Updated Aug. 3, 2016
“Have you heard about this Zika infection?” a patient asked me during her ultrasound. “What do you think?”
The first time a patient asked me about Zika virus was in January 2016, after it was reported that an increased number of babies in countries with Zika outbreaks were being born with microcephaly. This is a congenital malformation in which the baby’s head and brain are unusually small.
The Centers for Disease Control and Prevention (CDC) that month issued a warning advising pregnant women to postpone travel to areas affected by Zika virus, including Mexico, Puerto Rico, and parts of Central America and South America. At that time, U.S. residents who contracted the mosquito-borne infection did so while visiting affected countries or through sexual intercourse with someone who had.
My patient back in January canceled her planned vacation to Mexico, but I told her there was no need to avoid U.S. mainland destinations for the time being. That is no longer true.
After it was determined that more than a dozen people contracted Zika in a Miami neighborhood, the CDC on Aug. 1, 2016, advised pregnant women to avoid travel to the Wynwood Arts District of Miami.
News about this virus is changing quickly, and women and their partners should check the CDC Zika website for the most up-to-date travel and safety information. But even if you don’t plan to travel, it’s important to know the facts about Zika virus.
1. What is Zika virus and how is it contracted?
The Zika virus is a mosquito-borne infection that usually causes mild symptoms, if any. In fact, 80 percent of those infected never even know they have it. Common symptoms, which can last from a few days to a week, include fever, rash, joint pain, headache, and conjunctivitis (red eyes).
The Aedes species of mosquitoes that spread Zika virus are found throughout the world, including Texas. These mosquitoes (which are recognizable by the white markings on their legs) also have been known to carry West Nile disease, yellow fever, and dengue virus.
There is no medicine to treat Zika virus, nor is there a vaccine. Health care providers may recommend treating symptoms with rest, fluids, and medications such as acetaminophen to relieve fever and pain.
Sexual transmission also can be responsible for spreading the Zika virus.
If your partner has recently returned from an area where Zika infections are present, use condoms consistently or abstain from sex for the remainder of the pregnancy. Condoms provide good protection against the sexual transmission of viral illnesses.
The CDC advises that men and women who travel to Zika-infected areas wait eight weeks before trying to become pregnant, and that men with Zika symptoms wait six months to try to conceive with their partner.
2. Where is Zika virus found?
The Zika virus was first detected in animals in 1947 in Uganda, and it spread to other parts of Africa and Asia. It then crossed the Pacific Ocean, and in March 2015, the first case was reported in Brazil. Infections have now been reported in multiple North and South American countries.
Even though there haven’t been any cases of people contracting the disease by mosquitoes in Texas, at least one type of mosquito that can transmit the virus is found here. Texas appears especially vulnerable to the spread of Zika infection, according to computer modeling that combined information about mosquitoes, temperature profiles, and historical data about flights to the United States from areas with known infections.
3. Does Zika virus cause birth defects?
In April 2016, the CDC confirmed that Zika virus can cause microcephaly. The organization also said the virus can cause other serious birth defects involving a baby’s brain. Besides microcephaly, we don’t know what long-term effects Zika may have on a baby after birth. There also is concern that the Zika virus can infect the placenta and lead to poor growth of a baby
Microcephaly can lead to a range of problems – from mild to severe to life-threatening – including seizures, developmental delay, intellectual disability, hearing loss, and vision problems. Microcephaly also can be caused by other viruses, such as rubella. There is evidence that Zika infections in any trimester are associated with complications. Because most of the growth of a baby’s brain occurs in the third trimester, the condition may not be detected until a third-trimester ultrasound, if one is performed, or after birth.
The CDC now recommends that all pregnant women who travel to an area with active Zika infection be tested for evidence of infection – regardless of whether you had any symptoms for the disease. You will also be offered testing if your partner traveled to an area with active Zika and you had unprotected sex.
Two types of testing are being used. One looks for the presence of the virus in your blood and urine in the first couple weeks after exposure. The other test, Zika IgM, checks for the presence antibodies to the virus that are produced following an infection.
This is a complicated recommendation. We will be testing women for a disease for which there is no treatment. And you may need to be patient – the second test can take a longer period of time to get the results back. If you have had an infection, imaging of the baby can be performed with ultrasound and fetal magnetic resonance imaging (MRI) to look for evidence of problems.
For now, if you are pregnant, expect your doctor to ask about your travel history and sexual partners and to offer screening. If you have any questions, ask your doctor – or direct them to us at firstname.lastname@example.org.
4. How can pregnant women protect themselves?
I’ve been surprised by the number of women who choose not to heed the travel warnings – and then come home in a panic. Do yourself – and your baby – a favor and follow the CDC’s travel recommendations unless it is absolutely necessary to travel to a location with active Zika transmission.
The recommendations are changing as new information comes in, so look for the up-to-date list of areas on the CDC’s Zika travel health notices page. If travel can’t be avoided, protect yourself from mosquito bites.
A good insect repellant is a must – especially in Texas. Mosquitoes can be thick during the summer, and while Zika virus has not been detected here yet, we do see cases of West Nile virus and other mosquito-borne infections. DEET is one of the most effective mosquito repellants, and while it has a reputation of being a potent chemical, using it as directed on your skin will not harm you or your baby during pregnancy.
In Texas, pregnant women covered by Medicaid plans are eligible for free mosquito repellent through fall 2016.
Some women prefer natural repellants such as pyrethrum (or permethrin). You should not apply this to your skin, but you can use it on your clothing before you get dressed to repel mosquitoes. The Environmental Protection Agency offers tips to help you select an appropriate insect repellent.
A few other precautions you can take to protect yourself from mosquito-borne infections:
- Wear long-sleeve shirts and long pantsif the weather permits. Don’t rely on mosquito-repellant wristbands and clip-ons as they have been shown to have minimal to no effectiveness.
- Protect your home.Use window or door screens to keep mosquitoes out of your home. Sleep under a mosquito net if you are unable to keep mosquitoes out of your home.
- Use mosquito abatement programs in your yard.Empty standing water from containers such as buckets or flowerpots to keep mosquitoes from finding a place to breed. If you can’t get rid of all standing water, use larvicides, products that can be sprayed or that float in water and kill mosquito larvae.
- Be aware of spraying plans in your community.Mosquitoes become infected after biting infected people, so spraying is an effective way to slow mosquito-borne diseases.
Also in response to the Zika virus, national organizations such as the National Marrow Donor Program and the American Red Cross have instituted additional screening guidelines for the virus for blood and cord blood donations.
If you have questions about an upcoming trip or have taken a recent trip to an affected country, talk to your physician about the possible risks.
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