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What Oklahomans Need to Know About the Zika Virus

09 February 2016

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News stories have run everywhere in the last couple of weeks, and the images are terribly sad. Recently, hundreds of babies in Brazil have been born with microcephaly, a birth defect that causes malformed brains and abnormally small heads. The lifespan for babies with microcephaly can vary from a few months to 10 years.

According to reporting from YAHOO! News, in Brazil there are now 4,000 suspected cases of babies born with microcephaly, and 400 confirmed. To compare, Brazil had only about 150 cases annually in the last five years.

Many in the medical community, including the World Health Organization and the Centers for Disease Control and Prevention, have strong suspicions (although not yet scientifically proven beyond doubt) that there is a link between the outbreak of the Zika virus in Brazil and babies born with the birth defect there. Doctors think pregnant mothers infected with the Zika virus, from mosquito bites or from sexual contact with their partners, transmitted Zika to their fetuses during pregnancy or around the time of birth.

In light of the continuing media coverage about the Zika virus,  we talked with Dr. David Chansolme, an infectious disease physician at INTEGRIS Southwest Medical Center, and Dr. Courtney Seacat, an OB/GYN at INTEGRIS Health Edmond.

First, a Little About Zika

Dr. Chansolme says the Zika virus has been around for many years. It is a flavivirus similar to viruses like yellow fever, West Nile, dengue and chikungunya, which are all spread through mosquito bites. Dr. Chansolme says only 20 percent of people who get infected with Zika become ill with symptoms, and those who do have only mild, flu-like symptoms such as fever, rash, joint pain and conjunctivitis (pink eye). However, Dr. Chansolme points out that even those 80 percent who are infected without developing symptoms can still pass on the virus to a fetus if they are pregnant, or if they become pregnant while the Zika virus is still in their blood.

People with Zika rarely get sick enough to go the hospital, and rarely die of the infection. The incubation period (time from exposure to symptoms) is about a week, and the virus remains in the blood for about another week. Doctors aren’t sure yet how long it might stay in semen.

Currently, there is no vaccine to prevent, or medicine to treat, Zika infections.

Where Has Zika Been Found?

Prior to 2015, Zika outbreaks had occurred in areas of Africa, Southeast Asia and the Pacific Islands. In May 2015, the Pan American Health Organization issued an alert regarding the first confirmed Zika virus infections in Brazil. Currently, outbreaks are occurring in many areas of the world including South America, Central America and the Caribbean, in at least 29 countries so far. WHO estimates that three to four million people in the Americas will be infected with the Zika virus in the next year.

For a full list of countries that are currently experiencing an outbreak of Zika, check out this report from the CDC.

Has the Zika Virus Hit the U.S.?

As of today, 35 cases of Zika have been reported in the U.S. (most in Florida and Texas; none in Oklahoma). However, none of these cases occurred because someone was bit locally by a mosquito in the U.S. In 34 of the cases, patients had recently traveled to one of the countries currently suffering from the active Zika outbreak, but weren’t diagnosed as being infected until they returned to the U.S. Doctors call these cases “travel-associated Zika infections.” In the other case, a patient had sexual intercourse with someone who had recently returned from Venezuela infected with the mosquito-borne virus. In Puerto Rico and the U.S. Virgin Islands, there have been nine locally acquired cases reported so far, which means local mosquitos there are spreading the virus.

How Will Oklahomans Be Affected?

According to Dr. Chansolme, as of now there have been no reported instances in Oklahoma of travel-associated or locally acquired cases. But he cautions, “An imported case is certainly possible. The type of mosquito spreading the virus is not ubiquitous here, although similar species are.”

Comparing the Zika virus with his experience working on the West Nile virus outbreak in Oklahoma, Dr. Chansolme says, “I don’t think it will be as bad, because the Zika virus doesn’t make people very sick. The West Nile virus kills people, but Zika does not. It looks like there is a strong connection to microcephaly, but that is all for now. Hospitalizations are exceedingly rare with this virus.”

Doctor Recommendations

Researchers are trying to create a Zika vaccine, but that could be years away. Until more is known, Dr. Chansolme and Dr. Seacat (and the CDC) recommend if you are pregnant, or trying to become pregnant, you should avoid traveling where the active Zika outbreak is ongoing. Health officials in those countries are telling women to avoid pregnancy – in some cases for up to two years.

If you do have to travel to a country where Zika is present, the CDC advises strict adherence to mosquito protection measures: use EPA-approved repellent over sunscreen, wear long pants and long-sleeve shirts and sleep in air-conditioned, screened rooms.

As mentioned, although no local Zika cases have been found yet in the U.S. (meaning no mosquitos here are currently carriers), health officials worry that local mosquitos could bite a person infected during travel, which would then turn those mosquitos into local carriers.

If you have recently traveled to one of the countries currently undergoing the Zika outbreak, and you think you might be infected, Dr. Chansolme says, “You should see your doctor first, who will contact the Oklahoma Department of Health for testing instructions.”

An Ounce of Prevention is Worth a Pound of Cure

For now, the best defense is prevention of mosquito bites. Dr. Chansolme recommends eliminating standing water (for example in outdoor buckets and flowerpots) where mosquitoes breed, as well as wearing bug repellant such as Off! (or any repellant that contains DEET).

As for pregnant women, Dr. Seacat says, “The recommendations for pregnant women and the Zika virus are still evolving as we try to learn more about this disease process in pregnancy. Due to the lack of definitive information, it makes management and decision making difficult. It seems right now that prevention is the key – following the CDC guidelines,” she says.

Dr. Seacat says she plans to screen pregnant women who have recently traveled to one of the 29 countries where the Zika outbreak is active (within two to 12 weeks after they return home to Oklahoma), and will evaluate them for any Zika-like symptoms. Women who show virus symptoms will then be tested for the virus, via blood work, and have fetal screenings with ultrasounds throughout their pregnancies.

Dr. Seacat says, “The earlier this is done, the better, so patients can be educated on potential outcomes of an affected fetus, and the rest of the pregnancy can be managed appropriately by a high risk specialist.”

For pregnant women without symptoms of the virus during, or two weeks after travel to the at-risk countries, they too should have fetal evaluation with ultrasounds to evaluate and monitor fetal anatomy every three to four weeks, but do not necessarily need blood work.

As for breastfeeding, Dr. Seacat says there is little evidence of harm by the Zika virus present in breast milk. The benefits of breastfeeding likely outweigh the potential neonatal risks, so she recommends that women continue to breastfeed.