Image c/o CDC
Zika virus scares continue to worry expecting parents and pregnant moms. In addition, we’re now just learning about a state of emergency in the big island of Hawaii because of the rising cases of Dengue virus, a virus also transmitted by mosquitoes. Shifting lifestyle advice for growing families will continue as researchers and public health officials learn more. We should expect that the recommendations for travel will change and evolve this summer. As of today, news reports from Brazil coupled with public health officials new knowledge and evolving medical research from around The Americas has clarified a number of things for pregnant moms and families thinking about having babies. Some things we DO know:
- What is Zika: Zika virus is predominately spread by mosquitoes. It is a virus causing joint aches, red eyes, rash and overall yuck feelings in about 1 in 5 people who get it. Typically the virus causes mild symptoms and goes away on its own even in the minority of people who have symptoms. The virus typically clears the blood stream a week after symptoms show up but we know it can remain for longer periods in other bodily fluids (urine, semen). Zika has been around for decades but warmer climate and travel has spread the mosquitoes and the virus around the world. Then it caused a massive outbreak in Brazil (over a million people estimated to have had the virus). During the same period a surge in cases of birth defects worried health officials about a possible connection of serious side effects from the virus during fetal development.
- Where is Zika: Outbreaks of Zika have been reported in over 30 countries, including some cases (not outbreaks) in the United States. Zika is often found in small pockets of countries who have reported cases (costal areas, low-lying areas with standing water) and not ubiquitously throughout the entire landscape. It’s not a risk everywhere you go in Central America but it has touched every country. Further, even though we expect to have cases of Zika in most parts of the US over the upcoming months, you’re simply not likely to get Zika in most parts of the United States for a few reasons: mosquitoes that carry and transmit Zika typically only live in the gulf coast and Southeastern US, our measures to control mosquitoes in the US are effective, and many of us who live in warm climates where mosquitoes live spend the majority of the day in air-conditioning and have access to repellent if outside.OUTBREAKS ARE NOT EXPECTED here in the US but we certainly have no guarantee. Here is a nice infographic from Vox depicting the distribution of mosquitoes who can potentially transmit Zika in the US.
- Birth defects from Zika: The long-term effects from Zika remain unknown, however there are serious concerns about Zika virus and the association of a constellation of symptoms on developing babies, specifically life-altering brain and neurologic changes (microcephaly and developmental delays & changes in the eye). More evidence connecting Zika as the culprit has unfolded in recent weeks. Zika has been found in the brains of babies with microcephaly, it’s been found in the placenta of women who have miscarried, and it’s been found in affected babies eyes. These findings don’t yet prove a cause-and-effect relationship between Zika and these defects but it is more data to construct the case. It is unknown exactly how Zika could cause such devastating changes to a developing baby (for example, researchers cannot yet prove that it’s the virus itself versus our own immune response to the virus that causes devastating side effects in developing babies).
- Guillain-Barre from Zika: Zika virus typically doesn’t cause symptoms (only 1 in 5 people who get it will likely KNOW it). And thankfully, Zika virus isn’t particularly dangerous for non-pregnant women, children, and men but there are increased rates of Guillain-Barre´(GBS) in outbreak area populations. Nearly all people who get GBS recover from it but nonetheless, since it is a condition triggered by our immune response, potentially after Zika, it’s another reason to protect yourself, even when not pregnant, from Zika virus. GBS causes muscle weakness and sometime even paralysis so it’s a serious condition being closely tracked in Zika outbreak areas.
- Resources to read on Zika: CDC on Zika (this will stay up to date) and a great Q&A from USA Today that also is helpful.
- What is Dengue: Dengue is a virus transmitted to humans by mosquitoes. It’s common, with estimates of 50-100 million cases around the world annually. Symptoms of Dengue virus are a lot like Zika: yuck/soreness in body, fever, joint, aches and rash. Dengue is also a mosquito-transmitted infection and moves around in the same mosquitoes as Zika. That being said, the risks from Dengue are different. There are no known connections between Dengue and abnormal fetal development. Dengue is typically a self-limited disease meaning you get it, feel crummy and recover without side effects. And although children are not at any specific risk for getting Dengue, they are more likely to have serious presentations of the illness (they are more likely to be hospitalized, have dangerous changes to their blood pressure or shock). Of the near 100 million people who get Dengue, only 1/2 a million are hospitalized. That being said it is serious, as about 2.5% of people with severe Dengue requiring hospitalization die from it. Avoiding infection from Dengue (via avoiding mosquito bites) will always be the best prevention.
- Where is Dengue: Dengue is a common mosquito-born illness around the world though it is not endemic to Hawaii (meaning the mosquitoes there typically don’t spread it around). It’s typically found in Asia, The Pacific Islands, The Americas and India. This map from Hawaii helps detail where the current outbreak of infections is on the Big Island. If you’re traveling to Hawaii and in those regions, it’s not necessarily a place to avoid, it’s simply a place to avoid mosquito bites for added protection.
- Risks from Dengue for pregnant women & newborns: Dengue infection during pregnancy can have effects on your baby. Dengue can cause premature birth or low birth weight in babies. In addition, if a mom gets Dengue in the 2 weeks prior to delivery, her baby can be born and have a Dengue infection. Protecting moms from insect bites is therefore important! It’s safe to use repellent during pregnancy and while breastfeeding. I really like this Dengue Pregnancy Fact Sheet with more information if you’re traveling to Hawaii or areas that may have Dengue now.
New since my last post: we now know that sexual transmission of Zika virus is possible, but rare and unlikely. In addition, warnings about exchange of Zika virus in saliva have new cautions raised about even kissing someone with active or recent Zika infection. Current information about sexual transmission of Zika is based on reports of three cases. So what do parents, especially expecting parents do?
Testing For Zika When You Are Worried:
When pregnant (or not), testing for Zika exposure or infection isn’t as straight-forward or easy as determining if you’re iron deficient. There’s a nice infographic on the algorithm here (go to #3) for testing and surveillance for pregnant women. There is no commercially available lab test for Zika infection; state and national laboratories use PCR (polymerase chain reaction) and serologic (blood) testing to determine if you are infected or have potentially been exposed. The tests are not perfectly diagnostic in that some cross-reactivity can occur if you’ve had viruses in a similar “family” like Dengue or Yellow Fever. A negative test, if drawn at the proper time (2-12 weeks after travel or suspected exposure to Zika), is reassuring you don’t have Zika, but a positive test can mean a number of things: Zika infection, history or active infection from another virus like Dengue, or a false positive. Locally here in Seattle, testing for pregnant women can be completed King County Public Health; physicians need to report suspected cases to Public Health at 206-296-4774.
The Centers for Disease Control (CDC) just published interim guidelines for prevention of sexual transmission of Zika virus and are as follows:
Recommendations For Men & Their Pregnant Partners
These are conservative recommendations. Know that all recommendations are made in the context of your life and your risk. At any time, if you’re pregnant and concerened about this, I really recommend having an open conversation with your OB/GYN. I mean these recommendations are a bit startling, but important.
Recommendations: Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy.
Pregnant women should discuss their male partner’s potential exposures to mosquitoes and history of Zika-like illness with their health care provider; providers can consult CDC’s guidelines for evaluation and testing of pregnant women.
There have been isolated cases of spread through blood transfusion or sexual contact and that’s not very surprising. The virus is in the blood for about a week. How long it would remain in the semen is something that needs to be studied and we’re working on that now.” ~CDC Director Dr. Tom Frieden
Recommendations For Men & Their Non-Pregnant Sex Partners
Men who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus might consider abstaining from sexual activity or using condoms consistently and correctly during sex. Couples considering this personal decision should take several factors into account. Most infections are asymptomatic, and when illness does occur, it is usually mild with symptoms lasting from several days to a week; severe disease requiring hospitalization is uncommon. The risk for acquiring vector-borne Zika virus in areas of active transmission depends on the duration and extent of exposure to infected mosquitoes and the steps taken to prevent mosquito bites. After infection, Zika virus might persist in semen when it is no longer detectable in blood. How long can it persist? We don’t know yet.
Zika virus testing has been recommended to establish a diagnosis of infection in some groups, such as pregnant women. At present, Zika virus testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the incidence and duration of shedding in the male genitourinary tract is limited to one case report in which Zika virus persisted longer than in blood. At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended. As we learn more about the incidence and duration of seminal shedding from infected men and the utility and availability of testing in this context, recommendations to prevent sexual transmission of Zika virus will be updated.
Bottom Line Advice About Zika, Dengue and Pregnancy
Put these risks and learnings in the context of all the other things you do to promote having a health baby. Exercise, prenatal vitamins, sleep, limiting exposure to toxins, and seat belts. Now repellent and smart travels choices are on the list. That’s it. That’s all this needs to be. Just a couple more things on the list to make you feel like an AWESOME present or future parent. SMARTEST THING WE DO IS READ UP, CALM DOWN, and GRAB THE REPELLENT if in areas of Zika or Dengue. Make babies and parent like a pro!
Pregnant women, women trying to become pregnant, and all persons who do travel to areas with Zika transmission should adhere to steps to avoid mosquito bites to prevent Zika infection and other mosquito-borne diseases.” ~King County Public Health Advisory