME course on Zika virus and pregnant women to physician assistants at AAPA 2017.

A clinician on the CDC’s Pregnancy and Birth Defects Task Force, he gave the participants firsthand updates on management and prevention strategies for these infections in women who are already pregnant or are considering becoming pregnant and live or may travel to a Zika-affected area.

As of April 3, 2017, Galang said that the CDC has now issued travel notices for 60 countries where Zika has been confirmed, mostly in warmer, southern climates. In the United States, only Florida and Texas have reported local Zika transmission outbreaks, which he noted put a damper on spring break activities last year as the virus gained media attention.

A single-stranded RNA virus that is carried by 2 species of mosquitoes, Aedes aegytpi and Aedes albopictus, most people who are bitten by a Zika-carrying mosquito will never know. They will remain asymptomatic, or they may develop flulike symptoms, such as fever, rash, joint pain, and muscle pain, that may last about a week with no other effects. Medical management would be the largely same as for the flu: rest, fluids, and acetaminophen. It was important to note, however, Galang said, that if Zika was suspected, that non-steroidal anti-inflammatories be avoided until dengue fever was ruled out as the cause of the symptoms.

There is no vaccine for the virus currently.

However, for women who are pregnant or planning to become pregnant, there is a very real danger of being exposed to the Zika virus, whether through the direct route of an infected mosquito, or the other main route of transmission, which is unprotected sexual intercourse with an infected partner.

“Our understanding of Zika continues to evolve, and more work is being done to understand the full range of health problems,” Galang said. “Zika doesn’t occur in a vacuum…and so we’re trying to understand more about the interplay of these risk factors.”

Last year, the first year of the virus, 5000 pregnant women showed laboratory evidence of possible exposure to the virus in the United States. Researchers have since shown that the virus can be passed from an infected mother as soon as conception, making travel to affected areas an important consideration for women considering family planning as well. The virus has been shown to be present in fetal tissue as well as amniotic fluid.

Birth defects resulting from Zika include severe microcephaly, a condition in which the baby’s head is smaller than it should be for its sex and age. While some babies have been born with this defect already evident, it can also show up within the first year after birth.

Galang told the audience that last year, of the women who showed laboratory evidence of exposure to the virus, 6% of the fetuses of infants had birth defects in utero that were caused by the virus.

In 1000 women with laboratory evidence of exposure to the Zika virus, 5% with possible infection had babies with birth defects, and 10% with confirmed infection had babies with birth defects, emphasizing the importance of both proper travel planning and family planning for women and their partners who live or travel to a Zika-affected area and wish to start a family.

The current planning guidelines from the CDC are, in areas with active Zika virus and a CDC travel notice, that women wait at least 8 weeks after their last possible exposure or after symptoms begin before they start trying to conceive. Men should wait 6 months if they live or have traveled to one of these areas, because they can pass the infection on to their partners without being aware of it. During these windows, partners should either engage in protected sexual intercourse, or abstain entirely.

Galang further explained to the physician assistants that all pregnant women in the United States should be assessed for their risk for exposure to the Zika virus, and this is as simple as taking a good health history and asking the right questions about recent travel.

He also told them that all pregnant women who travel to a CDC travel area should be tested for the virus whether or not they develop symptoms, and pregnant women who have traveled to an area with a risk of the virus but no travel notice in place should only be tested if they develop symptoms.

“The information collected…help us to guide recommendations for monitoring, evaluation, and management of Zika during pregnancy,” Galang concluded. “Every new finding, every published study, every new data point, all feeds into what we know and directs public health action.”