Abstract

First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2–7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod-borne diseases are the only concern, isolation (contact, droplet, airborne) is unnecessary. Zika is a reportable disease and thus appropriate health authorities must be notified. The modified 3I tool will facilitate rapid analysis and triggering of appropriate actions for patients presenting to the ED at risk for Zika.

Highlights

  • Following closely after the 2014 Ebola outbreak, due to concerns for rapid spread and a link to birth defects, the World Health Organization (WHO) declared Zika virus a Public Health Emergency of International Concern (PHEIC) on February 1, 2016, making it only the fourth time in history for such a declaration.[1]

  • This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus

  • After microcephaly was reported in the Zika virus epidemic in South America, a retrospective analysis of the French Polynesia outbreak found that the number of microcephaly cases associated with Zika virus infection was 95 per 10,000 women infected in the first trimester, which is about 50 times higher than the baseline rate in the population.[5]

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Summary

INTRODUCTION

Following closely after the 2014 Ebola outbreak, due to concerns for rapid spread and a link to birth defects, the World Health Organization (WHO) declared Zika virus a Public Health Emergency of International Concern (PHEIC) on February 1, 2016, making it only the fourth time in history for such a declaration.[1]. CDC issued an unprecedented travel advisory for pregnant women[22], and health authorities have recommended that women living in affected areas delay pregnancy.[23] In addition, patients may seek information on the potential for development of microcephaly and other birth defects and the possibility of sexual transmission of Zika virus. Additional Considerations As with all contagious infectious diseases, the question of when to use the public health tools of quarantine and isolation is critical.[24,25] While at least one U.S politician has suggested that patients returning home from areas with ongoing Zika virus transmission such as Brazil should be quarantined, there is no scientific basis for this approach.[26,27] As noted previously, Zika virus is not readily transmitted from person to person, either before or after symptom onset. While not approved, in the U.S alone, President Obama requested 1.8 billion USD in emergency Zika funding.[30]

CONCLUSION
Findings
WHO statement on the first meeting of the International Health
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