Tips on how to talk to patients about Zika risks

With every passing summer day, the Zika virus alarm becomes more urgent in the United States, making it more important that physicians both address it and dispel rumors with their patients.

Hundreds of pregnant women are infected with the virus and are being monitored by the Centers for Disease Control and Prevention (CDC) in New York, Texas and other states. Thousands of other people are infected nationwide.

“You will start to see Zika cases transmitted by mosquitoes in the southern United States,” says Nitin S. Damle, MD, MS, FACP, a founding and managing partner at South County Internal Medicine Inc. in Wakefield, Rhode Island. “It could travel as far north as Maine. It is not exclusive to the south. Physician’s discussions about prevention are crucially important.”

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Physicians can educate patients about Zika in order to prevent microcephaly and other birth defects caused by the virus, as well as Guillain-Barré syndrome and newly detected Zika-related eye injury in any infected adult.

However, not all healthcare providers are convinced that Zika poses an imminent threat to Americans. The disease may well not spread as easily in the United States because living conditions—the use of air conditioning, closed windows in the summer, and window screens, among others – are very different compared with countries where Zika is epidemic. Also, the mosquito population—the ratio of mosquitoes to people—in the United States is lower than in countries such as Brazil, Mexico, Ecuador, Bolivia, and others, where Zika is currently more prevalent.

Nonetheless, the CDC recently held a briefing with governors from the states most likely to be affected by localized Zika outbreaks—Alabama, Arizona, California, Florida, Georgia, Hawaii, Louisiana, Mississippi, New York, and Texas. The states reviewed preparedness plans that include CDC Emergency Response Teams ready to deploy should an outbreak occur. CDC-advocated mosquito control programs are now widespread in the United States.

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By discussing the risks of Zika with patients, especially following travel to Zika-concentrated areas such as Brazil and Puerto Rico, and advocating the use of condoms for any type of sexual intercourse—even among monogamous couples—physicians can help patients avoid sexual transmission of the disease. By recommending the use of EPA-approved insecticides and other methods, physicians can help patients avoid vector-borne infection.

Next: Dispelling media hype

As of early summer, the CDC had not reported any cases of direct transmission of the virus by mosquitoes to humans in the United States. However, experts agree that it is simply a matter of time before this happens, for several reasons.

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First, Americans routinely travel to Zika-infested countries, are infected, and bring the virus home with them. Second, Americans are spending more time outside in the summer. Both of the mosquitoes that carry Zika—the Aedes aegypti and Aedes albopictus—hunt during the day, as well as at dawn and dusk. According to the CDC, both types currently inhabit more than half of the continental United States.

Physician Education Dispels Media Hype

“One question we get from patients is whether Zika is real or if the media is hyping it,” says Wanda Filer, MD, MBA, president of the American Academy of Family Physicians and is a family physician in York, Pennsylvania. “I tell them it’s serious.”

Damle, who is also president of the American College of Physicians and a member of the clinical faculty in the Alpert Medical School of Brown University, says the first thing physicians should do is take a good history and find out whether the patient has recently traveled to Zika-prevalent areas.
In addition, “The physician should ask whether a female patient is pregnant or planning to become pregnant,” says Damle. “Ask whether she has been exposed to Zika by a partner who has traveled to a Zika-infested area or has a partner who has been diagnosed with a Zika infection.”

“It is critically important that women who are pregnant or plan to become pregnant avoid Zika-infected areas,” adds Margaret “Peggy” Honein, PhD, MPH, an epidemiologist and chief of the birth defects branch at the CDC. “Parents must understand the risk that this may pose to the fetus.”

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If a woman’s history reveals that she has traveled to a region where Zika has been reported, she should wait at least eight weeks before attempting to conceive. If a history reveals that the male partner has traveled to a Zika-reported area or has shown signs of the disease, he should wait at least six months before attempting to conceive.

During these discussions, it is important for physicians to bear in mind that because as many as 50% of pregnancies are unplanned, the use of contraception is especially important, Honein notes. Any woman who could become pregnant risks microcephaly and a host of other birth defects in her child if she has been infected with Zika—either directly or through sex with an infected partner.

Next: Infection prevention

While the Zika talk need not be a long one, it is important for physicians to broach the subject and explain the risks for both adults and the fetus of any pregnant woman.

Infection Prevention

“Because Zika can infect all age groups, we are telling everyone this summer to be aggressive in the use of insect repellent.” says Jeanne Sheffield, MD, director of the division of maternal-fetal medicine and professor of gynecology and obstetrics at The Johns Hopkins University School of Medicine.

Experts say the methods of Zika prevention are:

·      Emphasizing to patients the need for all-day use of an EPA-approved insect repellent that contains DEET. Patients should follow the directions on the container for maximum protection. It is especially important to note in conversations with patients that DEET is safe for children, pregnant women, and all adults.

·      Patients should wear clothing that covers as much of the body possible—whenever possible.

·      EPA-approved insect repellents should be applied after sunscreen is applied.

·      Clothing that is permeated with permethrin has been shown to prevent mosquito bites. However, patients should still use an EPA-approved insect repellent on exposed skin, taking special care to apply repellent to the neck, nape, ears, face, and scalp, as well as exposed lower arms and legs.