Community Health and Population-Focused Nursing
The Zika virus causes a viral infection, transmitted mainly by mosquitos, that can be difficult to diagnose because most people infected have no signs or symptoms of the disease. Those who do experience effects of the virus typically present with mild and vague complaints which can include low-grade fever, rash, joint and or muscle pain, headache and conjunctivitis. It is extremely rare for Zika virus to cause death but it does have associated complications. Those infected can develop a neurological disorder, Guillain-Barre syndrome, and there are links to both miscarriage and a congenital brain defect, microcephaly, if Zika is contracted during pregnancy (“Zika virus disease,”2017). The Zika virus was first discovered in Uganda in 1947 and has since spread throughout the world with incidences of the disease documented in over 50 countries (Kindhauser, M.K., Allen, T., Frank, V., Santhana, R.S., & Dye, C., 2016). The most recent and ongoing outbreak of Zika infection began in Brazil in May of 2015 (“Zika virus infection – Brazil and Columbia,” 2015).
A region is considered to be experiencing an outbreak of the Zika virus when it is documented that the virus is being spread by indigenous or autochthonous mosquitoes. Autochthonous transmission of the Zika virus was first discovered in the Americas in Chile from February to June of 2014 (Pan American Health Organization & World Health Organization, 2015). The virus resurfaced in the Americas in May of 2015, causing an outbreak which began in Brazil. Since the discovery of the Zika virus in Brazil many more countries and territories throughout the Americas have confirmed autochthonous transmission of the disease. The dates which Zika was detected in the involved areas are as follows. Prior to October 2015 only Brazil was affected. From October to December of 2015 Colombia, El Salvador, French Guiana, Guatemala, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela became involved. From January to March of 2016 Aruba, Barbados, Bolivia, Caribbean Netherlands, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, Guadeloupe, Guyana, Haiti, Jamaica, Nicaragua, Saint Martin, Saint Vincent and the Grenadines, Trinidad and Tobago and the United Sates Virgin Islands became involved. From April to June of 2016 Anguilla, Argentina, Belize, Grenada, Peru, Saint Barthelemy and Saint Lucia were added to the list. From July to September of 2016 Antigua and Barbuda, Bahamas, British Virgin Islands, Cayman Islands, Saint Kitts and Nevis, Turks and Caicos Islands and the United States of America became among the areas involved. From October to December of 2016 Montserrat was the only new area afflicted by the Zika virus (Pan American Health Organization, 2017). The current Zika virus outbreak has not spread into any new areas within the Americas in 2018, however, there aren’t many areas left untouched seeing as how Canada, Chile, Uruguay and Bermuda are the only areas not involved.
As previously mentioned the Zika virus is mainly transmitted via mosquitos, but this is not the only way one can become infected. The Zika virus is also a sexually transmitted infection and can be passed from mother to baby during pregnancy (“Zika Virus,” 2018). The epidemiological determinant associated with the Zika virus outbreak is an increase in the mosquito population and therefore vectors. Scientists have been unable to definitively determine if the increase in climactic temperature and humidity directly leads to an increase in Zika infections or if these factors cause people to change their behaviors (i.e. wear less clothing and stay outside longer) (Gulich GA, 2016). Risk factors for contracting Zika virus include frequenting areas of known Zika infection, being bitten by mosquitos and having unprotected sex with an infected person (“Zika Virus,” 2018). There is not currently a vaccination for Zika, however, the rate of infection for the current outbreak is decreasing which leads scientists to believe it may be nearing an end. Scientists are attributing this decrease in infections to herd immunity, due to the fact that so many people have been infected (Gulich GA, 2016).
I live in San Diego County, California and the Zika virus has been detected however no autochthonous cases have been reported. All cases of Zika infection, no matter the circumstances of infection, must be reported to the California Department of Public Health (California Department of Public Health Division of Communicable Disease Control, 2016). If an outbreak were to occur in my community the systems impacted would be mainly OBGYN services (outpatient and inpatient), family planning services and the resources of the Vector Control Program. There would not be an initial widespread impact because only 20% of people infected develop symptoms and, as mentioned above, most experience only mild illness (Gulich GA, 2016). The main concern with Zika infections is the possibility of complications occurring in pregnant women or those trying to conceive. Due to these concerns, I would anticipate a Zika outbreak to cause an increase in the need for OBGYN visits and family planning services for infected or exposed pregnant women or those trying to conceive. The most effective way to stop the transmission of the Zika virus is to eliminate the vector, which is why if an outbreak occurred the Vector Control Program of San Diego County would be busy exterminating and investigating reports of mosquitos (San Diego County Health & Human Services Agency, n.d.). Long term impacts maybe farther reaching if a large amount of birth defects were observed. For example, if the Zika outbreak caused a high incidence of microcephaly then there could be a long-term increase in the need for specialized pediatric medical services and special needs education/transportation, as well as an economic burden placed on families and the community related to medical expenses and a loss of wages for caretakers.
In order to prevent an outbreak of the Zika virus in San Diego County I would recommend focusing mainly on community education and vector extermination. Community education should focus on how to protect oneself from mosquito bites, safe sex practices, risky travel destinations and current reproductive recommendations. This information would help prevent the spread of the disease and decrease the incidence of disease related complications. Vector extermination would decrease the potential for all mosquito-borne infections, including Zika. As mentioned above the County of San Diego has the Vector Control Program through which the community can report areas of mosquito infestation and they can be flagged for extermination services.
To conclude, the Zika virus is mainly transmitted via mosquitos. Infection with Zika is of most concern for women who are pregnant or trying to conceive because of associated birth defects and complications. There is an ongoing outbreak across the Americas that began in Brazil, however, the rate of infections are continuing to decrease. Current research and testing is being conducted but as of now no approved Zika vaccine exists (Kelly, 2017).
References
California Department of Public Health Division of Communicable Disease Control. (2016, May). Zika Information for Health Professionals.
Gulich GA (2016) Epidemiology, Driving Factors, Transmission and Control Options of Zika Virus: A Review. J Infect Dis Ther 4:278.
Kelly, J. C. (2017, October 5). Zika Vaccine Looks Safe, Promising in First Human Trial.
Kindhauser, M. K., Allen, T., Frank, V., Santhana, R. S., & Dye, C. (2016). Zika: the origin and spread of a mosquito-borne virus. Bulletin of the World Health Organization,675-686.
Pan American Health Organization, & World Health Organization. (2015, October 16). Zika virus infection. Epidemiological Update.
Pan American Health Organization. (2017, December 21). Countries and territories of the Americas with confirmed autochthonous cases of Zika virus (vector-borne transmission), 2015-2017. Washington, D.C.
San Diego County Health & Human Services Agency. (n.d.). Zika Virus.
Zika Virus. (2018, February 22)
Zika virus infection – Brazil and Colombia. (2015, October 21).
