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Zika Virus

Zika Virus

To those who may be traveling to HONDURAS, I would like to share with you what is my current understanding of the Zika virus and risk of travel to Central America.  (This is derived from an email written by Dr. Jenison who is  a medical team member traveling with Scott Strouse to Honduras.)

Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.

In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. The outbreak in Brazil led to reports of Guillain-Barre syndrome and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes.

It’s January 2016. News stories have inspired significant anxiety about Zika virus. It’s a scary topic because news about the outbreaks are just unfolding, and this affects an already anxious group: pregnant mamas and expecting families. I want to share with you real-time information and data to try to alleviate anxiety and educate the best I can.

I suspect with time some of this will change. I’ve curated the most common questions and answers directly from the Centers for Disease Control.  The most alarming information coming from these outbreaks are the effects of Zika on pregnant women and their babies.

First things first, Zika virus will only affect an unborn baby who is exposed to Zika in utero if mom is infected while she is pregnant. Meaning, women not pregnant who get Zika can have Zika virus, clear the virus from her bloodstream (typically about one week after illness resolves) and not transmit Zika to future babies. If you are pregnant, there is no question it makes sense to think carefully about travel. That babymoon just can’t be the priority if it will put you at risk. Zika is potentially dangerous to a baby during any trimester or pregnancy or at the time of delivery.

Additionally, it has just recently been reported that Zika may be spread through sexual contact (STD). Therefore, any male returning from infected areas may have contacted the virus unknowingly. They could potentially pass the virus to a pregnant mate. So, it is advisable to abstain from relations upon returning home long enough for the virus to clear his bloodstream.

Zika virus is unusual in a couple of ways: only 20 percent of people who get it know it — meaning most people infected won’t develop any symptoms. Secondly, we don’t have a vaccine, and we don’t yet have an anti-viral to protect pregnant moms and their babies from side effects. So, unlike infections caused by influenza and polio, or rubella or mumps, we have to change our social determinants of health — basically pregnant moms have to take precautions with where they go and how they expose themselves. 

What is Zika virus disease?

Zika is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week.”

Like mosquitoes all over the world, the mosquitoes that carry the virus and spread it to people breed in open ponds/pools of water. The ones that carry Zika tend to bite and infect primates and humans during the day. These little buggers can get the virus from an infected person and then bite another person and transmit it during outbreaks.

What are the symptoms Of Zika?

About one in five people infected with Zika will get sick — symptoms from being ill. For people who get sick, the illness is usually mild. For this reason, many people might not realize they have been infected. The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito.”

Remember, 80 percent of people who get Zika won’t have any symptoms. So heading off to a country with an outbreak and coming home feeling fine doesn’t ensure you haven’t been exposed. This is key in protecting those at risk. We can’t make a lot of assumptions of who has it and who doesn’t. There has even been a few  reports of cases here in the United States of people returning from Central America. 

How is Zika transmitted?

Zika is primarily transmitted through the bite of infected Aedes mosquitoes. Aedes mosquitoes, which spread the virus, live in every Western hemisphere country but Canada and Chile. It can also be transmitted from a pregnant mother to her baby during pregnancy.  We do not know how often Zika is transmitted from mother to baby during pregnancy.  Not every infected pregnant mother passes the infection to her baby.

 Research continues to evolve through these outbreaks. What we know is that unborn babies are at most risk for serious complications. 

Who is at risk of being infected?

Anyone who is living in or traveling to an area where Zika virus is found who has not already been infected with Zika virus is at risk for infection, including pregnant women.”

In addition, because mosquitoes that live in the US are capable of carrying the Zika virus, it is possible that a traveler could get infected, come home, and spread Zika in areas with mosquitoes. This hasn’t happened, and would be rare because we protect we have screens on our windows and better solid waste and trash treatment that limits our exposure. However, CDC is working to understand more with studies starting this month. Protecting yourself from mosquito bites if mosquitoes are active where you live now, especially if pregnant, makes sense.

Here’s the current theory: Pregnant women are being bitten by mosquitoes who carry the Zika virus. In turn, the mothers are infected with the Zika virus and transmit it to their unborn fetus, potentially contributing to changes in development of their baby (during any trimester) including how the brain and nervous system grows. This has been seen with other viral illnesses in the past like measles.   Because of the global data of increased cases of Zika concurrent to an increase in rates of microcephaly in the same region, researchers believe Zika may be the cause. This is yet to be officially linked and proven at a cellular or structural level. No one knows why Zika virus could cause this.

Some infants with possible Zika virus infection have been found to have intracranial calcifications and abnormal eye findings. It is not known if Zika virus infection caused any of these abnormalities.

Zika, microcephaly and poor pregnancy outcomes outside of the U.S.

Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age (head circumference in these babies is typically at or below 3 percent on the growth curve). Babies with microcephaly often have smaller brains that might not have developed properly. Brazil’s Health Ministry reported it had recorded over 4,180 suspected cases of microcephaly since October, 2014, and have confirmed a link to Zika in 270 of 700 of the 4,180 cases they have tested. This led Brazil to announce concerns in 2015.

Dr. Jeffrey Duchin at Chief at King County Public Health advised, “Pregnant women can be infected with Zika virus in any trimester. Maternal-fetal transmission of Zika virus has been documented throughout pregnancy, and Zika virus infections have been confirmed in infants with microcephaly. Studies are ongoing to investigate the association of Zika virus infection and fetal loss or microcephaly, including the role of other contributory factors (e.g., prior or concurrent infection with other organisms, nutrition, and environment).

I’m pregnant. Should I travel to a country where cases of Zika have been reported?

In my opinion, long story short, no, you should not. Many airlines and cruise companies are offering refunds and allowing for travel changes without penalty. Until more is known, and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant:

  • Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who do travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
  • Women trying to become pregnant who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.

What about future pregnancy?

If a woman who is not pregnant is bitten by a mosquito and infected with Zika virus, will her future pregnancies be at risk? It doesn’t appear to be a problem.  The Zika virus usually remains in the blood of an infected person for about a week. The virus will not cause infections in a baby that is conceived after the virus is cleared from the blood.

Preventing Zika virus

There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to avoid being bitten. Protect yourself and your family from mosquito bites. Here’s a few ideas how:

  • Wear long-sleeved shirts and long pants (these mosquitoes bite during the day).
  • Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside.
  • Use Environmental Protection Agency C. All EPA-registered insect repellents are evaluated for safety and effectiveness.
    • Always follow the product label instructions.
    • Reapply insect repellent every few hours. Even the best spray looses half of its effectiveness after six hours. 
    • Do not spray repellent on the skin under clothing.
    • If you are also using sunscreen, apply sunscreen before applying insect repellent.
    • It is safe to use EPA-registered insect repellents if pregnant and/or nursing.
  • If you have a baby or child:
    • Do not use insect repellent on babies younger than 2 months of age.
    • Dress your child in clothing that covers arms and legs, or
    • Cover crib, stroller, and baby carrier with mosquito netting.
    • Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.
    • Adults: Spray insect repellent onto your hands and then apply to a child’s face.
  • Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.

Zika virus treatment

Remember that 80 percent of people with the virus won’t seek treatment because they won’t have symptoms. If someone does come down with symptoms, there is no vaccine or specific medicine to treat Zika virus, but you can treat symptoms:

  • Get plenty of rest.
  • Drink fluids to prevent dehydration.
  • Take medicines such as acetaminophen or paracetamol to reduce fever and pain.
  • Do not take aspirin or other non-steroidal anti-inflammatory drugs.
  • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.

What is Zika virus?

Zika virus is a member of the flavivirus family (as are West Nile, dengue, and yellow fever viruses) And similar to other flaviviruses it is spread by mosquitoes.

It’s odd: If you were infected with Zika, you most likely wouldn’t know it. In fact, only 1 in 5 get any symptoms. You might develop a rash, red eyes, joint pain, headache and fever which resolve in less than a week.

That is, unless you are pregnant. Then it appears to be associated with miscarriages and microcephaly.

But what makes is so confusing is that this virus has been around since the late 1940s. It was discovered in the Zika forest of Uganda. It’s been in Africa, India, and Southeast Asia for decades and is not associated with microcephaly there.  Research is ongoing trying to understand this better. 

Give the right insect repellent advice 

For travelers who are not planning a pregnancy, or who are going to the tropics anyway you’ll need to use insect repellents properly.

Aedes mosquitoes bite during the day. They reside in cities and towns everywhere that humans live. Remember that they cannot judge their risk of being bit by the neighborhood; this insect thrives in elegant neighborhoods and in shabby ones too.

Each morning as they are dressing for the day you need to wear as much protective clothing as is comfortable. Long pants and sleeves can be a problem in the tropics, but encourage them to wear them anyway. Then apply effective repellent on all exposed skin. And reapply according to the instructions on the label.

 Effective repellents, in my opinion, are ones proven to work with a minimum of application, i.e., apply once every 8 to 12 hours. I’ve never heard of a traveler able to apply a product successfully every 2 to 3 hours when traveling.

 I suggest 20 percent Picaridin or 30 percent DEET in a long-lasting formulation. Encourage your patients to treat their clothing with Permethrin for added protection. Fortunately, Permethrin lasts six weeks or 6 washings, which is very convenient for extended traveling.