Zika virus: Should we worry?

Kirk Coverston, MD Kirk D. Coverston, MD, FAAP
I will admit to not having had a lot of training in tropical medicine during medical school and residency, but the Zika virus is a current virus that we all have questions and concerns about.  Using the Centers for Disease Control as a resource, I’m passing along the knowledge I acquired with the hope of instilling knowledge to our community and patients.

What is Zika virus?
It is an RNA virus that is in the same family as Yellow Fever, Dengue Fever and West Nile virus. Zika virus was first discovered in 1947, and the first human cases were detected in 1952.  Before 2015, cases were only in Africa, Southeast Asia and the Pacific Islands. 

How has Zika virus impacted the United States?
Local transmission of Zika has been reported in the United States, mainly in South Florida. Almost every state has cases of Zika virus but those infected were due to travel to endemic areas where they were likely bitten by a mosquito. Most cases of active (ongoing) Zika virus are in South America.

How is Zika transmitted?
It is spread primarily through the bite of an infected mosquito Aedes aegypti; from pregnant women to their fetus; sex with an infected person, and possibly through blood transfusions.
What are the symptoms and how long do they last?

Many people infected with Zika virus won’t have symptoms or will have mild to moderate symptoms of fever, rash, joint pain, pink eye, and headaches. Symptoms last several days to a week, and need for hospitalization is rare. A rare complication is Guillain-Barre syndrome where your immune system damages nerve cells, sometimes causing paralysis and respiratory failure.

How is Zika virus treated?
There is no vaccine. Most care is supportive – rest, fluids and acetaminophen. Avoid aspirin and Ibuprofen (as both can increase bleeding if infected with dengue fever).

How can Zika virus affect pregnancies?
The CDC is not sure why some fetuses are affected and others not. Zika virus can cause a stillborn birth, microcephaly (small head) and other severe brain and eye defects. There have been no reports of spreading Zika virus through breastfeeding.

What is the big concern?
The CDC is worried about Zika virus, because it is a mosquito-borne illness that also can be sexually transferred. A significant amount of money, time and research is going into learning more about the disease process and trying to develop a vaccine. Currently, most mosquito-borne illnesses are limited to only the person that is bit, resulting in mild symptoms such as fever and muscles aches and the illness resolves itself. The concern with Zika virus is the cycle of passage of disease and the unknown affects it may have to a pregnancy and the fetus.  It can be passed from a mosquito bite to a human and from human to human via sexual contact. The virus can be passed from an infected person to an unaffected mosquito through bites. It is not known if the severity of disease is equal whether transmitted by mosquito or sexual contact.

Who should be tested?
Any pregnant women should be assessed for Zika exposure at each prenatal care appointment. Greater risks are associated if you traveled or live in an area with active Zika virus or had unprotected sex with a partner who lives or traveled to an area were Zika virus is endemic. In the United States, that would be South Florida. Your provider may obtain tests if warranted.

Prevention is paramount  
• Avoid traveling to endemic (ongoing) areas of infection.
• Keep mosquitos outside. This type of mosquitos likes to bite during the day, so use window screens and A/C.
• Remove stagnant water weekly (they lay eggs in buckets and dog dishes).
• Cover up (wear long pants and sleeves).
• Wear insect repellant with DEET(can use on children 2 months and older). Apply sunscreen first.
• Zika can be passed through sex even before symptoms start, so use protection (condoms)… Always.
• If you are pregnant, do not go to areas with Zika virus. Talk to your doctor before you travel.
• If you travel, use strict mosquito precautions to prevent bites.

(Kirk Coverston, MD, is a Board-certified pediatrician with Visalia Medical Clinic. He is a Fellow of the American Academy of Pediatrics and has been in practice in Tulare County since 2012.)