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The World Health Organization has declared an international health emergency over the spread of the Zika virus, now known to cause devastating birth defects.
All pregnant women who have been to these regions should be tested for the infection, health officials have said, and should refrain from unprotected sex with partners who have visited these regions.
Here are some answers and advice about the outbreak.
- What is the Zika virus?
Can the Zika virus be sexually transmitted?
What is microcephaly?
How do I know if I’ve been infected? Is there a test?
I’m pregnant and live in or recently visited a country with Zika virus. What do I do?
I’m of childbearing age, but not pregnant and not planning to get pregnant. Should I go to an affected country?
Can I become immune to Zika? Will it be safe for me to get pregnant after I recover from Zika?
If I live in an area where the virus is circulating, should I delay becoming pregnant?
Does it matter when in her pregnancy a woman is infected with the Zika virus?
Should infants be tested?
I’m a man and have returned from a place where the Zika virus is spreading. How long until I can be sure that I won’t infect a sexual partner?
Is there a treatment?
Is there a vaccine? How should people protect themselves?
Q. What is the Zika virus?
A. A tropical infection new to the Western Hemisphere.
The Zika virus is a mosquito-transmitted infection related to dengue, yellow fever and West Nile virus. Although it was discovered in the Zika forest in Uganda in 1947 and is believed to be common across Africa and Asia, it did not begin spreading widely in the Western Hemisphere until recently — perhaps sometime in 2013, although its presence was not confirmed until May 2015, when it was identified as the “mystery disease” sweeping across northeast Brazil.
About four in five victims have no symptoms, and those who do usually recover within a week. Common symptoms include a fever rarely higher than 102 degrees, an itchy pink rash, bloodshot eyes, sensitivity to light, headaches and joint pains.
Q. Can the Zika virus be sexually transmitted?
In all known cases as of late June, transmission has been from a man to a woman or to another man, not from a woman to anyone else. The Zika virus has clearly been transmitted by vaginal and anal sex, and possibly by oral sex.
Viral RNA has been found in semen more than two months after symptoms disappeared. Scientists believe the prostate or testes serve as a reservoir, sheltering the Zika virus from the immune system. In at least one case, a man who never had Zika symptoms transmitted it sexually.
Health authorities now recommend that women who are pregnant or trying to become pregnant avoid contact with semen from men who have visited areas where the virus is transmitted. Pregnant women should abstain until they give birth, or should have sex only with partners using a condom.
To reduce the risk of sexual transmission, health authorities recommend that men who have visited areas in which the Zika virus is transmitted by mosquitos and who have had symptoms avoid unprotected sex for six months. Men who have had no symptoms should wait eight weeks.
Q. What is microcephaly?
A. An unusually small head, often accompanied by brain damage.
Babies with microcephaly have unusually small heads. Normally, some degree of microcephaly occurs in 1 in 5,000 to 1 in 10,000 of all births. In roughly 15 percent of cases, a small head is just a small head, with no effect on the infant.
But infection with the Zika virus causes a severe form of microcephaly. The brain may stop growing and be small and smooth, lacking the normal indentations. The long nerves connecting the eyes and ears to the brain may be damaged. Children may suffer from constant seizures or be born with permanently rigid limbs.
There is no treatment for the brain damage.
“There is no way to fix the problem, just therapies to deal with the downstream consequences,” said Dr. Hannah M. Tully, a neurologist at Seattle Children’s Hospital who specializes in brain malformations.
Q. How do I know if I’ve been infected? Is there a test?
A. It’s often a silent infection and hard to diagnose.
Only one of five infected people develop symptoms. There is currently no rapid test that can be done in a doctor’s office; tests must be sent to sophisticated laboratories, which delays diagnosis.
Q. I’m pregnant and live in or recently visited a country with Zika virus. What do I do?
A. Pregnant women should get blood tests and ultrasound scans.
According to the C.D.C., all pregnant women who have visited areas with Zika transmission should be tested, whether or not they have symptoms.
All pregnant women who live in those areas, such as Puerto Rico or American Samoa, should be tested at least twice during their pregnancies, whether or not they have symptoms.
All pregnant women who test positive or had symptoms should have a series of ultrasounds looking for evidence of fetal microcephaly or calcifications, small white spots indicating cell death or inflammation in the brain.
Brain damage has been detected as early as week 19 of a pregnancy — about midway through the second trimester. But it is not clear how quickly damage becomes detectable after an infection.
The current guidelines can be found here: http://www.cdc.gov/mmwr/index2016.html (search for ZIKA)
The surest way to detect the virus itself is with a blood or urine sample gathered in the first two weeks or less after symptoms appear. Antibody tests can be done later but, because the disease is closely related to dengue and yellow fever, false positives and false negatives may occur, especially in areas where those diseases circulate. More complex “neutralization assay testing” can lower the false-positive rate, but not eliminate it.
Q. I’m of childbearing age, but not pregnant and not planning to get pregnant. Should I go to an affected country?
A. Only if you use birth control consistently.
Half of pregnancies are unintended, according to some surveys. If you want to visit a country where Zika transmission has been reported, Dr. Laura E. Riley, a specialist in high-risk pregnancies at Massachusetts General Hospital, advises strict use of birth control.
Women who become unexpectedly pregnant while traveling or shortly afterward will have to deal with blood tests, regular ultrasounds and a great deal of anxiety.
“Why would you ever sign yourself up for that?” Dr. Riley said. “There’s enough in life to worry about. I wouldn’t add that to my list.”
Q. Can I become immune to Zika? Will it be safe for me to get pregnant after I recover from Zika?
Women who recover from the infection are believed to immune to it, so no harm can come to a new baby.
To be sure no virus is in the blood even after a silent infection, the C.D.C. recommends waiting eight weeks — triple the amount of time the virus has been known to persist — before trying to conceive.
Whether that immunity is lifelong is not yet known, because the virus has only been studied carefully for a brief time. But it is believed to be long-lasting.
“Our understanding thus far is that the risk is very, very low if you were in that place prior to conception,” Dr. Riley, of Massachusetts General Hospital, said.
“I wouldn’t be worried about if you conceived (in such a manner).”
Q. If I live in an area where the virus is circulating, should I delay becoming pregnant?
A. That may be wise, some officials say.
Health officials in several countries, including Brazil, Colombia, Ecuador, El Salvador and Jamaica — and in the territory of Puerto Rico — have suggested that women delay pregnancy temporarily. Obstetricians in some countries are privately giving patients the same advice, saying the risk of fetal damage during an epidemic’s peak is too great.
Once “herd immunity” is strong because many people have been bitten and have recovered, local epidemics may fade out, so that women can safely become pregnant again. Also, many companies are working on Zika vaccines, and delaying pregnancy will buy time for them to arrive.
Both the W.H.O. and the C.D.C. approach the topic very cautiously, but the C.D.C. has said that some women and their partners, in consultation with their doctors, “might decide to delay pregnancy” and should be provided with contraception if they do. The W.H.O. says that men and women “should consider delaying pregnancy and follow recommendations (including the consistent use of condoms) to prevent H.I.V., other sexually transmitted infections, and unwanted pregnancies.”
Q. Does it matter when in her pregnancy a woman is infected with the Zika virus?
A. Anytime during pregnancy may be dangerous.
Originally, doctors in Brazil believed that infections in the first trimester were the most dangerous, because mothers who gave birth to babies with microcephaly were usually infected then.
A later study found that some mothers infected late in pregnancy also had disastrous outcomes, including the sudden deaths of infants in the womb.
Some experts who have studied the long-term consequences of rubella — another virus that attacks fetuses — say they believe that children who survive a Zika infection without microcephaly nonetheless may suffer serious consequences, including blindness and deafness at birth, learning and behavior difficulties in childhood, and perhaps even mental disabilities later in life.
Q. Should infants be tested?
A. Other birth defects may be linked to the virus.
Federal health officials say that newborns should be tested for infection with the Zika virus if their mothers have visited or lived in any country experiencing an outbreak and if the mothers’ own tests are positive or inconclusive.
The reason, officials said, is that infection with the virus could be linked to defects in vision and hearing, among other abnormalities, even if the child does not suffer microcephaly.
Q. I’m a man and have returned from a place where the Zika virus is spreading. How long until I can be sure that I won’t infect a sexual partner?
A. Err on the side of caution.
Whether or not you have had symptoms, you should do everything you can to avoid infecting a woman who may be pregnant or is trying to become pregnant, because the consequences for the baby may be disastrous.
To do that, you must avoid vaginal, anal and oral sex for the length of the pregnancy — or use condoms every time.
It is not known how long the Zika virus remains infectious in semen, but viral RNA has been found in semen more than two months after symptoms subsided. The testes are somewhat shielded from the immune system, so it may take longer for the body to eliminate an infection there.
The C.D.C. recommends that men who have traveled to Zika-infected areas, but had no symptoms, wait eight weeks before having unprotected sex.
Men who have had a positive Zika test or any symptoms of infection, on the other hand, should wait six (to nine) months.
At least one gay man has infected his male partner through anal sex. Another man is believed to have infected his female partner through oral sex.
And in one case in France, a man who never reported symptoms is believed to have infected his wife through sex.
Q. Is there a treatment?
The C.D.C. does not recommend a particular antiviral medication for people infected with the Zika virus. The symptoms are mild – when they appear at all – and usually require only rest, nourishment and other supportive care.
Q. Is there a vaccine? How should people protect themselves?
A. Protection is difficult in mosquito-infested regions.
There is no vaccine against the Zika virus. Efforts to make one have just begun, and creating and testing a vaccine normally takes years and costs hundreds of millions of dollars.
Because it is impossible to completely prevent mosquito bites, the C.D.C. has advised pregnant women to avoid going to regions where the virus is being transmitted, and has advised women thinking of becoming pregnant to consult doctors before going.
Travelers to these countries are advised to avoid or minimize mosquito bites by staying in screened or air-conditioned rooms or sleeping under mosquito nets; wearing insect repellent at all times; and wearing long pants, long sleeves, shoes and hats.
More info from the CDC here: http://www.cdc.gov/zika/index.html