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Zika:


How to keep travel safe during the health threat


By Marcia Frellick T


he World Health Organization in February declared the spread of Zika a public health emergency, citing the suspected link between pregnant women infected by the virus and microcephaly in fetuses. In April, the organization stated there is a “scientifi c consensus” that Zika causes both microcephaly and Guillain-Barre syndrome. Recent case reports suggest there also may be a link between Zika and other neurological abnormalities such as myelitis (infl ammation of the spinal cord) or brain abnor- malities on scan in the absence of microcephaly. Although symptoms of Zika are usually not severe — primarily rash, fever and aches — the risks to pregnant women, their babies, as well as adults have left the public concerned about how to stay safe as the vacation season ramps up.


RN sees Zika case years back Although the Zika virus has only recently become commonly known in the U.S., New York nurse practitioner and Columbia University DNP candidate Dyan Summers’ experience with it dates back more than two years when she diagnosed the fi rst case brought back to the country by a recreational traveler in 2013. Summers, NP-C, MPH, CTM, who specializes in tropical disease,


travel medicine and home care, also is a Jonas Nurse Leader Scholar and, as part of her work in the program, wrote a paper on her Zika case experience, which was published in the Journal of Travel Medicine in December 2015. The paper examined the case of a 48-year-old man with a pervasive rash who, in December 2013, returned from his travels to Ecuador, Peru, Bolivia, Chile, Easter Island, French Polynesia and Hawaii, and came into the New York branch of the Traveler’s Medical Service where Summers worked, complaining of fever, muscle aches and a distinct rash. The patient’s illness was about to take Summers’ career in an unexpected direction. When Summers saw the maculopapular rash (with both red smooth spots and bumps), her fi rst thought was dengue fever. But


26 Visit us at NURSE.com • 2016


the patient, who had read about the Zika virus, suggested it might be Zika. He recalled being bitten by several mosquitoes — despite having applied a recommended repellent and using mosquito nets — and within a day of leaving French Polynesia, where there had been a Zika outbreak, developed rash, fever, fatigue and malaise. “I had heard of (Zika) … but I honestly had to look it up,“ Summers said. Summers sent blood samples to the


Summers said her experience illustrates why


it is important for nurses to listen to patients, even if their ideas seem far-fetched.


New York City health department, which performed repeated tests to confi rm the diagnosis. Zika and dengue both typically involve rash, joint and muscle aches and fever, but, “The thing that happens with Zika that does not


happen with dengue is that you get conjunctivitis,” she said. There is no vaccine for Zika. In most of those infected, the body


takes care of the symptoms; that was the case for her patient, who took antihistamines for the rash and Tylenol for the aches. At the 30-day follow-up, he was symptom-free. Summers said her experience illustrates why it is important for nurses to listen to patients, even if their ideas seem far-fetched.


Zika status at level 1 The Centers for Disease Control and Prevention upgraded its Emer- gency Response Activation Level for Zika to Level 1, its highest level, in February. This status has been assigned only three times before — for the Ebola outbreak in 2014, the H1N1 infl uenza outbreak of 2009 and Hurricane Katrina in 2005. The CDC’s travel Zika travel alerts for several destinations —


including South American nations, Belize, Puerto Rico and several others — stand at “Level 2: Alert,” which recommends that travelers follow “enhanced precautions,” as there is “increased risk,” and certain high-risk populations “may wish to delay travel to these destinations.” The CDC says pregnant women should avoid travel to aff ected countries, citing the Zika’s connection to fetal malfor- mations, neurological disorders and fetal death, as well as the wider geographical distribution of the disease. The WHO says pregnant


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