“We at Care Resource take the health and well-being of our employees and communities that we serve seriously. We implemented education to all of our staff, and instituted systems to be sure that any employees, patients or visitors that may have symptoms of Zika be properly identified so that they can receive the care they deserve, while at the same time limiting the spread of this disease.”
August 1, 2016, 1300 ET (1:00 PM ET)
The Florida Department of Health (FL DOH) has identified an area with local mosquito-borne Zika virus transmission (active Zika virus transmission) in Miami (http://www.cdc.gov/zika/intheus/florida-update.html). This is an ongoing investigation, and CDC is rapidly learning more about the extent of active Zika virus transmission in the area identified by the FL DOH. Care Resource-Midtown is located within the boundaries of the area identified by the FL DOH. With the recommendations below, CDC is applying existing guidance to the occurrence of Zika virus transmission in this area of Florida. As more information becomes available, we will update these recommendations.
1. Pregnant women should avoid non-essential travel to the area with active Zika virus transmission identified by the FL DOH.
2. Pregnant women and their partners living in or traveling to the area with active Zika virus transmission identified by the FL DOH should follow steps to prevent mosquito bites (http://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).
3. Women and men who live in or who have traveled to the area with active Zika virus transmission identified by the FL DOH and who have a pregnant sex partner should consistently and correctly use condoms or other barriers to prevent infection during sex or not have sex for the duration of the pregnancy.
4. All pregnant women in the United States should be assessed for possible Zika virus exposure during each prenatal care visit. Women with ongoing risk of possible exposure include those who live in or frequently travel to the area with active Zika virus transmission identified by the FL DOH. Women with limited risk include those who traveled to the area with active Zika virus transmission identified by the FL DOH or had sex with a partner who lives in or traveled to the area with active Zika virus transmission without using condoms or other barrier methods to prevent infection. Each evaluation should include an assessment of signs and symptoms of Zika virus disease (acute onset of fever, rash, arthralgia, conjunctivitis), their travel history as well as their sexual partner’s potential exposure to Zika virus and history of any illness consistent with Zika virus disease to determine whether Zika virus testing is indicated.
5. Women with Zika virus disease should wait at least eight weeks and men with Zika virus disease should wait at least six months after symptom onset to attempt conception.
6. Women and men with ongoing risk of possible Zika virus exposure who do not have signs or symptoms consistent with Zika virus disease and are considering pregnancy should consult their healthcare provider. Due to the ongoing risk of possible Zika virus exposure, healthcare providers should discuss the risks of Zika, emphasize ways to prevent Zika virus infection, and provide information about safe and effective contraceptive methods. As part of their pregnancy planning and counseling with their health care providers, some women and their partners living in the area with active Zika virus transmission identified by the FL DOH might decide to delay pregnancy.
7. Women and men with limited risk and who do not report signs or symptoms consistent with Zika virus disease should wait at least eight weeks after last possible exposure to attempt conception.
How is ZIKA Virus Transmitted?
- Through mosquito bites.
Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (A. aegypti and A. albopictus). These are the same mosquitoes that spread dengue and chikungunya viruses.
•These mosquitoes typically lay eggs in and near standing water in things like buckets, bowls, animal dishes, flower pots and vases. They prefer to bite people, and live indoors and outdoors near people. ◦Mosquitoes that spread chikungunya, dengue, and Zika are aggressive daytime biters. They can also bite at night.
•Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.
- Through Infected Blood or Sexual contact
Spread of the virus through blood transfusion and sexual contact have been reported. Sexual transmission of Zika virus is possible, and is of particular concern during pregnancy.
Recommendations for men and their pregnant partners
Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy. Pregnant women should discuss their male partner’s potential exposures to mosquitoes and history of Zika-like illness with their health care provider; providers can consult CDC’s guidelines for evaluation and testing of pregnant women.
Recommendations for men and their nonpregnant sex partners
Men who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus might consider abstaining from sexual activity or using condoms consistently and correctly during sex. Couples considering this personal decision should take several factors into account. Most infections are asymptomatic, and when illness does occur, it is usually mild with symptoms lasting from several days to a week; severe disease requiring hospitalization is uncommon. The risk for acquiring vector-borne Zika virus in areas of active transmission depends on the duration and extent of exposure to infected mosquitoes and the steps taken to prevent mosquito bites. After infection, Zika virus might persist in semen when it is no longer detectable in blood.
Zika virus testing has been recommended to establish a diagnosis of infection in some groups, such as pregnant women. At present, Zika virus testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the incidence and duration of shedding in the male genitourinary tract is limited to one case report in which Zika virus persisted longer than in blood. At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended. As we learn more about the incidence and duration of seminal shedding from infected men and the utility and availability of testing in this context, recommendations to prevent sexual transmission of Zika virus will be updated.
1. ZIKA VIRUS Signs & Symptoms:
- • The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes).
- • The illness is usually mild with symptoms lasting from several days to a week.
- • Severe disease requiring hospitalization is uncommon. Researchers are examining a possible link between the virus and unborn babies exposed during pregnancy.
- •Should you experience any of the following symptoms seek immediate medical attention.
1. What is the treatment for ZIKA Virus?
There is no vaccine or specific medicine to treat Zika virus infections.
Treat the symptoms:
Get plenty of rest.
Drink fluids to prevent dehydration.
Take medicine such as acetaminophen to reduce fever and pain.
Do not take aspirin or other non-steroidal anti-inflammatory drugs.
If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
What can people do to prevent becoming infected with Zika?
There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites.
When it comes to protecting against annoying mosquito bites—and potentially serious mosquito-borne illnesses—you are the first line of defense, according to the Miami-Dade County Department of Solid Waste Management (DSWM). Floridians and visitors are encouraged to take simple steps to reduce the chance of being bitten, such as draining any standing water (no matter how small), covering skin with clothing or repellent and maintaining
It is important to practice “Drain and Cover” at home, but also when you are traveling, particularly to areas where mosquitos are prevalent such as the Caribbean, Central America and South America.
Drain standing water to stop mosquitoes from multiplying. Eliminate all sources of standing water on your property, including in flower pots, old car tires and buckets. Empty and clean birdbaths and pet’s water bowls at least once or twice a week. Protect boats and vehicles from rain with tarps that will not accumulate water. Maintain swimming pools in good condition and appropriately chlorinated. Be sure to empty plastic swimming pools when not in use.
Cover skin with long sleeve/pants clothing or use repellent when outside. Wear shoes, socks, long pants and long sleeves. Apply mosquito repellent to bare skin and clothing. Always use repellents according to the label. Repellents with DEET, picaridin, oil of lemon eucalyptus and IR3535 are effective. Reapply insect repellent as directed.
If you have a baby or child:
- • Do not use insect repellent on babies younger than 2 months of age.
- • Dress your child in clothing that covers arms and legs, or
- • Cover crib, stroller, and baby carrier with mosquito netting.
- • Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.
- • Adults: Spray insect repellent onto your hands and then apply to a child’s face.
- • Treat clothing and gear with permethrin or buy permethrin-treated items. Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.
- • Do NOT use permethrin products directly on skin. They are intended to treat clothing.
Cover doors and windows with screens to keep mosquitoes out. Keep mosquitoes out of your house by using air conditioning and keeping doors closed. Repair broken screens on windows, doors, porches and patios.
- Miami-Dade County’s Mosquito Control Unit conducts numerous mosquito inspections and spraying operations throughout the County to help keep down the volume of mosquitoes. To request a mosquito inspection or to report a mosquito nuisance, please call 3-1-1. For more information on mosquito control in Miami-Dade County, visit www.miamidade.gov/solidwaste.
- Travel Warnings: The CDC has issued a travel notice for Zika virus in Puerto Rico, the Caribbean, Mexico, Central America and South America. More information about the CDC’s notices can be found here: http://wwwnc.cdc.gov/travel/notices.
1. SPECIAL CONSIDERATION: PREGNANT WOMEN
Pregnant women can be infected with Zika virus in any trimester. The incidence of Zika virus infection in pregnant women is not currently known, and data on pregnant women infected with Zika virus are limited. No evidence exists to suggest that pregnant women are more susceptible to Zika virus infection or experience more severe disease during pregnancy.
Maternal-fetal transmission of Zika virus has been documented throughout pregnancy. Although Zika virus RNA has been detected in the pathologic specimens of fetal losses, it is not known if Zika virus caused the fetal losses. Zika virus infections have been confirmed in infants with microcephaly, and in the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported. However, it is not known how many of the microcephaly cases are associated with Zika virus infection. Studies are under way to investigate the association of Zika virus infection and microcephaly, including the role of other contributory factors (e.g., prior or concurrent infection with other organisms, nutrition, and environment). The full spectrum of outcomes that might be associated with Zika virus infections during pregnancy is unknown and requires further investigation.
Does Zika virus infection in pregnant women cause birth defects?
There have been reports of a serious birth defect of the brain called microcephaly (a condition in which a baby’s head is smaller than expected when compared to babies of the same sex and age) and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. Knowledge of the link between Zika and these outcomes is evolving, but until more is known, CDC recommends special precautions for all pregnant women.
Recommendations for Pregnant Women Considering Travel to an Area of Zika Virus Transmission
Because there is neither a vaccine nor prophylactic medications available to prevent Zika virus infection, CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing. If a pregnant woman travels to an area with Zika virus transmission, she should be advised to strictly follow steps to avoid mosquito bites. Mosquitoes that spread Zika virus bite both indoors and outdoors, mostly during the daytime; therefore, it is important to ensure protection from mosquitoes throughout the entire day. Mosquito prevention strategies include wearing long-sleeved shirts and long pants, using U.S. Environmental Protection Agency (EPA)–registered insect repellents, using permethrin-treated clothing and gear, and staying and sleeping in screened-in or air-conditioned rooms. When used as directed on the product label, insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women. Further guidelines for using insect repellents are available online (http://wwwnc.cdc.gov/travel/page/avoid-bug-bites).
Recommendations for Pregnant Women with History of Travel to an Area of Zika Virus Transmission
Health care providers should ask all pregnant women about recent travel. Women who traveled to an area with ongoing Zika virus transmission during pregnancy should be evaluated for Zika virus infection and tested in accordance with CDC Interim Guidance. Because of the similar geographic distribution and clinical presentation of Zika, dengue, and chikungunya virus infection, patients with symptoms consistent with Zika virus disease should also be evaluated for dengue and chikungunya virus infection, in accordance with existing guidelines.
Zika virus testing of maternal serum includes reverse transcription-polymerase chain reaction (RT-PCR) testing for symptomatic patients with onset of symptoms within the previous week. Immunoglobulin M (IgM) and neutralizing antibody testing should be performed on specimens collected ≥4 days after onset of symptoms. Cross-reaction with related flaviviruses (e.g., dengue or yellow fever) is common with antibody testing, and thus it might be difficult to distinguish Zika virus infection from other flavivirus infections. Consultation with state or local health departments might be necessary to assist with interpretation of results. Testing of asymptomatic pregnant women is not recommended in the absence of fetal microcephaly or intracranial calcifications.
Zika virus RT-PCR testing can be performed on amniotic fluid. Currently, it is unknown how sensitive or specific this test is for congenital infection. Amniocentesis is associated with an overall 0.1% risk of pregnancy loss when performed at less than 24 weeks of gestation (19). Amniocentesis performed ≥15 weeks of gestation is associated with lower rates of complications than those performed at earlier gestational ages, and early amniocentesis (≤14 weeks of gestation) is not recommended. Health care providers should discuss the risks and benefits of amniocentesis with their patients. A positive RT-PCR result on amniotic fluid would be suggestive of intrauterine infection and potentially useful to pregnant women and their health care providers.
For a live birth with evidence of maternal or fetal Zika virus infection, the following tests are recommended: histopathologic examination of the placenta and umbilical cord; testing of frozen placental tissue and cord tissue for Zika virus RNA; and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies. CDC is developing guidelines for infants infected by Zika virus. If a pregnancy results in a fetal loss in a woman with history of travel to an area of Zika virus transmission with symptoms consistent with Zika virus disease during or within 2 weeks of travel or findings of fetal microcephaly, Zika virus RT-PCR and immunohistochemical staining should be performed on fetal tissues, including umbilical cord and placenta.
There is no commercially available test for Zika virus. Testing for Zika virus infection is performed at CDC and several state health departments. Health care providers should contact their state or local health department to facilitate testing and for assistance with interpreting results.
How to Treat Pregnant Women with Diagnoses of Zika Virus Disease
No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics. Fever should be treated with acetaminophen. Although aspirin and other nonsteroidal anti-inflammatory drugs are not typically used in pregnancy, these medications should specifically be avoided until dengue can be ruled out to reduce the risk for hemorrhage.
In a pregnant woman with laboratory evidence of Zika virus in serum or amniotic fluid, serial ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks. Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended
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