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Monday, July 18, 2016

Mom's Day Monday: The First Year of the Zika Epidemic

  • Zika, The first year of the epidemic as we understand it so far is summarized in these points. The information physicians are receiving is changing regularly, and it’s important to speak to your own physician about any personal concerns you have.
  •   As of June 2016 over 200 pregnant women in the US have tested positive for the Zika Virus.
  •   Zika is not yet being spread in the continental United States, other than by individuals who have traveled to areas with the Zika virus.
  •  In Brazil, where the epidemic began about a year ago, there have been over 1600 infections.
  • There is no vaccination for the Zika Virus.
  • The Zika virus is mostly spread by the Aedes aegypti mosquito. We do not have a lot of these mosquitoes in the US, but the few pockets we have are in the very southern parts of our country. These mosquito populations have not been shown to have the disease. There are a few other mosquitoes which can spread the virus if they should become infected, which they are not yet in the US.
  •   Zika virus can infect an unborn fetus and cause the head to be small in a condition known as microcephaly.  Other brain conditions are possible due to the virus infection, including calcium deposits in the brain.
  • When a mother gets an infection she may have a fever, a rash, generally feel poorly, or an eye infection. Often the mom does not have recognizable disease. If a mom is, in fact, very sick from Zika infection, then she is more likely to pass the infection on to her unborn child.
  • The Zika virus is from a category of flaviviruses, the other flaviviruses do not seem to cause similar fetal conditions. Other flaviviruses include dengue and chikungunya.
  • The similarity of these viruses may enhance infection of each other if you have had a prior infection.
  •   The Zika Virus can infect a fetus, but the placenta has some resistance to viruses (thus we do not see many viral infections of the fetus in pregnancy).
  • It is also possible that some women have infections of the uterine cavity itself, present prior to conception, and this is why the infection occurs to women exposed prior to, but not during, pregnancy.
  •   A very early infection might cause a miscarriage.
  • There are cases of Zika infection that have been reported as late as at 27 weeks of pregnancy, although  it  typically occurs only an infection very early in the pregnancy.
  • The virus can gain access into the uterus via sperm (like with HIV), via ruptured membranes, or from medical procedures (such as an amniocentesis).
  • The theory, therefore, is that the Zika Virus crosses the placenta into the fetus (only) very early in pregnancy before all the viral defenses of the placenta are functioning.
  • It is not clear whether Zika preferentially would infect fetal tissue verses mom’s tissue, but we do know that the Zika virus affects nerve cells.
  •   We classify a set of infections that can cause diseases in the newborns as TORCH infections: including toxoplasmosis, syphilis, cytomegalic virus infection, herpes, rebella, chicken pox, and parvovirus infection. Zika disease is different from all of these other infections, but can be much worse in pregnancy.

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