Joe Kurland, MPH
It’s the middle of winter in Minnesota, but our state health department staff have joined a growing list of global public health investigators reporting cases of a mosquito-transmitted disease. While we are enjoying the seasonal respite from our unofficial state bird, warmer countries are experiencing a pandemic with a recently recognized outcome that will impact their residents for years to come.
On Wednesday, the Minnesota Department of Health reported that a woman in her 60s was infected with Zika virus that she got while traveling in Honduras. She did not contract her illness in Minnesota and is not infectious to people in the state. Like all the other cases diagnosed in the United States, she acquired the virus while traveling in tropical and subtropical countries.
Zika is in the same family of viruses that cause dengue and yellow fever. It primarily infects humans and other primates and is spread through bites by the Aedes mosquito species. Zika virus can be transmitted directly, person to person, through sexual activity. These mosquitoes are mostly found in the tropical climates and like to live in urban areas. There are several species of mosquitoes in Minnesota, and Aedes mosquitoes have been found in recent years (during the warmer months), but there are no reports of the disease being spread in the state or anywhere in the U.S., as of Thursday night.
Not everyone who becomes infected with Zika virus feels sick. Reports show 20 percent of infected individuals will have symptoms including fever, rash, joint pain, conjunctivitis (red, irritated eyes), muscle aches and headache. These symptoms are generally mild, patients recover on their own, and most do not require hospitalization. There are no medications to treat or vaccines to prevent the virus. The incubation period for the virus is about one week, and the illness lasts another week before it’s cleared from the bloodstream.
Late in 2015, Brazil reported a suddent increase in children being born with microcephaly. The latest figure puts the country at 3,000 cases or about 20 times the expected, normal rate. On Thursday, the director-general of the World Health Organization sounded the alarm despite the lack of scientific evidence that Zika causes microcephaly; because the data is strongly suggestive of such a connection.
Microcephaly is a significant birth defect that may have a variety of symptoms depending upon the severity of the condition. The Centers for Disease Control and Prevention lists symptoms including:
- Developmental delay, such as problems with speech or otherdevelopmental milestones (sitting, standing and walking)
- Intellectual disability (decreased ability to learn and function in daily life)
- Problems with movement and balance
- Feeding problems, such as difficulty swallowing
- Hearing loss
- Vision problems
This is a lifelong condition for infants affected, and some children have increased medical complications and may not attain normal cognitive function. The condition can be diagnosed by ultrasound with the best chance of detection in the third trimester, but diagnosis is difficult to confirm before birth or even later until the child continues to grow and develop and problems emerge.
Screening pregnant women
This month, the CDC notified clinicians across the U.S. to ask pregnant women about recent travel to countries in Central and South America and the Caribbean. Because 80 percent of infected people will not suffer signs of illness, all pregnant women who recently traveled to the indicated areas should be evaluated for Zika virus and possible abnormal development of their unborn child.
Because of the extreme risk to the baby, women who are or may soon become pregnant should not travel to countries with Zika transmission. If you are planning trips to spring break getaways or a “babymoon,” review the list of countries provided by the CDC before you depart. Check the list frequently, or sign up to receive an email notification when they are updated, as more countries are added as the virus is detected. And, as always, speak with your clinician if you have concerns or questions.
If you are planning to become pregnant, consider waiting until after you return from your trip and are outside the window for infection, which is about two weeks after you return. The CDC reported that Zika will not cause infections in a baby conceived after the mother recovers from her illness.
@InfectiousJK Zika virus will not cause infections in a baby that is conceived after the virus is cleared from the blood. 2/4
— CDC (@CDCgov) January 27, 2016
@InfectiousJK Zika virus infection does not pose a risk of birth defects for future pregnancies. 3/4
— CDC (@CDCgov) January 27, 2016
Aedes mosquitoes are most abundant in urban areas and primarily bite during the daytime. If you must travel, take precautions to minimize your risk for mosquito bites:
- Wear clothing that covers your skin.
- Consider fabrics treated with mosquito repellents like permethrin.
- Use bug repellent as directed by the product.
- Reapply as indicated.
- Do not apply to children younger than 2 months.
- Do not use on children’s hands, eyes, mouth, on cuts or on irritated skin.
- Stay safe from sunburns: Apply the sunscreen first, insect repellent after.
- Keep bugs outside.
- Open windows should have screens.
- Use permethrin-treated bed nets when sleeping where mosquitoes are present.
Managing symptoms and preventing spread
If you return home and feel ill, see your doctor. Don’t take aspirin or other non-steroidal anti-inflammatory medications (NSAIDs) until dengue is ruled out to minimize the risk of a bleeding injury; use acetaminophen (Tylenol) to manage fever. If you have or suspect Zika, avoid being bitten by mosquitoes at home and help prevent the virus from circulating in your community. This will become more important in spring and summer.
Children’s Hospitals and Clinics of Minnesota staff, MDH, and the CDC are closely monitoring the developments of this rapidly progressing event. We will work to keep our families and staff informed as we have more information.
There are many fantastic sources of information about Zika and the current outbreak. Below are a few I would recommend to better understand and keep up to date with what is happening.
- Symptoms, diagnosis and treatment
- Zika travel information
- Travel health notice
- Zika virus spreads to new areas
- Facts about microcephaly
WHO announcement and information
Healthmap.org outbreak notice
- Outbreak of microcephaly connected to Zika virus in Brazil (The Daily Disease)
- Zika virus map alert