Jan 28, 2016

Dr. Jones: Oh, it's winter and it's cold. It will be wonderful to go somewhere warm for a vacation. A beach in a bathing suit maybe and mosquito bites? This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University Hospital and University Health Care, where we are talking about the mosquito bites, the Zika virus, and pregnancy on The Scope.

Announcing: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Over the past several months there have been alarming reports from Brazil about the spread of the Zika virus infection. Never heard of it? Well, neither had I. The Zika virus is one of many diseases spread by mosquitoes. Malaria, dengue, and here in the Intermountain West, West Nile are just a few. This virus was discovered about 40 years ago in the Zika forest in Africa and is common in Africa and Asia, and it's related to the virus that causes dengue fever. It has very recently been noticed, in May of 2015, in South and Central America for the first time. It's spread very rapidly by mosquito bites from one person, who is infected, to another person who is not because so few people have antibodies to this virus. It is spread by a type of mosquito that we don't have here in Utah yet because it doesn't like the cold. The concern has written [sic] to a level of travelers' advisory to the CDC. The people who travel to this country, where the Zika virus has been documented, have a chance of becoming infected.

Although only about one in five people who are infected become symptomatic, the symptoms can be nasty -- fever, rash, muscle aches, and red eyes.

The biggest worry though is a possible link to birth defects when pregnant women are infected. There's been a dramatic increase in the births of babies with microcephaly in Brazil. Microcephaly is a rare condition where babies are born with very small brains, and they may have other conditions, such as blindness and deafness.

It's not proven yet whether this increase is caused by the Zika virus, but we know that maternal viral of other types can cross the placenta and affect a baby's neurologic development.

So what do we know? We know that the virus is spreading very quickly, and the World Health Organization may soon announce a public health emergency. We know that the disease is usually nasty but short-lived, about two weeks, although rarely some people have longer neurologic symptoms. People who are symptomatic rarely need hospitalization.

We think that Zika virus lives in our bodies for one to two weeks after being infected. After that, we build antibodies, and the virus becomes undetectable.

What don't we know? Well, we don't have a vaccine, and we don't have a treatment. There is not a commercially developed test for the virus. The CDC has testing ability, but it doesn't recommend that everyone who's traveled to South or Central America get tested.

We don't know for sure that the increase in poor pregnancy outcome and birth defects reported in Brazil is caused by the Zika virus infection in pregnancy.

So what does the Center for Disease Control recommend? As of January 2016, the CDC has a travelers' advisory for those traveling to South and Central America, and I'll quote here:

"Until more is known and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant. Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who do travel to one of these areas should talk to their doctor or other health care providers first and strictly follow steps to avoid mosquito bites during the trip."

Okay. Forget the bikini. If you are pregnant or trying to become pregnant and you choose to travel in Central or South America, you should take serious precautions. Cover up. Wear clothes that have a mosquito repellent built into them. Repellent such as DEET is okay in pregnancy.

The virus is spreading quickly, and we are very fast on our learning curve. So the WHO and the CDC will be updating their recommendations regularly. Check out the CDC's website on the Zika virus.

What if you've already traveled there and you think you were infected and you're pregnant? This is the time to talk to your OB. There is no commercially available test, but your OB can talk to the health department about getting you tested.

The test isn't perfect yet, and it can confuse Zika with the dengue virus and the yellow fever virus, and neither of these two are thought to cause birth defects.

Unfortunately, there's no treatment or good diagnostic tool to tell if the fetus was affected. There are some ultrasound findings that might be suggestive, but you should talk with your OB.

And thanks for joining us on The Scope.

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