Zika Virus Surveillance – Improving Clinical Documentation for Public Health

Zika Virus – What Do We Know?

zika-virus-pathology-cdc-mosquito.jpgZika is a mosquito-borne virus, similar to the dengue and West Nile viruses. Relatively recent, it was first identified in humans in 1952.

Zika virus infection usually causes only a mild fever, with many persons experiencing no symptoms at all. However, there is growing evidence connecting Zika virus to the development of two serious conditions: the autoimmune disorder Guillian–Barre syndrome (GBS); and microcephaly, a nuerodevelopmental disorder that often results in infants being born with abnormally small head sizes.

An ongoing Zika virus outbreak began in Brazil in 2015, reaching pandemic proportions and subsequently spreading throughout South and Central America. Because of the rapid rise in cases of microcephaly in regions where Zika virus outbreaks are occurring, the World Health Organization (WHO) has declared “a public health emergency of international concern”—the same designation given to the Ebola virus outbreak of 2013–16. Concerns are heightened with the anticipated tourism for the 2016 Summer Olympics in Rio de Janiero, Brazil.

In the mainland United States, there are already dozens of cases of Zika virus infection confirmed in persons who have traveled to affected areas, and there have been a number of Zika infections that have been sexually transmitted. Puerto Rico has declared a public health emergency in the wake of dozens of confirmed cases of Zika virus, including one case associated with GBS. Because of the suspected link between Zika virus and microcephaly, the Centers for Disease Control and Prevention (CDC) now recommends that all pregnant women who have traveled to affected areas be tested for Zika virus.

Zika virus diagnostic testing is currently performed at only a handful of clinics in the United States, primarily the CDC’s Arbovirus Diagnostic Laboratory. And while public health officials are stressing the importance of Zika virus pathology tests, they also agree that increased testing is not enough.

zika virus pathology public health pathologistHow Will We Know More? – Pathology and Public Health

Microcephaly is still not causally linked to Zika virus infection, despite growing evidence. Much like diagnosing an individual patient, confirming suspected links requires tracking medical outcomes over time. WHO officials estimate it will be several months before a causal link can be confirmed, and this confirmation will require the coordinated efforts of public health officials, primary care physicians and pathologists.

The WHO Zika virus Emergency Committee has made several recommendations for healthcare providers, including that surveillance “should be standardized” and supported by “rapid and timely reporting and sharing of information”. It’s crucial that all suspected Zika virus patients have their healthcare services clearly documented, and that this documentation is able to be shared with public health researchers and task forces. With consistently reliable data, public health officials will be able to confirm Zika virus risks, and assess the efficacy of vaccine trials.

To ensure that clinical documentation is standardized, timely and actionable, the traditional narrative medical report is simply not enough. Narrative reporting can be time consuming, prone to medical records errors and difficult to interpret. Moreover, the inconsistency of the narrative report format creates undue complications for the cross-jurisdictional research initiatives that are necessary for contemporary public health.

Improving Clinical Documentation

Synoptic reporting standardizes clinical documentation with structured checklists, often incorporating interoperable codes. Synoptic reporting helps to produce more accurate, consistent and actionable medical reports—in less time and at a lower cost than narrative reporting.

Improving clinical documentation prepares your team to respond to public health emergencies like Zika virus outbreaks.