Like a lot of couples, my wife and I have waited to start a family until the time was right for us, which just so happens to be now-ish.  Unfortunately the right time for us has coincided with the spread of the Zika virus in North America, a virus that shows an association between infection with it during pregnancy and an increased risk of microcephaly (reduced brain/head size) in newborns. The Zika virus is not a new virus from a historical perspective, however, the newly accepted correlation with microcephaly seems to have given the virus a significant amount of media attention.

For any expectant parent – or couples planning on getting pregnant, like my wife and me  – the possibility of a Zika infection is terrifying.  My wife and I are the kind of people who like to arm ourselves with information, so let’s dive into Zika virus infections and take a look at some facts and figures.

A Brief History of the Zika Virus and Flaviviruses

Zika was first identified in Uganda in 1947. Since then, it has spread from Africa to Southeast Asia, then the South Pacific, South America, and now to the Caribbean. In 2013, there was a pretty intense outbreak of Zika in French Polynesia (located in the South Pacific) along with concurrent outbreaks of Dengue Fever. Then, through the travel of infected persons from the South Pacific to Brazil, the virus arrived in the Americas. Both Zika and Dengue are viruses in the Flaviviridae virus family, which includes the West Nile Virus, Japanese Encephalitis Virus, and Yellow Fever Virus. Of all of these, public health departments currently have licensed vaccines against Yellow Fever, plus a Dengue Virus vaccine in the later phases of development (with some promising results).

Flaviviruses are spread from human to human by mosquitoes, which carry the virus but are not affected by it. Zika is spread in this way, by the Aedes species of mosquito specifically.  These mosquitoes have quite the range, as you can see from the global distribution on the adjacent map:

Distribution of aedes albopictus mosquitos.

Distribution of aedes albopictus mosquitos, from “The invasive mosquito species Aedes albopictus: current knowledge and future perspectives” by Bonizzoni, Mariangela et al.

Aedes mosquitoes are the same culprits that spread Dengue Virus, West Nile Virus, Chikungunya Virus and Yellow Fever. That last one is important to note, and I’ll explain why in a moment.

As you can see from the map above, there is clearly a probability that Zika could make it to the United States via mosquito transmission. There is also a probability that it will spread in the United States, given the large distribution of this particular mosquito species. However, compared to other parts of the world, this second probability is minimal. It is so small, that other precautions need to be prioritized to avoid other viral infections or chemical exposures that could hurt a developing fetus or cause microcephaly.

In fact, by the time of this post, several cases of Zika have been reported in the United States, though all but one were travelers who have been infected abroad, and then entered the country while ill with the virus. The lone infection contracted on US soil is a extremely rare scenario of an individual contracting the virus through sexual activity, which is so rare, it has only been documented one other time in history. Nevertheless, there are sustained outbreaks in South America, and recent infections contracted in some Caribbean islands, Mexico, and Central America, and that is where the travel warnings from CDC are focused.

What You Need to Know About Zika Virus Infections

According to CDC, a Zika infection is characterized by a fever, rash, joint pain, and/or conjunctivitis [irritation of the membrane inside the eyelid], for individuals who have traveled to areas with ongoing transmission in the two weeks prior to the illness’ onset. In general, the disease is mild, and while there is no cure for Zika infections, patients usually recover on their own with supportive care. Like any other viral infection, there may be complications, especially in the very young, the very old, or those with compromised immune systems due to preexisting conditions or current drug therapies.

If a pregnant woman has a history of travel to any of the countries listed in the Zika alert by CDC, it is recommended that she be tested for exposure/infection regardless of the presence or absence of symptoms. The fetus should be monitored for the presence or development of microcephaly. And of course, symptomatic women should have their symptoms managed appropriately and as needed by a healthcare provider.

So we know that Zika is a virus that is spread by a mosquito breed that has a pretty wide range. We know that there is an ongoing outbreak in Brazil, and that there is an observed association between infection during pregnancy and an increased risk of microcephaly in a newborn child. And we know that CDC has recommended that mothers-to-be or those planning on getting pregnant should avoid certain countries where the mosquito and the virus are present, and there is good evidence of ongoing transmission.

The Risks and Mitigation Plan in the United States

What about the risk here in the United States?

Remember that bit I told you about Yellow Fever? Yellow Fever is very rare in the United States, with all cases of it reported in travelers. This is because there was a concerted and intense effort since the 1940s to eliminate mosquito-borne infections (like Yellow Fever and Malaria) in the US. These efforts included elimination of mosquito breeding grounds through the use of insecticide or by draining swamps. (Mosquitoes reproduce in stagnant water.) Houses and buildings started using screens to keep out flying insects, and installing air conditioning that reduced the need to open windows to regulate temperatures. Finally, coordinated public health surveillance efforts identified infected persons, treated them, and identified and eliminated possible sources of infection.

By most standards, the elimination of Yellow Fever and Malaria in the United States was a great success for public health. Almost 60 years later, we rely on the same successful techniques to keep West Nile Virus infections at bay, and we will likely rely on them to keep Zika from establishing itself in the contiguous United States as well as Alaska and Hawaii. Like West Nile has taught us, there can and will be cases of Zika in the United States, so we should be ready for that reality and we should do our part to stay safe.

Protect Yourself and Your Family

There are recommendations from CDC on the use of mosquito repellents and for avoiding mosquitoes and other insects that carry diseases. For example:

Click the image to download the CDC's Mosquito Bite Prevention Guide.

Click the image to download the CDC’s Mosquito Bite Prevention Guide.

  • Use repellent if you’re going to be in an area where mosquitoes are present (look at the map, or ask the locals)
  • Use long sleeves and pants to avoid being bitten in the arms and legs
  • Avoid being out in the open early in the morning or in the evening, when mosquitoes are most active.
  • Avoid sleeping with the windows open
  • Finally, eliminate any stagnant water around your house. If you keep a cistern for rain water, make sure it is covered with a screen or cloth to keep mosquitoes from depositing their eggs in the water

In addition to these, I recommend taking a proactive approach. My wife and I had a serious discussion about our plans to be parents in the next year or so. We went through a list of things, including many “What if?” questions. The question came up on what to do if she – for one reason or another – developed Zika, measles, German measles, chicken pox, the flu, or any other infection that could lead to fetal harm. We discussed the different options, and she discussed them with her healthcare provider as well. It’s a conversation that all couples should have, in my opinion, because we can do absolutely everything right but still be that unlucky couple who have to deal with something like Zika, or worse. So it’s best to have a plan.

I stress, if you are pregnant, or planning on becoming pregnant, and you absolutely must travel to an area where any of these diseases is active, have a talk with your healthcare provider.

Follow any instruction on how to avoid mosquitoes, and make sure that you are up-to-date on your immunizations. In the last few years, the United States saw a resurgence of measles, a disease that can have consequences just as serious as Zika. There are also plenty of cases of West Nile Virus. Although it has not been associated with fetal abnormalities, the possibility of it doing so is very real as it is also a Flavivirus that can cause encephalitis (inflammation of the brain).

In the next few weeks, the World Health Organization and other agencies will convene experts from different fields and come up with more recommendations and plans on dealing with Zika. While they probably should have convened and acted in 2013 during the French Polynesia outbreak, or in 2014 at the start of the Brazilian outbreak, it’s a good sign that there is some international collaboration on dealing with Zika now rather than later. So stay tuned to CDC’s website for updates on Zika, and – if you haven’t done so already – develop a good relationship with your healthcare provider in order to discuss Zika or any other concerns you may have before, during, and after pregnancy.


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Categories: Infectious Disease + Vaccines, Pregnancy, Birth + Family Planning