Zika Virus And Pregnancy

Zika virus (ZIKV) is a vector born disease that was discovered in Ugandan monkeys in the 1940s. It was not until the 1950s that it was found that ZIKV was transmittable to humans. Mosquitos transmit it when they bite humans. This disease is more common in tropical warm climates where mosquitos are plentiful. Unlike most mosquito-borne diseases, ZIKV can be spread through sexual transmission giving this virus a larger swath of transmission possibilities (Hinkle, Brunner, Cheever, & Suddarth, 2014, p. 2150). People who contract ZIKV can present as asymptomatic or have a range of symptoms for 2-7 days. They may present with the following symptoms: a mild fever, rash, headache, conjunctivitis, or joint and muscle pain. The truly devastating nature of this disease is the effects it has on the developing fetus if the mother contracts ZIKV while pregnant, or up to a month before pregnancy (Khabbaz, 2019). If the fetus contracts ZIKV it is called Congenital Zika syndrome. This presents with the fetus most at risk for developing severe microcephaly, which is a very small head. In extreme cases, the fetal head may be partially collapsed. ZIKV can also cause Guillain–Barré syndrome in the mother/patient, which presents with muscle weakness that can rapidly develop into the patient becoming completely paralyzed (Medina-Cucurella, et al., 2019). The purpose of this paper is to discuss how evidence-based research on the ZIKV and pregnancy has been used to provide information for health care professionals to better identify, treat, or prevent this virus in pregnant patients. Through assessments, diagnostic tests, community resources, and educating patients we can increase the ability to prevent ZIKV from occurring during pregnancy (Hinkle, Brunner, Cheever, & Suddarth, 2014, p. 2150).

Assessment Data

There are several assessments the nurse should make when encountering pregnant patients. In regards to ZIKV, all pregnant patients should be asked about recent travel, being especially aware of places where documented outbreaks of the ZIKV have been reported. Ask the patient if they have traveled to a known place where transmission has occurred, then ask the patient if they have presented with any symptoms while on the trip or up to two weeks after returning. If the patient is at risk, maternal serum testing is used to diagnose ZIKV. The serum testing is only performed in a few locations, so the health care provider should contact their state health department to arrange testing for the patient (Killion, 2016). If the virus is confirmed in a pregnant mother, then close fetal monitoring via ultrasound should be done to look for microcephaly, intracranial calcifications or other anatomical anomalies (Killion, 2016). Ultrasounds are recommended to be done every 3-4 weeks, which is more than would be done in a low-risk pregnancy. If there is a reason to believe fetal infection has occurred, an amniocentesis (testing of the amniotic fluid) for ZIKV should be done. This is to confirm if the fetus has Congenital Zika Syndrome (Khabbaz, 2019). Amniocentesis may also be done to test for other complications, even if the fetus does not have evidence of fetal distress. The fetus that has been confirmed to have Congenital Zika Syndrome is also at risk for other congenital defects that may not be detectable by ultrasound alone. Some issues include decreased brain tissue, damage to the posterior eye, joints with limited ROM (range of motion), and increased muscle tone which may restrict the baby’s body movement post-birth (Khabbaz, 2019). If a baby is born with congenital Zika infection, they should receive eye screenings and tests to check for eye and other health problems, even if the baby appears to be in good health after being born. A multidisciplinary team is essential for the pregnant patient with ZIKV. The patient will need to be referred to a disease specialist, maternal-fetal medicine, and potentially other specialties (Killion, 2016). Education on prevention is the best course of treatment but it is not always possible. Cases of ZIKV must be reported to state and local health departments. These departments will report the case to the CDC (Centers for Disease Control) so that they can closely monitor cases of ZIKV. (Stockwell, 2018).

Age, Gender, and Genetic Makeup

Women of childbearing age who live in areas where ZIKV is prevalent are at the highest risk for contracting the virus before and after becoming pregnant. ZIKV is an arbovirus, meaning that it is carried by arthropods: an invertebrate that includes insects (vectors) (Khabbaz, 2019). “Zika virus is a single-stranded RNA virus of the Flaviviridae family, genus Flavivirus” (Khabbaz, 2019). It is transmitted to humans through the bite of the Aedes mosquito. These are the same mosquitos that spread Chikungunya and dengue fever (Todd, 2016). Testing for the disease is a challenge. The only way that the virus can be detected is by using reverse transcriptase-polymerase chain reaction (RT-PCR) testing (Todd, 2016). As stated previously this test is only available in a few places, which makes diagnosing a challenge.

Potential Cultural, Ethical, and Psychosocial Aspects

Nurses must be aware of how to handle the patient’s psychosocial health when dealing with ZIKV and pregnancy. Referring the patient to a counseling resource is recommended even before ZIKV testing is completed (Khabbaz, 2019). This is recommended due to the amount of information to process and understand regarding the disease and potential fetal outcomes associated with the virus. If the woman is living in an area where the virus is a continual threat, this would also cause the patient stress. Counseling and teaching are essential in the overall mental and physical health of the patient and baby. Since there is very limited access to mental health professionals and shortages in most affected countries due to poverty, this “can lead to more stigmatization, panic and anxiety stress, depression, to suicidal and other social issues in pregnant women and affected communities” (Tambo et al., 2017, p. 12). Most countries affected by ZIKV are below the poverty line (Medina-Cucurella, et al., 2019). This makes dealing with mental health issues especially challenging. “It is urgent to address the epidemiologic, clinical knowledge and skills gaps and ZIKV complications issues requires urgent sustained funding support on new and appropriate evidence-based long-term contextual programs and mitigation measures, survivor (s) and family educational and psychosocial counseling to psychiatry rehabilitation activities” (Tambo, et al, 2017, p. 12).

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Evidence-Based Practice

The evidence-based practice article that was used is called: “Zika-Prevention Knowledge among Hispanic Women Living in Puerto Rico: A Cross-sectional Study.” The article’s objective was to determine the level of education in women regarding ZIKV exposure, its symptoms, potential complications, how the virus is spread, and precautionary measures for the Hispanic women living in Puerto Rico (Medina-Cucurella, et al., 2019). The results revealed that most of the women were aware of ZIKV and acceptable preventative measures. It also revealed a large number of the women were living in poverty, but most had health insurance (Medina-Cucurella, et al., 2019). A staggeringly low percentage of women received information regarding ZIKV through their primary care physician (PCP). Most heard information about ZIKV via the radio, news, or television. This study was mostly done with women in hospital waiting rooms. It is concerning that these women are not receiving adequate education, especially since they live within a city with a high incidence of ZIKV (Medina-Cucurella, et al., 2019). A huge part of nursing practice is patient education. While the women are receiving reproductive health care is a perfect opportunity to educate them on prevention and other pertinent information regarding ZIKV (Medina-Cucurella, et al, 2019).

Health Promotion and Recovery

Prevention is the only way to ensure ZIKV does not affect a developing fetus. Different forms of mosquito repellent should be discussed. Educating the patient on different forms of contraception is also imperative since ZIKV can be sexually transmitted. If the patient has ZIKV then the importance of frequent and vigilant prenatal care and ultrasounds needs to be emphasized. This can be a difficult thing to process and counseling services are strongly encouraged (Khabbaz, 2019). Regular pregnancy education should not be left out, even when dealing with something as traumatic as ZIKV. Patients should be taught about the signs and symptoms of preterm labor, rupture of membranes, and when to seek medical help or call their PCP.

Community Resources

As a nurse, it is important to help identify community resources for the patients, because these patients may not know that these resources exist or how to find them. There is a wealth of information on the CDC’s website (https://www.cdc.gov/pregnancy/zika/protect-yourself.html), and their phone number is 1-866-626-6847. The following website provides e-mail and chat support in both Spanish and English for patients with ZIKV or general pregnancy questions: https://mothertobaby.org/contact-expert/. ('Welcome to MotherToBaby', 2018).

Conclusion

ZIKV is a mosquito-spread condition that can present with distressing fetal anomalies. The hallmark finding in fetal development is microcephaly. Prevention is the best measure of protection, whether that means contraceptives or bug repellent. Education is vital, and nurses play an important role in assuring that patients receive adequate education on ZIKV. The stress of having a baby with potential complications can be psychologically challenging. Services and referrals should be recommended to the mother to help maintain her mental health.

References

1. CDC. (n.d.). Clinical evaluation & disease: Zika virus. Retrieved from https://www.cdc.gov/zika/hc-providers/preparing-for-zika/clinicalevaluationdisease.html.
2. Hinkle, J. L., Brunner, L. S., Cheever, K. H., & Suddarth, D. S. (2014). Brunner & Suddarth's textbook of medical-surgical nursing. Lippincott Williams & Wilkins.
3. Khabbaz. (2019, January 28). Clinical Evaluation & Disease | Zika Virus | CDC. Retrieved October 3, 2019, from https://www.cdc.gov/zika/hc-providers/preparing-for-zika/clinicalevaluationdisease.html.
4. Khabbaz, R. (2019, June 13). Patient Counseling for Pregnant Women on Zika and Pregnancy | CDC. Retrieved October 3, 2019, from https://www.cdc.gov/pregnancy/zika/testing-follow-up/patient-counseling-pregnant-women.html.
5. Khabbaz, R. (2019, May 14). Birth Defects | Zika virus | CDC. Retrieved October 3, 2019, from https://www.cdc.gov/zika/healtheffects/birth_defects.html.
6. Killion, M. M. (2016). Zika virus update. MCN, The American Journal of Maternal/Child Nursing, 41(4), 252. doi: 10.1097/nmc.0000000000000246
7. Medina-Cucurella, E., Acevedo-Canabal, J., León, J. D., Martínez-Torres, R., Cruzado-Ramos, G., & Romaguera, J. (2019, October 3). Zika-prevention knowledge among Hispanic women living in Puerto Rico: A cross-sectional study. Retrieved October 3, 2019, from https://www.pubfacts.com/detail/30576578/Zika-prevention-Knowledge-among-Hispanic-Women-Living-in-Puerto-Rico-A-Cross-sectional-Study.
8. Stockwell, S. (2018). The CDC updated guidelines for congenital Zika. AJN, American Journal of Nursing, 118(2), 14. doi: 10.1097/01.naj.0000530232.22909.7c
9. Tambo, E., Madjou, G., Khayeka-Wandabwa, C., Olalubi, O. A., Chengho, C. F., & Khater, E. I. (2017). Ethical, legal and societal considerations on Zika virus epidemics complications in scaling-up prevention and control strategies. Philosophy, Ethics, and Humanities in Medicine, 12(1). doi: 10.1186/s13010-017-0046-8
10. Todd, B. (2016, April). Zika virus: An unfolding epidemic. Retrieved October 2, 2019, from https://www.nursingcenter.com/journalarticle?Article_ID=3410173&Journal_ID=54030&Issue_ID=3409942.
11. Welcome to MotherToBaby. (2018, December 21). Retrieved October 3, 2019, from https://mothertobaby.org/.
12. ZikaVirus. (n.d.). Retrieved October 2, 2019, from https://www.nursingcenter.com/resources/clinical-topics/zika-virus.