The Zika Foundation Interim Health Advisories

Zika Foundation Interim Advisory for Health Care Workers

July 20, 2016

Recent cases from Zika Foundation clinicians treating patients in the tropical Americas have raised questions that Zika Virus might be transmitted to health care workers during patient-care activities. As of June 12, 2016, the Foundation has recorded three cases where health care workers (HCWs) have developed acute Zika viral disease (AZVD) following medical care of patients with high plasma viral loads (in excess of 10^5/ml). In each of these cases, the possibility that the HCWs might have been infected by mosquitoes in the region was felt to be very low, but could not be definitively excluded.

This week, the CDC and the Salt Lake County Health Department confirmed a case of health care-associated Zika viral disease. The case involves a family member who self reported providing routine care of a family member who was infected during travel prior to returning to Salt Lake County.  In this case, the possibility that this Zika infection occurred through other avenues, such as from an imported mosquito, from sexual contact with the elderly infected patient or needle-stick injury, have to date been excluded.

The summary of the Zika Foundation cases and the single well-characterized case in Utah require additional investigation and compels an escalation of interim precautions to protect HCWs, in particular female HCWs of child-bearing potential. While the Zika Foundation cases each involved invasive procedures (two central line placements, two obstetrical procedures) performed on patients with uncharacteristically high viral loads (8 x 10^4 to 7x10^5/ml), the details regarding the care provided to the Utah case remain unclear.

At this time, the Zika Foundation is escalating precautions to ensure protection of clinical collaborators providing direct care of Zika-infected patients. Draft recommendations include:

  1. Patients suspected of Zika Viral Disease will be admitted under contact precautions.
  2. Critically ill and deteriorating patients and those requiring invasive supportive care will be admitted under droplet precautions.
  3. HCWs who are pregnant are excluded from direct-patient care of suspect and confirmed Zika patients.
  4. Allied hospital personnel such as food services, house keeping and sitters are also excluded from direct-care responsibilities.
  5. All health care personnel, regardless of age and gender, will maintain droplet plus precautions while performing invasive procedures: N95, goggles, gloves.
  6. Family members visiting hospitalized patients will adhere to droplet precautions.

The Zika Foundation will revise these interim recommendations in response to evidenced-based epidemiology and case review by qualified health investigation agencies.

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