Zika Worries on Patients' Minds, Pharmacists Say
Zika virus infection isn't yet a public health crisis in the mainland United States, but pharmacists are already getting questions from patients about how the virus may affect them.
"It's definitely on people's minds," said Katherine K. Perez, infectious diseases (ID) clinical specialist at Houston Methodist Hospital in Texas.
She said many questions come from patients who want to travel to Zika-affected areas—or whose partner plans to do so—and want to know how to prevent infection.
Much of the concern relates to the risk of microcephaly and other serious birth defects associated with Zika virus infection during pregnancy.
"Our advice has been, if you're planning on getting pregnant, we don't recommend that you travel to those regions. But otherwise you should practice safe sex and use birth control," Perez said.
At Emory HealthCare in Atlanta, staff pharmacists as well as pharmacy residents who work at the health system's travel clinic are dispensing Zika-related advice to patients, said Steve Mok, antimicrobial stewardship specialist.
"People ask me what they should do, should they defer travel, what are the risks," Mok said. "For people who are actively trying to conceive, we're advising them to consider deferring travel or travel somewhere else."
For those who aren't trying to conceive, he said, it's important to use mosquito repellants and have strategies for avoiding bites, such as sleeping in screened or air-conditioned rooms. And he said men who return from Zika-affected areas are cautioned that "they need to use condoms to make sure they're not passing the virus along" to their partner.
Perez said the most common questions she hears from patients are how to know if they are infected with Zika virus and whether it's safe to use insect repellants during pregnancy.
"I wasn't really sure if [repellants] were safe in pregnancy until I really started looking into it," Perez noted.
According to the Centers for Disease Control and Prevention (CDC), insect repellants that are registered with the Environmental Protection Agency and used as directed in the product labeling are safe and effective for pregnant and breastfeeding women.
The Organization of Teratology Information Specialists likewise recommends that pregnant women protect themselves against insect bites, including bites from mosquitoes that may carry the Zika virus. The organization provides information on the risks and appropriate use of several chemicals that are widely used in insect repellants.
According to CDC, no cases of locally acquired, mosquito-transmitted Zika virus disease had been confirmed in the 50 states or the District of Columbia through June 30. But CDC reported 935 cases of travel-related Zika virus disease in these areas.
Among U.S. territories, Puerto Rico has been hardest hit by Zika, with 1970 cases, all but 5 of them locally acquired.
New York, with 236 CDC-confirmed reports, leads the states in Zika virus cases, followed by Florida, with 182 confirmed cases through June.
Georgia, with 26 cases, and Texas, with 49, together account for 8% of confirmed Zika cases in the states.
Mok said Emory has consulted with experts at the nearby CDC about the threat Zika is likely to pose in the Atlanta area. For now, he said, the consensus is that Zika virus, like Dengue and Chikungunya viruses—which are also spread by mosquitoes—will have limited transmission and not become established in the area.
"We are hoping . . . that we will not see a lot of local transmission," Mok said. "If there is a surge of cases of Zika virus disease in the Atlanta area, we are prepared to respond and have adequate drug supplies for babies that are born with microcephaly. So there is some planning for surge capacity."
Mok also noted that hospitals should be aware that they may need to use immune globulin to treat patients with Guillain-Barré Syndrome, a rare complication of Zika virus infection. CDC had confirmed 14 cases of the neurologic syndrome in the United States and its territories through the end of June.
Mok said Emory has already treated "a few cases" of confirmed Zika virus infection in travelers returning from Latin America with mild illness. He said supportive care for such patients includes fluids and analgesics.
But he said one of the patients is a pregnant woman who was infected abroad with Zika and has since been referred to a fetal–maternal specialist.
More than 500 pregnant women with laboratory evidence of Zika virus infection are part of a CDC-led registry that is tracking outcomes of the infection in the United States and its territories.
Houston's health department reported 11 confirmed cases of Zika through the end of June.
Perez said Zika "is definitely on our watch list" for the months ahead, and Texas Methodist is ready for a spike of Zika cases, if it should occur. But she said the hospital's ID group is predicting, for now, that the effects of the virus in the local area will be similar to those of Chikungunya virus.
According to provisional data from CDC, Texas reported 43 cases of Chikungunya virus infection last year. One infection that occurred last year was recently determined to have been locally transmitted, according to the Texas Department of State Health Services. All other cases were classified as travel associated.
"We expected Chikungunya to be a bigger issue last year, but it wasn't as big or dramatic as we thought," Perez recalled.
She said the pharmacy department isn't actively involved in the hospital's Zika response, because there is no drug therapy that specifically targets the virus. But as an ID pharmacist, she's involved in a general way with the management of Zika virus disease, just as she is with other vector-borne illnesses that occur in Houston.
"I wish there was a lot more I could do," Perez said.
She said pharmacists should be familiar with supportive therapy for any patient who seeks medical care for the type of nonspecific viral syndrome associated with Zika, Chikungunya, Dengue, or West Nile virus infection. She noted that Dengue and West Nile virus infections are "fairly frequent" in Texas, and said the hospital performs "a lot of molecular testing" for these infections.
The hospital in late February announced that it had developed, in collaboration with Texas Children's Hospital, a rapid diagnostic test for Zika virus infection. The test has not been approved for marketing by FDA.
"We can use it here for our patients," Perez said. "We are not providing it as a referral test for anybody who is not a patient here."
Under an emergency use authorization, FDA in April approved the first commercially available rapid diagnostic test for Zika, from Quest Diagnostics. Additional commercial diagnostic tests from other companies have since then been approved, also under emergency use authorizations.