Health Brief on the Zika Virus

By: Caroline Stella, MD

Caroline Stella, MD and Diana Adams, MD, Maternal Fetal Medicine specialists at Greenwich Hospital provide the following information regarding the Zika virus and its impact upon pregnancy.

Zika Virus Introduction: At the present time, little information is known regarding the impact the Zika virus has upon pregnant women and their fetuses. However, what is currently known and most disturbing, is that pregnant women infected with the virus often deliver babies afflicted with severe disabilities. Moreover, since information regarding the Zika virus is constantly evolving, recommendations as how to best reduce the risk of maternal virus infection and manage potential complications during pregnancy will most likely change in the days and weeks ahead.

Zika Symptoms: Zika virus symptoms are usually mild. In fact, up to eighty percent of those who are infected with the virus, do not get sick or have any symptoms. Symptoms tend to occur two to seven days after an infected mosquito has bitten the person and may include a light fever, rash, joint pain, and pink eye.

Zika and Pregnancy: The Zika virus can be extremely dangerous for pregnant women’s babies. Many women infected with the virus during their pregnancies have been giving birth to babies with smaller heads than expected, i.e., microcephaly. Unfortunately, babies with microcephaly have a wide range of problems, such as developmental delays, intellectual disabilities, seizures, and hearing and vision loss.

Transmission/Exposure: Expectant mothers can contract the Zika virus after an infected mosquito bites them. The mother can then pass the virus on to the fetus, and as a result cause the baby to be born with microcephaly. Transmission of the virus can occur in any trimester. However, first trimester transmission is most concerning, since earlier exposure to the virus may have more of an impact on the baby’s development.

Sexual Transmission: Although not thoroughly investigated, there are reported cases of the Zika virus transmitted through sexual contact from an infected male. Hence, male partners of pregnant women who recently traveled to affected areas, should refrain from sexual relations or use protection (condoms) while having sex for the remainder of the pregnancy. If you are pregnant or have recently conceived, and your partner has recently traveled to a Zika affected area, it is advisable to undergo testing. Currently, it is unknown if females can transmit the virus via sexual contact.

Blood Transmission: The Zika virus can also be transmitted through transfusion of blood from infected donors. Although there have been multiple reports of cases in Brazil, there have not been any confirmed blood transfusion transmission cases in the United States. However, the risk to the U.S. blood supply could change depending on how many Americans become infected with the virus. The Food and Drug Administration recommend that if you have or may have the virus, wait at least four weeks before donating blood.

Is the Zika virus Contagious: Since the virus is not airborne, the threat of getting the virus from standing close to an infected person is nearly non-existent. Additionally, the virus is neither foodborne nor waterborne. The virus requires a vector – a mosquito – to pass it to humans.

Infection and Future Pregnancy/Conception: There is evidence that the Zika virus remains in an infected person’s blood for about one week. However, there have been cases of the virus remaining in other bodily fluids – (i.e., semen) longer. Hence, to ensure that prior exposure to the virus does not impact a future pregnancy, those who have recently traveled to affected areas, should wait at least two months before attempting to conceive

Treatment/Prevention: Currently there is no antiviral treatment or medication to treat the Zika virus, nor is there a vaccine to prevent infection. Like other viruses, it is advisable that if you are pregnant and become affected with the virus: rest, drink plenty of liquids, and take pain relievers.

Acutely Affected Areas: The Zika virus has become a major health crisis in many tropical and subtropical areas of Central and South America. In Brazil, more than 4,000 babies were born with microcephaly during the past three months. As a result, health officials in many Zika affected areas advise women to postpone pregnancy until the epidemic subsides. In the United States, all of the reported cases of the virus connect to travel abroad. However, United States health experts are worried that if a mosquito does bite an infected person, an outbreak can occur here.

Restrict Travel: Since there is no effective vaccine against the Zika virus, the most effective way for pregnant women to prevent exposure is limiting their travel to acutely affected areas. In fact, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all pregnant women and those wishing to become pregnant delay travel to areas where the virus is active – South America, Central America, Mexico, and the Caribbean, including Puerto Rico, Aruba, and the U.S. Virgin Islands.

Required Travel Guidelines: If pregnant women and those trying to conceive cannot avoid or must travel to an affected area, special care must be taken to prevent and avoid mosquito bites, such as always wearing long sleeves, shirts and pants; applying insect repellent, as directed on the product label; and staying in screened-in or air-conditioned rooms.

Zika Testing: Since Zika virus symptoms do not manifest in the vast majority of infected pregnant women, the CDC recommends testing and screening on all pregnant women or those whom might have conceived during their travels to or residence in Zika virus-affected area. It is critically important that such women inform their obstetrician/gynecologist, whom can refer to a Maternal-Fetal Medicine specialist for further testing and management.

In addition, for women who recently conceived and traveled to a Zika affected area, screening should depend on how long after traveling conception occurred. However, since many pregnant women do not know exactly when conception occurred, it is prudent to test all women who have become pregnant subsequent to traveling and/or residing in affected areas.

There are several ways to determine if a pregnant woman has contracted the Zika virus. The first line screening for those suspected of having exposure to the Zika virus consists of a blood test. In most cases, the recommendation is to perform an ultrasound and/or amniocentesis to test for fluid around the fetus. Additionally, Zika virus testing is advisable for babies born to mothers with positive or inconclusive test results for Zika virus. It is also advisable to test infants born with microcephaly or intracranial calcifications whose mothers traveled or resided in areas with high Zika virus transmission levels while pregnant.

If you have questions, please contact the Greenwich Hospital Maternal-Fetal Medicine Team:
Our team consists of Dr. Caroline Stella and Dr. Diana Adams, board-certified Maternal-Fetal Medicine Specialists. They provide sonographic diagnosis and follow-up of Zika-related fetal complications. Heather Kamen, a board-certified genetic counselor, provides counseling on Zika virus and related testing. The Greenwich Hospital Perinatology suite offers amniocentesis for Zika testing onsite. Zika serum testing occurs at the Greenwich Hospital laboratory. Specimens go to either the Connecticut Public Health Laboratory in Rocky Hill or the New York State Department of Health Wadsworth Laboratory.

For any questions, please call our office at 203-863-3674.

References: 
http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak
http://www.who.int/mediacentre/factsheets/zika/en/

Greenwich Hospital is a member of Yale New Haven Health. Greenwich is a 206-bed (includes 32 isolettes) community hospital serving lower Fairfield County, Connecticut and Westchester County, New York. It is a academic affiliate of Yale School of Medicine. Since opening in 1903, Greenwich Hospital has evolved into a progressive medical center and teaching institution representing all medical specialties and offering a wide range of medical, surgical, diagnostic and wellness programs. Greenwich Hospital is recognized throughout the healthcare industry as a leader in service and patient satisfaction excellence. Greenwich Hospital has the prestigious Magnet designation from the American Nurses Credentialing Center, the nation’s highest honor of nursing excellence. www.greenwichhospital.org