In a stuffed auditorium On Children’s National Medical Center On Monday, doctors, nurses and residents gathered in the District of Columbia for an academic session Zika virus, Which has infected at least three people in the city and 49 others across the country who are visiting the US or returning after traveling in Latin America.
Head of the hospital’s pediatric infectious diseases Dr. Roberta DeBisi took the stage this season explaining that the infection is transmitted through mosquitoes carrying the dengue and chikungunya virus.
“If you’re thinking of those two, you need to think about Zika,” she said of patients who present with some travel history.
The session is an example of how hospitals are planning for Zika, which has exploded in Latin America, leading the World Health Organization to declare a rare Public health emergency. In Brazil, Zika has infected 1.5 million people, and is an estimate To infect 4 million worldwide during the coming year. To get ahead of potential transmission in the US, hospitals are reminding their staff to tell patients if they have recently traveled, and they are working with public health officials to see where and how Zika is spreading. Mistakes of past epidemics are part of the conversation, and officials emphasize the importance of the following protocol.
Professor of Medicine at the University of Medicine, Washington, Dr. “When you speak from recent experiences, being able to work collaboratively with the public health system is the most important part,” says Jeff Dutchin. A member of the Infectious Diseases Society of America.
The National Session of Children has shown that it is still not unknown about Zika, and to what extent hospitals rely on the information of scientists and public health officials and prevent disease.
For most people, the virus shows no symptoms or is otherwise mild, causing fever, rash, and joint pain. But officials say evidence suggests that the effects of the virus are far worse Fetal development, Leading to pregnant women or those focusing most of their health guidance on women who are of childbearing age. In Brazil, the virus is believed to be associated with more than 4,000 cases Children born with microcephalyA state of having abnormally small heads and sometimes underdeveloped brains. In Colombia, Health officials have not seen an increase in microcephaly, but noted that the virus appears to be tied to a neurological disease called Gillian-Barré syndrome, which can cause paralysis and cause three deaths in the country.
“As much as we know and as much is coming out each day, there are still hundreds of questions,” Debiasi told the audience. It is not known whether an infected person who does not have symptoms can still spread zika, or whether sputum and tears are contagious, she cites as examples.
After the presentation, doctors and nurses asked questions about whether the virus could be spread through breast milk, and whether people who got the virus became immune against it – more so that scientists still do not know.
Although America was not like the outbreak As seen in other parts of the world, the virus advances rapidly. Zika has been broadcast locally in at least 25 countries and territories, and the virus has been confirmed in passengers arriving or returning in at least 16 states and the District of Columbia, with one case in Dallas. sexually transmitted.
This reality leads to multilevel guidelines about prevention. in absentia Vaccine or treatment, Officials stress the best way is to avoid mosquito bites by wearing repellent and long sleeves while traveling to infected areas. At Children’s National, Debbie tells staff that they should advise pregnant women to cancel travel plans affected area. The Centers for Disease Control and Prevention has advised women not to have sex with their partners until they do so with condoms.
Professor of Epidemiology at the University of Michigan School of Public Health, Drs. “You have to work with the unknown,” says Arnold Monto. “This is where we are with Zika. … The situation here is so fluid that we have to be on alert right now. “
Looking at the way the virus is predominantly spread, Monto says that the US is unlikely to see a high number of overall transmissions, although he says that it is a case of some cases of transmission in the southern part of the US Can see where the climate is hot and mosquitoes. Thrive Nevertheless, they point out that hospitals have not followed certain protocols in the past that have led to missed cases, such as an Ebola patient who entered a Dallas hospital that transmits the disease to health care workers, and Toronto SARS was broadcast in 2003, killing 44 people in 2003.
“Even with protocols, there will be errors and omissions,” he says.
Dworkin says Zika is another reminder of how important it is for medical staff to ask about the history of travel. “The outbreak of infectious disease is really being exposed which we also saw Measles, Ebola, MERS, SARS and H1N1, “he says.” There’s a growing appreciation [travel history queries] In the medical community in general. “
In addition to infection control and tracking, hospitals are preparing to potentially manage cases of infants born with microcephaly. When women are infected during pregnancy, American hospitals are more likely to have sonograms, although it is difficult for doctors to tell by the second trimester whether the fetus is developing microcephaly.
Debra Bingham, vice president of nursing research, education and practice of the Association of Women’s Health, Obstetric and Neonatal Nurses, says each case will be evaluated and treated according to its needs. If necessary, a woman who is pregnant and whose fetus shows signs of microcephaly may be assigned. Hospital that specializes in handling more difficult cases – As is usually already done in neonatal practice.
“There will be no need to redo this process,” Bingham says. “He has been identified and established. The entire country is organized that way. “
Newborns are trained to care for infants with microcephaly, which has a number of other causes, resulting in 2,500 infants experiencing the condition in the US each year. Care after birth will vary, Bingham says, as newborns can cope with the problems of maintaining their temperature and feeding. Specially, Hospital Events will need to be tracked and continue to see if they have an upsurge of cases in a particular area.
So far, no child in the US has been born with microcephaly that has been linked to zika.
More data will be available according to reports of hospitals in the states. Hospitals and state public health systems are interdependent for treatment and monitoring, explains Vicky Allen, spokeswoman for the Association for Professionals in Infection Control and Epidemiology and director of infection prevention at Caromont Health, Gastonia, North Carolina. They are not only looking out for Zika, but keeping an eye on events like diseases. Tuberculosis And chicken pocks, And then looping into the CDC to detect the outbreak.
The problem with tracking Zika, she explains, is that most people do not have symptoms, so they would be unlikely to go to the hospital even if they are infected.
But even in such cases, the lack of continued investment in public health can lead to slow monitoring and disrupt the ability of authorities to overtake the outbreak, Richard Hamburg, a CEO for Trust for America Health, An organization advocates prevention measures.
Every year the organization sheds light on how states differ. Prevention efforts, Revealing significant gaps in funding based on where Americans live. Hamburg says the White House has proposed $ 1.8 billion in federal funding to combat the virus, but – As seen with ebola – The country’s lack of overall focus on prevention and mitigation of outbreaks was highlighted.
“The tendency is to focus on the most dangerous, most dangerous threat,” says Hamburg. “How many times do we need to burn before we change the way we work?”