Zika: Updated guidance for providers


Our empirical understanding of Zika virus is rapidly evolving. This can present challenges for us as clinicians: to stay abreast of the changes and facilitate understanding and clarify implications for our patients.

Zika virus was discovered over 50 years ago, and there have been outbreaks before. However, the current global epidemic is the largest and most far-reaching to date. Currently, there are approximately 60 countries with Zika activity.  Most affected countries are in the Americas; Oceana has the next highest number of countries with current local transmission.

Certainly, the implications for pregnant women are most concerning and can result in severe fetal birth defects.  Our counseling for pregnant women is very clear: avoid travel to areas with local transmission of Zika, avoid sexual exposure from partners who may have traveled and take steps to avoid mosquito bites. However, most women aren’t currently pregnant. The message to we give to them must be as clear, and this is where family planning takes a central role. These messages are particularly important when we consider that still nearly half of pregnancies are unintended. The office of population affairs, OPA, has created a toolkit for providers that provides guidance about contraceptive counseling using the principles outlined in QFP modified for the local Zika context (https://www.hhs.gov/opa/pdfs/zikatoolkit.pdf).  Recommendations include first assessing a woman’s reproductive goals, then assessing her risk of Zika exposure, and finally working collaboratively with the knowledge of her goals and potential risks to determine a plan that will work best for her.  Ultimately, our goal as family planners is similar to what it has always been: to provide women with the tools they need to reach their reproductive health goals.  The difference is that now the threat for additional negative outcomes in the face of an unintended pregnancy are amplified.

Though cooler months are approaching and our local mosquito transmission may be slowing here in the US.  However, the mosquito that transmits the virus lives in tropical and sub-tropical climates and is still at threat around the globe. We do not know how long this epidemic will last in the US and abroad, so this conversation must continue. Providers should connect to their local health departments to be aware of risk of local transmission. The CDC has a Zika widget (http://www.cdc.gov/widgets/zika/index.html) that can be downloaded to office desktops or practice websites that will provide the up-to-date information on the epidemic. ACOG also has a Zika page that has current recommendations for evaluation and management in pregnancy as well as prevention through family planning (http://www.acog.org/About-ACOG/ACOG-Departments/Zika-Virus).

Feel free to reproduce the following two infographics for patients developed by the CDC, also available through these links: Zika: Plan Your Pregnancy and Zika: What We Know and What We Don’t.

Zika-thinking-about-having-a-baby Zika-what-we-know

Melissa Kottke, MD, MPH, MBA, Director, Jane Fonda Center Associate Professor, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta GA