Becker's Clinical Quality & Infection Control

20 SPOTLIGHT ON ZIKA Zika May Be Transmittable Through Oral Sex By Brian Zimmerman A group of French scientists have raised the possibility that Zika could be transmittable through oral sex and maybe even deep kissing, according to a letter to the editor detailing the account of a likely case of Zika transmission through sexual contact published in e New England Journal of Medicine. e case relayed in NEJM involves a 24-year-old French woman who became infected with Zika aer engaging in seven sexual encounters with a 46-year-old man who had recently traveled to Brazil. e man had experienced symptoms related to the virus while in Brazil, but they had dissipated when he reached France. Aer the woman became sick, both were tested for Zika. e man had high levels of the virus in his urine and semen, but not in his blood or saliva. e virus was detected in the woman's urine and saliva, and antibodies generated by the virus were also detected in her blood. Indications of the virus were not detected on a vaginal swab. During their seven sexual interactions the two engaged in vaginal sex without ejaculation and oral sex with ejaculation. e study's authors write, "ese data support the hypothesis of sexual transmission (either oral or vaginal)...we cannot rule out the possibility that transmission occurred not through semen but through other biologic fluids, such as pre-ejacu- late secretions or saliva exchanged through deep kissing." William Schaffner, MD, head of preventive medi- cine at Nashville, Tenn.-based Vanderbilt Univer- sity Medical School, told e New York Times he agreed with the assessment that the most likely method of transmission in this case was oral sex, but stated, "I don't think this changes anything, but it shows you how elaborate the number of avenues of possible transmission can be." John T. Brooks, MD, an epidemiologist at the CDC studying sexual transmission of the Zika virus, told the Times he wasn't surprised to see likely transmission of the virus through oral sex, but countered that transmission through kissing wasn't likely. Dr. Brooks said, "Casual kissing has got to be safe because, if it weren't, don't you think we'd see a lot more Zika? Every mom who kissed her baby would pass it on...to be sure, we'd have to look for deep kissing in the absence of sexual contact, and that's hard to find." n Accidental Zika Infection at Pittsburgh Lab By Brian Zimmerman A lab worker from the University of Pittsburgh accidentally stuck herself with a needle while working with the Zika virus, resulting in what appears to be the first known Zika infection occurring in a laboratory, according to The New York Times. The accident occurred May 23, after which the unidentified research- er developed symptoms attributable to the virus. A blood sample confirmed the infection. The researcher returned to work on June 6 and reportedly has to wear long sleeves and pants and apply insect repellant for three weeks, according to the Times. Karen Hacker, MD, director of the Allegheny County Health Depart- ment, said, "We want to remind residents that, despite this rare inci- dent, there is still no current risk of contracting Zika from mosquitoes in Allegheny County. For those traveling to countries affected by Zika, we urge caution. Pregnant women particularly should avoid travel to affected countries." Recently, the World Health Organization issued guidance, recom- mending couples in regions where local Zika transmission is preva- lent to consider delaying pregnancy. The CDC named lab safety as one of its six public health threats to focus on in 2016. n Boston Hospitals Report Uptick in Patients Arriving With Zika Concerns By Max Green W hile the true impact the Zika virus will have on U.S. citizens remains to be seen, hospitals are reporting pregnant moth- ers concerned about their viral status and what they can do to prepare themselves in the event of Zika are increasingly reaching out, according to a report from The Boston Herald. A growing number of patients at major Boston-area hospitals, such as Massachusetts General Hospital, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, are worried about the virus' potential impact on their fetuses. "There has been a huge uptick in consultations and ultrasound visits for Zika virus exposure and counseling of patients who are contem- plating travel to Zika-endemic areas," Steve Ralston, MD, director of the division of maternal-fetal medicine at Beth Israel Deaconess Medical Center, told the Herald. "It takes a tremendous amount of manpower to counsel patients and infrastructure." MGH is potentially dealing with a small pool of patients who have been exposed to Zika, Jeffrey Lawrence Ecker, MD, department chief of obstetrics and gynecology at the hospital, told the Her- ald. A Brigham and Women's spokesperson also told the Her- ald the hospital is on the lookout and testing patients who may be infected. n

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