New Outbreaks of Zika Virus Causing Fear in Texas Border Towns
There have been 18 new cases of Zika virus (ZIKV) in the southwest Texas cities of McAllen and Brownsville in the Rio Grande Valley, within miles of the Mexico border.
One woman delivered a baby last week who was born with microcephaly. It will be a matter of time before doctors know the complete extent of the birth defects but babies born with ZIKV are known to have neurological damage, potential eye defects, and require life-long. They may have other complications due to their birth defects. There have been two reports of abnormal fetal ultrasounds and 7 more that appear normal. However, not only do we now know the virus can cause microcephaly, or a small brain and cranium, doctors have identified a range of symptoms beyond microcephaly known as Zika virus congenital syndrome (ZVCS).
The Zika virus is spread through mosquito bites, blood transfusions, and unprotected sex. Unfortunately there is no vaccine, so, once a woman is infected, if she gets pregnant, there is no protection for an unborn baby. Zika is dangerous to the fetus at any stage of pregnancy according to Dr. Karin Nielson, professor of clinical pediatrics at the David Geffen School of Medicine at the University of California Los Angeles.
Dr. Nielson, along with Dr. Patricia Brasil and colleagues at the Oswaldo Cruz Foundation in Rio de Janeiro were studying the effects of dengue fever, a cousin of the Zika virus, when an extremely high number of cases of newborns with microcephaly (~4,000) sent up red flags within the medical community. They expanded their research to include as many women manifesting with dengue like symptoms of fever , muscle and joint pain, bloodshot eyes, headache and in particular a rash.
From September 2015 to May 2016 the researchers tested the blood and urine of 345 women. 182 or 53% tested positive for ZIKV. The study was the first to follow a significant group of women in various stages of pregnancy infected with ZIKV and the virus effect on the pregnancy and babies.
Researchers found that the Zika virus enters brain cells in an unborn baby, where the virus replicates, killing these brain cells. The spectrum of defects includes calcifications in the brain and areas that may not develop. There may be eye defects and growth retardation including a malformed cranium. While it appears some babies may not be as seriously affected, there remains the possibility the virus can cause damage to the placenta leading to in utero fetal death even if the pregnancy was carried to near term. Other pregnancies may result in miscarriage or spontaneous abortion at any stage of the pregnancy. Even if the infection took place in the third trimester there was still the possibility of damage to the fetus. Their findings were published in The New England Journal of Medicine (NEJM) December 15, 2016.
The current problem with ZIKV infection is we now know it can be spread via sexual intercourse as well as being bitten by mosquitoes infected with the virus. According to the Centers for Disease Control (CDC), Zika virus can be spread through sexual contact including vaginal, anal, oral, and via sex toys. What is concerning is that an infected person may have very mild symptoms. As many as 80% of people infected may not show any symptoms and therefore not know they have the virus. Pregnant couples are urged to use protection when having intercourse, both condoms and dental dams, during the entire pregnancy to avoid potential infection of the fetus. Anyone of child-bearing age should use precautions to prevent pregnancy. Any woman planning on becoming pregnant should be tested for Zika. If a pregnant woman develops symptoms of Zika she should be tested for the virus within a week. Anyone traveling to areas where Zika is widespread should also be tested before attempting to get pregnant.
Women in very high risk areas such as El Salvador and Brazil are being asked to postpone pregnancy and to use birth control, however there are still unplanned pregnancies and a high number if infections occurring.
Spring and summer months when temperatures are high and mosquitos breed are very high risk times of the year and tropical areas are high risk year round. Many cities spray for mosquitoes but overall effectiveness is unknown. One of the best ways to prevent mosquito breeding is to eliminate any reservoirs of standing water. Wear protective clothing and mosquito spray when outside. When it comes to combatting the Aedes Egypti that transmits Zika, not every repellent is effective. Natural products such as essential oils may not be effective at all. Consumer Reports found that repellents containing either 25 percent DEET or 20 percent Picardin work best.
People who have traveled to any of the 50 countries that are considered by the CDC as high risk for Zika virus are now being asked by the Red Cross to wait 28 days before giving blood. Women considering getting pregnant are being encouraged by the CDC to postpone travel to those countries
There is a very real danger, despite most cases of Zika virus being concentrated in tropical areas, that due to international travel and the potential for transmission via sexual contact or blood transfusions the spread of Zika could become pandemic. There have been known cases of transmission via sexual contact of people traveling to high risk areas for business or vacation that have contracted the virus and then infected a partner who had not traveled to any high risk area, received blood transfusions or been bitten by a mosquito. Prevention of pregnancy in high risk areas and in suspected infections is vital to stop the spread of this virus which is having far reaching social, health, and economic effects as babies being born with these disabilities will require life-long care.
Currently Zika has been confirmed in every state in the U.S. except Alaska, and in the District of Columbia, American Samoa, Puerto Rica and the U.S. Virgin Islands.