Zika Virus Outbreak: Epidemiological Determinants, Transmission, and Prevention

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Table of Contents

Description of the Outbreak
Epidemiological Determinants and Risk Factors
Route of Transmission
Impact on the Community
Reporting Protocol
Two Strategies to Prevent an Outbreak in My Community
References

Description of the Outbreak

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).

References

Basu, R., & Tumban, E. (2016). Zika Virus on a Spreading Spree: What we now know that wasunknown in the 1950’s.Virology Journal, 13(1), 165.

Centers for Disease Control and Prevention. (2019).Overview: Zika Virus.

Hills, S. L., Fischer, M., & Petersen, L. R. (2017). Epidemiology of Zika Virus Infection.The Journal of Infectious Diseases, 216(suppl_10), S868–S874.

Minnesota Deprtment of Health. (2019a). Reportable disease poster: Infectious disease reporting.

Minnesota Deprtment of Health. (2019b). Reporting Zika virus disease.

WHO. (2022). Zika epidemiology update: February 2022.

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