Your Non-Alarmist Guide to the Zika Virus
It’s been linked with brain damage in babies, and the World Health Organization just declared South America’s Zika epidemic a public health emergency. You may not live in South America, but in today’s world of global travel and fast-moving infections, let’s talk about whether you need to worry.
What is Zika and Why Are People Worried About It?
Zika might cause brain damage in newborns if their mothers contract the virus while pregnant. There is no vaccine for Zika, no cure, and no way that we know of (yet) to prevent Zika from harming a baby. The good news is that Zika and its complications are rare.
Zika virus causes fever, rash, joint pain, and bloodshot eyes in about 20% of the people who contract it, and no symptoms in the other 80%. It’s a member of the Flavivirus genus, making it a relative of yellow fever,chikungunya, and dengue viruses. Like them, it’s transmitted by mosquito bites.
The CDC has advised women who are or might be pregnant not to travel to the countries where Zika is spreading.
The link between Zika and microcephaly is not proven, but it’s plausible. Zika arrived in Brazil recently, possibly during the 2014 World Cup, and the surge in microcephaly cases followed. More worldwide spread is possible—the 2016 Summer Olympics will be held in Rio de Janeiro in Brazil. (Athletes are stocking up on bug spray.)
The Brazilian government is now investigating over 4000 cases where babies have heads smaller than 13 inches around, compared to just 150 cases in a typical year.
That large number may be inflated; more than half of the babies investigated so far just had small-but-normal heads, or had microcephaly for some other reason. But whatever the exact numbers, there is definitely a surge, and fingers are pointing at Zika.
I’m Not a Pregnant Woman. Should I Worry?
Maybe a little. You don’t have to be pregnant to experience the virus’s other possible complication, Guillain-Barre syndrome. And there’s a possibility that someone who contracts the disease via mosquito could pass it on as a sexually transmitted disease.
Guillain-Barre syndrome (GBS) is a rare condition where a person’s immune system attacks their nerve cells. Paralysis can result. It can be triggered by an infection, including Campylobacter (a form of food poisoning), or even the flu.
The link between GBS and Zika is unsure. Brazil’s Ministry of Healthnoticed a surge in GBS cases around the same time as the surge in Zika cases, so they and the US’s Centers for Disease Control and Prevention(CDC) are investigating.
Sexual transmission of Zika seems to be possible. A patient contracted Zika in Texas, apparently through sexual contact from a partner who was sick after traveling to a Zika-affected area.
Commenting on these last two cases, infectious disease specialist Scott Weaver told the New York Times, “If I was a man and I got Zika symptoms…If my wife was of childbearing age, I’d want to use protection, for a few weeks at least.”
If sexual transmission exists, it’s probably rare, but still worth considering. If you travel to a Zika outbreak area, you might want to pick up some condoms on your way home.
There’s one other consideration. If you’re not pregnant or trying, but would consider keeping a surprise baby, you may want to follow the same precautions as for women who are pregnant.
In other words, up your birth control game before and during your trip, and be really fastidious about the bug spray just in case.
Will Bug Spray Keep Me Safe?
Yes! Nothing is foolproof, but insect repellents containing DEET are very effective at keeping mosquitoes away. Some brands with picaridin or oil of lemon eucalyptus work well too.
DEET is safe, in case you were wondering, and the CDC’s travel adviceexplicitly includes a statement that all three repellents are safe in pregnancy. Make sure to reapply often; here are the results from a test of how popular brands fared after hours on the skin.
Where Am I Most at Risk? Is Zika Coming to the US?
The CDC’s list of Zika-affected areas is here. It currently includes 25 countries and territories in the Americas, plus a few islands elsewhere in the world. Mexico and a good chunk of South America are included.
Microcephaly cases are highlighted below. (This is just a screenshot of areally awesome interactive map—check it out for more details on each country.)
Zika was first found in Africa, but there have only ever been a handful of cases in miscellaneous African and other countries until the recent outbreak.
Fears about Zika (and dengue, and chikungunya) spreading are based on the range of these mosquitoes, which extends into the southern US—see the map below. Note that the viruses aren’t widespread in all of these areas yet, but if they arrived, mosquitoes would be available to transmit the disease.
So it’s possible that Zika and these other viruses can come to the US. The mosquitoes are also moving northward, as temperate regions get warmer and stay warm longer, thanks to climate change.
But the chance of a major Zika outbreak in the US is fairly low because most people in the US hang out indoors in the air conditioning, install window screens, use bug repellent, and keep their yards free of standing water. (If you don’t keep your yard free of standing water, please go out and dump that birdbath. You’re breeding mosquitoes for the whole neighborhood.)
If I Go to a Zika Affected Area, What’s the Chance of Having a Baby With Microcephaly?
The risk is small. Nationwide, Brazil’s 4000 cases of suspected microcephaly are around one-tenth of one percent of all the country’s births in 2015.
That number is not too far off from the rate of microcephaly in the US caused by a virus called cytomegalovirus (CMV). And back before we had a measles-mumps-rubella vaccine, the rubella virus often caused microcephaly, too. So this isn’t a huge jump from the risks you were already ignoring.
So the risk of having a baby affected by Zika is very small, even if you do travel to Brazil while you’re pregnant. It’s definitely worth being careful about mosquitoes, and you may want to heed the travel advisories and cancel your trip. But the risk is perhaps smaller than you feared.
How Would I Find Out if my Baby Has Zika?
Definitely tell your doctor if you’ve been to a country with Zika while you’re pregnant, especially if you had a rash, fever, or something that seems like pink eye. The CDC put out recommendations for appropriate testing and treatment; you might want to bring a copy to your doc. (Vox has translated them into flowchart form here.) The suggestions include:
- Sending a blood sample to the state health department for testing. This works best within a week of infection. If you’ve had Zika in the past, the health department can test for antibodies, but that result is less precise.
- Considering amniocentesis, which means taking a sample of the amniotic fluid surrounding a baby. This test is risky by itself, with a 0.1% chance of miscarriage if it’s performed before 24 weeks. The fluid can then be tested for Zika.
- Performing ultrasounds every 3-4 weeks to look at the baby’s brain development, if a blood test or amniocentesis turned up positive results.
There’s a major caveat here: We don’t know how test results relate to a baby’s chances of being born with microcephaly or other complications. Microcephaly also often can’t be detected by ultrasound until 24 weeks or later—after most states’ cutoffs for legal abortion.
If it turns out that you may have had Zika, you’re in a very tough situation with a lot of unknowns. We don’t know how likely microcephaly is for somebody with a positive blood or amnio test, and we don’t truly know how babies with microcephaly from Zika will be affected throughout their lives.