Local Expert Provides the Latest on Zika

Scarsdale's Dr. Susan Klugman is the Director of the Division of Reproductive and Medical Genetics at Einstein/Montefiore where they are now seeing pregnant patients at risk for Zika infection. She is an obstetrician with a specialty in genetics. Though she runs a general obgyn practice most of her days are spent in the Reproductive Genetics Department at Montefiore seeing pregnant patients whose fetuses are at risk for genetic disorders. She also see patients considering pregnancy, patients at risk for hereditary cancer syndromes and patients whose family members have genetic disorders

Since we have an expert in our midst, Scarsdale10583 asked Dr. Klugman for the latest information on Zika – and here is what she shared:

You recently attended a national meeting where Zika was discussed. Tell us what you learned?

The meeting was over a month ago and so much has developed since! Just last week, with certainty the CDC declared that Zika does in fact cause microcephaly. This is unprecedented! This is the first time that a mosquito bite is associated with a severe birth defect. We are keeping current through the American Congress of Obstetrics and Gynecology, the Centers for Disease control (CDC) and the NYS Department of Health. Plus at Montefiore we have a team addressing this issue. We have pediatricians, obgyns, pathologists and others on the team

What has been your experience with Zika at the hospital? Have you seen any cases? What advice are doctors giving these patients?

We are currently screening all patient who have had travel to one of the countries with known Zika and we are also screening pregnant patients who have been sexually active with partners who have travelled to one of the known countries on the CDC list. As of April 27,2016 there are 36 cases of Zika infection in pregnant women in the US. All of these cases are associated with travel outside of the US and 8 are sexually transmitted. Any positive cases at Montefiore are followed by an interdisciplinary team along with the Department of Health, as mentioned above.

At what point in a pregnancy can tests show whether or not a fetus has been affected by the virus?

This is a very difficult question to answer. We can tell if a woman has an active infection by blood and/or urine tests if performed at the appropriate time (i.e. close to the time of infection). However there is uncertainty as to whether or not a fetus is infected if a mother shows signs of infection. For example, an amniocentesis can be performed to look for Zika in amniotic fluid but even if it is found to be positive that does not mean the fetus is infected. Also, if a patient is positive for Zika and her fetus has microcephaly, we cannot assume with 100% certainty that the microcephaly is due to Zika. There are other causes for microcephaly.

Currently , it is believed that those patient with microcephaly had Zika exposure late in the first trimester to early in the second trimester. Patients who have Zika exposure are at risk for miscarriage and those exposed late in pregnancy make have poor growth or fetal death. In addition, there are many neurologic issues that may affect the fetus.

The CDC's recommendation is that women and men avoid pregnancy/conception for 2 months if they have travelled to an area with known Zika infections and men avoid conception for 6 months if they have had a Zika infection. Women with Zika virus disease should wait until at least 8 weeks after symptom onset before attempting conception. No data are available regarding the risk for congenital infection among pregnant women with asymptomatic infection.

Concerning travel, what are your recommendations?

Avoid travel to destinations where local transmission of the Zika virus has been reported (that means where infected mosquitoes have transmitted the virus to people) There are good recommendations for prevention on the CDC website if patient has to travel. 

When do you think a vaccine will be available?

This is unclear

How long do you think it will take for the situation to be controlled?

That is a very difficult question to answer. Hopefully there will be government funding soon to help combat the problem and research the options for control and possible elimination of the virus.

For more information please check the CDC website or call Dr. Klugman's office between the hours of 9 and 5 :914-287-7730 Tuesday and Thursday OR 718-405-8150, Monday to Friday.