Zika Virus

Please see updated post on 2/2017 with current Zika updates

This week we received a health advisory from the public health department regarding the Zika virus. There are 3 categories of announcements from the health department:

• A health update  provides us with updated information regarding a situation; these are unlikely to require immediate action
• A health advisory may or may not require immediate action
• A health alert conveys the highest level of importance and does require immediate action

You may have heard about it on the news, in between stories about snow storms and absurd politics. As expected the questions are coming in:

-   Is there concern about breastfeeding mothers and Zika?

-   Are there any particular concerns for children getting the virus?

-   The CDC site says the virus leaves the blood after a week. Are there concerns for possible future pregnancies?

Here are some Zika factoids:

Zika virus was first identified in 1947 in a rhesus monkey in Uganda's Zika forest (which gave the disease its name.) For decades Zika was a virus that turned up in monkeys and occasionally in humans in Africa and southeast Asia. Its symptoms were mild and the number of confirmed human cases was low.

This virus is on the rise. Until now, almost no one on this side of the world had been infected. Few of us have immune defenses against the virus, so it is spreading rapidly. Millions of people in tropical regions of the Americas may have recently gotten it.

Zika virus is spread to people through mosquito bites. The most common symptoms of this disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon. Only about 1 in 5 people infected with Zika virus even become symptomatic.

The nasty type of  mosquito responsible for Zika,  also spreads dengue virus, yellow fever virus and Chikungunya. Mosquitoes that spread Zika virus bite mostly during the daytime. My general  warning to be especially careful to avoid mosquitoes during dusk and dawn doesn’t offer any protection in this case.

Just as with malaria, people are the source for spreading the virus. A female mosquito bites an infected person and then can carry the virus to the next person she bites, so when people travel, they can bring the virus with them. They are thought to be infectious the first week only. The virus can take hold if enough people become infected for it to become endemic, meaning it's in a region permanently.  Mosquito bites and mother to unborn baby aren't the only ways this virus is transmitted. The new CDC report notes documented cases of infection from sexual transmission, blood transfusion and laboratory exposure. To date there are no confirmed cases of mothers passing the virus to the baby through breast milk. Either way, the benefits of breastfeeding way outweigh the risk and exposure would not be a reason to stop nursing. People infected with Zika virus don't infect one another through casual contact.

There is no vaccine or specific antiviral treatment available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of acetaminophen for fever and/or discomfort. Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or Chikungunya virus infection.  People infected with any of these illnesses should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission.

Zika has a few especially  frightening aspects. There seems to be an alarming rise in Guillain-Barre syndrome that is probably related. This is a nerve disorder that causes muscle weakness. Most people recover in a few weeks, but severe cases can require life support to help with the breathing. Anyone of any age can get Guillain-Barre, although it is pretty rare. It is thought to be triggered from an infection. The scientists are actively studying this possible link.

There is also a probable connection between birth defects and pregnant women infected by the Zika Virus. In Brazil, where most of the reported cases seem to be, there have been many babies born with microcephaly (small heads) and the associated significant health issues. The most dangerous time is thought to be during the first trimester – when some women do not even  realize they are pregnant. Experts do not know how the virus enters the placenta and damages the growing brain of the fetus. Some countries are so concerned about this that they are suggesting that no one get pregnant until they have a better handle on controlling the spread (good luck with that!)

Okay how does all of this impact you? If you have not been traveling lately and have no plans to travel this should have little or no impact on you. If you have recently returned from a trip to any of the Zika hot spots AND have any illness symptoms, make sure that you share that info with your doctor or nurse. If you are pregnant and may have been exposed, contact your OB as soon as possible. Testing must be coordinated with the local health department and would only be done for someone who has been in one of the impacted areas and is showing symptoms.

If you have an upcoming trip planned, keep in mind that until there are firm answers, the CDC has issued a travel advisory to pregnant women to avoid traveling to any countries where the Zika virus is rampant. If travel is not optional, strict mosquito avoidance is essential. Keep body parts covered, use DEET or other mosquito repellents according to the labels. Stay indoors with screen protection as much as possible.

http://nursejudynvp.blogspot.com/2015/10/mosquito-biteswest-nile-virus.html

The good news is while it's not certain, scientists believe once an individual has been infected with the virus, they are immune and won't become infected again.There is currently not concern for future pregnancies.

For up to date information on which countries are impacted, check the CDC website:

I

http://www.cdc.gov/zika/

Cradle cap/Nurse Kenlee's tips

Cradle cap is one of those things  that we get calls about on a regular basis. I was amazed to find that Nurse Judy had not yet tackled the issue in one her blogs.  I asked if I could give it a shot and she agreed, so here we go!

Cradle cap, also known as infantile or neonatal seborrhoeic dermatitis, crusta lactea, milk crust, or honeycomb disease is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. The cause is unknown but most doctors believe it is hormonal and is related to an abnormal amount of oil in the hair follicles. It is common to see cradle cap on the scalp but can occur anywhere there is hair growth, such as eyebrows, eyelids and armpits. It usually occurs within the 1st few months of life and can continue until around 1 year old or until they get their hair.

 Pediatric dermatologist, Dr. Sorrell of Lucile Packard at Stanford advised to use plain mineral oil (found in constipation aisle) daily to area. Use a soft toothbrush or baby brush to gently brush away the scaly skin. If this does not work, try using a mild topical hydrocortisone cream 1% twice daily. Also, use a liberal amount of Vaseline to scalp to lock cream in. Yes, your child’s head and hair will look greasy but it will improve the cradle cap. If scalp is still resistant, talk to your doctor about adding an antifungal cream, stronger steroid or getting a dermatology referral.

Natural approaches that many people have luck with include massaging pure natural oil into the scalp such as coconut oil or olive oil and letting it soak for about 15 minutes per day prior to washing head. After shampoo, gently brush scalp with a soft bristle brush or cloth to remove loose, dead skin. Also, a baking soda rub overnight was reported to help a few patients. On occasion, for stubborn cases, Dr. Kaplan may suggest an OTC dandruff shampoo such as Selsun Blue or Head and Shoulders.

Of course if at any point the dryness spreads beyond the scalp, the scalp becomes inflamed, painful or starts to bleed; you should notify us right away. Bottom line from Nurse Judy, if you child seems bothered from the condition in any way, check in with your doctor.

While working in the emergency room, cradle cap was not a common complaint but I did see it from time to time and knew that it was normal, harmless and no treatment was really required. Then along came my daughter who stayed bald until right before her 1 year photo shoot. As her hair grew, her head started to get flaky.  I initially thought I must have let my poor baby’s head get sunburn and it was peeling. After crying with mommy guilt to Dr. Hurd, she assured me, it was cradle cap and I started my home remedy of coconut oil massages. However, no one ever warned me that as the skin peeled off so would clumps of her new beautiful hair!

I swore that she must have had alopecia but she is now a 21 month old beauty with a full head of wonderful blonde hair.