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Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department.
West J Emerg Med. 2016 May; 17(3):238-44.WJ

Abstract

First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod-borne diseases are the only concern, isolation (contact, droplet, airborne) is unnecessary. Zika is a reportable disease and thus appropriate health authorities must be notified. The modified 3I tool will facilitate rapid analysis and triggering of appropriate actions for patients presenting to the ED at risk for Zika.

Authors+Show Affiliations

University of California Irvine Medical Center, Department of Emergency Medicine, Center for Disaster Medical Sciences, Orange, California.University of California Irvine Medical Center, Department of Emergency Medicine, Center for Disaster Medical Sciences, Orange, California; Qassim University, Department of Emergency Medicine, Saudi Arabia.University of California Irvine Medical Center, Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Orange, California.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27330653

Citation

Koenig, Kristi L., et al. "Identify-Isolate-Inform: a Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department." The Western Journal of Emergency Medicine, vol. 17, no. 3, 2016, pp. 238-44.
Koenig KL, Almadhyan A, Burns MJ. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department. West J Emerg Med. 2016;17(3):238-44.
Koenig, K. L., Almadhyan, A., & Burns, M. J. (2016). Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department. The Western Journal of Emergency Medicine, 17(3), 238-44. https://doi.org/10.5811/westjem.2016.3.30188
Koenig KL, Almadhyan A, Burns MJ. Identify-Isolate-Inform: a Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department. West J Emerg Med. 2016;17(3):238-44. PubMed PMID: 27330653.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department. AU - Koenig,Kristi L, AU - Almadhyan,Abdulmajeed, AU - Burns,Michael J, Y1 - 2016/04/04/ PY - 2016/02/24/received PY - 2016/03/21/accepted PY - 2016/6/23/entrez PY - 2016/6/23/pubmed PY - 2017/6/24/medline SP - 238 EP - 44 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 17 IS - 3 N2 - First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod-borne diseases are the only concern, isolation (contact, droplet, airborne) is unnecessary. Zika is a reportable disease and thus appropriate health authorities must be notified. The modified 3I tool will facilitate rapid analysis and triggering of appropriate actions for patients presenting to the ED at risk for Zika. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/27330653/Identify_Isolate_Inform:_A_Tool_for_Initial_Detection_and_Management_of_Zika_Virus_Patients_in_the_Emergency_Department_ L2 - http://escholarship.org/uc/item/72w2v02d DB - PRIME DP - Unbound Medicine ER -