By
Robert Hatcher, MD, MPH
Professor Emeritus of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta
Zika infections are viral infections spread from an infected person by a mosquito called the Aedes aegypti mosquito. For the Zika infection to gain a foothold in an area of the world, it must be an area that sustains Aedes aegypti mosquitoes, which is the case for all countries in our hemisphere, except for Canada, which is too cold, and Chile, which is too cold and too dry.
Zika is a disease receiving a great deal of attention. News in the first week of February 2016 alone included the following:
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The World Health Organization (WHO) has warned that the Zika virus is spreading explosively. Public health experts from around the world assembled in Geneva on Feb. 1, 2016, to discuss approaches to the Zika virus. A Public Health Emergency of International Concern was issued by the WHO following the meeting.1
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Spread of Zika virus from Africa to Brazil may have occurred at the time of the 2014 World Cup in Brazil.2
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In 2016, there may be 4 million people infected with this virus.
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There have been several cases of sexual transmission of the Zika virus, and spread of this virus by transfusion and transplantation cannot be ruled out.
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Leaders with the Pan American Health Organization believe that Zika eventually will infect people in our entire hemisphere except Canada and Chile. This predicted spread includes southern U.S states, including all the Gulf Coast states and Georgia; Central and South America; the Caribbean; and the West Indies.3
Most people infected with the Zika virus have minimal symptoms, and 80% have no symptoms. The symptoms people may develop include:
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mild fever;
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sore, red eyes (conjunctivitis);
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headache;
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joint pain;
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infrequently, temporary paralysis and peripheral neuropathy (Guillain- Barré syndrome).
PREGNANCY AND ZIKA
The major problem is when the Zika virus infects pregnant women. Then the problem is not so much for the woman herself, but for her baby. In the Perambucca area of Brazil, Zika infections in pregnant women led to fetal abnormalities in 300/100,000 infected pregnant women. This rate is three times the rate of fetal abnormalities caused by rubella (German measles) infections several decades ago. Since 2015, a possible association has been observed in Brazil between the unusual rise of Zika cases and cases of microcephaly (head size of newborn of less than 31.5 to 32 cm at birth).
German measles also caused birth defects, including microcephaly, several decades ago. Then, a vaccine against German measles was developed by Stanley Plotkin, MD, emeritus professor at the University of Pennsylvania Medical School. Plotkin recently observed that he sees no obvious problem in developing a vaccine; however, cost for licensing such a vaccine would run $500 million.4 Yet it is difficult to calculate the cost and sadness caused by a serious neurological problem in babies born to woman infected by the Zika virus.
ADVISE ON CONTRACEPTION
If traveling to an area where there are Zika infections, women should postpone becoming pregnant by using very effective contraception. Laura Riley, MD, an expert in the field of high-risk pregnancies at Massachusetts General Hospital in Boston, has said that if women do become pregnant and have been in an area where there are Zika infections, they will face blood tests, monthly ultrasounds to determine if their babies have microcephaly, much anxiety, and, in some cases, consideration of having an abortion.
“Why would you ever sign yourself up for that?” said Riley. “There’s enough in life to worry about. I wouldn’t add that to my list.”5
What are some tips to approach 100% contraceptive effectiveness and zero unintended pregnancies? Patients and their providers can consider the following options:
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Use abstinence — no sexual intercourse.
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Use outercourse — also 100% effective.
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Use the contraceptive implant Nexplanon, which is the most effective of all contraceptives. It is more effective than male or female sterilization, or either of the two available intrauterine devices.
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if combined oral contraceptives are chosen, they should be taken continuously (no hormone-free days).
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If the contraceptive injection is chosen, it should be administered every 13 to 15 weeks.
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Whatever contraceptive is selected — the implant, pills, or shot — use a condom for every instance of coitus.
REFERENCES
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World Health Organization. WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Accessed at http://bit.ly/1STUtYL.
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McNeil DG, Romero S, Tavernise S. How a medical mystery in Brazil led doctors to Zika. New York Times; accessed at http://nyti.ms/1SEwL3o.
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Pan American Health Organization. PAHO statement on Zika virus transmission and prevention. Accessed at http://bit.ly/1Lx8q7B.
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Sternberg S. Zika disease in pregnant women can be devastating. US News & World Report; accessed at http://bit.ly/1RKUfDs.
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McNeil DG, Saint Louis C, St. Fleur N. Short answers to hard questions about Zika virus. New York Times; accessed at http://nyti.ms/1PVmfOi.
