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The Zika Virus and Pregnancy: What You Need To Know

There have been numerous concerns regarding the outbreak of Zika virus and pregnant women or those who are trying to get pregnant.  The virus can cause early miscarriage in some cases, but for those pregnancies that continue the consequences to the fetus can be devastating.  Infected babies are born with head defects, brain defects, and eye problems.  I've addressed them briefly here, but you can find more detailed answers in the Frequently Asked Questions section.

Regions with known risks of the Zika virus:

  • South America, the Carribbean, North America and Central America

Transmission of the Zika virus to humans:

  • Mosquito bites from an infected mosquito native to the above-mentioned areas.
  • Sexually-transmitted from an infected partner
  • Blood transfusion from an infected donor
  • From an infected pregnant mother to her unborn baby

Safe steps to take to avoid the Zika virus:

  • Avoid affected areas at all costs.  If you are forced to travel and you are not pregnant, or if you are trying to conceive and either recently travelled or had sexual contact with someone who was in an affected area, you should avoid conception for 8 weeks if you are female, and 6 months if you are male.  This will essentially eliminate any risk of fetal infection.
  • If you are already pregnant, avoid travel to endemic areas unless it is absolutely a necessity.  For those who must travel, take all precautions against mosquito bites and do not have unprotected intercourse with anyone who has possibly been exposed.

 

Fertility therapy does not eliminate the chances of passing the virus to the fetus.  Therefore, if you have recently travelled to an affected area, or were exposed sexually, please follow the guidelines for women and men as outlined above.  

For more detailed information, feel free to explore the FAQ below.  If you still have questions, don't hesitate to contact us.

 

 

Frequently Asked Questions

What is the Zika Virus?

Zika is a virus that was first found in Uganda Africa in 1947.  It is a single-stranded RNA virus, that is part of the Flavivirus family and is closely related to dengue, West Nile, Japanese encephalitis, and yellow fever viruses.

 

How is it transmitted?

The virus can be transmitted by one of four methods:

  1. Mosquito bite
  2. Blood transfusion
  3. Vertical transmission from a pregnant mother to baby
  4. Sexual transmission

Currenly, the most common mode of transmission is through mosquito bites, though if more people contract the virus there will be increasing concerns regarding sexual transmission and vertical transmission in pregnancy.  As of September 22, 2016 there have been 286 reported cases in Canada.  Of these, two hundred and eighty-two cases were related to travellers, two cases were acquired through sexual transmission and two cases were maternal-to-fetal transmission, including one with severe neurological congenital anomalies.

 

What are the symptoms if I get Zika virus?

Symptoms of Zika virus infection are generally rare with only 25% of patients developing symptoms.  These may include:

  • a flat, red rash on the skin covered with small bumps
  • red eyes
  • weakness
  • headaches
  • fatigue
  • muscle or joint pain (with possible smaller hand and foot joint swelling)
  • low grade fever ie. <38.5°C
  • In rare cases it may be associated with Guillain-Barre syndrome.  This is a condition that affects your nervous system and can result in severe consequences including temporary paralysis.

Symptoms typically appear 3-12 days after infectio  and can last for up to one week.

 

How do I get tested?:

Testing for Zika virus involves assessing your risk factors for exposures, including travel history, sexual history and history of recent symptoms.  The actual test involves drawing a blood sample and checking for either viral RNA or antibiodies:

  1. Polymerase chain reaction (PCR) tests during acute illness to directly detect viral RNA
  2. Antibody testing in serum both during and after exposure

If you think you have been exposed it is imperative to be tested as soon as possible, as the virus will only be active in the blood for up to 7 days after exposure.

 

I'm not sure if I was infected or exposed.  Should I get tested?

The following guidelines have been developed by Health Canada:

Testing for Zika virus infection should be considered in the diagnosis of any ill traveller:

  • with underlying medical conditions
  • with compatible epidemiologic and clinical history
  • who develops more serious symptoms that could be consistent with Zika virus infection
  • who visited a country where Zika virus transmission is ongoing or widespread and has symptom onset: within 3 days after arrival

Testing is generally not warranted for returned travellers:

  • who have travelled and remain asymptomatic
  • whose clincally compatible illness has resolved

This doesn't mean you should try to conceive.  Patients who have potentially been exposed should avoid conception for 8 weeks if female and 6 months if male to reduce the risks of fetal transmission.

Testing should be offered to pregnant women with:

  • a fetus suspected of having a congenital anomaly
  • acute signs and symptoms compatible with Zika virus
  • a clinical history of a compatible Zika virus-like illness, either during or after travel to an area with Zika virus transmission

Testing of pregnant returning travellers who are asymptomatic should be discussed between the woman and her health care provider.

For the most up to date Canadian guidelines, please visit http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/zika-virus/index-eng.php

 

 

How do I get treated if I have been infected or exposed to Zika virus?

Treatment is symptomatic, meaning rest, hydration and treatment of fever, headaches and pains with acetaminophen or ibuprofen.  There is no other therapy for Zika virus infections.  Patients with severe symptoms or those with other health conditions such as cancer, immunosuppression, or pregnancy should be seeing a health care provider immediately.

 

Where should I avoid travelling to?

Zika virus is currently maily being found in South America and Mexico, though the Carribean and parts of the southern United States are also affected.  The mosquitos carrying the virus do not like higher altitudes.  So if you are staying at elevations above 2500 ft, there should be minimal risk.  Unfortunately, the majority of coastal cities are well below this level and travellers are at risk.  

 

What are the risks of infection for patients trying to get pregnant?

Because the virus clears from a woman's blood within seven days, there is no evidence that there is any risk of fetal abnormality if the virus is out of a woman's system at the time she becomes pregnant.   For fertility patients this means that there is no risk to a fetus from previous maternal infection as long as there is no virus in the mother's blood at the time of conception.  However, the Centers for Disease Control and Prevention still recommend a period of waiting to minimize any risk.  In other words, if you are travelling to an area where you may be exposed, or have been bitten by mosquitos while in an area known to be at risk for Zika virus wait at least 8 weeks before attempting to conceive.  

For men the situation is more complicated.  While the virus exists in the blood for only 7 days, they have found viral RNA in sperm samples up to 62 days after infection.  As a result, the Centers for Disease Control are currently recommending that men avoid attempting conception for 6 months from the time of exposure.

Click on the link for the complete details and most up to date data from the Centers for Disease Control and Prevention. https://www.cdc.gov/zika/

 

What happens if I'm infected when I'm already pregnant?

The risk of transmission from mother to fetus is unknown. In one study from French Polynesia the incidence of transmission was only 1%.  But in a more recent study from Brazil 27% of infants were affected.  Therefore, pregnant women should avoid travel to areas with high risk of Zika virus infection.

For pregant women, the virus can be devastating.  Scientists have determined that it can cause:

  1. Microcephaly, a condition where the fetal head is smaller than normal
  2. Severe fetal brain defects
  3. Eye defects
  4. Hearing loss
  5. Impaired growth

There is no treatment for these condions. There is also some evidence that the virus may cause miscarriage in the early first trimester.

If you are pregnant and believe that you have been exposed contact your physician immediately.

 

How can I avoid infection?

There are no vaccines for Zika virus.  But there are three easy steps to avoiding infection:

  1. Avoid travel to areas where there are high risks of the Zika virus.  Please visit the Government of Canada's website for the most up to date list of affected areas.  http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/zika-virus/index-eng.php
  2. Avoid unprotected sex.  Do not have unprotected sex with anyone in an affected area or anyone who has recently been in an affected area (ie. Within the last 6 months).  Condom use is protective against sexual transmission of Zika virus.
  3. Avoid mosquito bites.

                                        A. Wear loose-fitting clothing.

                                        B. Stay indoors in areas with air condiitioning and screening or mosquito nets

                                        C. Use insect repellent.  Environmental Protection Agency - registered insect repellants are                     

                                              safe even in pregnancy.

       

In summary, the Zika virus is a virus that can be transmitted through several means to patients who are either trying to get pregnant or those who already are pregnant.  Unfortunately, the virus can have significant consequences for pregnancies.  As a result, it is critical that patients avoid affected areas, take all precautions if forced to travel to these areas, and avoid conception for at least 8 weeks for women and 6 months for men, after any potential exposure.

 

Dr. Rahi Victory MD, FRCSC                                        

                                        

 

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