As warmer weather returns, mosquitoes will reemerge from hibernation. The Zika virus made headlines last year as studies revealed it was associated with microcephaly and Guillain-Barré syndrome, particularly in Brazil and the Caribbean. Zika was first identified in the mid 20th century, but it was not until 2016 when the World Health Organization (WHO) announced a public health emergency for the association between Zika and neurological disorders.
The virus is spread by two types of infected mosquitoes, present throughout the southern hemisphere and part of the northern hemisphere, who bite both during daytime and nighttime. Transmission is most prevalent in the Caribbean, Central America and the northern portion of South America. According to WHO, there are currently 84 countries with confirmed evidence of mosquito-born Zika virus. As of March 2017, 13 countries have confirmed cases of person-to-person transmission of the virus. There are 31 countries and territories with reported microcephaly and other central nervous system malformations that are associated with Zika, mostly in Central and South America. There are also confirmed cases of infected mosquitoes in Florida and Texas, and a number of individuals have tested positive in the United States after acquiring the virus stateside or after returning from travel.
Zika is of particular concern to women who are pregnant or who may become pregnant since the virus can be transmitted from an infected mother to her fetus and cause developmental defects. Aside from the widely reported association with microcephaly, infants born to mothers infected with Zika during pregnancy have also been found to have eye defects, hearing deficits and impaired growth.
Consequently, this is now a real issue for practicing obstetricians. Best practice for women who are pregnant or trying to become pregnant is to avoid regions with documented cases of infected mosquitoes, including southern Florida. It is important that patients understand that although the virus is not dangerous to children and adults, it is associated with serious birth defects and can cause devastating developmental impairments to a fetus.
Notably, Zika can also be transmitted during sexual intercourse, even from people who are not exhibiting any symptoms of the virus. Physicians should counsel their patients who are trying to become pregnant with a partner who recently traveled to a known Zika region to avoid doing so and use condoms. Initial research has shown that the virus survives in semen longer than in other bodily fluids, including blood. The CDC recommends that men with diagnosed Zika use condoms for at least six months after diagnosis, and women who are diagnosed should wait at least eight weeks before trying to become pregnant.
When counseling patients who are traveling to areas known to have documented cases of Zika, it is critical to advise them of the risks during prenatal development should they contract Zika. Like any directive to your patient, it is highly important to document your conversation about the risks of travel during pregnancy to any of the affected areas. If your patient must travel to a region with Zika-infected mosquitoes, you should recommend wearing long sleeve clothing pre-treated with mosquito repellant, including those sprays with DEET. While indoors, the risk of Zika can be further reduced by using screens in windows and doors and sleeping under a mosquito net.
Although Zika was widely covered in the news last year and numerous advertisement campaigns were undertaken to warn of the risks of Zika during pregnancy, physicians should remain vigilant in warning their patients about the risks of the virus. There is no indication that the rate of infection and transmission has significantly decreased. As the media becomes more relaxed about the risks of Zika during pregnancy, it is even more important for healthcare professionals to disseminate accurate, up-to-date information about Zika, and ensure that their patients are fully aware of the dangers of the virus before traveling to Zika-infected regions.
Anthony M. Sola and Emma B. Glazer are attorneys at Martin Clearwater & Bell LLP. For more information, visit mcblaw.com.