As Zika expands its reach – affecting 2,722 people in the U.S. including 624 pregnant women at last count according to the Centers for Disease Control and Prevention.1 (CDC) — the headlines keep getting scarier for women of reproductive age (and their partners). Among them: “Zika Wreaks Havoc in Baby’s Brains”2 “Zika Hides in the Vagina” 3 and “Woman Got Zika from Partner with No Symptoms.” 4
If you’re pregnant or planning a pregnancy, learn all you can about staying safe—including steps to take whether you live close to a Zika transmission point in South Florida or thousands of miles away, recommends Edward McCabe, MD, PhD, Distinguished Professor Emeritus in the Department of Pediatrics at the University of California Los Angeles and Chief Medical Officer for the March of Dimes. 5 What to know:
According to the CDC, Zika is currently being transmitted by mosquitos in two neighborhoods in Miami-Dade County, FL 6 and most of Central and South America, Singapore and some Pacific Islands. (Check CDC Zika travel information for an updated list.) If you’re pregnant and live in or have visited any of these locales, the CDC recommends getting tested for Zika and staying alert for symptoms. These include a fever, skin rash, red eyes, joint pain, muscle pain or a headache. “But an estimated 80% of people with Zika do not have symptoms or have only very mild symptoms,” Dr. McCabe notes. “Healthcare professionals have to be very vigilant about asking pregnant women about their Zika risk at every visit, to spot potential problems early.”
If your partner has been to a Zika area —or has had sexual relations with someone who has traveled to one—wait at least eight weeks from when you may have been exposed before trying to get pregnant or before having unprotected sex, the California Department of Public Health (CDPH) recommends. 7 While you’re waiting it out, abstain from sex or use a condom for any type of sexual activity. Zika can be passed to a partner during sex even if the infected person has no symptoms.8
“It’s a good idea for anyone who’s been in an area with Zika to avoid unprotected sex when they return home,” Dr. McCabe notes. “All of the focus in the media is on women of reproductive age, but anyone who may have been exposed could pass the virus along once they’re back home. Doing your part to prevent the potential spread of Zika helps your community.”
The CDC recommends pregnant women not travel to areas where Zika is currently being transmitted by mosquitos – and that women trying to get pregnant talk with their doctor first (and avoid mosquitos if they do go). “Unless you absolutely have to go for work or another reason, you may have more peace of mind if you change your plans and don’t travel to areas where Zika is being transmitted by mosquitos,” Dr. McCabe says.
Outside of about 35 mosquito-caused cases in Miami-Dade County, the rest of the Zika cases in the U.S. involve people who had traveled to a Zika area or are their sexual partners or babies infected during pregnancy, according to the CDC. 9 So far, no other mosquito-borne cases have been reported in the U.S.— though the two types of mosquitos that carry the virus—Aedes aegypti and Aedes albopictus – live in southern states as far west as California and as far north as Iowa, Indiana, New York, New Hampshire and southern Maine.10 “These mosquitos live in homes and can be aggressive biters during the day, not just at night like other mosquitos,” Dr. McCabe says. “Your risk right now is low in that situation, but it pays to double up on prevention.”
Repellent registered with the Environmental Protection Agency (EPA) that contain DEET, picaridin (also listed as KBR 3023, Bayrepel or icaridin), oil of lemon eucalyptus or IR3535 are effective and safe for pregnant women. The Environmental Working Group recommends repellents containing up to a 20-30% concentration of DEET or a 20% concentration of picaridin or IR3535. 11 For DEET, higher concentrations aren’t any more effective according to research by Consumer Reports, but have been associated with rashes, disorientation, and seizures.12
“Follow label directions,” Dr. McCabe advises. "You can also protect yourself by also wearing long sleeves and long pants, staying indoors during times of day when these mosquitos are active and running the air conditioner. It’s also wise to get rid of any standing water outside or inside your home – mosquitoes can breed in a few teaspoons of water in a soda cap lid, or in water in the plumbing of a sink you don’t use very often.”
All of these measures are vitally important in reducing the risk to pregnant women. If these measures are carefully and consistently used, the woman’s risk of acquiring Zika infection will be very low. But even when women carefully follow these “Zika control” measures, remember that the more “mosquito-y” your geographic location, the greater the risk. The south and southeast coasts of the U.S. are more able to support the spread of Zika infection than are cooler, drier areas,” according to Betsy Todd MPH, RN, CIC, Clinical Editor of the American Journal of Nursing.18 “While the risk for most pregnant women in the U.S. (assuming they’re carefully following “Zika control” measures) at this time is quite low, we all need to stay on “high alert” about this infection simply because the consequences of Zika infection during pregnancy can be so devastating.”
“Right now, testing is recommended only for pregnant women who have traveled to or live in an area with Zika; those who have had sex with a partner who has been in one of those areas and for pregnant women who have symptoms,” Dr. McCabe says. Men and nonpregnant women who have symptoms and have been to a Zika area or had sex with someone who has may also be tested. “Access to testing has been limited, with most of it being performed by the CDC and state health departments,” Dr. McCabe says. “As more private labs gain approval it may be easier for more people to be checked.”
Blood and urine tests are used to confirm a Zika infection.14, 15 Several different tests are used, depending on when you first developed symptoms or think you may have been exposed to the virus.16 While a positive result on one test, called the rRT-PCR test, confirms infection, a negative result doesn’t necessarily mean there’s no Zika if viral levels in your blood have dropped. You may need more than one type of test to find signs of infection.17
Yes, but you should wait for a period of time. The wait time differs depending on your gender. The CDC recommends men who’ve had Zika symptoms or a positive Zika test wait six months before trying to conceive; a woman should wait at least eight weeks.13 (The CDC says these waiting periods are based on tripling the longest known time for Zika to persist in the body.) If you conceive after the infection is fully resolved, it shouldn’t affect your baby according to the CDC.
In the new poll, researchers at Harvard T.H. Chan School of Public Health polled 1,275 adults—which included 105 people who live in households where someone is pregnant or considering getting pregnant in the next 12 months—and discovered there is a lot of confusion about Zika. For example, they found that close to 40% of people believe the Zika virus can harm future pregnancies. Currently, the U.S. Centers for Disease Control says there’s no evidence that the Zika virus will cause birth defects in the future among non-pregnant women with current or previous infection.
1. CDC: Zika. https://www.cdc.gov/zika/. Accessed Sept 1, 2016
2. Daily Mail. August 23, 2016 Pictured: How Zika wreaks havoc in a baby's brain and causes the skull to collapse in on itself. http://www.dailymail.co.uk/health/article-3755347/Study-shows-extent-brain-damage-Zika-infections.html
3. CNN.com, August 26, 2016. “Zika hides in vagina, baby's bloodstream longer than previously thought.” http://www.cnn.com/2016/08/25/health/zika-hides-vagina-bloodstream/
4. Pittsburgh Post Gazette, August 29, 2016. “CDC: Woman got Zika from partner with no symptoms.”http://www.post-gazette.com/news/nation/2016/08/29/CDC-Woman-got-Zika-from-partner-with-no-symptoms/stories/201608290083
5. Interview with Edward McCabe, MD, PhD, Distinguished Professor Emeritus in the Department of Pediatrics at the University of California Los Angeles and Chief Medical Officer for the March of Dimes.
6. CDC: Advice for people living in or traveling to South Florida. http://www.cdc.gov/zika/intheus/florida-update.html
7. CDPH Zika Virus FAQs for Healthcare Providers: August 19, 2016. Accessed September 1, 2016
8. CDC: Transmission & Risks. https://www.cdc.gov/zika/transmission/index.html
9. CDC: Zika. https://www.cdc.gov/zika/. Accessed Sept 1, 2016
10. CDC: Estimated range of Aedes albopictus and Aedes aegypti in the United States, 2016*. https://www.cdc.gov/zika/vector/range.html
11. Environmental Working Group: Insect Repellents. http://www.ewg.org/research/ewgs-guide-bug-repellents/pregnant#block0. Accessed September 2, 2016.
12. Consumer Reports: Mosquito Repellents That Best Protect Against Zika. http://www.consumerreports.org/insect-repellents/mosquito-repellents-that-best-protect-against-zika/
13. CDC: CDC Issues Updated Zika Recommendations: Timing of Pregnancy after Zika Exposure, Prevention of Sexual Transmission, Considerations for Reducing Unintended Pregnancy in Areas with Zika Transmission. http://www.cdc.gov/media/releases/2016/s0325-zika-virus-recommendations.html
14. American College of Obstetrics and Gynecology: Practice Advisory on Zika Virus. August 3, 2016. Accessed Sept 1, 2016. http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak.
15. CDC: WHAT HAPPENS WHEN I AM TESTED FOR ZIKA AND WHEN WILL I GET MY RESULTS? http://www.cdc.gov/zika/pdfs/what-happens-tested-for-zika.pdf
16. CDC: Guidance for U.S. Laboratories Testing for Zika Virus Infection. Accessed September 2, 2016. http://www.cdc.gov/zika/laboratories/lab-guidance.html
17. Alabama Department of Public Health – Health Alert Network (HAN). Zika Testing and Recommendations for Subsequent Zika IgM Antibody Testing 6/23/16. Accessed September 2, 2016. http://www.adph.org/mosquito/assets/ZikaIgMAlert.pdf
18. Interview with Betsy Todd MPH, RN, CIC. Clinical Editor, American Journal of Nursing.