Zika Virus Precautions for Those Who Are Pregnant or Trying to Get Pregnant

The Zika Virus, which has been linked to birth defects in babies, continues to make headlines around the world. Coastal wants to make sure our patients stay abreast of the latest information and precautions in regards to this disease. Please take a moment to read vital information in the blog below written by Sunita Kulshrestha, M.D. FACOG who is with our Integramed affiliate partner, Shady Grove Fertility.

The World Health Organization has called the emerging health threat, Zika virus, a “Public Health Emergency of International Concern.” This health threat is extremely important for those individuals who are pregnant or who are considering getting pregnant as infection with the virus has been associated with babies with birth defects and poor pregnancy outcomes.

The American Society for Reproductive Medicine (ASRM) urges patients who are pregnant and who are considering becoming pregnant to exercise caution in avoiding exposure to Zika virus. Zika virus can be transmitted through mosquito bites from infected mosquitoes, and has also been reported to be transmitted through sexual activity, blood transfusions, and reproductive tissues.

The Centers for Disease Control and Prevention (CDC) has issued a travel alert urging those pregnant or seeking to become pregnant and their sexual partners to avoid travel to those areas with known outbreaks or use enhanced prevention and follow-up if travel cannot be avoided. The current list for travel alerts include:
a). Mexico, b). the Caribbean islands of Puerto Rico, the US Virgin Islands, Jamaica, Barbados, Curacao, Dominican Republic, St. Martin, Martinique, Cape Verde, Guadeloupe, and Haiti, c). South American countries of Brazil, Venezuela, Bolivia, Columbia, Suriname, Paraguay, Guyana, French Guiana, Ecuador, d.) The Central American nations of Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama, e.) The Pacific Islands of Samoa and Tonga. As of 2/11/16, there have been 35 cases of Zika virus infection reported in the U.S. associated with travel to affected areas. This includes patients in Virginia, Washington D.C., New Jersey, and Pennsylvania. It is likely that this list will quickly expand; therefore potential travelers are advised to stay abreast with current information from the CDC website.

WHAT ARE THE CONCERNS WITH ZIKA VIRUS IN PREGNANCY?
The Zika virus infection in pregnancy has been associated with congenital microcephaly, a condition in which the head and brain are small and underdeveloped. Such brain damage may lead to mild to severe disabilities that are lifelong and irreversible. In some cases it can be life threatening. Common sequelae include seizures, developmental delay (affecting balance, sitting, walking, and movement), mental and intellectual disability, feeding problems, loss of hearing and vision, and control of vital body functions.

WHAT IS ZIKA VIRUS AND HOW IS IT TRANSMITTED?

• Zika virus is transmitted to humans through infected mosquitoes (the same type of mosquito responsible for the spread of dengue and chikungunya viruses).
• Infected mosquitoes transmit the virus to people through bites. These mosquitoes are aggressive daytime biters, prefer to bite people, and live indoors and outdoors near people.
• Anyone traveling to, or living in areas where transmission has been reported, is at risk of becoming infected.
• When a person is infected with Zika virus, it is found in the blood during the first week of becoming infected.
• It can spread from person to person through mosquito bites.
• Currently, there are no medications or vaccines that can prevent the Zika virus.
• There is not a commercially available test for the Zika virus.

WHAT ARE THE SYMPTOMS OF THE ZIKA VIRUS?

• According to the CDC, about one in five infected individuals (or 20 percent) will become sick (develop symptoms). The incubation period (from time of exposure to symptoms) is likely to be 2 to 7 days.
• Common symptoms include: fever, rash, joint pain, conjunctivitis (red, inflamed eyes), muscle pain, and headache. The symptoms are very similar to dengue fever and chikungunya virus.
• Zika virus illness is usually mild and the symptoms may only last from a few days to a week.
• Hospitalizations and deaths are rare.
• The CDC is currently investigating a possible link between Zika virus and a disease that can cause paralysis called Guillain-Barré.

GUIDELINES AND INFORMATION FOR ZIKA VIRUS AND PREGNANCY: PREGNANT WOMEN AND WOMEN TRYING TO BECOME PREGNANT

• Out of an abundance of caution, the CDC advises that all women who are pregnant or considering pregnancy and their sexual partners avoid or postpone travel to areas where Zika virus transmission is ongoing.
• If you must travel to one of the affected areas, talk with your healthcare provider first and strictly follow the steps outlined in the next section to avoid mosquito bites during the trip.
• There is a connection between Zika virus infections and congenital microcephaly in infants.
  -There have been reports of congenital microcephaly in infants of mothers who were infected with the Zika virus while pregnant (most notably in Brazil). Zika virus infections have been confirmed in several infants with microcephaly, but it is unknown how many of the microcephaly cases are associated with the Zika virus infection. Studies are currently investigating the association of the Zika virus infection and microcephaly, including the role of other contributing factors such as prior or current infection with other organisms, nutrition, and environment.
• Should women who have traveled to an area with Zika virus transmission wait to get pregnant?
  -The Zika virus usually remains in the blood of an infected person for up to a week. According to the CDC, there is no evidence that prior Zika virus infection poses a risk for birth defects in future pregnancies. The currently reported recommended time interval to wait to try to conceive after travel to a high-risk area has ranged between 2 to 4 weeks.

LATEST INFORMATION AND PRECAUTIONS OF SPREADING ZIKA VIRUS THROUGH SEXUAL CONTACT

• The CDC has identified Zika virus transmission to non-infected persons as a result of sexual intercourse with a person infected with Zika virus.
• The CDC has recommended the use of condoms by partners who have returned from an area where transmission of the Zika virus has been reported.

WHAT TO DO IF YOU EXPERIENCE SYMPTOMS OR ARE TRAVELING TO AN AFFECTED AREA

• If you experience any of the symptoms noted above AND have recently traveled to one of the countries on the CDC travel advisory list, please consult your doctor immediately.
• If you are considering travel to one of the affected areas in the near future, please discuss prevention strategies with your doctor. You are advised to practice “enhanced precautions” to avoid mosquito bites, which includes wearing long sleeves and pants, using insect repellents (DEET), using air conditioning or window and door screens, and using bed net sprayed with permethrin (insect repellent). When used as directed on the product label, insect repellents containing DEET, pi9caridin, and IR3535 are safe for pregnant women.
• As the knowledge of Zika virus infection and pregnancy is rapidly evolving, please continue to monitor the CDC website for the latest updates and recommendations.

FOR MORE INFORMATION

• Additional information about basic precautions for protection from mosquito bites can be found on the following CDC sites:
  –http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf
  –http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_us.pdf
• Updated Zika-travel related advisories can be found here.
• For more information on Zika, please review information from the CDC found here.

For any questions or concerns about the Zika virus, please consult your primary care physician immediately. To request an appointment or to speak with one of our New Patient Coordinators, please call 843-883-5800.