GPs advised to test for Zika virus in patients returning from affected areas

GPs should perform blood tests for Zika virus infection on all patients with symptoms who are returning from transmission areas and refer all pregnant women for ultrasound, according to updated primary care advice.

The RCGP and BMA have backed primary care Zika advice from Public Health England (PHE) advising all pregnant women who have recently travelled to transmission areas to notify their GP, obstetrician or midwife to receive tests and monitoring.

GPs should advise women to not try to conceive for 28 days after leaving an area with active Zika transmission. This covers a 14-day incubation period and an estimated 14-day period of viraemia.

GPs are notified that pregnant women may also request letters to justify suspension of travel to affected areas on medical grounds.

Pregnant women returning from infected areas who show symptoms of the Zika virus should be tested for the infection and be referred to a local antenatal ultrasound service for a baseline fetal ultrasound.

Zika guidance

PCR blood tests and urine samples should be taken and sent to the local laboratory, with both a standard request form and a Rare and Imported Pathogens Laboratory (RIPL) form.

All other pregnant women who travelled to transmission areas should be offered a baseline ultrasound scan.

Other non-pregnant patients who are exhibiting symptoms should also be tested for the virus.

Non-pregnant patients who were diagnosed elsewhere and have now recovered do not require further investigation and should be assured that Zika virus is typically short-lived and self-resolving.

Male travellers should be advised about sexual transfer of the disease. Condom use is recommended for 28 days following return from a transmission area if they experienced no Zika-like symptoms and for at least six months following recovery is compatible symptoms or laboratory-confirmed Zika virus is reported.

Zika virus has now been detected in semen of three infected male patients and two cases of male-to-female sexual transmission have been reported. The sexual transfer risk, although still largely unknown, is considered to be very low.

Prevention

There is no vaccine or drug to prevent Zika infection. Travellers should take insect bite avoidance measures to reduce their risk of infection, such as by applying DEET to exposed skin and wearing light cover-up clothing.

A total of six cases have been confirmed in UK travellers between 2014 and the end of January 2016. All had recently visited South and Central American countries, including Colombia, Guyana, Venezuela, Suriname and Mexico.

The majority of people affected have minimal to no symptoms, but those that do typically exhibit a mild febrile disease over two to seven days. Usual symptoms include a low-grade fever, joint pain, rashes, conjunctivitis, headaches, eye pain and muscle pain.

But mounting evidence has linked the virus to microcephaly and other congenital brain malformations when women are infected during pregnancy.

Photo: iStock

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