Update on Zika virus
We want to provide our patients with the current updates and recommendations regarding the spread of the Zika virus. We also want to ensure that you have the adequate resources to access further information with the most up to date news. If you are pregnant and have traveled to an endemic area or have any concerns, please contact your doctor.
What is the Zika virus?
As most of you may already know, Zika virus is transmitted through mosquito bites, specifically the Aedes mosquitos that live in tropical regions. These mosquitos can be identified by their white stripes found on their black bodies and legs. Since the initial identification of Zika virus in humans in 1952, outbreaks have occurred in Africa, Asia, the Americas, and the Pacific in 2007 and 2013. In May 2015, the first confirmed infections in Brazil were reported. Transmission occurs through the bite of an infected mosquito, and the virus usually remains in the blood for a few days to a week. Aedes mosquitos tend to bite during daytime in the early morning and evenings, and can also transmit dengue and yellow fever.
What are the signs and symptoms of Zika virus infection and how is it diagnosed?
People can experience a fever, rash, fatigue, muscle and joint pain, conjunctivitis, and headache. Symptoms typically last for days up to a week. Most cases are asymptomatic; about 4 out of 5 patients may not experience any symptoms at all. Diagnosis of the virus can be made from isolation in blood samples and PCR, ideally within 3-5 days of symptom onset.
What are the potential complications for pregnant patients?
With the surge of infections noted recently in Brazil, health authorities have also discovered a parallel increase in the number of babies born with a life-threatening condition called microcephaly. An alarming 3,000 cases of microcephaly have already been identified in Brazil since September 2015. Congenital microcephaly is a condition where babies are born with a significantly smaller head circumference, and can cause severe brain damage and even death. Brazilian health officials have established a link between mothers that were infected with Zika virus and babies born with microcephaly, however more studies are needed to confirm the association at this time. No other adverse pregnancy outcomes have been related to Zika infection thus far. The CDC and WHO are advising that all pregnant women and those planning pregnancy should avoid all endemic areas at this time. Trasmission of Zika virus through breastfeeding has not yet been observed, but transmission of similar viruses through breastmilk has been documented.
What are the potential complications for non-pregnant patients?
During prior outbreaks in 2013 and 2015, health authorities reported possible neurological and autoimmune complications from Zika virus infection, such as Guillain-Barre syndrome. This has also been observed in the current outbreak in the Americas, although the direct relationship between the virus and syndrome has not been definitively established. Guillain-Barre syndrome is a condition in which the body’s immune system attacks the nervous system. It most commonly causes muscle weakness and tingling, however severe complications can occur requiring hospitalization. Most affected individuals will recover, although some may continue to experience symptoms long-term.
Is there any treatment or cure for Zika virus?
Treatment is limited to supportive care at this time, including treatment of symptoms. There is no current vaccine for the Zika virus, which may take years to develop.
What can I do to protect myself?
The best form of prevention is protection from mosquito bites. Fortunately during the winter mosquito bites are much less common, and most Aedes mosquitos in the United States are found in southern and south-eastern states. However, studies have shown that some populations can adapt to a temperate climate and survive through winters, so I would encourage everyone to take precautions. To date there have been no cases of a patient being infected from a mosquito bite while here in the continental U.S. If travel to an endemic area is necessary, take all precautions to avoid mosquito bites. Pregnant and breastfeeding woman can use all EPA-registered insect repellants containing DEET, according to the product label. The CDC has a helpful guide on prevention found here: http://www.cdc.gov/zika/prevention/index.html
Is the Zika virus sexually transmitted?
As of February 1st, 31 cases of Zika virus had been confirmed in 11 states and Washington in the U.S. All were cases that had been associated to travel to endemic areas. On 2/2/16, Dallas health officials received confirmation from the CDC of the first reported Zika virus transmission from sexual contact in Dallas County. During a prior outbreak in Polynesia in 2013, Zika virus was isolated in a semen sample from a man who was also found to have the virus in his urine. This raises strong concerns over the potential spread of the virus from individuals who have been infected while traveling to endemic areas to their partners. The director of the Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, reported that though we can expect to see local transmission, widespread outbreaks are unlikely. He said during a press briefing: “We think these would occur in pockets, similar to what we now see with dengue and chikungunya. We are not being cavalier about this; we are preparing. But large-scale outbreaks are not something we are likely to see, based on our experience with dengue and chikungunya.”
Though federal health officials don’t expect large-scale infections here in the U.S., we still have to remain on high alert and be vigilant in taking precautions. I would advise partners of pregnant patients and those planning pregnancy to avoid travel to endemic areas at this time.
Where is Zika now?
On February 1, 2016 the director-general of the World Health Organization (WHO) declared a Public Health Emergency of International Concern. An international response has now mounted to build awareness for the problem, and to expedite diagnosis of infections as well as the development of diagnostic tests and vaccines to protect people at risk. As this will continue to be an ongoing concern, it is imperative that we spread awareness in our local community, with our friends and families. Travelers should be warned of the risks and all precautions should be taken to prevent transmission of Zika virus and other diseases from mosquitos.
For now, the CDC’s Zika travel alert includes Puerto Rico, Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Saint Martin, Samoa, Suriname, Venezuela, the U.S. Virgin Islands, and the Dominican Republic.
Important links:
http://www.who.int/topics/zika/en/
http://www.cdc.gov/zika/index.html
http://www.paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688&lang=en
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