According to data from the CDC, 1,248 suspected cases of microcephaly had been reported in Brazil as of November 28, 2015, compared to the annual rate of just 150 to 200 such cases during 2010 through 2014. “Examination of the fetus [and] amniotic fluid, in some cases, has shown Zika virus, so there seems to be an association,” Dr Senanayake clarified, adding that “the [ANVISA – Brazilian Health Surveillance Agency] has told women in certain districts where there’s been a lot of microcephaly not to get pregnant.”
Brazil is set to host millions of guests from around the world as the 2016 Olympics get underway in only a few months’ time. Women who are pregnant or anticipate becoming pregnant should consider the risks if they are planning to travel to Rio de Janeiro. The risk of microcephaly does not apply to infected women who are not pregnant, however, as the CDC states that “Zika virus usually remains in the blood of an infected person for only a few days to a week,” and therefore “does not pose a risk of birth defects for future pregnancies.”
Dr St. Joy also stated that “public health personnel are still cautioning pregnant women to take special care to avoid mosquito bites during their pregnancies,” adding that the “[Pan-American Health Organization] is working on its guidelines for surveillance of congenital abnormalities.”
Clinical Insights
With treatment options so sparse—there is no vaccine or drug available specifically meant to combat a Zika virus infection—what can healthcare providers do for their patients? The CDC advises health care providers to “treat the symptoms,” which means telling patients to stay in bed, stay hydrated, and, most importantly, stay away from aspirins and NSAIDs “until dengue can be ruled out to reduce the risk of hemorrhage.” Acetaminophen or paracetamol are safe to use, in order to mitigate fever symptoms.
Those who are infected are also advised to stay indoors and remain as isolated as possible for at least a week after symptoms first present. While the risk of a domestic outbreak is probably low, Dr St. John said, the more exposure a Zika virus-infected individual has to the outside world, the more likely they are to be bitten by another mosquito, which can then carry and transmit the virus to another person.
“Chikungunya and dengue virus, which are transmitted by the same vectors [as Zika virus], have not managed to establish ongoing transmission in the United States despite repeated importations, [so] it is likely that Zika virus’ spread would follow a similar pattern,” Dr St. John noted.
Though rare, sexual transmission of Zika virus has also been found in at least one case, although it had been previously suspected for some time. In December 2013, a 44-year-old Tahitian man sought treatment for hematospermia. Analysis of his sperm, however, found Zika virus, indicating possible sexual transmission of the virus.
“The observation that [Zika virus] RNA was detectable in urine after viremia clearance in blood suggests that, as found for [dengue] and [West Nile virus] infections, urine samples can yield evidence of [Zika virus] for late diagnosis, but more investigation is needed,” the study concluded.
“The best way to control all this is to control the mosquito,” said Dr Senanayake. “You get a four-for-one deal; not only do you get rid of Zika virus, but also chikungunya, dengue, and yellow fever.” Dr Senanayake added that advanced research is currently underway in mosquito control efforts, including the idea of releasing mosquitoes into the wild that have been genetically modified so they cannot breed.
Now that the Illinois Department of Health has confirmed two new cases of Zika virus infection in that state, with other new cases cropping up in Saint Martin, Guadeloupe, and El Salvador, providers should remain vigilant, taking note of patients who have traveled to afflicted regions and show mosquito bites. Person-to-person transmission is “rare as hen’s teeth,” said Dr Senanayake, which is to say, it is highly unlikely to occur. Nonetheless, he said information and communication is the best way to ensure that Zika virus does not spread widely in the United States.
Study Characterizes Intracerebral Hemorrhage With New Oral Anticoagulants
BY MARY ANN MOON
FROM JAMA NEUROLOGY
Vitals Key clinical point: Intracerebral hemorrhage (ICH) related to new oral anticoagulants frequently involves hematoma expansion and does not appear to respond to prothrombin complex concentrate. Major finding: Mortality was 28%; 65% of survivors had unfavorable outcomes; and substantial hematoma expansion occurred in 38% of patients. Data source: A prospective, multicenter, observational study involving 61 patients treated during a 3-year period in Germany. Disclosures: The RASUNOA registry was supported by the University Hospital Heidelberg. Dr Purrucker reported receiving support from Pfizer unrelated to this study, and his associates reported ties to numerous industry sources. |