And Now ... Zika

The recent scares from Ebola, SARS, Swine Flu, Bird Flu and now Zika have hit us with the realization that we are vulnerable to diseases from the third world.

Zika virus has been all over the news for the past couple of weeks and with each day there is more information about the virus. The Aedes mosquito has been causally linked to Zika virus but other modes of transmission are also being investigated. And this is happening right around the time that many people from our area are leaving the not-so-bitterly-cold winter behind and taking off for some fun in the sun in the Caribbean, Puerto Rico, and other areas that have been affected by the virus.

There is still little known about the increasing spread and prevalence of the Zika virus. It appears that it may be linked to microcephaly in infants whose mothers had the virus during pregnancy as well as possibly Guillain-Barre Syndrome. The general population, however, is not severely affected by Zika virus in that only 20% of people are symptomatic. Signs and symptoms are generally mild and short-lasting and may include fever, rash, join pain, conjunctivitis, headache and muscle pain lasting a few days to a week.

There have been sporadic cases of people diagnosed with Zika virus in New York but all were infected outside of the country. Perhaps more alarming is the recent sexually transmitted case of Zika in Texas. A woman tested positive for Zika virus after having unprotected sex with an infected person who had traveled to a Zika-affected country. There are more people testing positive for Zika virus on a daily basis especially in Florida. Thus far, everyone affected had travelled, but Florida is one of the places that houses populations of the vector mosquito. A person gets infected with Zika after a mosquito ingests virus laden blood from an infected person and then transmits it to its next host.

Dr. Judy Stone, an infectious disease specialist, cautioned that if Zika adapts to the Asian Tiger Mosquito, people in 32 states in the U.S. could be at significant risk for the virus. This type of mosquito can adapt to colder temperatures by becoming dormant in the cold months.

Dr. Fred Bomback, a local and well-respected pediatrician, said, "Some pregnant women are worried. If I know someone is pregnant or planning on getting pregnant I would strongly recommend not going at this time to an area where Zika has been confirmed."

The CDC has issued a travel warning for women who are pregnant or trying to get pregnant to countries affected by Zika. To date, those countries include most of Central America (Belize is safe!), much of the Caribbean including the U.S. Virgin Islands and Puerto Rico, Mexico, Cape Verde, Samoa, and all of South America except for Uruguay, Argentina, Chile, and Peru. Only necessary travel is recommended in places affected with Zika virus until more is known about transmission and the effect the virus may have on the fetus. If a pregnant woman must travel to these areas, strong precautions are suggested to avoid mosquito bites including using EPA-registered insect repellant, wearing long sleeves and pants, and staying inside as much as possible in a place with screens on the windows.

Dr. Peter Piot, the scientist who discovered Ebola, is very concerned about the explosive outbreak of Zika in the Americas. In a recent BBC interview, (http://www.bbc.co.uk/programmes/p03h7056) he said the top priority needs to be establishing proof that Zika is causing birth defects. After that a good diagnostic test needs to be developed as well as a vaccine. In the meantime, effective mosquito control must be sought. Even with an effective test for the virus, however, who would be tested? Only a minority of people experience detectable symptoms and many mimic other diseases including the flu and the common cold.

A popular OB/GYN affiliated with WESTMED Medical Group said that he is being asked a lot of questions about Zika virus. He is following the CDC suggested travel warnings- advising that pregnant women or those contemplating getting pregnant refrain from travelling to Zika-affected areas. "Until we know more, I think women should heed the travel warning. Why are we seeing so much more of this virus than in the past? Is Zika virus actually causing microcephaly in babies? We are still lacking much information about this virus," he said.

He has also had patients ask how long they should wait after coming back from an affected area to get pregnant. "A lot of people have been saying one to two months is probably sufficient," he said. "The virus does not linger in the bloodstream for very long." He's getting calls from patients who have been invited to weddings and bachelorette parties in affected areas and most who are pregnant or thinking of getting pregnant are postponing or canceling their trips.

For now, the doctor's staff asks patients if they've traveled recently to any of the countries on the CDC list of places with Zika virus. "But if they have, and if they're pregnant," he said, "testing is not so easy. Your doctor can't just order a blood test. It has to be approved by the health department and certain criteria must be met in order to be a candidate for testing."

"From a pregnancy perspective," he continued, "you may not be able to pick up any of the defects until late in the pregnancy and by that time there's not much you can do for it. In my mind, one of the scary parts of this virus potentially causing birth defects is that you may not be able to detect any abnormality at the point that the pregnancy could be terminated if desired." He also cautioned that abortions could increase unnecessarily.

For now, the most updated and trusted source of evidence-based information about Zika virus can be found on the CDC websites.