(Last week’s article is repeated at the end of this article. It may be helpful to read that article first.)
February 11, 2016. To stay current with the latest on the Zika virus you’ll need to constantly process new and often conflicting reports peppered with words and phrases such as “possibly”, “apparently” and “the latest information seems to indicate.” Yesterday’s “facts” may be incorrect today. Your best sources of accurate information: the Centers of Disease Control (CDC) at http://wwwnc.cdc.gov/travel/page/zika-travel-information and the World Health Organization (WHO) at http://www.who.int/features/qa/zika/en/ They receive data from sources worldwide and filter that data into warnings and advisories. This is where local health organizations, physicians and the media get their information.
As of today (note this article is dated) the CDC and WHO continue to advise that only pregnant women and women contemplating becoming pregnant need to limit travel to countries where the Zika virus is circulating widely. The number of such countries increase almost daily. Most of these countries are in the tropics.
Currently there are no advisories to curtail travel for infants, children and non pregnant adults. This is largely based on the belief that Zika virus spreads exclusively via the bite of specific Zika virus-infected mosquitoes and that the virus is harmful only to the fetus of pregnant women. To have a virus so virulent for the fetus yet cause other individuals only mild or no symptoms is not unique. Rubella, another viral disease, acts similarly.
Is it possible that the Zika virus spreads by means other than from bites of infected mosquitoes? There are reports that “in a few cases” infection may have been via sexual contact. If so, a man infected while traveling in the tropics could come home and infect his female partner. If she happened to be pregnant her fetus could be damaged. However, the few cases so far reported could be due to laboratory errors and to other reasons. Presently, there is insufficient evidence to change travel advisories.
Is it possible that the Zika virus is not as harmless to infants, children, and non-pregnant women as is presently believed? In some countries where the virus is active, there has been a slight increase in the incidence of a well known but rare neurological condition, Guillain Barre Syndrome (GBS). In the past, GBS has been associated with viral infections. The disease affects people of all ages but is quite rare in infants and young children. GBS causes paralysis which is usually temporary. The increase in the number of cases of GBS in Zika-infected areas is presently statistically too small to draw conclusions regarding travel advisories. Time will tell.
Curtailing travel has enormous economic ramifications. Many Zika-infected countries are poor and rely heavily on tourism. Some health organization have suggested cancelling the upcoming summer Olympics in Brazil, the epicenter of the epidemic. The Games will bring huge numbers of tourists to Brazil, including thousands of female athletes of child bearing age.
Presently, several airlines and cruise lines are offering refunds and other considerations to pregnant travelers and their companions who have booked trips to a destination in Latin America that is affected by the Zika virus. Just provide a doctor’s note confirming your pregnancy when you request a refund.
Should families with infants and young children postpone travel to countries where the Zika virus is currently circulating?
February 1, 2016. Travel with infants and young children to such areas appears to be safe. There are no restrictions. Presently both the US Centers for Disease Control and the World Health Organization recommend restricting travel only for pregnant women and women contemplating becoming pregnant.
What is known about the Zika virus?
The virus has been linked to catastrophic and permanent damage to developing fetuses. Infection leads to small heads (microcephaly), severe brain damage and other developmental issues.
Does the virus infect only pregnant women?
No. Infection occurs at random as the result of a bite by certain mosquitoes that carry the virus. Infants, children and adults are equally susceptible. If by chance a pregnant woman becomes infected, the infection may or may not spread to her fetus. The earlier in pregnancy infection occurs, the more likely there will be damage to the fetus and the more severe the damage is likely to be.
What happens when infants, children and non-pregnant adults become infected?
In the majority of cases there are no symptoms. Only laboratory tests reveal that infection took place. Likely, once infection occurs, that person is immune for life and, for women, future pregnancies will not be affected.
If symptoms do occur, what are they?
Most commonly reported are flu-like symptoms: fever, fatigue, aches and pains, and red eyes, sometimes with pain in the back of the eyes. Symptoms may last for up to a week. The presence or absence of symptoms in the mother is not an indication of whether or not the fetus will be damaged.
Is it unusual for a virus to cause severe damage to fetuses and not to the rest of the population?
It is not unusual. Many viruses have predilections for specific parts of the body or for rapidly developing organs – such as are present in the fetus. The rubella virus is another example. It too may inflict catastrophic damage to the fetus when the mother becomes infected during pregnancy yet causes few, if any, symptoms after birth. In the massive 1964 rubella outbreak, an estimated 50,000 US pregnant women were exposed to rubella, resulting in miscarriages, stillbirths, and 20,000 babies born with heart and brain damage. When the rubella vaccine became available, these problems virtually disappeared.
Is there a cure for the Zika virus disease?
No. Vaccines are in the very early stages of development. It will be many years before they become available.
What can be done to prevent infection?
Precautionary measures against insect bites should be taken seriously. The Zika virus is one of many diseases transmitted by insects. While many such diseases are more common in the tropics (where there are no cold winters to reduce insect populations), mosquitoes and viruses exist everywhere. International travel and climate changes may play an important role in these diseases spreading widely.
The proper use of an effective insect repellent is extremely important. Products containing the following active ingredients are deemed safe for use in infants and in pregnancy. Note that there are different lower cutoff ages for infants. Check labels.
DEET (For infants, use concentrations between 20 and 30%.)
Oil of Lemon Eucalyptus
For further information on repellents and other insect precautions, please see: