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AAFP President offers guidance on what PCPs should tell their patients about Zika

Primary care physicians are going to be on the “front lines” in the effort to prevent and curb the spread of Zika virus, as more cases of the mosquito-borne disease are confirmed, Wanda Filer, MD, president of the AAFP, told Healio Family Medicine.

With 544 cases of Zika virus diagnosed in the continental United States as of May 12, and nearly 300 pregnant women diagnosed in the United States and U.S. territories, the AAFP said it is working to educate members on how to discuss the disease with patients. According to Filer, patients need information on how to protect themselves from the disease, and physicians need help identifying and diagnosing it.

“Our members [conduct] 1 out of 5 U.S. office visits, and so they’re really going to be the front lines on this,” Filer said. “They’re the ones who are going to be seeing these people coming into their offices, not only educating and preventing but also diagnosing those cases. And we want to make sure they’re ready for it.”

Wanda Filer, MD

Following the example of the CDC guidelines, the AAFP has released information to members recommending that they advise patients to wear clothing that protects them from mosquito bites, noting that the specific species most known for spreading the virus, Aedes aegypti, is a daytime feeder. Another preventive strategy is using bug repellent with DEET, Filer said.

“We also try to let family physicians know what to advise their patients – very similar to what we’ve done for West Nile virus – such as get rid of any standing water near their home,” Filer said. “Give very concrete examples. I think a lot of times patients think standing water means a fountain or a swimming pool, so try to bring it home and think of very practical examples,” such as gutters and outdoor pet dishes.

The CDC has also recommended that pregnant women in any trimester consider postponing travel to areas of active Zika transmission, including Puerto Rico, the U.S. Virgin Islands, the Dominican Republic and Mexico. In addition, pregnant women who do travel to such areas should strictly follow steps to avoid mosquito bites.

PCPs may also need some guidance on recognizing and diagnosing Zika, as symptoms can be similar to the dengue and chikungunya viruses, which are transmitted by the same mosquitoes and can circulate in the same areas. According to Filer, physicians may have to rely on knowledge of their patient’s history to tell the difference.

“They want to know what it looks like; they’ve never seen Zika,” Filer said. “Many patients will not have symptoms. Some patients will have mild symptoms and will not seek care. The rash seems to be the number one symptom with Zika compared with the other diseases it can mimic. However, many viruses cause rash. So it’s going to be about the history. If [a patient has] a travel history right now, I’m going to have a higher index of suspicion. It’s going to be a combination of things.”

Other common symptoms of Zika include subjective fever, arthralgia and conjunctivitis. In pregnant women, it has been confirmed to cause microcephaly and is thought to trigger Guillain-Barré syndrome among infants.

In addition, on the same day the CDC published interim guidelines for Zika virus antibody testing and result interpretation, Filer added that the lab test situation is “constantly evolving.”

“New tests are being approved and sent out by the FDA,” Filer said, noting that family physicians in these situations often have laboratories they can call for direction on how to handle blood samples they draw themselves.

Among her own patients in Pennsylvania, Filer said the most common question she hears is whether the disease has been overplayed in the media. She added that physicians should “walk a fine line” between counseling a healthy respect for the virus without causing undue anxiety in patients.

“They ask, ‘Is this really that big of a deal?’” Filer said. “Unfortunately the media has a tendency to cry wolf a lot, so patients don’t really know what to believe. It’s important to help patients to keep everything in balance, making sure they have respect for this virus, and that the physician knows about it, but also that the patient doesn’t get panicked. You might use a different approach for each patient.”

The AAFP was one of four medical professional organizations, in addition to the CDC, to call on Congress to quickly approve emergency funding for prevention and treatment of the Zika virus.

The Senate this month voted 68-29 to approve $1.1 billion in emergency funding for Zika response, short of President Barack Obama’s $1.9 billion request, but nearly double the $622.1 million package approved by the House of Representatives in a 241-184 vote. In addition, the House bill would use resources allocated for the Ebola response.

Since then, lawmakers in both chambers have been unable to come to an agreement over reconciling the two bills. Congress adjourned at the end of last week, and will not return until June 6. According to Frieden, approving the Zika funding through a regular spending bill would take months.

According to Filer, the time has come for Congress to overcome their disagreements and act in the best interest of the country.

“They need to get moving,” Filer said. “From my perspective, protecting the public is the core function of government, and [the Zika funding] is clearly for protecting the public. This has potentially devastating consequences, especially for a newborn population.”– by Jason Laday

Additional reading:

http://www.cdc.gov/media/releases/2016/s0531-zika-testing.html