Friday, February 17, 2017

What's new with Zika?

What's new with Zika
Last year Zika was all over the news. Some viruses make a big splash in the headlines, but then fade away. Unfortunately Zika is still something that we need to pay attention to.
Here are some facts about Zika:
Zika virus was first identified in 1947 in a rhesus monkey in Uganda's Zika forest (which gave the disease its name.) For decades Zika was a virus that turned up in monkeys and occasionally in humans in Africa and southeast Asia. Its symptoms were mild and the number of confirmed human cases was low.
This virus is still on the rise. Until a few years ago almost no one on this side of the world had been infected. Few of us have immune defenses against the virus, so it is spreading rapidly. Millions of people in tropical regions of the Americas may have been infected within the past couple of years
The world is shrinking, and mosquitoes don’t pay too much attention to borders. This year Zika has made it’s way to our country, There are now pockets of reported cases in Florida and Texas.
It is constantly evolving. Some areas where it was very prevalent are perhaps seeing a decrease.  Other countries like Mexico are seeing more cases.
For up to date information on which countries are impacted, check the CDC website:
The Zika virus is spread to people through mosquito bites. The most common symptoms of this disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon. Only about 1 in 5 people infected with Zika virus even become symptomatic.
The nasty type of  mosquito responsible for Zika also spreads dengue virus, yellow fever virus and Chikungunya. Mosquitoes that spread Zika virus bite mostly during the daytime. Just as with malaria, people are the source for spreading the virus. This is how it works: a female mosquito bites an infected person and then can carry the virus to the next person she bites, so when people travel, they can bring the virus with them. An infected person is thought to be infectious the first week only. The virus can take hold if enough people become infected for it to become endemic, meaning it's in a region permanently. Mosquito bites and mother-to-unborn baby aren't the only ways this virus is transmitted. The CDC now confirms documented cases of infection from sexual transmission and blood transfusion. Although the Zika virus can be found in breast milk, to date there are no confirmed cases of mothers passing the virus to the baby through nursing. Either way, the benefits of breastfeeding way outweigh the risk and exposure would not be a reason to stop nursing. People infected with Zika virus don't infect one another through casual contact. 
Men who have been in a Zika hot spot should be careful to use birth control for 6 months after any possible exposure. Women should avoid pregnancy for 2 months after any possible exposure.
There is no vaccine or specific antiviral treatment available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of acetaminophen (not ibuprofen) for fever and/or discomfort. 
Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or Chikungunya virus infection. People infected with any of these illnesses should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission.
Zika has a few especially  frightening aspects. Approximately 1 in 4,000 cases are having the complication of Guillain-Barre syndrome. Guillain-Barre is a nerve disorder that causes muscle weakness. Most people recover in a few weeks, but severe cases can require life support to help with the breathing. Anyone of any age can get Guillain-Barre, although it is pretty rare. It is thought to be triggered from an infection. 
Even more widespread  is the documented connection between birth defects and pregnant women infected by the Zika Virus. In Brazil, where most of the reported cases seem to be, there have been many babies born with microcephaly (small heads) and the associated significant health issues. The most dangerous time is thought to be during the first trimester – when some women do not even realize they are pregnant.  Unfortunately there are new studies showing that a young baby’s developing brain can be impacted even if they did not get infected in utero. Infants under 18 months may be at risk for developmental delays if they contract this virus.
Okay how does all of this impact you? If you have not been traveling lately and have no plans to travel, Zika is not something that you need to fret about here in the Bay Area. If you have recently returned from a trip to any of the Zika hot spots AND have any illness symptoms, make sure that you share that info with your doctor or nurse. If you are pregnant and may have been exposed, contact your OB as soon as possible. Testing used to be coordinated with the local health department but It is now available at commercial labs. Testing should only be done for someone who has been in one of the impacted areas and is showing symptoms. The the tests are far from perfect.
Testing for Zika is not recommended for any non pregnant patients.
If you have an upcoming trip planned, keep in mind that until there are firm answers, the CDC has issued a travel advisory to pregnant women to avoid traveling to any countries where the Zika virus is rampant. If travel is not optional, strict mosquito avoidance is essential. 

  • Make sure that you have intact screens on all windows
  • Get rid of any standing water that is around where you are staying; do a double check to make sure there are no pots, bird baths...etc. that are places where mosquitoes can breed. The larvae are dependent on water for breeding. 
  • The type of mosquitoes that carry Zika don't care what time of day it is. While may mosquitoes prefer biting at dusk and dawn, there is always risk with these nasties.
  • Try to wear (keep your child covered with) long pants/ long sleeves etc. Light colored clothing is recommended.
  • If you are going into a heavy mosquito area use bug spray on exposed skin and clothing. The EPA has five registered insect repellents. Of those, there are three products that are more easily available.
 - DEET is one of the more popular options. It is considered safe for infants over the age of 2 months.
 - Oil of Eucalyptus is considered one of the least toxic options but interestingly, the age recommendation for it is for 3 years and older.
 - Picaridin is a newer option. It is odorless and is approved for children 2 years and older. It is great as a mosquito repellent but it is not thought to be as effective against ticks as DEET if you are going into the deep woods.


As with any new  product, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz it. They all come in different concentrations. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes.

Mosquitoes don’t like fans! The nasty insects are lightweight enough that a good breeze may make it hard for them to zoom in on their target.
The good news is while it's not certain, scientists believe once an individual has been infected with the virus, they are immune and won't become infected again.There is currently no concern for future pregnancies.

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