Planning a baby & Zika :10 Things you need to know if in Rajasthan

Zika in Rajasthan needs awareness. Please read this if you are planning your pregnancy or have Zika exposure in the first trimester.

Twenty-nine people have tested positive for Zika virus in Jaipur, as reported by officials in Rajasthan’s Health Department on 9th October 2018. First reported on 23rd September.

ICMR (Indian Council of Medical Research), National Centre for Disease Control and DGHS (Directorate General of Health Services) are closely monitoring the situation continuously. I want to assure citizens of India that everything is under control and there is no need to panic,” Union Health Minister J P Nadda said, according to PTI.(source)

Planning a baby while traveling to Zika affected country still needs a lot of thought.

An epidemic of  Zika in 2015 in South and Central America and the Caribbean shocked the world. This virus when infecting pregnant woman was possibly responsible for serious developmental problems in the fetal brain.

Many countries in Asia is endemic for this virus. But traveling to endemic countries is less dangerous than countries with an ongoing Zika epidemicThis previously unheard of virus took the world by storm.

The scare unfortunately continues. With the 2016 Olympic in Brazil in August certain precautions for travel needed looking into. Even though the virus causes a simple infection in adults, its effect can be terrible on the developing fetal brain.

The strange thing about this mosquito-borne virus is, it can be sexually transmitted. That makes it doubly dangerous for women planning a baby.

1) List of countries with active  Zika infection reported is regularly updated at CDC. Check it out before planning your travel.

2)What causes Zika?

Zika is a type of flavivirus.It is mosquito born. Aedes species of mosquito causes this disease.Protection against mosquito bite will help keep you safe.

Best Ways to Protect against mosquito bites:

• Mosquito net to prevent mosquito bites
• Covered clothing with minimal skin exposure.
• EPA-registered insect repellent should be used.
• Don’t let water accumulate in open containers.
• Some studies suggest Zika might be Sexually transmissible. (Reference 1,2,3)

Read about Dengue fever 

Fetomaternal transmission.  Zika will infect the baby if mom is pregnant and has Zika infection.

3)How long is the risk of transmission?
Both men and women can transmit the virus to their Sexual Partners
Limited data at present on the persistence of Zika virus RNA in blood and semen (2,3,4).
For men:6 months after symptom onset to plan a baby
For women:8 weeks after symptoms start you can plan your conception.

4)Zika virus  Symptoms

• Mostly no symptoms  (5).
• If present they are mild.
• Fever
• Rash
• Pain in the bones and joints
• Conjunctivitis  (eye infection )
• Hearing defect (5).
• The incubation period for Zika virus disease is:3–14 days (3,6)
• Duration of Zika viremia: few days to 1 week (6);

5)What is Zika Exposure? (7)

You live in an area with reported Zika cases.
You have traveled to a Zika affected region.
Unprotected sex with a man who is exposed
Correct and consistent use of a condom can prevent  Sexual transmission of Zika infection.

6)What test will be done in suspected Zika infection?
A) Testing of women with symptoms of Zika infection during travel or within 2 weeks of exposure.
Zika virus reverse transcription-polymerase chain reaction (RT-PCR).
Zika IgM (immunoglobulin M) in serum
Neutralizing antibodies in serum
Rule out other virus infection like Dengue and Chikungunya
B) Testing of  pregnant women without clinical illness  but a history of exposure
Zika virus IgM.
If Ig M test result is positive or indeterminate, neutralizing antibodies on serum specimens.
Its recommended the test should be done. 2–12 weeks after travel.

When do you say Zika infection positive?

• Zika RNA in a clinical sample
• Zika virus IgM will be positive.
• Titers of Zika virus neutralizing antibody should be <4 fold higher than that of Dengue virus.
• Serial fetal ultrasounds: Recommended in  Zika infected pregnant women

6)What can happen if someone has Zika infection and is pregnant?
The exact amount of risk associated: still under research.

According to this study (12), microcephaly can affect up to 1% of fetuses or infants born to women infected with Zika virus, during the first trimester of pregnancy.

A Brazil-based study found 29%of women with lab-confirmed Zika infection during their pregnancy with various fetal problems.

Zika Virus baby problems:(8-11)

• Microcephaly(Small head and brain )
• Intracranial calcifications, other brain abnormalities
• Abnormal cerebral artery flow
• Intrauterine growth restriction
• Eye infection
• Hearing Problem
• Fetal death (13).
• Zika infection in early pregnancy (less than 7 weeks)   is more likely to cause a more severe effect.As a major part of fetal brain  development occurs within the first 12  weeks of gestation.

What exactly is microcephaly?

When the size of the head is significantly small, due to decreased fetal brain development .

What can cause this microcephaly?

•  Infections during pregnancy: Rubella, Toxoplasmosis, Cytomegalovirus, Zika
• Severe malnutrition, meaning a lack of nutrients or not getting enough food
• Harmful product exposure: alcohol, certain drugs, or toxic chemicals
• Anoxia or low oxygenation of the baby brain due to the reduced blood supply.

Microcephaly is multifactorial.It can have genetic and environmental causes. It can manifest as mental retardation, cerebral palsy and epilepsy, eye and hearing defects.

7)Should you get tested for Zika if you have been exposed but no symptoms?

Local health officials will help decide when to implement testing of asymptomatic pregnant women.This is based on information about levels of Zika virus transmission and laboratory capacity.

8)Treatment:
Mainly supportive.No specific medicines available.

9)No vaccine is available currently.

10)No data is available regarding the effect on future pregnancies.

Takeaway:

1)If you are pregnant, planning to get pregnant definitely consult your doctor before traveling to countries with reported Zika cases.
2) Correct and consistent use of a condom can protect against Sexual transmission of Zika .
3)The risk of Sexual transmissible with asymptomatic infection is unknown and needs more research.Men who have suspected  Zika infection needs to wait to east 8 weeks or longer before planning a baby.

You can protect your unborn child fromZika.Just plan your pregnancy.

India & Zika May 28th, 2017
WHO has confirmed 3 cases of Zika in India. All cases were from Gujrat.

Zika Virus Vaccine: Though phase 2 Zika Virus vaccine trial has started in the US, results are still a long way off!

Do you know about Zika virus? Let me know in the comments below.

Related: 5Tests you must do if you are planning a baby

Disclaimer: This is meant as a public health awareness article and is not a replacement for professional medical advice. Please read my full disclaimer.

(Also published on momspresso as and expert contributor)

Reference

1)Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential? Sexual transmission of Zika virus. Emerg Infect Dis 2015;21:359–61. PubMed

2)Mansuy JM, Dutertre M, Mengelle C, et al. Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen? Lancet Infect Dis 2016;16:405. PubMed

3)Foy BD, Kobylinski KC, Chilson Foy JL, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011;17:880–2.  PubMed

4)Lanciotti RS, Kosoy OL, Laven JJ, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14:1232–9. PubMed

5)Duffy MR, Chen T-H, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536–43. PubMed

6)Rudolph KE, Lessler J, Moloney RM, Kmush B, Cummings DA. Incubation periods of mosquito-borne viral infections: a systematic review. Am J Trop Med Hyg 2014;90:882–91. PubMed

7)Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:122–7. PubMed

8)Calvet G, Aguiar RS, Melo AS, et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Infect Dis. Published online February 17, 2016.  PubMed

9)Mlakar J, Korva M, Tul N, et al. Zika virus associated with micrcephaly. N Engl J Med 2016;374:951–8.  PubMed

10)Martines RB, Bhatnagar J, Keating MK, et al. Notes from the field: evidence of Zika virus infection in brain and placental tissues from two congenitally infected newborns and two fetal losses—Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65:159–60.  PubMed

11)Meaney-Delman D, Hills SL, Williams C, et al. Zika virus infection among US pregnant travelers—August 2015–February 2016. MMWR Morb Mortal Wkly Rep 2016;65:211–4. PubMed

12)Cauchemez M, Dub T, Guillemette-Artur P, et al. Association between Zika virus and microcephaly in French Polynesia, 2013–2015: a retrospective study. Lancet. Published online March 15, 2016.

13)Brasil P, Pereira JP , Raja Gabaglia C, et al. Zika virus infection in pregnant women in Rio de Janeiro—preliminary report. N Engl J Med. Published online March 4, 2016.Petersen EE, Polen KN, Meaney-Delman D, et al. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:315–322. DOI:http://dx.doi.org/10.15585/mmwr.mm6512e2

(Also published on momspresso as and expert contributor)