As Viral Threats Expand, Nurses Must Continue to Step Up

February 2016
David Vlahov

In her January 24, 2016, report to the Executive Board of the World Health Organization (WHO), Director-General Margaret Chan spoke about viral infections that are sowing fear and having deep, often lasting health effects around the globe.

In this report, she warned that even though the Ebola outbreak has been declared over in Liberia – the last country to report cases – the risk of further flare-ups would persist. Indeed, the next day, Sierra Leone confirmed its first new case since September 2015.

Dr. Chan told of new cases of the Middle East respiratory syndrome coronavirus appearing in Korea.

And she pointed to the increase of Zika virus cases in Latin America. Just over a week later, the WHO declared the Zika outbreak a global emergency.

Global warming, population growth, urbanization and air travel are among the reasons for the rapid, far-reaching spread of these infections. Yet regardless of the inciting cause, nursing’s essential and often central role in public health and prevention demands that we stay on top of emerging information about all of these global threats.

Zika, of course, is top of mind right now. We have known about the virus for decades, but in mid-2015, it exploded – most notably in Brazil, but also in 26 countries in the Americas. In the US, we’ve seen cases related to travel in affected regions and, as of this writing, two cases related to sexual transmission. We believe the infection lasts up to a few weeks and confers lasting immunity.

Prior to the current outbreak, we also believed the Zika virus typically causes asymptomatic infection, with reports of a rash and fever in about 20 percent of cases. Yet in cases throughout Latin America, though causality has not been established, the Zika virus is now associated with infected mothers giving birth to infants with microcephaly – a smaller-than-normal head that typically leads to abnormal brain function and shorter life span. Some have postulated potential links to Guillain-Barré syndrome. A recent JAMA article found a potential connection to blindness.

But at this point, it’s the increase in cases of microcephaly in Brazil that is most alarming. There have been 4,783 cases between October 2015 and February 2016, which dwarfs the average of 140 annual cases seen in previous years in the same country.

Mosquitoes of the Aedes genus spread Zika; they can breed in a pool of water as small as a bottle cap and usually bite during the day. The Aedes genus is found in tropical and warmer climates and in the US has appeared most frequently in Florida, the Gulf Coast and Hawaii. Yet it also has appeared as far north as Chicago during particularly hot weather.

Although much remains unknown, a number of ideas are emerging for how to prevent contracting the virus and putting infants at risk.

  • Some countries have recommended that women delay becoming pregnant for two years, in the hope that researchers might develop a vaccine in that time frame. Brazil recently reached an agreement with the University of Texas Medical Branch at Galveston to develop such a vaccine, hopefully within the next year.
  • Women intending to become pregnant should avoid travel to affected regions.
  • Men returning from affected areas should abstain from sex for a month or wear condoms.
  • For persons in affected areas, Aedes mosquitoes are more prevalent during the day, so many are advising wearing long-sleeve shirts, long pants and hats during the day and using insecticide at all times to avoid bites .
  • Those in affected regions should drain all standing water to minimize mosquito breeding.

By drawing on the best available information, nurses can help patients and clinical colleagues make the most informed decisions about how to prevent these infections. We can and should be scrupulous in screening, educating and referring patients, and also be prepared to educate the public in a wide variety of settings. Schools of nursing should review plans and procedures for infection prevention and response, especially schools that provide international experience or rotations; we have already begun our own review.

New information, however, arrives almost daily, and it is our responsibility to stay on top of it and incorporate it into what we do each day. 

Add new comment