Since the February discovery of the Zika virus in saliva, scientists and physicians are currently determining whether or not the mosquito-borne virus can be transmitted through saliva. Because the outcome could have implications for the dental world, I spoke with one Florida dentist to discuss her concern level and talk about practices she’s implementing, if any, to increase the safety of her employees.
But before we get to that, here’s a quick Zika fact recap:
According to the Center for Disease Control (CDC), the Zika virus spreads primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain and conjunctivitis in the eyes. The illness is usually mild with symptoms lasting from several days to a week after transmission. Because people rarely die of the virus, and because most people don’t usually get sick enough to go to the hospital, many don’t realize they’ve become infected. Just like the chicken pox, once a person has been infected, he or she is likely to be protected from future infections of the virus.
Those of us in the United States are patiently awaiting (and fearing) the imminent transmission of the Zika virus via mosquito, which has already become the case for our South and Central American neighbors. The virus, which blew up on the international scene in January, has been spreading through countries like wildfire and likely causing birth defects, such as microsephaly, to babies in utero. According to the CDC, no mosquito-borne Zika cases have been reported in the US, but there have been travel-associated cases, so the CDC has been suggesting for pregnant woman not to travel to countries with confirmed cases of the virus. The center also said pregnant women should not travel to the Summer Olympics in Brazil. “With the recent outbreaks, the number of Zika cases among travelers visiting or returning to the United States will likely increase,” The CDC website states. “Eighty percent of cases will not be diagnosed. These imported cases could result in local spread of the virus in some areas of the United States.”
As of March 16, the CDC reported 258 cases of of the virus among U.S. travelers returning from Zika-infected areas. Of the 258 cases, six of them were sexually transmitted. Eighteen of the infected U.S. residents are pregnant women. Not included in the 258 cases are 283 locally-aquired cases of the virus in U.S. territories, with 259 in Puerto Rico, 14 in American Samoa and 10 in the U.S. Virgin Islands. Thirty five of cases in the U.S. territories are in pregnant women. CDC Director Tom Frieden said Puerto Rico is the most affected area and has the potential for hundreds of thousands of cases of the virus.
On March 21, Florida Surgeon General John Armstrong said the the total number of Zika cases among state residents has risen to 71. All of the cases, he said, were travel-related. In February, Florida Governor Rick Scott declared a health emergency in Miami-Dade, Hillsborough, Lee, Santa Rose and Broward counties, and so far, 12 Florida counties have one or more Zika-infected residents. With the recent discovery of the virus in saliva, I thought it would be a good idea to talk with a Florida dentist to see if she is worried about transmission to her employees.
Dr. Joslyn Vann’s practice is located in Jacksonville, Fla., which is not in one of the 12 counties with confirmed cases.
[UPDATE 7/8/2016 – 26 counties in Florida have confirmed, travel-related cases of the Zika Virus]
Despite the detection of the virus in saliva, Vann said she hasn’t changed any of her day-to-day procedures and practices because she already follows Occupational Safety and Health Administration (OSHA) protocol and practices Universal Precautions. The guidelines and precautions allow medical employees to avoid contact with bodily fluids by way of personal protective equipment such as eyewear, masks, gloves, waterproof lab jackets, hair nets when there is aerosol involved in treatment, infection control protocols for instrument sterilization, waste disposal, and disinfection of treatment rooms. Because some patients aren’t truthful about diseases or viruses they carry, and because some of them don’t know they’re carrying a disease or virus, the Universal Precautions approach to infection control has medical employees treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other blood borne pathogens. “Every time we treat a patient, there is the possibility of viral infection so our method of dealing with this is following OSHA protocol and using Universal Precautions,” she said. Vann said she’s dealt with exposure incidents when she had blood splatter in her eye, and again when two contaminated instruments broke through her skin. “In the case of the exposure through the eye, I followed the guidelines for continuous flushing of the eyes,” she said. “In all exposure incidents, I followed up with a physician for baseline Hepatitis and HIV testing followed by sequential testing at later dates. I have never gone on preventive anti-viral medications.”
When it comes to protecting her employees from Zika, continuing to practice the guidelines and precautions already put in place is her best bet, however, there are some additional measures she said could be taken. “I also feel that more thought should be given to disinfecting door knobs, countertops in front desk areas and other places that patients frequently touch, as patients frequently place their hands in their mouths during dental appointments and do not wash their hands before touching pens, doors, etc.”
Editor’s note: This is part one of a two-part series on the Zika virus, continue to part 2 here.