July 2016: Updates on the Zika Virus Epidemic

July 27, 2016

Kristina Dragovic, MD

 

The Zika virus has been a hot topic in the world of Obstetrics. Within the past year there has been a significant increase in birth defects in areas where the mosquitoes that carry and transmit the virus live- starting mainly in Brazil. In addition to causing flu like symptoms (rash, joint paint, pink eye and fever) in those who are infected via mosquito, there is also transmission from mothers to their fetuses; known as vertical transmission. Pregnant mothers who are infected with Zika have given birth to infants with Microcephaly, a condition that significantly impacts the child’s development and ability to survive. The virus has greatest impact in the first and second trimesters as the brain develops. Besides mosquito and maternal transmission of the Zika virus however, it was also found that men infected with the virus could sexually transmit it to their partners.

 

As time has progressed since the spike in cases found in South America-the virus has been found in other environments where the mosquito can live- and cases have been found in the US.  The most common modes of transmission, via mosquito, from mother to child and via sexual contact- have now come into question as the virus may have been transmitted in other ways. Two new cases, in New York and Utah, have come about via different modes of transmissions.

 

In June of this year Fox news in NY reported that a woman who visited an area with prominent Zika transmission had unprotected sex upon her return to New York and subsequently developed symptoms of Zika and was diagnosed. Several days later, her partner had the same symptoms and was diagnosed as well. This case then prompted the CDC to address all pregnant women (whether their sexual partners be male or female) and encourage them to use barrier method or avoid sex during pregnancy to avoid vertical transmission.

 

In Salt Lake City, Utah, US News has reported that the caretaker of an elderly man who was found to have Zika after traveling abroad was also diagnosed with Zika. Though it was found that there was over 100,000 times more of the virus in eldery’s blood than is usually found in infected individuals.  The climate of Utah is not typical breeding grounds for the mosquito that harbors Zika- however it has not been ruled out that a mosquito could have been brought back in his suitcase.

 

These new cases in the US make the typical modes of transmission come into question. Thus, the more we learn about Zika, the more we can prevent vertical transmission and avoid congenital abnormalities. In order to prevent transmission, the best step is to avoid travel to areas with mosquito transmitted Zika, use protective measures against mosquitoes in areas with transmission and to avoid pregnancy if any flu like symptoms start thereafter visiting these areas.

 

It is of utmost importance for mothers who travel to areas with Zika transmission to be tested within 2 weeks of suspected exposure, and to avoid sexual transmission with barrier methods, and of equal importance for men to avoid sexual contact with partners for approximately 6 months after diagnosis if she is pregnant or planning to conceive. Please check the CDC’s website for a guide to prevention: https://www.cdc.gov/zika/