This Guest Blog Post was written by Dr. Kudus Akinde, MD FAAP of Glencoe Pediatrics.
Today, the World Health Organization (WHO) declared a public health emergency (AAP News). There is strong suspicion that recent clusters of fetal microcephaly are occurring in babies of infected mothers in areas where Zika virus transmission appears to be common. The CDC & the AAP have become involved in issuing recommendations to health care providers and to the general public in the matter.
Zika is a mosquito-borne flavivirus with RNA as its genetic material. It is transmitted by Aedes aegypti mosquitos. An estimated 80% of all people infected have no symptoms according to the CDC’s Morbidity and Mortality Weekly Report (MMWR) from Jan 22, 2016. The report goes on to explain that symptoms are usually mild with usually a few days of fever, rash, joint aching and pink eyes without mucus or pus buildup. No antiviral medicines exist to treat Zika virus. Treatment is supportive (acetaminophen, rest, oral fluids); avoid aspirin or ibuprofen in pregnant women.
So what’s the big deal about the Zika Virus? Infections happen all over the world. Right?
Well, it turns out that there are areas in the Caribbean, North and South America where children are being born with microcephaly (heads. therefore brains, that are abnormally small for their gestational age) or intracranial calcifications. This is a problem because these findings can be associated with a whole host of neurologic and developmental delays that can be lifelong in duration.
Since the outbreak is currently ongoing, it is difficult to make associations and good reliable information about infection during pregnancy is unavailable. As a matter of fact, pregnant women aren’t known to be more susceptible to infection with Zika virus than anybody else. It seems to infect people of all ages across the board. However, it can infect pregnant women in any trimester and if they are infected, the virus can be transmitted to the developing fetus in any trimester as well.
How To Prevent The Zika Virus?
All pregnant women should be screened for travel. If they haven’t traveled, they should strongly consider postponing travel to all endemic areas. If they do travel, they should practice strict mosquito avoidance. This includes:
- Long-sleeved shirts and pants are preferred to the shorter varieties
- EPA-approved insect repellants
- Permethrin-infused clothing and other equipment
- Using screens and air conditioning as much as possible
Pregnant women who have travelled to areas of ongoing Zika, dengue and chukungunya (similar flaviviruses with similar symptoms and also transmitted by Aedes mosquitos) infection should be tested according to CDC guidelines if they have symptoms consistent with Zika (fever, rash, pink eyes within 2 weeks of travel OR fetal microcephaly or intracranial calcifications after travel). Women wtihout symptoms and with normal fetal ultrasounds do not need to be tested according to current recommendations. If lab testing confirms Zika by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR), then prenatal ultrasounds to diagnose and monitor problems are recommended as well as Meternal-Fetal Medicine (MFM) specialist (high-risk obstetrics) or an Infectious Diseases specialist with expertise in the care of pregnant women. An antibody test also exists but the decision for which test to order should be made with/by the treating provider.
What Testing Can Be Done For The Zika Virus?
RT-PCR can be done on amniotic fluid but there are limitations to the testing. Amniocentesis carries higher risk of complications early in pregnancy (at 14 weeks or less) so it should be done at a minimum 15 weeks gestation. For babies born with evidence of Zika, testing should be done on available tissues (umbilical cord and placenta). In cases of fetal loss, RT-PCR should be done on fetal tissues as well (cord and placenta). There are no commercial tests available for Zika virus infection. The CDC and state public health agencies are the ones who can help with testing.
A Summary of the Zika Virus:
- Zika virus infection is suspected of an association with clusters of fetal microcephaly and intracranial calcifications in many countries in North and South America as well as the Caribbean Islands.
- Most infected people don’t even know they’re infected (up to 80%).
- Pregnant women are being cautioned not to travel to areas Zika virus transmission. Pregnant women should be asked about travel at their pre-natal visits. If they have traveled and felt no symptoms of illness, they do not need testing.
- Testing should be done for Zika virus (also dengue and chukungunya) on symptomatic pregnant women who have travelled to endemic areas.
- If testing is positive for Zika, serial ultrasounds and very specialized care with MFM or Infectious Diseases specialist with focus on pregnancy should be obtained.
- If a baby is born with evidence of Zika virus infection, testing of the umbilical cord and placenta by RT-PCR should be done.
- If fetal loss occurs in a symptomatic mother with known travel to an endemic area, RT-PCR should be done.
*Special thanks to the CDC, WHO, and AAP for their leadership in this emerging matter.
Dr Kudus Akinde, MD FAAP is the practicing physician at Glencoe Pediatrics in beautiful Glencoe, IL. Glencoe Pediatrics provides services including: sick or urgent visits, minor scrapes & bumps, annual check-ups, school physicals, camp physicals, sports physicals, pre-surgical physicals and more. Dr. Akinde graduated from University of Illinois with a Bachelor of Science Degree in 1995. He attended the University of Illinois College of Medicine and obtained his MD in 2002. He completed his Pediatrics Residency at Rush University Medical Center in 2005. He has practiced in various locales from small to large communities, urban, suburban and rural (including Rockford, Belvidere, Evergreen Park, Oak Lawn, Highland Park & Chicago, IL). He has never met a kid he does not like. His interests include newborn care, immunizations, nutrition, gastroenterology and adolescent issues. He loves to spend time with his children when he is not at work. He enjoys web browsing, bike riding, football, basketball, music and traveling among other things.