An UPDATE is available here.
Is Zika virus a big bad wolf waiting to harm young women?
Sometimes as a travel doctor you feel like Red Riding Hood’s mother.
Your patients come in asking for advice about upcoming travels. Much like Red’s mother you want to wrap your patients up in a protective cape and guide them on safe travels.
You want to teach them avoid any wolves that may be lurking ‘out there’.
Like impetuous teenagers, your patients don’t always listen.
And Zika virus just made it worse for women.
Which leaves you wondering…are you an overprotective mom or a simply a pragmatic advisor? What advice will you give your patients about Zika virus?
I’m usually a calm person not prone to hyperbole. But Zika virus is big deal.
I know because I’m a pediatrician and I’ve been through other emerging outbreaks before. I’ve never seen anything like this. I also know first hand how devastating a diagnosis of microcephaly can be.
What is Zika virus?
Zika virus is a member of the Flavivirus family (as are West Nile, Dengue and Yellow Fever viruses) And similar to other Flaviviruses it is spread by mosquitoes.
It’s odd, if you were infected with Zika you most likely wouldn’t know it. In fact, only 1 in 5 get any symptoms. You might develop a rash, red eyes, joint pain, headache and/or fever 3 to 12 days after a mosquito bite; all of which resolve in less than a week.
That is, unless you are pregnant. Then it can cause miscarriages and profound birth defects such as microcephaly in your baby.
But what makes is so confusing is that this virus has been around since the late 1940s. It was discovered in the Zika forest of Uganda. It’s been in Africa, India and Southeast Asia for decades and is not associated with microcephaly there.
Recently Zika spread to South and Central America. In May of 2015 it invaded Brazil and at the same time thousands and thousands of babies were born with microcephaly: a 26-fold increase!
Preliminary biopsy reports point to Zika virus as the cause.
There is a lot we don’t know about Zika virus, such as why this Brazilian strain is so problematic during pregnancy, but there are some things we do know.
Microcephaly, or small head, is a devastating birth defect causing severe mental and physical handicaps. It’ll turn a family upside down and stress healthcare systems.
And who can forget the photos? They’re haunting.
Your eyes fill with tears yet you can’t stop looking at them.
A photo of a brother filled with love for his baby brother. A baby with a head so small that it seems impossible he is alive.
And you know how hard it will be for that family to provide the attention and care he will need everyday for the rest of his life. And your heart feels heavy.
This is no ordinary virus. Something has changed and it’ll take years to figure it all out.
What will you recommend to your patients who want to travel to the tropics especially Brazil?
I for one, am specifically recommending that women of child bearing age carefully consider travel to Barbados, Bolivia, Brazil, Cape Verde, Columbia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, and Venezuela until more is known.
Especially if they are planning a pregnancy or are currently pregnant.
It’s just not worth the risk. There are plenty other places to visit while scientists get this Zika thing figured out. The stakes are just too high.
The problem is that travelers most likely to be affected are long-term travelers. People going ‘home’ to visit their friends and relatives. Or students studying abroad. They are also in the age groups most likely to get pregnant.
Unfortunately, they are the group least likely to get pre-travel advice.
So you, as their general medical provider, need to be aware of the potential of Zika virus to cause birth defects and advise your patients accordingly.
Wolves vs. Mosquitoes
It’s hard to convey risk. Red’s mom had to warn her about wolves. You need to warn your travelers about mosquitoes.
The thing is with a wolf, at least you can see it before it attacks. You can beat it off with a stick or scare it away.
How do you warn your travelers about something they cannot see? Aedes mosquitoes are tiny and aggressive. You almost never see them. Instead you need to envelop your patients in a cloak of mosquito repellant.
Give the right insect repellent advice.
For travelers who are not planning a pregnancy, or who are going to the tropics anyway you’ll need to teach them to use insect repellents properly.
Aedes mosquitoes bite during the day. They reside in cities and towns, everywhere that humans live. Remind your patients that they cannot judge their risk of mosquito bites by the neighborhood; this insect thrives in elegant neighborhoods and in shabby ones too.
Each morning as they are dressing for the day ask your patients to wear as much protective clothing as is comfortable. Long pants and sleeves can be a uncomfortable in the tropics, but encourage them to wear them anyway. Then apply effective repellent on all exposed skin. And reapply according to the instructions on the label.
Effective repellents in my opinion are ones proven to work with a minimum of applications ie apply once every 8-12 hours. I’ve never heard of anyone being able to apply a product successfully every 2-3 hours while traveling.
Suggest 20% Picaridin or 30% DEET in a long-lasting liposomal formulation (ex. Sawyer or Ultrathon). Encourage your patients to treat their clothing with Permethrin for added protection. Fortunately Permethrin lasts 6 weeks or 6 washings, which is very convenient for extended travel.
Whenever possible, advise your patients to stay in air conditioning or in buildings with screens and doors.
Treatment options you can recommend.
Remind you patients that if they become ill with symptoms of Zika they should see a doctor.
- Take time to rest and drink plenty of fluids.
- There are no medications or vaccines to prevent or treat Zika virus.
Acetaminophen can be used for fever and pain control, but avoid ibuprofen until Dengue can be excluded as a cause of their symptoms. (Dengue has similar symptoms and is spread in the same locales by the same mosquitoes and sometimes causes internal bleeding.)
- To prevent spread of Zika to others, stay indoors away from mosquitoes that can spread the infection.
Our understanding of Zika virus is evolving.
There are always risks to traveling; your patients are counting on you to be up to date so that you can help them make travel plans based on their health and preferences. To help you the CDC has created patient handouts for you to share with your patients.
Zika virus is usually a mild infection which resolves on its own. Recently something has changed, and now it appears to cause terrible birth defects. We are awaiting more information from investigational scientists. But until we have more information we need to caution our travelers, especially our young women of childbearing years, about the potential risks of Zika.
What advice are you giving your patients about travel to the tropics? Share your comments below.