Zika virus has become a household word since it first showed up on our collective radar in May 2015 when the first reports came out of South America. Fast forward a year and a half, and now Zika has spread throughout the Americas including the United States. The Center for Disease Control and Prevention or CDC has monitored the spread and is doing its best to disseminate information while trying not to alarm an already anxious public. Nowhere is that anxiety higher than with the demographic I and other obstetricians serve every day. The American College of Obstetricians and Gynecologists have worked diligently to keep practitioners abreast of the latest news and information. As physicians, we are called to advise and guide our patients to understand the many facets of this evolving public health matter.
It is now understood that the Zika virus spreads to humans primarily through infected Aedes species mosquitoes. Transmission can also occur from an infected mother to fetus in pregnancy and is also sexually transmitted from both male to female and female to male contact. Many individuals who acquire Zika virus from the mosquito may not experience any symptoms at all while others may suffer from symptoms such as fever, rash, and joint pain. Often times the symptoms are mild. Currently the CDC reports that they believe the incubation period for the virus is about 3-14 days. Further it is believed that once a person is infected with Zika they may be protected from future infections.
Zika alone appears to be a mild condition, but the alarm arises when pregnant women or women who wish to become pregnant contract Zika as it can pose a risk to those pregnancies including miscarriage, microcephaly (small head) as well as other brain and eye abnormalities. The CDC has registered cases of Zika in all trimesters of pregnancy and found Zika virus to be present in fetal tissue, amniotic fluid, placenta, and full-term infants. There is still so much about Zika that is unknown at this time, and there is not good research yet to understand how the virus causes these abnormalities.
Absent a current vaccine against the Zika virus, The American College of Obstetricians and Gynecologists is advising practitioners to share various recommendations to their patients. Foremost, the advice is to avoid areas where Zika outbreaks are ongoing. As of August 19th, ACOG is telling pregnant women at all stages of pregnancy and any women who plan to become pregnant and their male partners to avoid travel to specific areas of Florida, Puerto Rico, many Caribbean counties, and parts of Africa and Asia. For the most up-to-date list, go to: www.cdc.gov/zika/geo/active-countries.html. Avoiding these areas will help to reduce the likelihood of exposure.
If you must travel to an area that may carry the potential to exposure, it is highly recommended that you take precautions to avoid mosquito bites. If possible, remain indoors or stay in screened areas to avoid bites. Take typical insect repellant precautions by covering any exposed skin and using an EPA-approved insect spray that contains DEET. As always, follow manufacturers recommendations to ensure safe use of any product. These precautions should be adhered to both day and evening to avoid being bitten.
Since the severity of symptoms is great if you become pregnant following a Zika virus infection, the CDC is recommending that couples in a Zika prone area receive pre-conceptional counseling to ensure that couples are aware of the risk involved. Since Zika is considered a sexually transmitted disease, healthcare providers are recommended to review contraception measures to avoid pregnancy. Additionally, if a couple wants to conceive, they need to follow specific timelines to avoid conceiving while the virus is still active in their bodies. Currently women who are diagnosed with Zika virus and even asymptomatic women with possible exposure to Zika should wait at least eight weeks from symptom or exposure to Zika before trying to conceive. It is advised that men in the same circumstance wait six months before attempting to get their partner pregnant.
Many couples that are pregnant or plan to become pregnant want to know about Zika testing, and ACOG with guidance from the CDC has come up with an extensive algorithm about who should be tested and at what point. This chart considers both symptomatic and asymptomatic pregnant women and the presentation of their symptoms and possible exposition to the Zika virus. Your healthcare provider should be acquainted with these materials to guide any necessary testing. If you would like to review yourself, you can go to www.acog.org or www.cdc.gov/zika/pregnancy/protect-yourself.html.
If a pregnant couple is tested and shown to have a positive Zika virus exposure, the pregnant women will continue to be monitored for the presence of the virus and will be offered ultrasound studies to evaluate the fetus. Since the virus remains in the body and the fetus, additional testing such as amniocentesis may be needed. A healthcare provider may consult with or refer a patient to a maternal-fetal medicine provider as well as an infectious disease physician and will make the medical information available to the CDC.
Hopefully, in the near future, there will be a vaccine to prevent the transmission of the Zika virus to humans. Until that day comes, it’s imperative that the public and their healthcare providers stay aware of the potential obstetric dangers of Zika and do their utmost to help limit the spread of this virus.
Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. Please visit www.atlanticobgyn.com.