Concern About Zika Virus in US Set to Escalate

U.S dermatologists may start to receive calls from patients who are concerned about infection with Zika virus – particularly pregnant ones.

Zika is now spreading rapidly across Latin America and the Caribbean. So far, one case has been identified in Houston, but the possibility that this virus will find its way to these shores has been generating much media coverage in recent days and weeks. The person diagnosed in Texas had recently traveled from Latin America. U.S. health officials are now considering a travel warning about Zika virus.

“There does not seem to be evidence of transmission in Houston or the Gulf Coast Area, but it is quite possible that this could happen in the Spring or Summer, so we have to be on the lookout for it,” says Peter J. Hotez, M.D., Ph.D, the Founding Dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.

Common symptoms of Zika virus are fever, rash, joint pain, and conjunctivitis.  A possible connection between Zika virus infection in pregnant women and risk for microcephaly is now being investigated in Brazil.  

“The main fear is the possible connection between Zika and microcephaly. This is being investigated and the link is not definitive at this time,” adds Matthew D Sims, M.D., Ph.D, the Director of Infectious Diseases Research at Beaumont Hospital in Royal Oak, Michigan.

“It’s one thing if the Zika rash and fever occur in non-pregnant adult, but if it happens in a  woman who could be pregnant, she must see her obstetrician,” Dr. Hotez says. "If a pregnant woman or a woman planning to become pregnant is considering travel to parts of the world where Zika is endemic, she should be counseled on the risks associated with such travel."

Making the Diagnosis

“There is nothing specific about the rash with Zika compared to other virus transmitted by insects,” he says. It is similar in appearance to rashes associated with Dengue and Chikungunya. "Zika rash is morbilliform, can be itchy and heals with desquamation,” he says.

Skin hemorrhaging has been seen with the Dengue virus, and could potentially occur with Zika as well, he says.

Patients may present with a very mild rash, general viral prodome along with history of travel to endemic areas, Sims says. “If the patient is not coming from an endemic area it is not likely to be Zika at this time.” The Federal Centers for Disease Control and Prevention  provides a map of where Zika virus can be found.

There are specialty tests take that can be done through state health departments. “If you have a patient who you suspect is infected with Zika, contact your local or state health departments about the best way to process blood samples or other specimens,” he says.

There's no vaccine against Zika and no treatment for it, which means that prevention is the key. “Avoid mosquities if traveling to endemic areas,” Dr. Sims says. This includes use of repellents containing DEET, picaridin and IR3535, he says. Patients should be told that they should apply sunscreen before repellent. "Mesh mosquito nets can also be helpful," he says.