Zika virus is in south and central America and doctors have been told they should tell pregnant women very simply, do not go there.
That is the crux of interim treatment guidelines issued by the Centers for Disease Control and Prevention today to healthcare providers across the nation. This follows an urgent Level 2 travel warning to pregnant women issued on Friday, warning of the danger of contracting the Zika virus.
The regions covered under the travel warning with ongoing Zika virus transmission are: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.
There is no protection against the illness which is transmitted by mosquitoes and no treatment for those who are infected as for most it is a manageable illness. The danger from Zika virus is that it can pass from infected mothers to their unborn child, causing miscarriages or leading to the malformation known as microcephaly, a condition where brain development is disrupted in the unborn baby. This condition often times leads to the death of the newborn or severe lifelong disability.
As part of the guidelines, health care providers are urged to tell patients not to travel to the areas while pregnant. The only danger of contracting the disease is by exposure to an infected mosquito, this is the only form of transmission.
In addition doctors should ask all pregnant women if they have traveled to any area where the virus is active. If they have and present two or more of the symptoms consistent with Zika virus while they were in the areas or within two weeks of returning, they should then be tested for the presence of the virus. Symptoms of Zika exposure include fever, rash, joint pain and conjunctivitis or red eyes.
Though there is no treatment available it is recommended that in the event a pregnant woman tests positive for the virus, there should then be continued monitoring via ultrasound of the unborn child. It is also recommended that the mother be referred to a maternal-fetal specialist or an infectious disease specialist with expertise in pregnancy management.
Adding to concern is the fact that the Aedes mosquito also can carry dengue and chikungunya virus in addition to Zika. It is then also recommended that all those who have symptoms of Zika also be tested for the dengue and chikungunya virus.
Unlike Zika, which is in most cases poses a danger only to the unborn child, dengue virus is a leading cause of illness and death in the tropics and subtropics. Chikungunya virus normally does not cause death but the symptoms can be extremely severe and debilitating.
If a pregnant women elects to travel to any of the areas where Zika is active, the CDC recommends that they strictly follow steps to avoid mosquito bites. Unlike many of the mosquitoes in North America, the Aedes species of mosquito is most active indoors and out during the daytime so precautions must be taken at all times.
Some of the steps that can be taken include wearing long sleeved shirts and long pants, ensuring that sleeping areas are screen or closed air conditioned rooms. Also suggested is the use of an approved insect repellent such as those containing DEET, picaridin, both of which the CDC says are safe for pregnant women.
Considerable information on avoiding insect bites is available at the CDC website along with recommendations on housing and clothing that can be used.
On Friday when the travel alert was issued, Dr. Lyle Petersen, director of CDC’s division of vector borne disease discussed the outbreak and the dangers posed by the virus to pregnant women.
“(Brazilian) officials there have noted a rather significant increase in cases of microcephaly, which means smaller than expected head size in infants”, Dr. Petersen said. “Many are pointing to an association between that and Zika virus infection. According to Brazilian health authorities, more than 3,500 microcephaly cases were reported in Brazil between October 2015 and January 2016”.
Though there has not been an absolute direct link to Zika virus and microcephaly, studies continue at the CDC to find if other contributing factors are at work. But because of the severity of the outcome when a child is born with microcephaly or the possibility of miscarriage, directors at the CDC felt it was imperative to warn travelers of the danger and take steps for those possibly infected.
Moving forward, the CDC will continue to work with the World Health Organization and the Pan American Health Organization to investigate Zika virus and other diseases that pose a danger.
More information on Zika virus is available at the CDC Zika webpage, the . For information on protection from biting insects the CDC has a comprehensive section on the subject.
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