Get The Facts: Pregnancy and the Zika Virus

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Zika’s spread in the Americas –

Reuters is reporting that the number of countries and territories in the Americas that have documented cases of the mosquito-borne Zika virus has risen to 24 as of Jan. 26. According to the Pan American Health Organization (PAHO), this is more than double the number of reported cases a month ago.

On Jan. 25, the World Health Organization (WHO) predicted the virus would spread to all countries across the Americas, except for Canada and Chile. The virus was first identified in Uganda in 1947 and wasn’t known in the Americas until 2014. At present, there is no cure and no vaccine.

Brazil has the highest rate of infection, followed by Colombia. Zika outbreaks have also been reported in Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela, among others.

Researchers in Brazil and the WHO say there is evidence that links Zika to microcephaly, a neurological disorder in which babies are born with smaller-than-normal heads and brains. In northeast Brazil, there has been a large increase in cases of newborn babies with microcephaly. Brazil’s health ministry has said the number of suspected cases of microcephaly in newborns has risen to 3,893 as of Jan. 16. Colombia’s health ministry says Zika has already infected 13,500 people across the country and there could be as many as 700,000 cases in 2016.

Zika can also be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth. But, researchers don’t know yet exactly how this happens. 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.

The Aedes species mosquito is also known to transmit dengue, chikungunya and yellow fever. In addition, its bite might be responsible for transmitting Guillain-Barre syndrome (GBS), a rare disorder where a person’s immune system damages the nerve cells, causing muscle weakness and sometimes, paralysis. The Brazil Ministry of Health is reporting an increased number of people affected with GBS.

What precautions should pregnant women in the U.S. take?

The U.S. Centers for Disease Control and Prevention said the United States has 31 confirmed cases in 11 states and the District of Columbia. Lyle Petersen, director of CDC’s vector-borne disease division, said that all of the cases so far have been due to U.S. residents traveling to infected areas, not by local transmission. The CDC is also working to determine if Zika and Guillain-Barre syndrome (GBS) are related.

Here is the web page that the CDC has developed specifically for pregnant women.

According to Scientific American, reported cases have occurred in these states:

  • Arkansas – 1 case originating from Central America
  • California – 6 cases (2 from 2015, and the rest from 2013 and 2014)
  • Florida – 3 cases originating from Colombia and Venezuela
  • Hawaii – 1 case of a woman who gave birth to a child with microcephaly and had lived in Brazil
  • Illinois – 2 cases originating from Honduras and Haiti (both women were pregnant)
  • Minnesota – 1 case originating from Honduras
  • Montana – Not confirmed, but one case may have been discovered in northwest Montana, but labs haven’t confirmed it yet
  • New Jersey – 1 case originating in Colombia
  • New York – At least 7 cases
  • Oregon – 3 cases originating from Polynesia
  • Texas – 2 cases originating from El Salvador and Colombia
  • Virginia – 1 case from Central America
  • Wisconsin – no further information given

On Jan. 28, New York City officials said that one case of Zika involves a pregnant woman. There have also been 20 similar cases in U.S. territories, including 19 in Puerto Rico and one in the U.S. Virgin Islands. The CDC has issued a travel alert (Level 2-Practice Enhanced Precautions), highly recommending that women who are of child-bearing age, especially those who are trying to get pregnant or already are pregnant, should not travel to the infected areas. At present, travel advisories are in effect for: Cape Verde, the Caribbean, Central America, South America, Mexico, and Samoa.

If you must travel to one of these areas, talk with your doctor first and strictly follow steps to prevent mosquito bites during your trip. If you are trying to become pregnant, you should talk to your doctor about your plans to become pregnant and the risk of Zika virus infection before traveling to these areas.

Travel companies, including United Airlines, have begun offering refunds or allowing pregnant women to postpone trips to regions affected by Zika with no penalty. Many Americans planning to travel to Rio de Janeiro, Brazil this summer for the 2016 Summer Olympics, the country hardest hit by the virus so far, may need to change their plans.

In a blog post last week, U.S. National Institutes of Health Director Dr. Francis Collins cited a Jan. 14 study in which researchers predicted the Zika virus could be spread in areas along the East and West Coasts of the United States and the Midwest during warmer months. The study showed that 22.7 million more people live in humid parts of the country where mosquitoes carrying the virus could live year round. Collins said “it is now critically important to confirm, through careful epidemiological and animal studies, whether or not a causal link exists between Zika virus infections in pregnant women and microcephaly in their newborn babies.”

What actions can parents take now?

There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to avoid being bitten. Health officials say that you can protect yourself and your family from mosquito bites by:

  • Wearing long-sleeved shirts and long pants.
  • Staying in places with air conditioning or that use window and door screens to keep mosquitoes outside.
  • Using Environmental Protection Agency (EPA)-registered insect repellents. Follow the product label instructions, and reapply insect repellent as directed. If you are also using sunscreen, apply the sunscreen before applying the insect repellent. Avoid the use of insect repellent on babies younger than 2 months of age. Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin. Spray insect repellent onto your hands and then apply to a child’s face.
  • Dressing your child in clothing that covers arms and legs.
  • Covering your baby’s crib, stroller, and baby carrier with mosquito netting.
  • Treating clothing and gear with permethrin or purchase permethrin-treated items. Treated clothing remains protective after multiple washings. Do not use permethrin products directly on skin, as they are intended to treat clothing only.
  • Sleeping under a mosquito bed net if you are overseas or outside, and are not able to protect yourself from mosquito bites.

What are the symptoms of the Zika virus?

The Zika virus is usually relatively mild, with symptoms such as skin rash, fever, muscle and joint pain, lasting up to seven days. Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito. It is uncommon for people infected with Zika to need hospital treatment. Only one in four people infected with Zika develop symptoms and many cases of Zika go undetected. Many people with the virus may not even know they have it.

Listen to the CDC video on what to expect.

If you do suspect that you, or a family member might have the virus, see your healthcare provider and tell him/her where you’ve recently traveled. Your healthcare provider may order blood tests to look for Zika or other similar viral diseases like dengue or chikungunya. You’ll also want to get plenty of rest, drink fluids to prevent dehydration, and take a OTC medicine, such as acetaminophen. Do not take aspirin or other non-steroidal anti-inflammatory drugs

There is no evidence that the Zika virus can cause death, but sporadic cases have been reported of more serious complications in people with preexisting diseases or conditions, causing death. Pregnant women and children are the most vulnerable. Though no advisory is in place in the United States, Colombia’s health ministry has advised women to delay becoming pregnant for six to eight months to avoid possible risks related to the Zika virus. Jamaica’s health ministry has recommended women delay becoming pregnant for the next six to 12 months. El Salvador has advised women to avoid getting pregnant until 2018.

What’s the U.S. Government doing to prevent the spread of Zika?

To date, local transmission of Zika virus has not been identified in the continental United States. The only U.S. cases thus far have been due to travel to infected areas. On Jan. 28, CDC deputy director Anne Schuchat told reporters that living conditions in the United States, such as better air conditioning, more window screens and less crowding, are factors that make it much less likely for a widespread outbreak of Zika. “Mosquito control is difficult even in this country, she said, and “state and local authorities need to be vigilant to jump in if there are locally transmitted cases.”

Schuchat also said the Food and Drug Administration is also looking into whether any additional guidance is necessary regarding blood donations. “Zika virus stays in the blood for only a few days, and most people have cleared it by about a week,” she said. The FDA is assessing whether travelers who have visited affected regions should hold off in donating their blood, and are working on recommendations to help maintain a safe blood supply in U.S. territories where the virus is present.

After being briefed on the potential spread of the virus by his top health and national security officials, on Jan. 26, President Barack Obama called for the rapid development of tests, vaccines, and treatments to fight the Zika virus. U.S. health officials are “stepping up efforts” to study the link between Zika virus infections and birth defects, citing a recent study estimating the virus could reach regions where 60 percent of the U.S. population lives. A White House statement said: “The president is… accelerating efforts to ensure that all Americans have information about the Zika virus and the steps they can take to better protect themselves from infection.”

The U.S. Centers for Disease Control and Prevention also announced new instructions for pediatricians treating infants whose mothers may have been exposed to the virus during pregnancy. In those guidelines, the CDC made it clear that doctors should contact their state or territorial health departments to get testing for potentially-infected infants.

Sources:

U.S. Centers for Disease and Control Prevention (CDC)

World Health Organization (WHO)

Pan American Health Organization (PAHO)

Reuters

CNN

CBS News

The Washington Post

The New York Times

Scientific American

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