What is the Zika Virus and how can you get infected?
The Zika virus was first reported in South America in 2015, and has since spread to many parts of the world. Like other viruses in the same “family”, it is mainly spread through the bite of an infected mosquito. Infected mosquitos now found in many countries, including several U.S. territories (see below for travel information). Recent evidence also points to transmission through unprotected sexual intercourse (including vaginal, anal, oral or sharing of toys) with an individual who is infected. Additionally, there have been rare cases of blood donors who tested positive for the virus after donating their blood, leading to a theoretical risk of transmission in those who receive unscreened blood transfusions.
What are the symptoms and potential health problems?
Most people who get infected with the Zika Virus won’t experience any symptoms, or will have mild symptoms typical of a common viral infection. If symptomatic, individuals are most likely to experience a few days of low grade fever, body rash, conjunctivitis (red eyes), and pain in their muscles or joints. Unless your immune system is already compromised, it is rare for people to need hospital care after getting infected. The danger, however, is for women who are pregnant. The virus can travel in the blood across the placenta, and cause serious complications for fetal development.
If a pregnancy gets affected by the virus, outcomes can range from minimal to serious complications. When serious complications occur, the virus tends to impact cranial development more than other parts of the body, causing issues such as microcephaly (small head size), impaired brain development, and problems with hearing or vision. It has also been reported that fetal growth can be compromised. For these reasons, it is crucial that women who either plan to get pregnant or are currently pregnant avoid all risks exposing themselves to potential infections.
How long should you wait to try and get pregnant after potential exposure?
If you are already pregnant and believe you have been exposed to the Zika virus by mosquito bite or sexual intercourse, you need to see your obstetrician as soon as possible to get tested. For individuals trying to conceive or planning on conceiving soon, the Center for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) have issued guidelines on how long to wait after possible exposure.
For women who have traveled to an area with known Zika exposure, it is advised to wait at least 2 months before trying to conceive, regardless of whether you have symptoms or not. For men, it is advised to wait at least 6 months before trying to conceive. The reason for the discrepancy is that the virus has been shown to live in semen for extended periods of time and can be passed through sexual intercourse.
To date, there are no reports of passing the virus through breastfeeding, so all women are encouraged to breastfeed, even in the setting of having a possible Zika infection.
There are currently no instances of viral transmission through assisted reproductive technology, such as using In-vitro fertilization, however, it is still theoretically possible. For this reason, even if you are planning on using IVF, you should abide by the above guidelines before attempting to conceive.
Zika Testing and Treatment
Testing for the Zika virus can be done by your primary care physician, or your obstetrician if you are pregnant. There are currently two types of recommended testing methods, one is a blood test and the other is a urine test. As a rule, any pregnant woman should be tested if they have traveled to an area with known Zika transmission, or have had sexual exposure with a partner that’s been to an area of zika transmission, regardless of whether symptoms are present. All pregnant woman should also be screened at each prenatal visit for possible exposure. Additionally, non-pregnant women and all men with Zika exposure AND Symptoms should be tested. If asymptomatic however, testing non-pregnant woman and men is not currently recommended. For more information and resources on testing, you can visit the CDC webpage: https://www.cdc.gov/zika/symptoms/diagnosis.html.
Travel Precautions and Transmission Zones
When researching areas that have Zika Transmission, it is important to know the difference between “local transmission” and “travel-associated” transmission. Areas with local transmission are known to have Zika infected mosquitos which can pass the virus to any individual it bites, and should be avoided by any pregnant woman or couple planning on conceiving within 2-6 months. Travel-associated transmission areas are states/countries where individuals have tested positive after obtaining the infection elsewhere, and are generally safe to travel to.
As of March 2017, local Zika transmission has been reported in only a few regions of the United States. These regions are South Florida, Brownsville Texas, Puerto Rico, and the U.S. Virgin Islands. Travel to any of these regions is not-recommended if pregnant. For more detailed and up-to-date information including both U.S. and International transmission areas, you can visit the CDC website’s advisory page: https://www.cdc.gov/zika/geo/index.html.
What can you do to prevent Zika infection?
Unfortunately, there is no vaccine available to protect you from infection. If avoiding exposure to the Zika transmission zones is not possible, you should use strict precautions to try and minimize your exposure. Use of EPA-registered insect repellent should be used, ideally with any of the following active ingredients: DEET, Picaridin, IR3535, OLE, PMD, or 2-undecanone (CDC). Wearing long sleeves/pants and sleeping in a house with screens on all windows can also aid in minimizing your risk of being bitten. In addition to minimizing mosquito bites, it is important to remember to use condoms when engaging in sexual intercourse, both while in at-risk areas as well as when arriving home, until you have been screened for the virus by a physician (refer to above recommendations on who should be tested).
For more information or any further questions you may have regarding the Zika Virus, excellent resources can be found on both the CDC Website as well as the ACOG Practice Advisory on Zika Virus, from which the above information was obtained.