Emerging Threat Zika Virus Remains Serious Concern for Pregnant Women

Dr. Stuart Rose says the Zika story is essentially a tale of two viruses.
For anyone except women who may be pregnant, “it’s a pretty harmless virus; it’s not going to affect you much. It’s in the same viral class as dengue and chikungunya,” said Rose, naming two viruses commonly encountered overseas that he prepares travelers for at his Northampton business, the Travel Medicine Center of Western Massachusetts.
“In fact,” he went on, “Dengue is a much more severe illness in terms of symptoms — high fever, severe muscle aches, even some fatalities. With Zika virus, the symptoms are very mild. For people who aren’t pregnant and aren’t concerned with conceiving, there’s little concern at all.”
However, the mosquito-borne virus, which recently surged to prominence in South America, Central America, the Caribbean, Southeast Asia, and the Pacific islands, is a major problem for pregnant women, having been linked to congenital microcephaly, a neurological condition that causes a child’s developing brain to grow improperly, causing a small head size and effects ranging from impaired motor functions and balance difficulty to speech delays and learning disabilities.
“We’ve had inquiries from young people who want to conceive, who are going on their honeymoons, things like that,” Rose continued. “It’s a major concern for people traveling to many destinations.”
The disease made waves in the Bay State in late January, when a Boston resident, who contracted the virus while traveling in a country where transmission is common, was diagnosed. A second Massachusetts case followed, also travel-acquired.
“The species of mosquito that transmits Zika is rarely found in Boston,” said Dr. Anita Barry, director of the Infectious Disease Bureau at the state Public Health Commission. “However, we encourage those traveling to countries with a high risk for Zika transmission — especially those who are pregnant or may become pregnant — to take the utmost care to avoid contracting the virus.”
If that were the extent of the threat — mosquitos not commonly found in the Northeast — Zika would still be a concern for pregnant women. Unfortunately, it may also be transmitted sexually, noted Dr. Andrew Healy, an ob/gyn with Baystate Health who specializes in maternal-fetal medicine.
“The Zika virus is a mosquito-borne illness, and it is only spread by mosquitoes,” he said. “While it is generally believed that it cannot be transmitted from person to person, observational evidence in some small studies suggest those infected with Zika can pass the virus to others through sexual intercourse.”
With no vaccine available and the virus already present in all regions of the U.S. — as of March 2, according to the Centers for Disease Control (CDC), 153 cases were reported in 28 states — Zika promises to remain a concern for at least the immediate future.

Varied Effects
Like Rose, Healy was quick to note that most people who contract Zika will have no symptoms at all, although some may experience fever, joint and muscle pain, rash, headache, and conjunctivitis. The CDC puts that figure at around 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of infections, with the rest exhibiting symptoms including fever, rash, and conjunctivitis.
But for pregnant women, he said, the virus is not only associated with fetal microcephaly, but other poor pregnancy outcomes, including Guillain-Barre syndrome, a nerve disorder.
“People in general should not be concerned about traveling to Zika-affected areas, with the great exception of pregnant women or women who are trying to become pregnant,” he said. “If you are pregnant and have plans to travel to regions where the Zika virus has spread, contact your doctor beforehand.”
The threat to pregnant women and their babies has the CDC working daily to assess the threat and issue appropriate warnings. As of March 2, Florida and Texas were among the U.S. leaders with 42 and 15 confirmed cases, respectively, but it was hardly contained to the South — New York state has reported 23 cases. The agency is currently advising pregnant women to avoid travel to countries where Zika is circulating, a list that includes Mexico, nine South American nations, six in Central America, and 12 Caribbean islands.
For people who do plan to travel to those destinations, Rose said the best protection is simply to keep the mosquitos away, which means using insect repellent with at least 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} DEET and clothing treated with a chemical called permethrin. The CDC also recommends wearing long-sleeve shirts and long pants, staying in places with air conditioning or that use window and door screens to keep mosquitoes outside, and using a mosquito net if one must sleep outdoors.
That won’t quell the anxiety of travelers returning to the U.S., Rose admitted. “Say a young couple goes down to the Caribbean, and they want to have a baby. How long should they wait after coming back? Could somebody have picked up the virus without knowing it? Testing is complex — there’s no commercial test kit available; it’s not a routine thing.”
In fact, blood samples must be sent to labs available only in a handful of states, and are typically performed only on hospital patients. Late last month, two Texas hospitals announced they had developed a more rapid test that detects genetic material from the Zika virus; doctors hope it becomes available on a widespread basis.
Meanwhile, researchers are still studying the sexual transmission of Zika and have determined so far that only men can pass the virus to their partners. Beyond abstinence, the CDC said, regular and correct condom use is the best way to reduce the risk of transmission.
In the meantime, Healy said, pregnant women reporting Zika-like symptoms during their trip or within two weeks of travel are candidates for laboratory tests. Patients with a history of travel to at-risk areas, but no history of symptoms, may be offered a serial fetal ultrasound to detect microcephaly. In any case, he added, pregnant women should contact their ob/gyn if they have a history of recent travel to at-risk areas.

Travel Fears
How much the disease will impact travel plans remains to be seen, and Olympic organizers worry about turnout at the 2016 Summer Games in Rio de Janeiro. CBS News reported that one travel agent in Florida, the hardest-hit state, said she has cancelled about 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of customers’ planned trips to Central and South America since the outbreak became public.
But locally, response hasn’t been nearly as pronounced, said Don Anderson, owner of the Cruise Store in East Longmeadow.
“If they’re going on a trip, they’re not saying, ‘I don’t want to travel to Disney’ or ‘I don’t want to travel to the Caribbean.’ At this juncture, as far as we can see, it’s not leading to cancellations,” he told HCN. “But I think people, particularly women who are pregnant or may become pregnant, should follow the precautions the CDC advises people to take.”
After all, Zika isn’t the first outbreak the travel industry has faced, he noted. Others include the 2009 outbreak of H1N1 influenza and even the late-2014 resurgence of Ebola.
“You can do nothing and stay in your house, or live your life and follow the guidelines the medical field and the CDC and the State Department are advising,” Anderson said. “We’ve all gone through these virus cycles. Hopefully, the minds of the world will come together and come up with a solution to this.”