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Volume 24, Number 11—November 2018
Policy Review

Stakeholder Insights from Zika Virus Infections in Houston, Texas, USA, 2016–2017

Stephanie R. MorainComments to Author , Catherine S. Eppes, Joslyn W. Fisher, Courtenay R. Bruce1, Martha Rac, Kjersti M. Aagaard, Rebecca Lunstroth, Savitri Fedson, Pallavi Dinesh, and Jean L. Raphael
Author affiliations: Baylor College of Medicine, Houston, Texas, USA (S.R. Morain, C.S. Eppes, J.W. Fisher, C.R. Bruce, M. Rac, K.M. Aagaard, S. Fedson, P. Dinesh, J.L. Raphael); McGovern Medical School at the University of Texas Health Science Center, Houston (R. Lunstroth)

Main Article

Table 2

Challenges expressed by key stakeholders with regard to Zika virus infections in Houston, Texas, USA, 2016–2017*

Challenge Quotation
Logistical burdens with collecting 
and submitting samples “I was filling out a form for the city. I was filling out another form for the state, and another for CDC. All to just be able to submit the samples for testing… it took me about 15–20 minutes just to fill out the paperwork [per patient]. And a lot of it was redundant.”—infectious disease specialist
Delays in receiving laboratory 
results “… for a lot of women, [test results are] going to make no difference at all because they are going to continue their pregnancy... but, for other women, it may completely change their decision-making…. So that turnaround time matters, absolutely.”—maternal–fetal medicine specialist
Complexity and limitations of 
available Zika virus tests “The testing is not very specific. It doesn’t necessarily eliminate your risk of having Zika, so there’s lots of limitations even with a negative test.”—academic pediatrician
Influence of commercial testing “Frankly, the commercial labs–they’re a blessing and not so much a blessing at the same time… when PCR specimens are done in a commercial lab and they’re positive… we may have a patient name and that’s it. Maybe their age, maybe their address, maybe not. And so we don’t have all of the demographic information and epidemiologic information that we’d like to have to do a full case investigation.”—state official
Poor mechanisms for exchanging 
laboratory data
“We get [Zika test results from the health department] through the fax… and we’ll have medical records scan it in and then I sent that to the provider who is seeing the patient. It’s a little clunky, but that’s the only way we can do it because of the mode that we’re getting it through the fax.”—community obstetrician
Travel screening
Insufficient clinician initiation “We would love it if our safety net providers… were doing a similar type of Zika screening for all patient visits, not just OB visits, ‘cause you’re kind of behind the ball if you wait ‘til the person’s already pregnant and has been exposed.”—public health physician
Inaccurate referral information “So I think particularly for the immigrant population here in Harris County, there is also concerns that, ‘why are they asking those questions, do they want to know where I’ve been and what I’ve done?’ So I think there is also the concern for people who are here illegally perhaps that they don’t want to divulge their travel history.”—maternal–fetal medicine specialist
Insufficiently precise information
“… pathology would receive a blood sample on a mom who had been to Florida. She said yes to Florida… but based on the form that pathology got, it doesn’t say the city that she visited. Before they will send it, they have to verify that it was Miami. I call the mom, well, she went to Jacksonville. She didn’t go to Miami. That kind of stuff is very time intensive for somebody to follow up on.”—genetic counselor
Patient demographic and immigration status
Transient and low socioeconomic 
level population “… A lot of these patients are very underprivileged and have very low resources, living in charity homes, living in homeless shelters…. How do we provide resources for these patients that have almost no resources to begin with? ... that’s a big issue that I’m not really sure how to fully tackle. I think it’s a very large issue”—academic pediatrician
Language barriers “… 100% of our moms were Hispanic and low income. I can’t remember a single one of them that spoke English either. And so there’s a dynamic of we’re trying to have interviews with them in a language that a number of our epidemiologists don’t speak and try to find translators to convey whatever we’re trying to ask, but then there’s the dynamic of these patients with their own providers… there’s a loss of information there just on the basis of translation.”—public health physician
Undocumented immigration status
“… we’re definitely hearing from some people… parents who are not here legally—even if their kids are here legally—are afraid to access medical care for fear of deportation.”—community pediatrician
Collaboration among public health clinicians
Confusion as to appropriate 
Zika virus “point person” within 
public health system “We [academic medical centers] are the laboratories that are actually going to see those patients come in with [an infectious disease] … when you have these brand-new, emergent infections… that line of communication is not well-established. Who’s in charge of that at public health? We don’t always know.”—academic pathologist
Poor communication of testing 
results to patients
“‘They [the public health epidemiologists] say things like, ‘You don’t have anything to worry about, your IgM is negative.’ What they don’t know is that this patient’s been persistently viremic… and we were very concerned and in fact that patient had an affected fetus… and so then we have to call the Health Department and say, ‘Yeah, they have a positive PCR.’”—maternal–fetal medicine specialist
Collaboration among clinicians
Poor communication between 
obstetrics and pediatric teams “… the joke always goes as pediatricians, we knew where babies came from but we didn’t know how they got there.... I don’t think there’s a highly reliable system across the state that ensures that OB providers are giving appropriate information to the [pediatric] team.”—public health official
Questions of case “ownership” “Follow-up for our babies was a big [issue] … who was actually going to do the follow-up? ... They’ve passed or they’ve failed their hearing test, so now where do we send them? ... it was just a big black hole.”—academic pediatrician

*CDC, Centers for Disease Control and Prevention; OB, obstetrics; Pedi, pediatrics.

Main Article

1Current affiliation: Houston Methodist Hospital, Houston, Texas, USA.

Page created: October 16, 2018
Page updated: October 16, 2018
Page reviewed: October 16, 2018
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