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What You Need To Know: Zika

Dr. Rita Driggers, director of Sibley's Maternal Fetal Medicine department, responded to questions submitted by the public through Facebook as part of our "Ask The Expert" chat, and later elaborated on some of the issues in a short "As The Expert" video. See both below.


 

"Ask The Expert" Chat

Questions submitted through the Sibley Memorial Hospital Facebook page.

I am 5 months pregnant; is it true that there is no risk of microcephaly after the first three months?

We don’t know when in pregnancy Zika infection might cause the greatest harm to the fetus. If the Zika virus behaves as other viruses (such as cytomegalovirus or rubella), the earlier in pregnancy the baby is infected, the more profound the effect. Early fetal loss and fetal death have been noted in association with maternal infection that occurred between 6 and 32 weeks of gestation. Microcephaly appears to be a risk later in pregnancy - some evidence indicates that fetal brain damage can occur late during the second trimester or even early in the third trimester. There are indications that Zika is less dangerous late in the pregnancy. A study from Columbia looked at 1,850 pregnant women who were believed to have been infected with Zika in their third trimester (over 90% of whom had given birth) and found no newborns with apparent abnormalities, including microcephaly, which is encouraging but that study did have some limitations. Since there are still so many unknowns, the recommendation at this time is to protect against Zika infection throughout pregnancy.

I am going on vacation in July to the Dominican Republic with my 1 year old. Is the baby at any higher risk of infection or disease severity from Zika because of the young age?

We do not know the long-term health outcomes for infants and children with Zika virus infection. Therefore, you should protect your child (and yourself) from this disease by taking steps to prevent mosquito bites.

  • To protect your child from mosquito bites, the CDC recommends:
  • Dress your child in clothing that covers arms and legs.
  • Cover crib, stroller, and baby carrier with mosquito netting.
  • Do not use insect repellent on babies under 2 months of age.
  • Do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old.
  • In children older than 2 months, do not apply insect repellent onto a child’s hands, eyes, mouth, or to irritated or broken skin.
  • Never spray insect repellent directly on a child’s face. Instead, spray it on your hands and then apply sparingly, taking care to avoid the eyes and mouth.

Is it known how long the Zika virus lives in your system? Can you get physically sick from the Zika virus?

At this time, the longest known duration of viremia (viruses in the blood) in a non-pregnant female is 11 days. The most common symptoms of Zika virus disease are fever, rash, joint pain, and red eyes. The illness is usually mild, with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.

I am getting married and me and my future husband will be living in the Dominican Republic (he currently lives there and is unsure if he has had Zika, as there seem to be multiple viruses going around). I am currently using birth control, but are there any other precautions that I need to take? 

There is no vaccine to prevent, or medicine to treat, Zika ¬– so at this point, and avoiding infection is the best precaution. Your partner should be taking steps to prevent mosquito bites, to avoid Zika or any other mosquito-transmitted virus. When in areas where Zika virus or other viruses spread by mosquitoes have been reported, use Environmental Protection Agency (EPA) -registered insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens. Sleep under a mosquito bed net if air conditioned or screened rooms are not available or sleeping outdoors. Treat clothing and gear with permethrin or purchase permethrin-treated items (do not apply permethrin products directly to the skin). 

If you’re planning on starting a family, you just need to wait allow any infections to pass.  At this time, the longest known duration of viremia in a non-pregnant female is 11 days. Therefore, the CDC recommends waiting 8 weeks after symptoms to conceive. Zika has been isolated in semen up to 62 days after symptom onset so the CDC recommends waiting 6 months to conceive if the male is infected. If your husband does not have symptoms, you should wait at least 8 weeks to conceive. 

It's also a little concerning that many people can have Zika and never show any symptoms. I don't think there is testing available to see if one has had it. Is this like the chikungunya virus where you only get it once and then you are immune?

It is unknown at this time if Zika infection confers immunity to reinfection. A recent study using monkeys showed that monkeys inoculated with Zika virus made antibodies to the virus within 21 days and these antibodies made the monkeys immune to infection when they were inoculated with the virus again 10 weeks after the initial inoculation. However, we still need evidence that the same immune response happens in humans. 

What insect repellants are safe and what are not safe for pregnant women?

Use Environmental Protection Agency (EPA) registered insect repellents with one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women.

How long after you've traveled to the Caribbean should you hold off on trying to get pregnant? I've heard so many different things. Also should I be concerned about Zika if I'm traveling to Miami during the winter months? 

You should wait 8 weeks to get pregnant after returning from the Caribbean. Miami is not currently a Zika affected area.

Is this disease seasonal? What are the crucial times of the day should I worry about mosquitos & are all mosquitos carrying this disease? 

Zika virus is spread mostly by the bite of an infected Aedes species mosquito. These mosquitos are aggressive daytime biters, but they also bite at night. Zika can also be spread by a man to his sex partners. The disease peaks correlate with mosquito season (which varies by location). All mosquitos aren’t carrying the virus, but to be safe you should treat all mosquitos as though they are.  

How long does it take to show signs of the disease?

The incubation period for Zika virus is unknown, but if it is similar to that of other mosquito-borne flaviviruses, it is expected to be generally less than 1 week. The most common symptoms of Zika virus disease are fever, rash, joint pain, and red eyes and these symptoms usually present within 3 to 10 days. The illness is usually mild with symptoms lasting from several days to a week.  

I know that women who are pregnant and contract Zika have a chance of having a baby with problems. But if a woman gets infected with the Zika and then gets better, does that mean she will always have a chance of having a baby with defects?

No, the baby is only at risk if you have the Zika virus in your blood while you are pregnant. The CDC recommends waiting 8 weeks after infection before attempting to become pregnant. It’s not yet known if an infection gives people immunity to Zika later in life.

I’m a woman who isn’t pregnant and don’t have plans to start a family. Is there any reason I shouldn’t travel to South America or the Caribbean? 

The most common symptoms of Zika virus disease are fever, rash, joint pain, and red eyes. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon. As long as you wouldn’t be too inconvenienced by these mild symptoms, feel free to travel!

Where did Zika come from so suddenly? Is it really something to be concerned about, or is the media overblowing the threat?

The Zika virus is not new–it was first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations but because the symptoms of Zika are mild and similar to those of many other diseases, many cases may not have been recognized. The Zika virus epidemic occurred in Brazil in early 2015 and has spread rapidly in the Americas since. Available data from this most recent outbreak supports that prenatal Zika virus infection causes microcephaly and other serious brain anomalies.