Q&A: What women want to know about Zika
As the Northern Hemisphere enters a second summer with the possibility of a Zika virus outbreak at any time, many women are worried about the effects the virus may have on their pregnancy plans. With the likelihood of more cases of local transmission in Texas, it’s important for women, especially, to know the facts of how Zika can affect them, their unborn children and their infants. Carrie Byington, MD, dean of the Texas A&M College of Medicine and one of the physicians responsible for the health of Olympians during the 2016 games in Rio de Janeiro, Brazil, the country at the epicenter of the Zika outbreak, answers actual questions women asked about the virus and how they can protect themselves and their families.
Q: What makes the Zika virus different?
A: Zika is a virus spread by both the mosquito and by sexual transmission. This is the first time in history that a virus has been recognized with both these forms of transmission. Therefore, the virus is of extreme interest to scientists. The other important feature of the Zika virus is that it passes from a mother to her unborn child and is one of the few known viruses able to cause a devastating congenital syndrome. The Zika virus syndrome is even more severe than the congenital rubella syndrome which was responsible for an outbreak in the 1960s.
Q: Why have we never heard of Zika before?
A: It’s been around for years, mostly in wild places, away from metropolitan areas, but now we travel everywhere. We have a global society and these diseases can spread so much more quickly as a result. Also, because it doesn’t usually cause complications in adults, it wasn’t considered a pathogen of major concern. That changed once many, many people started becoming infected and we saw the consequences to unborn infants. There will be other viral outbreaks like Zika, like Ebola. I cannot tell you what the next new virus will be or when it will emerge, but I can promise that there will be another one. For that reason, I consider public health and surveillance capabilities integral to homeland security.
Q: I’ve heard that there are other ways, besides sexual transmission and mosquito bites, that I could be infected. What are they?
A: We know that the virus can be passed via laboratory exposure to scientists who are studying Zika. To date, there have been no confirmed transfusion-transmission cases of Zika virus in the United States, but cases of Zika virus transmission through platelet transfusions have been documented in Brazil. In addition, there was a case in Utah of a man who went to Mexico and was infected with Zika and later died from the virus. That in itself was highly unusual—the virus usually isn’t fatal in adults—but the man’s adult son, who was helping to care for him, was also infected, even though he hadn’t traveled. Nobody expected that to happen—we were looking for the virus at the borders, not in Utah. It’s still considered the mystery case in the United States, but it seems that in the right circumstances, the virus can likely pass to another person through casual contact, perhaps through contact with tears or saliva.
Q: Where do Aedes mosquitos live?
A: Texas is a good home for these mosquitos: we have hot weather, we have humidity, and we have lots of travel. The other places where these mosquitos live are where you might expect and include most of the Southern United States. However, if you look at a map of their habitat, there is a spot in Colorado all by itself, where you might not expect the mosquitos to be. That is home to a facility that receives used tires from all over the world for destruction, and it is a hotbed of Aedes mosquitos. Our world is completely connected, and that’s why it’s so true that an infectious disease anywhere can affect everyone.
Q: How do I recognize the type of mosquito that carries Zika?
A: Zika is spread by the Aedes mosquito, which can be identified by its size—it’s a little bit bigger than other types of mosquitos—and by its markings. It’s been called the Asian tiger mosquito due to its stripes. If you look around your homes and see this type of mosquito, you know you need to get rid of it.
Q: How do I recognize Zika symptoms?
A: It’s important to know that for 80 percent of people infected with Zika, there are no symptoms. For those who do show signs of infection, the symptoms can be non-specific and similar to other infections. The primary symptoms are fever, red eyes, joint pain and a rash. With Zika, unlike many other viruses that produce a rash, the rash itches. That is important to know if you’re coming home from a Zika-endemic area. If you have fever and a rash that itches, you need to talk to your health care provider and ask for a Zika test.
Q: What medications should I take to feel better if I’ve been infected with Zika?
A: There are no effective treatments for Zika virus. All we can do is try to treat the symptoms, such as fever, and help people to feel better as they recover. Symptomatic care includes rest, plenty of fluids and the use of anti-pyretics like acetaminophen to reduce fever. Because you can have Zika and other mosquito-borne illnesses like dengue at the same time, it is important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen because you shouldn’t take them with dengue virus infection, as they increase the risk of hemorrhage.
Q: Will I experience long-term consequences of Zika infection?
A: For most people, if they experience any symptoms at all, they will begin to feel better in a week or so. Severe complications in adults are very rare. If they don’t become pregnant during that small window of time, there will likely be no long-term consequences. Furthermore, we think that once you’ve been infected, you will likely be immune from the virus for many years, or possibly even for your whole life, but we don’t know that answer for sure yet.
Q: When I come home from traveling to a Zika-endemic area, what do I need to remember?
A: Because mosquitos become infected by biting someone who has Zika, if there is any chance that you’re infected, you need to continue to use mosquito repellant after you return home to help protect others. Remember, 80 percent of people with Zika have no symptoms. Keep wearing mosquito repellant for at least three weeks after you come home to keep mosquitos from biting you and potentially transmitting Zika to another person.
Q: What stage of pregnancy is the fetus most at risk for Zika?
A: Zika can infect the fetus at any stage of pregnancy, though we believe the greatest risk is in the first and second trimesters. The virus enters into the fetal brain and spinal cord and causes the destruction of these tissues, and this is dangerous during any part of development. About 10 percent of babies infected before birth will be affected with severe congenital Zika virus syndrome and will have life-long developmental problems. Other infants may be born with less severe abnormalities, and we still don’t know much about the long-term outcomes of infants that appear normal at birth, like the recent case of the infant in Nueces County, Texas, whose mother traveled to an endemic area and was diagnosed with Zika during her pregnancy. They could experience effects that we just don’t know about yet.
Q: So, should I wait until after the summer is over to become pregnant?
A: The virus can live in the testes for perhaps as long as six months, and a man can have no symptoms but still be able to pass Zika to his sexual partners. That’s why it is so important to wait a sufficient period of time after either of you might have been exposed to Zika before you try to become pregnant. However, if you are living in an area where the virus is endemic, it’s impossible to simply say that it’s been six months since either of you have traveled to a place where you might have been infected. The timing of pregnancy is a very personal decision that every woman considering pregnancy should discuss with her health care provider. Pre-conception testing for Zika virus may be prudent for those at highest risk.
Q: What happens if young children are infected with Zika?
A: The virus can cause meningitis in infants, and we don’t know if there are long-term effects. Therefore, it’s important to be especially cautious and perhaps avoid traveling to Zika endemic areas with children younger than 2.
Q: When can we expect a Zika vaccine?
A: There are currently many vaccine candidates being developed, and several have entered clinical trials. We need a Zika vaccine to protect future generations from Zika infection. The best hope for a vaccine will be from research, much of it supported by the National Institutes of Health or other federal agencies. That is one reason why supporting those funding agencies is so important for the health of our nation.
Carrie L. Byington, MD, dean of the Texas A&M College of Medicine, senior vice president of the Texas A&M University Health Science Center and vice chancellor for health services at The Texas A&M University System, is a pediatric infectious disease specialist, and she was the chair of the Infectious Diseases Advisory Group for the US Olympic Committee formed to study the long-term effects of the Zika virus, should Olympians contract it during the 2016 games in Rio de Janeiro, Brazil. Byington and her team counseled about 1,900 people about the virus and enrolled about 1,000 of them in the study of those potential long-term effects.