Zika virus disease outbreak in 2014 created lots of turmoil among the healthcare organizations worldwide. Many countries and territories were involved in the process of virus localization, which is claimed to occur in Brazil and spread over large territories by infected mosquitoes. As Musso, Nilles & Cao‐Lormeau (2014) state, Zika infection carries potential danger for everyone especially pregnant women since it can cause serious complications during pregnancy and even lead to brain defect of an infant called microcephaly.
Naturally, the problem could not remain unnoticed by the Centers for Disease Control (CDC): the Big Cities Health Coalition (BCHC) was formed to take measures regarding the virus and combat the consequences caused by it. The coalition is known to act on behalf of the US government healthcare department.
Analysis
The main purpose of the professional coalition is to understand and better control Zika virus. As to its objectives, the coalition operates to collect and compare data from 28 big cities of the United States in order to figure out a gross appearance of the incidence (Waltz, 2016). The Big Cities Health Inventory data platform currently serves as the major tool of data collection and objectives fulfillment. It shows data regarding all the infectious diseases and epidemic bursts that currently take place on the controlled territories. The platform is the first of its kind to provide data analysis on a city level since previously those were only represented at a state or country level only.
A professional coalition consists of the 28 largest urban public health departments. The departments represent approximately one in every six Americans involved in a public health community. Waltz (2016) highlights that with an introduced platform providing a large-scale monitoring of the biggest cities it has become even easier for users to find out how exactly city populations are faring on one of the biggest health challenges of the present. Such an unprecedented level of citizens’ involvement forms a formidable background for the coalition expanding and including more clinicians and healthcare organizations into its number.
The Big Cities Health Coalition has established rigorous clinical monitoring to detect Guillain-Barre Syndrome or any other infection reoccurrence and act with no slightest delay. Considering that a transfusion-related virus transmission is a huge risk, molecular screening was implemented for blood donors throughout the biggest cities of the United States. It should be noted that back in spring 2016 US Senate voted for issuing $1.1 billion to the coalition to fight the occurring epidemy.
These funds were used to develop the first of its kind software platform, allowing for more efficient monitoring of the incidence and assigning more units to deal with the problem on a local basis. Providing a shared value to the BCHC membership created a favorable environment for improving the infrastructure and forming the local health departments, subordinate to the central coalition office. Such complex measures gave nudge for building a strong organization and fostering the leadership development (Musso et al., 2014).
Conclusion
In closing, one should stress that the US Government took serious measures regarding the Zika virus spread prevention. The formed Big Cities Health Coalition used all the available funds and assets to localize the virus and stop its further reoccurrence. The presence of such constituents as the Big Cities Health Inventory data platform and sufficient human resources created a suitable environment for fast responding to the issue and establishing a strict control over the healthcare situation in the largest cities.
References
Musso, D., Nilles, E. J., & Cao‐Lormeau, V. M. (2014). Rapid spread of emerging Zika virus in the Pacific area. Clinical Microbiology and Infection, 20(10), 595-596.
Waltz, E. (2016). GM mosquitoes fire first salvo against Zika virus. Nature Biotechnology, 34(3), 221-223.
The contemporary healthcare environment is affected by several new trends. According to Minute Videos (2016), the popularity of international travel for leisure and business contributes to the spreading of infectious diseases to new destinations. Thus, promoting global health and strengthening the country’s health security has become one of the main goals of American care providers (Office of Disease Prevention and Health Promotion [ODPHP], 2014). The present paper will discuss the role and responsibility of nurses working in primary care in recognizing and responding to the threat of the Zika virus. The essay will also reflect on the most important and relevant aspects of the course.
Nurses and Global Health
Zika virus disease has become a popular topic in global health over the past few years. Edelman and Kudzma (2018) note that the disease is often asymptomatic, although it poses a significant threat to pregnant women and infants who live in or travel to countries with a high risk of Zika virus transmission. The virus can be transmitted through sexual intercourse and mosquito bites (Centers for Disease Control and Prevention [CDC], 2018). To promote global health, nurses must recognize and understand this threat and take the necessary measures to address it in their practice settings.
Nurses play a critical role in global health promotion due to their unique position in the healthcare sector. Edmonson, McCarthy, Trent-Adams, McCain, and Marshall (2017) state that nurses work at micro-, macro-, and mesosystem levels to provide care to patients, advocate for significant health issues, and enhance the quality of medical care on a global scale. For example, nurses often work in interprofessional teams, which allows them to build alliances with care providers and organizations, thus obtaining more resources for evidence-based care and prevention (Sherwood, n.d.). Based on this information, it can be concluded that nurses in primary care should respond to the emerging threat of the Zika virus by advising traveling patients about disease transmission and prevention, collaborating with other medical professionals to strengthen the U.S. national health security, and spreading awareness about Zika virus and its importance to global health. Nurses can also participate in disease prevention by evaluating evidence-based prevention strategies and advocating for global health.
Community Health Promotion
One particular aspect of the course that was the most relevant and important to my future practice is community health promotion. The Windshield Survey and the resulting Community Education Program have helped me to improve my understanding of health issues affecting the local community and my role as a primary care provider in addressing these problems. Educating communities on disease prevention and health promotion can help to improve population health and reduce premature mortality from non-communicable diseases, which is among the key global health goals of the 21st century (World Health Organization, 2018). Thus, I will seek to use patient education and advocacy to promote the health literacy of communities, thus improving the delivery of care and patient outcomes.
Conclusion
All in all, the course has offered useful insight into health promotion on global and local levels. On a global scale, health is impacted by globalization and infectious diseases, including Zika virus disease. Nurses could help to address this threat by enhancing prevention efforts, partnering with other care providers, and providing information about transmission and prevention to patients. On the local level, nurses can promote population health by improving patients’ health literacy, thus aiding in reducing the incidence of preventable diseases, such as diabetes and heart disease. The information obtained from the course will help me to improve the delivery of care in my practice setting, thus contributing to health promotion.
The major concern of the US healthcare sector is the gradual improvement of the health of the nation via the elimination of the main causes for the deterioration of people’s state and education that might help individuals to engage in healthy behaviors. However, despite this focus, there are still many issues that should be solved because of their negative impact on the state of populations. For instance, in accordance with the latest statistics, Zika virus is taken as one of the dangerous pathogens that might result in critical consequences (World Health Organization [WHO], 2018). The situation is complex, as in the USA there are cases of this disease, which means that there is a fundamental need for the introduction of an appropriate prevention program that will help to improve the situation, reduce the incidence, and guarantee that no similar cases will appear in future. Under these conditions, community education and prevention program should be taken as a potent tool to improve the health of communities.
A critical part of education is the improved understanding of the background of the problem and why it remains topical. Zika virus (ZIKV) is a dangerous pathogen that is spread by daytime-active mosquitoes (WHO, 2018). Since its discovery in 1947, ZIKV has turned into a serious threat to global health, and today, the epidemic can be noted (WHO, 2018). The central problems associated with the virus is dengue, Japanese encephalitis, yellow fever, and other complications associated with alterations of body temperature (WHO, 2018). Additionally, the ZIKV can be transmitted through sexual contacts and bold transfusions (Centers for Disease Control and Prevention [CDC], n.d.). It can precondition the appearance of multiple undesired effects and be dangerous to pregnant women. For this reason, the main aspects of community education should include the emphasis on these factors and the provision of information to members in ethical and understandable ways.
The first and the most important principle of healthcare ethics that should be allied regarding the situation is autonomy. It states that all offered procedures or interventions should contribute to the increased independence of clients and their improved decision making. That is why patients should understand the benefits and risks of any issue that is discussed. Regarding the situation with Zika virus, the educational program should remain voluntary for all people and contribute to the improved level of knowledge among them with the primary aim to achieve the desired goal (Musso & Gubler, 2016). Prevention is one of the most effective ways to struggle against the disease. For this reason, observing the principle of autonomy, healthcare workers will be able to include wide populations and do not violate their basic rights.
The second critical idea is the application of the principle of non-maleficence. Any procedure or services should not harm involved patients or other members of the community (WHO, 2018). That is why Zika virus educators should operate with the idea that they cause no harm to the target population by explaining the basic principles of prevention and contraception (Musso & Gubler, 2016). At the same time, regarding the existence of multiple ethical concerns related to the questions of sex and blood transfusion, as one of the possible ways of ZIKV spread, the use of the principle of non-maleficence should mean that any kind of educational activity should not be used in offensive or unacceptable ways. It also preconditions consideration of religious and cultural peculiarities of various communities with the primary goal to select the most effective ways to explain the main threats associated with the virus and how they can be avoided.
Finally, the principle of integrity should be utilized while designing programs for struggling against Zika virus in various locations. The given model presupposes that all aspects of the discussed issue are taken into consideration when creating a specific approach that is expected to help to improve the community’s health (Musso & Gubler, 2016). From this perspective, it becomes fundamental to guarantee that all themes and questions, including financial aspects, are covered by educational programs and given specific attention. In many cases, integrity contributes to improved outcomes because of the ability to create a new environment deprived of knowledge gaps related to various aspects of particular diseases. For this reason, while speaking about ZIKV, specialists should be ready to create approaches promoting the improve understanding of all existing factors.
Altogether, the problem of Zika virus cannot be disregarded as today the situation is described as the epidemic. The appearance of new cases in various regions of the world precondition the need for the creation of effective community education and prevention programs. They should rest on the principles of autonomy, non-maleficence, and integrity to be accepted by wide populations and contribute to improved results among various groups. The given framework will help to achieve the desired goals and ensure the reduction of incidence. Accepting the fact that prevention is one of the best possible ways to struggle against ZIKV, the given programs acquire the top priority as the most potent tool to promote the health of the nation and protect people from various factors that have the negative impact on them.
In this paper, the Alabama Department of Public Health’s policy on the Zika virus, as well as the ethical approach in business, will be discussed.
Alabama Department of Public Health’s Policy
As the first Zika virus case was confirmed in Alabama at the beginning of 2016, the Alabama Department of Public Health launched a campaign to educate and prevent the spread of the disease among Alabama citizens. Moreover, 345 submissions were received by the Alabama Department of Public Health from the citizens that wanted to be tested; 39 of these tests demonstrated positive result (Alabama Department of Public Health, 2016).
The ADPH also issued an advisory for pregnant women, as well as travelers, and provided webcasts and videos about the Zika virus for citizens of the state. The policymaking continued as the disease reached Alabama and first residents were confirmed with the virus. Alabama physicians were asked to contact the ADPH if any of their patients demonstrated symptoms of the disease.
All suspected cases were asked to be reported to Infectious Diseases & Outbreaks via the ADHP website. Specific submission forms were provided for residents who wanted to be tested for Zika or chikungunya and dengue viruses. Specimens for the tests could be dropped off at local departments and were later delivered to BCL.
The ADHP and Senior Services worked together on the education of residents about the Zika virus; coloring books that contained information about the virus were distributed to pre-kindergarten students, as well as more than 8.000 citizens of the state.
Information for clinicians was provided via the website in the form of PDF files. As of today, the ADHP accepts proposals from the residents on mosquito surveillance.
Sarah’s Case
Business ethics in large enterprises do not forbid recommendations from employees, even if these recommendations concern their friends or family. Thus, Sarah will not break any rules if she decides to interview Jane. However, she should hand her written recommendation to the director of the company so that the interview process is transparent. It would be unethical if Sarah did not mention that Jane is her friend and decided to conduct the interview herself, without any mentions about their relationships.
As the company does not provide money to fund additional training for the other two applicants, and Jane is qualified for the position, it seems logical to interview Jane for the job. However, if it is possible, the director of the company should be present at the interview to ensure that Sara does not supervise her friend or interviews her incorrectly.
The most ethical approach here would be to conduct an interview with all three applicants and choose one of them depending on the results of the interview. Sarah’s choice cannot be entirely ethical as it is limited by the budget of the company. The other two applicants can be more suitable for the position but only after specific training. However, it is impossible to train at least one of them due to the financial issues of the company. If the main aim of the company is to find a qualified employee for the position, it is reasonable to interview Jane but at the highest level of transparency.
The ethical approach can be both the best and the worst one depending on the context. However, the advantage of the ethical approach is that it tries to avoid conflict of interests and present all parties with equal opportunities or choices. Nevertheless, it also heavily depends on the situation.
Reference
Alabama Department of Public Health. (2016). Zika virus. Web.
The non-structural protein 5 (NS5) is considered to be the largest strain, which is coded by the Zika Virus RNA. According to Elshahawi et al. (2019), the product has about 904 amino-acids along its entire length. It is comprised of two domains, which complement each other’s function. In particular, it has an RNA-dependent polymerase (RdRp) domain, which is located at its C-terminal and is joined to a methyltransferase (MTase) at its N-terminal through a linker. The NS5 strain is a critical element in the replication of Zika Virus. Moreover, it is also important in the survival and evasion of immunity of the system it enters, in addition to other functions. According to Upadhyay et al. (2017), ZIKV NS5 protein is similar in several structures to the Japanese encephalitis virus (JEV). This paper hypothesizes that the Zika Virus mutates, thus varies from different geographical locations and time, and NS5 ensures its survival and infectivity.
Methodology
Zika envelope genome. Every Zika virus genome used in this analysis was obtained from the National Center for Biotechnology Information (NCBI) Virus
Variation Database (www.ncbi.nlm.nih.gov). The searching of genome sequence was done through the database using Zika Virus and protein envelopes of about 500 sequence in length.
Multiple sequence alignments. MUSCLE alignment method was used to align the protein sequence downloaded. It was noted that the multiple protein sequence alignments were achieved through the MUSCLE algorithms, using the standard generic translation code, with universal settings, which provided the best results.
Phylogenetic tree. The phylogenetic tree was created from the aligned sequences using PhyML Maximum with probability method utilizing 20 bootstraps replicate searches, which resulted in the best possible scoring tree (Ebranati et al., 2019). The SRT & NNI search were used to perform this tree improvement, resulting in 300 drafts, which complement ZIKV genomes in the NCBI database.
Results
Figure 1. Multiple sequence alignment of flavivirus NS5 proteins. The Flavivirus NS5 proteins show genomes of 16 Zika Virus, mainly found in Africa, North America, South America, Asia, including the Dengue viruses, Yellow fever, West Nile, which have been used as negative controls in this experiment. The accession numbers include QDP14353, QDP14356, ABY86749, AAC58803, ART29818, AMP44573, ANK57866, AMR96778, AMC39589, AME17082, AME17079, AJA40023, AJA40024, AJD79005, AKH87424, AHL43494, AHL43498, and AHL43470. The alignment of the sequences has been achieved as a result of using the MUSCLE alignment method and the standard genetic translation code, with all settings left at their default values to give the most accurate results. The highlighted blocks show conserved regions along the alignment of the protein.
Phylogenetic analysis
Figure 2. The phylogenetic trees of ZIKV NS5 are generated from Africa, North America, South America, Asia. The contig sequences were analyzed using 4 different references with African origins, 10 Asian lineages, 1 North America, 1 South America lineages. This led to detecting four major lineages, which include African, Asian, North American, and South American variants. A genetic distance of 0.03 was used though it is also important to note that the figure 2 is not drawn to scale. In addition, the analysis used a bootstrap greater than 70 in each of the nodes of the phylogenetic tree.
The algorithm used to analyze the maximum likelihood of ZIKV NS5 phylogenetic tree led to the understanding of probabilities of the sequences based on their evolution from one branch to the other.
Discussion and Conclusion
ZIKV is one of the recently emerging pathogen carried by mosquitoes. According to Polonio et al. (2017), it was first analyzed and understood in 1952, when it was separated in 1947 from a sentinel Rhesus macaque and a year later in Aedes Africanus in Ugandan, Zika forest. However, since its first reporting, few cases of infections were registered until 2007, when a massive outbreak happened in Micronesia. According to Musso et al. (2018), it was later detected and confirmed in 2013, when 396 cases were positive from laboratory tests. Ever since, different variants of the virus have continued to affect other parts of the world.
The current and previous phylogenetic tree analyses have mostly identified African and Asian lineages. It has also been understood that the virus is transmitted through mosquitoes, such as those in the Aedes genus, particular in the Culicidae family, when they are in their sylvatic phase. Humans are considered to be the most stable amplification host, where other primates are absent (Scaturro et al., 2018). This indicates that these viruses can survive in primate hosts, but where these are not present, human body becomes the most suitable host for them. Ending the disease has been an issue due to mutation of the virus, changing how the antivirus works from different branches.
The NS5 protein performs different essential functions, which ensure that the virus can replicate and survive, which makes it an important factor to target. While there are several outcomes resulting from the behavior of the virus, it is critical to discuss drug repurposing against the virus. While testing the inhibition behavior for ZIKV NS5, it is possible to screen several drugs against the virus. However, this can consume resources and time, which can be used in other analyses. Consequently, it is critical to examine present nucleoside analogues as these have demonstrated how effective they are in viral inhibition. For instance, these can include the pyrimidine or purine, having similar structure as that of the virus’ RNA or DNA, hence can trick them to grow longer chains, thus terminating earlier than normal. In addition, some other characteristics include the efficiency in uptake of various factors and activating them within the infected cells.
Conclusion
NS5 is critical in the Zika Virus’ survival and infectivity, making it a crucial target for developing an anti-viral drug. Since it has a crystal-like structure, the ZIKV can mimic different groups of antiviruses, thus it is possible to design a drug which can inhibit the activities of RdRp domain or can be made to target multiple allosteric behaviors happening as a result of reaction between NS5 and its various cofactors. Moreover, it is important to repurpose drugs in the present markets, particularly, those which indicate they have potential as anti-NS5 in various flaviviruses as its proteins have conservative nature. It is also crucial to consider the study of the NS5 protein, which can help in understanding the host proteins which need to be targeted to cause maximum ZIKV inactivity.
References
Ebranati, E., Veo, C., Carta, V., Percivalle, E., Rovida, F., Frati, E. R., Amendola, A., Ciccozzi, M., Tanzi, E., Galli, M. and Baldanti, F. (2019). Time-scaled phylogeography of complete Zika virus genomes using discrete and continuous space diffusion models. Infection, Genetics and Evolution, 73(1), 33-43. Web.
Musso, D., Bossin, H., Mallet, H. P., Besnard, M., Broult, J., Baudouin, L., Levi, J. E., Sabino, E. C., Ghawche, F., Lanteri, M.C. and Baud, D. (2018). Zika virus in French Polynesia 2013–14: Anatomy of a completed outbreak. The Lancet Infectious Diseases, 18(5), e172-e182. Web.
Polonio, C. M., de Freitas, C. L., Zanluqui, N. G., & Peron, J. P. S. (2017). Zika virus congenital syndrome: Experimental models and clinical aspects. Journal of Venomous Animals and Toxins including Tropical Diseases, 23(1), 1-9. Web.
Scaturro, P., Stukalov, A., Haas, D.A., Cortese, M., Draganova, K., Płaszczyca, A., Bartenschlager, R., Götz, M. and Pichlmair, A. (2018). An orthogonal proteomic survey uncovers novel Zika virus host factors. Nature, 561(7722), 253-257. Web.
Upadhyay, A. K., Cyr, M., Longenecker, K., Tripathi, R., Sun, C., & Kempf, D. J. (2017). Crystal structure of full-length Zika virus NS5 protein reveals a conformation similar to Japanese encephalitis virus NS5. Acta Crystallographica Section F: Structural Biology Communications, 73(3), 116-122. Web.
In my research of the Zika virus outbreaks, I have seen it written in various articles abbreviated as ZIKAV or ZIKV and Congenital Zika Syndrome as CZS. The research articles I read conferred that Zika was first isolated in 1947. “ZIKAV was first isolated in 1947 in the Zika Forest of Uganda from a sentinel rhesus monkey that was part of a yellow fever research study”(Basu & Tumban, 2016). “ZIKV has been associated with several sporadic human infections, based on detecting anti-ZIKV antibodies in serum, starting from 1952 in Africa and 1954 in Asia” (Hills et al., 2017). “Phylogenetically, ZIKV can be divided into two main linages-African and Asian-based on the geographic origin” (Hills et al., 2017).
“In 2007, a ZIKV outbreak was reported from the autochthonous transmission in Yap Island in the Federated States of Micronesia, and the Asian linage caused the outbreak. Six years later, in 2013, another outbreak was reported -5000 miles away from Yap Island, in French Polynesia that also linked 99% to the Asian strain” (Hills et al., 2017). I want to focus on the March 2015 outbreak in Brazil.” The first cases of ZIKV outbreak (from autochthonous transmission ) were reported in Bahia, Brazil. This outbreak’s nucleotide sequence analysis showed 99% identity with the ZIKV strain that caused the 2013 outbreak in French Polynesia” (Hills et al., 2017). The Journal of Infectious Diseases “Epidemiology of Zika Virus Infection, 2017” states that the outbreak in Brazil was confirmed in May 2015 after testing samples collected earlier in 2015 from patients with febrile rash symptoms (Basu & Tumban, 2016).
Epidemiological Determinants and Risk Factors
One of the epidemiological determinants is the nature of the virus. The CDC reports that many people infected with Zika won’t have symptoms, and if they do, it is mild, and they are usually not sick enough to seek healthcare (Centers for Disease Control and Prevention, 2019). “Zika was believed (until less than a decade ago) to be transmitted to humans only through bites of Aedes spp mosquitos” (Hills et al., 2017).
Virology Journal states, “there are no vaccines to protect against ZIKV infection or drugs to treat infected patients” (Hills et al., 2017). In addition, the Journal of Infectious Diseases discusses how in late 2015, the Brazilian Ministry reported an increase in congenital microcephaly and a possible link to Guillain-Barre Syndrome (GBS) from suspected ZIKAV infection (Basu & Tumban, 2016). Another risk factor that the World Health Organization (WHO) talks about is that accurate data on Zika may be limited in many areas of the world as many cases are asymptomatic and mild, and many countries have limited resources for detection, monitoring, or monitoring reporting ZIKV cases (WHO, 2022).
Route of Transmission
According to the CDC, Zika spreads primarily through the bite of an Aedes species of mosquito, and the mosquito can bite day or night. Other modes of transmission can be through sex with an infected person, from a pregnant woman with the illness to her fetus, and possibly through blood transfusions (WHO, 2022).”It is likely that the outbreaks in almost all the islands, including the one in Brazil, were first imported to these islands/country by infected individuals who later served as reservoirs hosts for mosquito transmission to naive individuals” (Hills et al., 2017).
Impact on the Community
The impact on my community at a systems-level will involve many resources. Recognizing that ZIKA, Congenital Zika Syndrome (CZS), or GBS can happen in our community is one step requiring testing and education of both the community and the healthcare system. In addition, we would need an increase in all types of healthcare providers (nursing assistants, personal care attendants, respite workers, nurses, physical therapists, occupational therapists, social workers, public health nurses, and providers, to name just a few). The hospital will need to increase the bed capacity for pediatrics, ICU, and general medicine. The clinics will need to increase the reproductive services so that people will have increased access to reproductive health.
It would involve increasing vector (mosquito) control at the city, county, and state levels. Community awareness of mosquito control methods the public can do in their area to help. Research and data collection will need to be done and studied to determine if ZIKA is in our area because of travel-related cases versus spreading from human to human. All of this requires funding. Unfortunately, our community is limited in its financial resources and would require additional funding than what the community can fund on its own. The cost to the parents to care for a child born with CZS will be more than I can imagine. In addition, the school systems will need to increase the staff and resources the public education system offers.
Reporting Protocol
The reporting protocol for an outbreak in my community varies. The Minnesota Department of Health (MDH) has the Zika virus on the list to be reported within one working day (Minnesota Department of Health, 2019a). The MDH has a phone number or form that can be used when registering the disease. eThe MDH states, “Health care practitioners (health care facilities, medical laboratories, and in certain circumstances veterinarians and veterinary medical laboratories) are required to report disease to the Minnesota Department of Health (MDH) under Minnesota state law” (Minnesota Department of Health, 2019b). It also adds”any person in charge of any institution, school, child care facility, or camp is also required to report disease to MDH” (Minnesota Department of Health, 2019b).
At our local hospital in northern Minnesota, I spoke with our infection control department manager Lisa Hesse. Lisa informed me that the department runs the reports of infectious diseases for our hospital twice a week and if a reportable disease like Zika is on the list, she reports it to MDH (April 27, 2022). At the clinic, Nurse Practioner Amanda Perkovich stated her nurse runs daily reports during the workweek and notifies the reportable illnesses to the MDH (May 2, 2022). The lab results are also sent to the provider who ordered the test, informing the patient in both situations. The MDH takes the information, sets up the needed contact tracing, and will contact the local area health department of the outbreak for further assistance.
Two Strategies to Prevent an Outbreak in My Community
Two strategies to prevent an outbreak in my community would involve education and mosquito control. Through education, I would attack this topic on multiple levels. First, I would send information/brochures to the health care providers about the potential travel risk to inform their patients of childbearing age to take precautions such as mosquito repellent, birth control measures, and condom use for two months after traveling to a high-risk area. I would also speak with the local travel agencies and inform them of high-risk areas and have information available for their clients. I would work with the area public school nurses and health educators to educate students on mosquito illnesses and preventative methods. I can write to legislators/policymakers about the importance of implementing testing for Zika on babies born with microcephaly or CZS, whether or not any known symptoms/travel were identified.
Secondly, we can help decrease mosquito-related illnesses through mosquito control, including Zika. The CDC states, “The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites” (Centers for Disease Control and Prevention, 2019). The CDC recommends wearing long-sleeved shirts and pants, using approved insect repellent as the label directs, but stresses not to use lemon of eucalyptus or para-menthane-idol on children less than three years old (Centers for Disease Control and Prevention, 2019). The CDC also recommends using air conditioning and window screens and keeping doors shut. If unable to, then they suggest sleeping under a mosquito bed net. Finally, to prevent the spread of Zika from sexual intercourse, they recommend using condoms or abstinence (Centers for Disease Control and Prevention, 2019).
Hills, S. L., Fischer, M., & Petersen, L. R. (2017). Epidemiology of Zika Virus Infection.The Journal of Infectious Diseases, 216(suppl_10), S868–S874.
Zika virus (ZIKV) belongs in the Flavivirus genus, which consists of other 52 viral species capable of being transmitted by mosquitoes and ticks, among other arthropod vectors (Song et al., 2017). Moreover, within this genus, the ZIKV is regarded as a mosquito-borne virus that holds a phylogenetic relationship to other mosquito-borne flaviviruses of significant global public health concern.
Spread of Zika Virus across International Borders
Virus Spread in Africa and Asia before the Year 2000
It was initially discovered in 1947 in Uganda when it was isolated from the sera of the sentinel rhesus macaque monkey that was placed in the Zika forest to surveil YFV (Song et al., 2017). Momentarily after, it was identified in the Aedes Africanus mosquitoes habituating in the same region. Later serological studies evidenced widespread but confined prevalence of the ZIKV across the narrow equatorial belt running from Africa to Asia (Song et al., 2017). These included countries, such as Sierra Leone, Uganda, Senegal, Gabon, Nigeria, Kenya, Egypt, Central African Republic, India, Tanzania, Thailand, Pakistan, Malaysia, Indonesia, the Philippines, and Indonesia. The first non-African ZIKV strain was detected in 1967 in Malaysia from the A. aegypti.
Spread of the ZIKV to the Yap Island and South East Asia between the Late 2000s to Mid-2010s
In 2007, the first largest outbreak of ZIKV outside Asia and Africa was on Yap Island, part of the Federated States of Micronesia (Song et al., 2017). This is on the northwest of the Pacific Ocean. Studies reveal that the virus entered Yap Island via Southeast Asia. In the early to mid-2010s, relatively few cases were reported in Southeast Asian countries consisting of Indonesia, Thailand, Cambodia, Malaysia, and the Philippines.
The outbreak in French Polynesia and the Pacific Islands in the early 2010s
In the years 2013 and 2014, a significant outbreak of ZIKV ensued in a French overseas territory found in the middle of the southern Pacific Ocean, French Polynesia (Song et al., 2017). Even though the source of the virus in this region remains unknown, research has revealed that it is genetically related to Cambodia’s strains in 2010 and Yap Island’s in 2007 (Song et al., 2017). Later on, ZIKV expanded to other neighboring islands in the South Pacific Ocean between 2014 and 2016 (Song et al., 2017). It affected the Cook Islands, New Caledonia, and Easter Island. Furthermore, it spread to other distant countries, such as Japan, Australia, Italy, and Norway.
Outbreak in Brazil and Spread in America between 2015 and 2016
The first case of ZIKV in Brazil was discovered at the beginning of 2015 in the northern region of Brazil (Song et al., 2017). After its emergence in Brazil, the virus has been spreading at a relatively fast rate throughout South and Central America, and the Caribbean.
Epidemiological Determinants and Risk Factors
Research suggests that most individuals without prior exposure to ZIKV are more susceptible to infection (Obore et al., 2019). Inhabitants of regions with the ongoing vector-borne transmission of the virus are susceptible to disease. Moreover, mosquitoes tend to breed in contaminated aquatic environments, such as stagnant water; therefore, people with homes around such areas are prone to vector-borne ZIKV infection. Mosquito larvae and pupae can take up the virus from the contaminated aquatic environments, thereby leading to ZIKV infected adult insects. Nevertheless, unlike other species, the A. Aedes mosquito is predominant in urban areas where it breeds in indoor and outdoor settings, such as flower vases, rubber tires, and water storage tanks. Thus, homes with unscreened or open windows, particularly in areas with ongoing ZIKV transmission, are highly susceptible to infection.
Studies also link sexual transmission, specifically from travelers or individuals from endemic regions returning to other areas without vector-borne transmission (Obore et al., 2019). Other social factors that affect ZIKV infection comprise high population density and poverty that heighten the probability of transmission and infection. Impoverished people often have low-quality housing, unscreened windows, and poor drainage that leads to greater mosquito abundance and biting rates. Aside from human factors, environmental factors like temperature and humidity favor mosquito breeding; therefore, they play a significant role in sustaining the vector population.
Route of Transmission of the Zika Virus
The virus is primarily transmitted through the bite of infected mosquitoes; however, it can also be passed via other non-vector-borne methods. These different types of transmission make it challenging to formulate control and prevention strategies against the virus.
Vector-borne Transmission
ZIKV transmitted by the mosquito has two distinct transmission cycles, including the sylvatic and urban cycles. The sylvatic process entails the maintenance of the virus between mosquitoes in the forests and non-human primates. On the other hand, the urban cycle comprises the maintenance of the virus between mosquitoes and humans in urban areas. ZIKV has been identified in the serum of several mosquito species in the Aedes genus. This comprises the A. africanus, A. aegypti, A. furcifer, A. look, A. albopictus, A. vittatus, A. apicoargenteus, A.luteocephalus. However, the A. albopictus, the Asian tiger mosquito, and A. aegypti, the yellow fever mosquito, are considered to be associated with the highest transmission rates (Song et al., 2017).
Non-vector borne transmission
Direct human-to-human transmission of the virus has been identified to be primarily transmitted through sexual relations, blood transfusion, and breastfeeding. The virus can be transmitted from an infected mother to her child during pregnancy. This is illustrated by the presence of the ZIKV RNA in the urine, amniotic fluid, and serum of mothers whose babies were found to have brain abnormalities (Song et al., 2017). The RNA has also been detected in breastmilk, hence, indicating that they have a probable risk of being transmitted through breastfeeding. On the other hand, sexual transmission is evidenced by the presence of the virus in the semen of an infected individual. However, male-to-female transmission tends to occur more than female-to-male or male-to-male transmission (Song et al., 2017). Lastly, although uncommon, a direct transmission might also occur via the skin or mucous membranes (Song et al., 2017).
Effect of the Zika Virus on the Florida Community
Overall, the ZIKV hurts the community at a systems level. Local governments are usually at the frontline of the outbreak, and this would be due to the heightened spending on Medicaid and public health. The local government will have to reallocate general revenue funds or identify supplemental appropriations to enable the local public health agencies to manage the virus. This would offset their current budgets, and to balance it, this would mean making cutbacks with reduced spending, higher tax rates, or fees. Higher tax rates would adversely affect consumer spending; thus, having a rippling effect on businesses due to the increased price of goods.
Furthermore, ZIKV would put a strain on hospitals, especially on pregnant mothers who are highly at risk of transmitting the virus to their fetuses or babies through breastmilk. ZIKV has been associated with other neuropathies, such as Guillain– Barré syndrome (GBS), microcephaly, and brain abnormalities (Song et al., 2017). According to the Centers for Disease Control and Prevention (2019), approximately one in seven babies exposed to the virus before birth had one or more health concerns caused by Zika. Some were apparent at birth; however, others became apparent as the babies grew older. This would strain the health systems as more personnel with relevant expertise are required to deal with the outbreak. Moreover, more social workers, speech, physical, and occupational therapists would be required to care for babies born with Zika-associated defects. Lastly, Zika-associated congenital disabilities would pressure the education system as teachers would require training on how to facilitate learning among children with brain abnormalities, visual and hearing impairments.
Reporting Protocol of a Zika Outbreak in the Florida Community
According to the Florida Health Government (2018), all health practitioners are obligated to notify the Florida Department of Health as ZIKV falls under the list of diseases and conditions of public health significance under Chapter 64D-3.029 of the Florida Administrative Code. Moreover, the law states that a laboratory report of test results is insufficient to disregard the practitioner’s duty to alert the Department of the viral infection. This is because the Department is reliant on such notifications to assess the community’s health and direct preventive action. Furthermore, ZIKV falls under the list of diseases meriting notice upon suspicion (referred to as Suspect Immediately) that should be reported at any time of the day, week, or month (Florida Health Government, 2016). Such diseases are of immediate public health concern because of their highly infectious nature. Practitioners are required to make a phone call following initial clinical suspicion. The aim of the ‘Suspect Immediately’ timeframe it alert the public health authorities to provide the required response, for instance, prophylaxis or issuing a mosquito control notification to prevent further exposure.
ZIKV Outbreak Prevention Strategies
Since there is no known cure for ZIKV and measures of preventing prenatal mother-to-fetus transmission, personal protection, and home vector control measures are the only feasible ones. Implementation of ZIKV prevention behavior promotion intervention is essential in maximizing these self-protective behaviors. Such interventions can change behavior by tackling behavioral barriers, creating incentives, and enhancing individuals’ capabilities to embrace the behavior. Health education can be facilitated by either or both patient and community education strategies. As patient advocates, health practitioners have a significant impact on helping them change their health behaviors. For instance, nurses are often in a position to detect early symptoms of an infection; therefore, playing an essential role in recognizing and reporting outbreak situations. As a result, it is their responsibility to assist in the control of the spread of ZIKV. To effectively support patients diagnosed with ZIKV and the community at large, nurses are required to keep current with the latest information and guidelines. This might entail conducting door-to-door visits to educate the community regarding preventing transmission and protecting themselves from the virus.
Other educative opportunities comprise print, television, radio, and social media channels to strategically disseminate prevention information. On the other hand, in a patient setting, particularly among patients diagnosed with ZIKV, nurses can advise them on pathways of viral transmission and enlighten their patients on how to protect others. For women of reproductive age and their sexual partners, practitioners can offer counseling and propose delayed pregnancy as suggested by the World Health Organization (World Health Organization, 2016). Furthermore, including their partners in such discussions might prove crucial as both parties will recognize the significance of delaying pregnancy and participating in safe sex to facilitate disease prevention.
References
Centers for Disease Control and Prevention. (2019). Zika virus. Web.
Obore, N., Papabathini, S., Ghimire, U., Kawuki, J., & Musa, T. (2019). Zika virus in Africa: Epidemiology and determinants. Journal of Advances in Medicine and Medical Research, 30(11), pp. 1-13. Web.
Zika virus is a flavivirus closely related to the viruses that cause yellow fever, dengue fever, and West Nile fever; it is spread by mosquitoes. Zika virus was first identified in Uganda in 1947 in a rhesus monkey, and in 1952, it was identified in humans (Favoretto et al., 2019). It is believed to have originated in East Africa, and its outbreaks have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. In 2015, the first case of Zika virus infection was reported in Brazil; later in the year, cases of Zika virus were confirmed in many states of Brazil (Favoretto et al., 2019). Zika virus has its few characteristics and shares some similarities with Flaviviridae family viruses.
Discussion
The hallmarks of a Zika infection vary depending on the demographic of human hosts infected. In pregnant women, the hallmarks include an increased risk of miscarriage and serious birth defects in babies born to infected mothers. For other demographics, such as adults who are not pregnant, the hallmarks include fever, rash, joint pain, and conjunctivitis (red eyes) (Nico et al., 2018). The virus can sometimes lead to neurological complications, including Guillain-Barré syndrome and microcephaly in newborn babies. Outbreaks of Zika have been associated with increased rates of microcephaly. The measures for preventing Zika virus disease (Zika) are the same as those recommended to prevent mosquito bites. Zika is spread by Aedes aegypti mosquitoes, which are found in many parts of the world, including the continental United States (Nico et al., 2018). There is no vaccine or specific medicine for Zika, but to help prevent Zika, one should wear long-sleeved shirts and long pants and stay in places with air conditioning and screens on doors and windows.
Additionally, it is still unclear exactly how the Zika virus causes microcephaly and other neurological problems. However, researchers believe the virus may disrupt fetal brain development by infecting and damaging developing nerve cells (Guarner & Hale, 2019). Zika is similar to other Flaviviridae family viruses, including Japanese encephalitis, dengue, and West Nile viruses (Favoretto et al., 2019). Like Zika, mosquitoes primarily transmit these viruses and can cause serious neurological problems. However, Zika appears to be much more virulent than other Flaviviridae viruses; while dengue and West Nile typically cause only mild symptoms or no symptoms at all, Zika can lead to severe birth defects.
Moreover, the Zika virus is a member of the Flaviviridae family, which includes other viruses such as dengue, West Nile, and yellow fever. Although these viruses share some common features, each has unique characteristics that can be studied to better understand how Zika functions. For example, dengue and Zika are transmitted by the same type of mosquito, but dengue causes much more severe symptoms than Zika (Guarner & Hale, 2019). This difference could help scientists develop treatments for Zika that are more specific and less harmful than current options for dengue. Additionally, the West Nile virus rarely causes serious illness in humans; therefore, understanding why this is the case could lead to insights into how to make Zika less harmful. Similarly, the Zika virus is transmitted by mosquitoes, while dengue and yellow fever are transmitted by other insects (Guarner & Hale, 2019). In addition, the Zika virus can lead to serious birth defects in pregnant women, while dengue and yellow fever do not appear to cause these same defects. Finally, the Zika virus has been found in parts of Africa and Asia where dengue and yellow fever are absent.
Conclusion
In conclusion, the Zika virus is a mosquito-borne flavivirus that was first identified in 1947. It is closely related to other well-known viruses in the Flaviviridae family, such as dengue fever, yellow fever, and Japanese encephalitis. Zika infection hallmarks include mild fever, maculopapular rash, and conjunctivitis. The illness is typically self-limiting and lasts for a few days. While the majority of infections are asymptomatic, Zika has been linked to serious health conditions in some rare cases. These include microcephaly (an abnormally small head) in newborns whose mothers were infected during pregnancy and Guillain-Barré syndrome.
References
Favoretto, S. R., Araujo, D. B., Duarte, N., Oliveira, D., da Crus, N. G., Mesquita, F., Leal, F., Machado, R., Gaio, F., Oliveira, W. F., Zanotto, P., & Durigon, E. L. (2019). Zika virus in peridomestic neotropical primates, Northeast Brazil. EcoHealth, 16(1), 61–69.
Guarner, J., & Hale, G. L. (2019). Four human diseases with significant public health impact caused by mosquito-borne flaviviruses: West Nile, Zika, dengue and yellow fever. Seminars in Diagnostic Pathology, 36(3), 170–176.
Nico, D., Conde, L., Rivera-Correa, J. L., Vasconcelos-Dos-Santos, A., Mesentier-Louro, L., Freire-de-Lima, L., Arruda, M. B., Freire-de-Lima, C. G., Ferreira, O., Jr, Lopes Moreira, M. E., Zin, A. A., Vasconcelos, Z., Otero, R. M., Palatnik-de-Sousa, C. B., Tanuri, A., Todeschini, A. R., Savino, W., Rodriguez, A., & Morrot, A. (2018). Prevalence of IgG autoantibodies against gd3 ganglioside in acute Zika virus infection. Frontiers in Medicine, 5, 25.
