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The Snohomish Health District Health Officer Dr. Gary Goldbaum sends alerts via email to local health care providers. Alerts cover current local, regional or national health threats and important updates on medical care and protocols. Alerts are written as needed to cover urgent or emergent health issues.

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Zika virus infection, pregnancy, and sex; Ebola; Sexually transmitted infections

Today’s topics:

  • Zika virus infection, pregnancy, and sex
  • Ebola
  • Sexually transmitted infections

Zika virus infection, pregnancy, and sex

Action requested: Be aware of current recommendations for to prevent sexual transmission of Zika virus and to protect against Zika virus infection during pregnancy.

Background: Out of 312 cases of Zika reported in US states, 27 were pregnant women, 6 were sexually transmitted, and one had Guillain-Barré.  Given that Zika virus infection during pregnancy has been associated with microcephaly, the Centers for Disease Control & Prevention (CDC) has issued new recommendations to prevent sexual transmission of the disease.

Recommendations:

  1. Ask all pregnant patients and their sexual partners about recent travel and advise pregnant patients to consider postponing travel to areas where Zika virus transmission is ongoing.  Advise pregnant women who cannot postpone such travel to strictly follow steps to avoid mosquito bites (including use of insect repellents containing DEET, picaridin, and IR3535, which are considered safe for pregnant women when used as directed).
  2. Advise women who test positive for Zika virus disease or who had symptoms of Zika after possible exposure to wait at least 8 weeks after their symptoms first appeared before attempting to conceive.
  3. Advise women with possible exposure to Zika virus, but without clinical illness to wait at least 8 weeks after exposure before attempting to conceive.
  4. Because no specific antiviral treatment is available for Zika disease, treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics. Pregnant women who have a fever should be treated with acetaminophen.
  5. Advise men who have traveled to an area of active Zika virus transmission and who have a pregnant partner to abstain from sexual activity or consistently and correctly use condoms during any sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy.  Advise couples in which a man traveled to an area with active Zika virus transmission, but did not develop symptoms of Zika virus disease to consider using condoms or abstaining from sex for at least 8 weeks after departure from the area. Advise couples in which a man had confirmed Zika virus infection or clinical illness consistent with Zika virus disease to consider using condoms or abstaining from sex for at least 6 months after onset of illness.
  6. Report suspected cases of Zika virus infection to the Health District at 425-339-5278. Although there are no commercial tests for Zika infection, the Health District can arrange PCR and serologic testing.  Call to determine if testing is appropriate.  Testing is generally appropriate for anyone reporting two or more of the following symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis during or within two weeks of travel to an area of active Zika virus transmission OR within two weeks of unprotected sex with a man who tested positive for Zika virus or had symptoms of Zika infection during or within two weeks of return from travel to an area with Zika transmission.  Testing is also appropriate for pregnant women who may have been exposed through travel or sex and for infants born to women who may have been exposed.

For more information about these recent recommendations, see the following Morbidity and Mortality Weekly Reports:

  1. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016 (http://www.cdc.gov/mmwr/volumes/65/wr/mm6512e2.htm?s_cid=mm6512e2_e)
  2. Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016 (http://www.cdc.gov/mmwr/volumes/65/wr/mm6512e3.htm?s_cid=mm6512e3_e)

Ebola virus

Action requested: Be aware that Ebola is no longer considered a public health emergency.

Background & Recommendations: The World Health Organization has declared that “the Ebola situation is West Africa no longer constitutes a Public Health Emergency of International Concern and the temporary recommendations adopted in response should now be terminated.  Therefore, universal screening of patients for potential travel from West Africa is no longer required.  However, other diseases (such as Zika virus infection) are of concern, so a travel history is always appropriate, especially when symptoms suggest an infectious condition.

Sexually transmitted infections

Action requested:  Use the Health District’s new fillable form to report sexually transmitted infections (STIs).

Background & Recommendations: Washington State requires that STIs such as gonorrhea, syphilis, and chlamydia be reported to the local public health jurisdiction within three business days.  To reduce the burden on providers, the Health District offers a fillable reporting form.  The form can be found at http://www.snohd.org/Portals/0/Snohd/Provider/files/2016_STD_CaseReport.docx.


You can find my recent health alerts posted on the Provider pages of our website, at http://www.snohd.org/Providers/Health-Alerts.

Gary Goldbaum, MD, MPH | Health Officer & Director | Administration

3020 Rucker Avenue, Ste 306 | Everett, WA 98201 | 425.339.5210 | ggoldbaum@snohd.org

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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.