In the past two months since our last post, the field of research and public health attention surrounding the Zika virus has expanded dramatically. In February, the correlation between Zika virus and the birth defect microcephaly was only being postulated. In March, the New England Journal of medicine published a study which included 42 pregnant participants from Rio de Jainero with laboratory confirmed Zika infection. This study confirmed Zika infection during pregnancy to be associated with severe outcomes including fetal death, placental insufficiency, and damage to the central nervous system (including microcephaly). Likewise, according to the CDC, the predicted connection between sexual transmission and Zika virus has been confirmed through further studies. The cultural and political climate surrounding fertility regulation continues to complicate women’s ability to receive appropriate preventative care, including the recommendations to avoid pregnancy without the contraceptive infrastructure to support the population in this goal.
On April 11, 2016, I attended the Consortium of Universities of Global Health Conference, where a panel of leading experts discussed updates in Zika research and next steps for public health response. Among these experts were Dr. Catherine Spong, the acting director of the National Institute of Child Health and Human Development (NICHD) and Dr. S. Patrick Kachur, the acting principal deputy direction of the Center for Global Health of the US Centers for Disease Control and Prevention (CDC). Both of these individuals highlighted the CDC’s high commitment to finding solutions for this epidemic, and also encouraged governments and clinics to implement already known methods to prevent transmission. This panel discussed many of the following points, and discussed ways to advance Zika research and intervention to the forefront of public health focus.
What we know now
- Confirmed Zika cases in US states: 388 including 33 pregnant, either related to travel or sexual transmission.
- Confirmed link with Guillian-Barre Syndrome, where a person’s own immune cells damages nerve cells, causing muscle weakness and sometimes paralysis.
- Confirmed transmission through Aeges mosquito.
- Confirmed possible sexual transmission of Zika from men to their sex partners. Furthermore, the virus can live longer in semen than in blood, so a man may be infectious for months after contracting the virus. In many cases, individuals with Zika infection do not display symptoms, so even greater precautions should be taken to prevent spread of the virus – especially to pregnant sexual partners. Infectious virus can live in semen up to 14 days after symptoms begin, and particulates can be detected over 62 days after symptoms begin.
- Confirmed link between Zika and microcephaly. (New England Journal of Medicine)
- Confirmed vertical transmission of Zika from mother to infant. On April 20, 2016 the CDC declared the virus teratogenic, or capable of mother to child transmission. Zika can impact the fetus both by causing microcephaly or remaining in the baby after delivery.
- There remain no vaccinations or treatment, although significant finances are being directed toward research and vaccine development.
What we don’t know
- Can Zika virus be transmitted through breastfeeding? Breastfeeding can give infants the best nutritional and immunological start in life, so women are being encouraged to still breastfeed in areas with Zika prevalence.
- Can Zika be transmitted through blood transfusion and organ transplant? No such transmission has yet been detected.
- Can Zika be transmitted through oral sex, or from a woman to her sexual partner? Until this mode of transmission is confirmed, correct and consistent condom use remains the best method to prevent Zika transmission.
- Can Zika influence fetal development during any window of exposure? While many cases of pregnant women infected with Zika have shown higher than average rates of microcephaly, the time of infection in fetal development has not been specified. The current assumption is that infection during any trimester may harm the fetus.
Recommendations
- Mosquito Transmission: Best prevention includes utilizing long sleeves, bed nets, and EPA-registered mosquito repellant.
- Sexual transmission: Correct and consistent use of condoms is the best way to prevent the transmission of Zika. Condom use is critical both for individuals living in areas with high Zika prevalence, and also for those who have travelled to areas with Zika prevalence and return to their home countries – even if they do not experience symptoms of Zika.
- Conception: The CDC recommends for women to wait at least 8 weeks after date of Zika symptom onset or 8 weeks after exposure before attempting conception. Recommendations are for men to wait 6 months after symptom onset to attempt conception, or 8 weeks after last exposure if no symptoms develop.
- Clinical Transmission: Although no clinical cases of Zika transmission have been confirmed, hospital settings that care for Zika-positive patients much increase prevention tactics, especially relating to labor and delivery settings.
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With the advent of new data confirming sexual transmission of Zika and the effects of the virus on fetal development, the need for comprehensive access to contraceptives and open dialogue about individuals’ reproductive life plan is critical. The Arizona Family Health Partnership is proud to currently engage in this education and service delivery on a local level, and hopes that through strong partnership, a solution to the Zika epidemic will soon be achieved.
– Annie, Intern
References:
Thank you to Kristin Stookey, CRNP, Clinical Program at AFHP for providing clinical training on Zika virus.
Brasil P, Pereira JP Jr, Raja Gabaglia C, et al. Zika virus infection in pregnant women in Rio de Janeiro preliminary report. N Engl J Med 2016. Published online March 4, 2016.
Centers for Disease Control and Prevention. “Updated Interim Zika Clinical Guidance for Reproductive Age Women and Men, Sexual Transmission of Zika, and the U.S. Zika Pregnancy Registry .” http://emergency.cdc.gov/coca/ppt/2016/coca-call-april12-zika-virus-clinical-guidelines.pdf
Oster AM, Russell K, Stryker JE, et al. Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:323–325. DOI: http://dx.doi.org/10.15585/mmwr.mm6512e3.
