Zika Virus Disease

January 25, 2016- An increase in Zika virus infections in Brazil has put much of the Western Hemisphere, as well as parts Asia and Africa, on alert for its possible link to microcephaly and its known connection to Guillain-Barré syndrome. With no known vaccine against Zika virus infection, authorities have advised persons in at-risk areas to employ anti-mosquito measures, while some countries have suggested that women delay pregnancy.

In the United States, the CDC has issued a travel advisory warning against travel to Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, the U.S. Commonwealth of Puerto Rico, Barbados, Bolivia, Ecuador, Guadeloupe, Guyana, Cape Verde, Samoa and the island of Saint Martin.

The World Health Organization has warned that the virus was likely to spread throughout the Americas, except for Canada and Chile, and two recent cases suggest that Zika virus infection could spread via sex, although the CDC has said such a determination might be premature. 

 

PREGNANCY

Infection with Zika virus in pregnancy can lead to serious birth defects. Pregnant women can be infected with Zika virus in any trimester and current information on the risk to the unborn child does not specify time during pregnancy when infection has occurred. Our experience with this comes from the current outbreak in Brazil where maternal-fetal transmission of Zika virus has been documented throughout pregnancy. Zika virus appears to cause premature labor and fetal loss as well as birth defects including microcephaly.

As a result the Centers for Disease Control and Prevention (CDC) has issued the following travel advisory: Pregnant women considering travel to an area of Zika virus transmission in South and Central America and the Caribbean, should consider postponing travel to areas where Zika virus transmission is ongoing. If a pregnant woman has no choice but must travel to one of these areas, she should be advised to follow steps to avoid mosquito bites, such as wearing long-sleeved shirts and long pants, using insect repellents that contain DEET or picaridin, using permethrin-treated clothing and gear, and staying and sleeping in screened indoor air-conditioned rooms. Zika virus is transmitted by day-biting indoor mosquitoes and the challenge is to remind pregnant women to use insect repellent indoors as well as outdoors.  

 

GUILLAIN-BARRÉ SYNDROME 

Persons infected with Zika virus are at risk for development of the Guillain-Barré syndrome which is an immune mediated condition affecting nerves which may lead to muscle weakness, in some cases severe, as well as other neurological symptoms including paralysis.

 

BACKGROUND

Zika virus is a mosquito-borne virus transmitted by the Aedes Aegypti and Aedes Albopictus mosquitoes. These mosquitoes, which are prevalent in the Caribbean, Central and South America may also transmit other viral infections including Dengue Fever and Chikungunya.

Zika virus causes the acute onset of fever, rash, joint pains, and conjunctivitis and symptoms can last from several days to a week. Roughly one in five of those infected with the virus develop symptomatic disease. Generally symptoms are mild and self-limited however there are two serious concerns about Zika virus infection which you should be aware of:

In May 2015, the World Health Organization reported the first local transmission of Zika virus in the Western Hemisphere with locally acquired cases identified in Brazil. Outbreaks of Zika virus disease have been reported previously in Africa, Asia, and islands in the Pacific.

As of January 2016, local transmission has been identified in at least 14 countries or territories in the Americas, including Puerto Rico. Further spread to other countries in this region is highly likely. Zika virus infections have been reported in travelers returning to the United States and the number of Zika virus disease cases in most travelers will likely increase. These imported cases may result in local spread of the virus in some areas in the continental United States where the Aedes mosquitoes are present such as in the southern portion of the United States.  


SUMMARY

Until more is known, out of an abundance of caution, pregnant women should consider postponing travel to any area where Zika virus transmission is ongoing. There is no specific treatment for Zika virus disease and no vaccine or preventive drug is currently available.  

The best way to prevent Zika virus infection is to take the following steps:

  1. Avoid mosquito bites.
  2. Use air-conditioned or window and door screens when indoors.
  3. Wear long pants and shirts with sleeves.
  4. Use insect repellents which contain DEET or picaridin.  
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