Pregnant women should discuss Zika risk at every check-up, CDC says

US health officials are strongly urging doctors to ask all pregnant women about a possible Zika infection at every check-up. The Centers for Disease Control and Prevention (CDC) has also warned that the virus can be transmitted through unprotected sex with an infected female partner.

Related: ‘This is why people hate Congress’: politics stymies fight against Zika virus

Previously, the CDC and other experts believed the virus could only be sexually transmitted by males because it can reside in semen potentially for several months.

The Zika virus is mainly spread by mosquito bites, but can also be transmitted through sex. Infection during pregnancy can result in birth defects. So far, there have been no confirmed cases of a Zika infection from a mosquito bite in the US, although officials expect mosquitoes will start spreading it in southern states. All US illnesses have been connected to travel to areas with Zika outbreaks.

The advice came on Monday as the CDC fine-tuned its guidance. It urged doctors to at least ask pregnant women if they or their sex partner had been in an outbreak area, and suggested expanded use of a sophisticated blood test. The CDC previously recommended that men who had been infected abstain from unprotected sexual contact for at least six months with a partner who was pregnant or hoping to become pregnant.

But a recently reported case of female-to-male sexual transmission in New York City, and limited human and non-human primate data indicating that Zika virus RNA can be detected in vaginal secretions, led to the new warning about unprotected sex with an infected female partner, the agency said.

The CDC’s expanded warnings on sexual exposure to Zika now caution against sex without a condom or other barrier method of protection with any person, male or female, who has travelled to or lives in an area with Zika; the warnings include concerns over female-to-female transmission with a pregnant partner.

The CDC also expanded the window for Zika-specific blood testing from a week after the onset of symptoms, or believed exposure, to 14 days.

“New information has indicated that some infected pregnant women can have evidence of Zika virus in their blood for longer than the previously recommended seven-day window for testing after symptoms begin, and that even pregnant women without symptoms can have evidence of the virus in their blood and urine,” the agency said.

The CDC also advises that pregnant women, with possible Zika exposure but no symptoms, receive testing too.

“Expanding the use of the Zika-specific test could provide more women with Zika virus infection a definite diagnosis and help direct medical evaluation and care,” the CDC said.

Zika: New York officials announce first microcephaly case

Zika has been proven to cause microcephaly, a birth defect marked by small head size that can lead to serious developmental problems, and has been linked to other severe fetal brain abnormalities.

The connection between Zika and microcephaly came to light last fall in Brazil, which has now confirmed more than 1,600 cases of microcephaly that it considers related to Zika infections in the mothers.

Last week, New York health officials announced the first birth of a baby with microcephaly in the city.

On Monday, health officials in Barcelona said a woman had given birth to a baby boy with microcephaly associated with the Zika virus – the first detected case in Europe. The health ministry said Spain had recorded 190 Zika infections, with all but one contracted abroad. One case of sexual transmission was found in Madrid.

Pregnant women should discuss Zika risk at every check-up, CDC says

Clinical commissioning groups the one-year health check-up

GPs are best able to lead on transforming the way healthcare is delivered, says Rick Stern. Photograph: PHOVOIR / Alamy/Alamy

In April 2013, CCGs were introduced to replace primary care trusts as the commissioners of most services funded by the NHS – and they now control about two thirds of the NHS budget. The key change is that clinicians play a greater role in deciding how funds are spent on commissioning services and all general practices in England are legally obliged to be a member of a CCG.

Not all GPs are involved with their local CCGs and therefore the extent to which GPs are actually engaged in making decisions about the management of the NHS varies. Kate Adams, a GP in Hackney, thinks overall engagement between GPs and CCGs is growing under the new arrangements. “GPs are working more closely together between practices and there is closer working between doctors and managers, which is a good thing,” she says. GPs have an important role to play in giving “clinical input to redesigning care pathways”, she adds.

According to a report by the King’s Fund and the Nuffield Trust, GPs who have got involved with CCGs have seen a definite impact – 66% of GPs who led CCGs felt that their CCG was “owned” by its members, compared with 35% of those without a formal role in the CCG.

Nicholas Hicks is chief executive of Cobic, a consultancy advising commissioners and providers on outcome-based healthcare services, which aims to secure “both value for money and better outcomes for patients”. He thinks that GPs will be instrumental in changing the way services are commissioned: “GPs are far more involved with commissioning than before and they bring fresh perspective, not least because they are less inclined to accept central directions that they do not believe make sense.” He adds that: “A fresh eye has meant that CCGs are far more open to adopting innovative approaches to commissioning than were the majority of their predecessor PCTs.”

Rick Stern, chief executive of the NHS Alliance, thinks the strength of the CCGs is their clinical focus and “different style and approach in leadership”. PCTs, he says, were felt to be “too distant and bureaucratic, and the real test for CCGs will be to show they are radical and different, and a break with the past.”

CCGs have two main roles – commissioning services and supporting improvement in general practice.

There is the opportunity here, Adams says, “to address the bigger issue of society, health and wellbeing – GPs understand how important this is and how to make an impact on people’s lives.”

Hicks agrees: “A growing number of CCGs want to commission in a different way – they are taking steps towards letting contracts that pay providers on the quality of the outcomes they achieve for people that use the services rather than on the volume of activity.” 

Traditionally, PCTs and CCGs place one-year contracts with providers such as hospitals in which the value of the contract is determined by the number of patients a hospital treats. Under the outcome-based model, Hicks explains, the provider (which may be a new alliance of hospital, community and social service providers) is given a “longer-term contract, a base sum of money for the care of a group of people (such as older people, people with drug and alcohol problems), and money for improving the outcomes for the people using the services.”

How services are commissioned is integral to managing change and we need a different style of commissioning, says Rick Stern. “CCGs must work with their patients and the wider community and work through difficult decisions – there will be massive problems with budgets in years to come and we need to look at transforming the way healthcare is delivered – this is a big and complex debate.” And it’s a conversation that the GPs are best able to lead, he says. “Are people willing, for instance, to let go of the sacred position of their local district hospital and have more services offered in the community and in specialised centres?”

Trying to improve and measure outcomes for people who use NHS services will be an area that every CCG will be working on but it will take time. As Adams says: “The future is about transforming services – giving benefits to patients and freeing up money for things that really matter – preventative and community health and wellbeing.”

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Clinical commissioning groups the one-year health check-up