Zika Virus Infection and Surgery

The recent epidemic of Zika virus infection as a blood-borne viral pathogen and its clinical association with microcephaly in the newborn child has increased attention to prevention of transmission of this virus [1]. Intense research will accelerate in the hope of developing an effective vaccine to arrest the rapid dissemination of this infection. Special attention for prevention of the infection is focused on pregnant women and women of reproductive age [2]. Other than an unusual case of Guillian-Barre syndrome [3], most infections in the non-pregnant population are limited illnesses. The patients have acute rash, fever, and other systemic symptoms of an acute viral illness that runs its course within a week [4], although this perception may change as more information evolves. A viremia exists while the patients are symptomatic and transmission does not appear to be an issue after the viremia clears. At present, there does not appear to be a chronic phase of the disease as observed with HIV, Hepatitis B, or Hepatitis C infection. Thus, why should there be commentary about Zika infection in surgery?

As the full scope and severity of this epidemic continues to unfold, reports of sexual transmission [5] and transfusion-associated infection [6] with Zika virus are reminiscent of HIV and chronic hepatitis. It means that patients infected recently by a mosquito in a remote location can be in your operating room today. It means that airplane travel can transport patients from an area with a new epidemic to an unexposed and unsuspecting environment in North America [7]. The number of blood-borne viral pathogens continues to increase with each passing year, and there is no reason to expect that this active evolution of the microbiological world will cease. The observations in the United Kingdom of transfusion-associated Creutzfeldt-Jacob disease [8], and speculation about prion-transmitted Alzheimer's disease, would implicate infectious proteins as yet another blood-borne risk [9]. Blood exposure in the course of surgical care has current and future unknown risks.

During the 1990s, surgeons were keenly aware of HIV and the chronic hepatitis syndromes as occupational risks in performing surgical procedures. Increased compliance with better operating room barriers and double gloving to prevent blood exposure were used generally because surgeons were concerned about occupational viral transmission. However, the fears of the 1990s gave way to increasing lassitude and indifference in the 2000s, as HIV was not the occupational risk that many feared, effective Hepatitis B vaccination became deployed widely, and more recently, the development of effective antiviral chemotherapy has diminished many of the concerns about Hepatitis C. Compliance with barrier protections, face shields, double gloving, and care with use of sharp instruments in the conduct of procedures has waned. The emergence of Zika, Ebola, and even infectious protein means that the risk of blood exposure remains undefined, and vigilance in the practice of standard precautions should not be eliminated. Better barriers in the operating room means better protection against occupational risks, and, better infection control in the care of patients for whom we are responsible.