Shared decision-making approach to Zika best for travelers

(HealthDay)—An approach to shared decision-making that stratifies risk might be most appropriate for preventing Zika infection, according to an Ideas and Opinion piece published online July 17 in the Annals of Internal Medicine.

Noting that public attention has waned with the decline in reported Zika cases, Daniel S. Graciaa, M.D., M.P.H., from the Emory University School of Medicine in Atlanta, and colleagues address the recent rebound in travel to Latin America, including by pregnant women and those planning to conceive.

The authors suspect that many travelers are unaware of or choose not to adhere to public health recommendations relating to taking precautions against conception after travel or symptomatic infection. However, up to 80 percent of Zika virus infections may be asymptomatic, and these can result in complications, including sexual transmission and adverse fetal outcomes. Without tests validated for asymptomatic persons seeking to conceive, providers may use and interpret available tests inappropriately; assays currently under development may prove useful for preconception counseling. Guidance that can be tailored to individual travelers would be welcomed. Zika prevention guidelines that take the approach of helping travelers weigh the risks against the importance of travel might be more effective than the current strategy for preventing adverse outcomes.

"Until the risk for Zika can be further mitigated by vaccination or improved vector control, enhanced surveillance and diagnostic test validation must underpin the tools used in shared decision making with travelers to Zika-affected areas while incidence is decreasing yet unpredictable," the authors write.

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