Printed in the New Hampshire Union Leader Medical Journal, August 21, 2016
Throughout 2016, Zika virus has become a growing health concern, and with the recently reported cases in Florida, the need for education has increased. Zika virus is spread primarily by the bite of an infected Aedes aegypti or Aedes albopictus mosquito. In addition, Zika can also be sexually transmitted, even if the infected partner shows no symptoms. While most people who are infected never have symptoms, the time from exposure to the appearance of symptoms is 3-14 days. For those who are symptomatic, the resulting mild illness includes fever, rash, joint pain and red eyes and will resolve completely. While the exact transmission rate for pregnant women to their unborn babies is unknown, initial estimates are up to 13%. In these cases, Zika is known to cause pregnancy loss, poor fetal growth, and severe birth defects resulting in eye and brain abnormalities, including microcephaly. There is no safe time in pregnancy, although the majority of resulting birth defects likely occur from first trimester infections. Following delivery, small amounts of Zika have been reported in infected mothers’ breast milk; however, it is unlikely to be harmful so breastfeeding is still recommended.
While vaccines are in development, the best way to avoid Zika exposure is to avoid the mosquitoes that carry the virus. Women who are trying to conceive or who are currently pregnant are strongly advised to avoid areas with reported virus transmissions. As of early August, there were 16 known cases of Zika virus that were acquired from local mosquitoes in Miami, FL. In this same timeframe, there were 8 cases of Zika virus diagnosed in NH, all of which were acquired internationally. Since Zika is sexually transmitted, any partner of a woman who is pregnant or could become pregnant should use condoms. Women who test positive for Zika virus should wait at least 8 weeks and men with Zika should wait at least 6 months after symptoms began to try to conceive. Even if no infection is known, couples should wait at least 8 weeks after traveling to an area where Zika is active prior to attempting conception.
The Center for Disease Control recommends Zika testing for anyone who is pregnant or considering conception and traveled to the Miami area after June 15 or to other Zika-affected areas. All pregnant women should be screened for potential Zika exposure at every prenatal visit. For women currently living in areas with reported Zika, preventing mosquito bites is critical to minimizing the chances of infection: wear long sleeves; use pregnancy-safe insect repellants, and/or use permethrin-treated clothes/shoes. The US Environmental Protection Agency maintains a list of safe, effective insect repellants on their website.
Discuss any recent or upcoming travel plans with your OB/GYN who may advise adjusting your travel plans to avoid unnecessary Zika exposures. Some airlines may even reimburse your ticket. Remember that even if you don’t travel, your partner can bring the virus home, so use a condom. The CDC maintains an updated list of locations affected by Zika and where to avoid travel if pregnant or trying to conceive on their website. Similarly, there are guidelines and information on the American Congress of Obstetricians and Gynecologists website. Links referenced within this article are published on our website and Facebook page.
Dr. Caroline Scoones and Dr. Emily Amarosa are OB/GYNs at Harbour Women’s Health located in Portsmouth, NH. For over 50 years, our practitioners have provided compassionate, experienced care for high- and low-risk pregnancies as well as the full range of gynecologic services. We are dedicated to providing personalized, progressive care throughout each stage of a woman’s life. Our practice offers OB/GYN physicians, a fellowship-trained Urogynecologist, North American Menopause Society (NAMS) certified practitioners, and Women’s Health Nurse Practitioners on staff to care for patients. Call 603-431-6011 today to make an appointment and experience a different kind of care.
In addition to the information presented in this article, please visit the Centers for Disease Control and Prevention and the ACOG Zika Tool Kit for regular updates on the Zika Virus.