• Zika Virus Infection and Pregnancy

    Definition

    A Zika infection is caused by a virus that is usually passed from an infected mosquito.
    The virus may cause flu-like symptoms in some but has little effect on most people.
    The virus can cause significant birth defects to developing fetuses. More studies are needed to determine the exact reason but national organizations have issued some safety guidelines.

    Causes

    A specific type of mosquito can pick up the Zika virus when it bites someone with a current infection. The mosquito can then pass the virus to the next person it bites.
    Though most infections pass from mosquito to person, some infection may pass from person to person:
    • The virus may pass from person to person during sex with a Zika infected man, whether or not he has symptoms.
    • The virus can pass to a fetus if the woman was infected with Zika during or just before pregnancy.

    Risk Factors

    The greatest risk factor is spending time in a high-risk area without proper mosquito protection. A current outbreak of Zika has been reported in:
    • South America, particularly Brazil; Colombia, Bolivia, Ecuador, French Guiana, Guatemala, Guyana, Paraguay, Suriname, and Venezuela
    • Mexico and Central America, particularly El Salvador; Honduras, and Panama
    • The Caribbean, particularly Barbados, Dominican Republic, Guadeloupe, Haiti, Martinique, Puerto Rico, and Saint Martin
    • Southeast Asia and the Pacific Islands
    Previous outbreaks have been reported in Africa. Check with government travel resources to see where current outbreaks are before you travel.

    Symptoms

    If symptoms develop, they may appear a few days after the bite. Symptoms may last a few days to a week and can include:
    • Fever
    • Rash
    • Conjunctivitis—redness and irritation of the eye
    • Headache
    • Joint pain
    • Muscle pain
    Zika infection in pregnant women may cause certain complications for the baby, such as:
    • Microcephaly—a small head due to underdevelopment of the brain
    • Fetal brain defects
    • Eye defects
    • Hearing loss
    • Impaired growth
    • Spasticity and seizures
    • Abnormal joints
    • High muscle tone

    Diagnosis

    A blood test is needed to confirm the presence of the zika virus or zika antibodies. Antibodies are made by the body in response to a specific infection and may be present for up to 12 weeks after an infection.
    You may be asked about your risk of Zika exposure before and during the pregnancy. This includes travel to or residence in high risk areas and risk of infection in your sex partner. Blood tests may be recommended for:
    • Pregnant women who are at risk and have symptoms of Zika.
    • Pregnant women who have not had symptoms of Zika but have an ongoing risk of exposure to Zika. Testing may be offered throughout the pregnancy.
    • Women who may have been exposed and fetus has had abnormal prenatal ultrasound results.
    Placental and fetal tissue may be tested in woman who do not have a confirmed Zika infection but have a fetus or infant with Zika-associated birth defects.
    If the test is positive for Zika and you are pregnant, you may be referred to a maternal-fetal specialist or an infectious disease specialist with expertise in pregnancy.

    Treatment

    There are no medications to treat a Zika infection. If symptoms appear, they should pass on their own within a week. Basic home care, including rest and drinking enough fluids, can help with recovery.
    Acetaminophen may be advised to help decrease fever or pain. Other over the counter medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), are not advised if the specific virus has not been identified. NSAIDs and aspirin can cause complications with other mosquito-borne illnesses, such as dengue infection.
    If you have the Zika virus, it can be passed directly to other people through sexual contact. If a mosquito bites you while you are infected, that mosquito can then pass the infection to someone else. The mosquito will most often affect people nearby, such as family members or neighbors. It is important to take precautions against mosquito bites while you are infected, for about a week, to prevent the spread of the virus.

    Family Planning

    The Zika virus may exist in the body or in sperm for a short time even after symptoms have passed. To decrease the risk of passing the virus to a new fetus the US Center for Disease Control (CDC) recommends:
    • Women who have been infected or suspect an infection should wait at least 8 weeks before trying to get pregnant.
    • Men who have been infected or had possible exposure to Zika should wait at least 6 months before trying to have a child with your partner.

    Prevention

    There are some recommended precautions for women who are pregnant.
    • Pregnant women who live in areas without Zika should:
      • Delay travel to any area where Zika virus is spreading.
      • If travel is unavoidable, pregnant women should closely follow mosquito precautions. Travel advisories are available from the Centers for Disease Control and Prevention or the World Health Organization.
      • Use a condom during sex or abstain from sex with a male partner who has lived in or traveled to an area with Zika.
      • See a doctor or healthcare provider.
      Pregnant women who live in areas with Zika should:
      • Closely follow mosquito precautions.
      • Use a condom during sex or abstain from sex with a male partner who has lived in or traveled to an area with Zika.
      • See a doctor or healthcare provider.

    RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    World Health Organization http://www.who.int

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Society of Obstetricians and Gynaecologists of Canada http://sogc.org

    References

    Pregnant women: how to protect yourself. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/zika/pregnancy/protect-yourself.html. Updated August 16, 2017. Accessed August 28, 2017.

    Zika and pregnancy. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/Zika/pregnancy/question-answers.html. Updated August 9, 2016. Accessed August 28, 2017.

    Zika virus in pregnancy and congenital Zika syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T910450. Updated July 24, 2017. Accessed August 28, 2017.

    Zika virus infection. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T909469/Zika-virus-infection. Updated June 23, 2017. Accessed August 28, 2017.

    9/30/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T909469/Zika-virus-infection :CDC Zika interim response plan. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/zika/public-health-partners/cdc-zika-interim-response-plan.html. Updated May 5, 2017. Accessed September 19, 2017.

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