The Pediatric Insider
© 2016 Roy Benaroch, MD
I last wrote about Zika in January*, and there’s a whole lot more we now know about this mosquito-borne virus. And still a lot we don’t know. Time for a Q&A-styled** update!
Give it to me straight, doc. Does Zika really cause birth defects?
Yes. As is typical for scientist-written press releases, early reports this winter were equivocal—you’d see phrases like “is associated with” or “likely caused by”. That’s because unlike pushers of GMO-free foods, real scientists try to respect the intelligence of their audience. Back then, it was clear that there was both a big spike in cases of Zika-associated illness during pregnancies (mostly in South America), and a big spike in cases of microcephaly and other neurologic birth defects. But did one cause the other?
More-recent reports have included evidence of Zika in the brain tissue of affected fetal brains, and also in the brain and nerve tissues of children and adults suffering from neurologic symptoms during Zika infections. It’s clear that Zika is a neurotropic virus – it likes to invade neurologic tissue.
We also know more about the structure of Zika. At the molecular level, we know it has a structure that interacts with brain cells. That is completely cool—we know exactly what the virus looks like and how its molecules are arranged. That’s one step away from designing a vaccine. All of this research was done in just a few months. Science!
Is Zika coming to America?
It’s already in America, dummy. South America, which (last time I looked) was part of America. Oh, you mean North America? Which includes Mexico? Which is also part of America? Maybe you should just start over.
Is Zika coming to the United States?
It’s already here. Zika-virus associated infections have been reported in almost every US State, though at least so far the only locally-acquired cases have been transmitted through sex. (No, not sex with mosquitoes, you sicko.)
OK, so that means as long as I don’t have sex with anyone who’s been traveling, I’m protected, right?
Maybe for now, but not for long. Over 300 cases of Zika have occurred in the continental US, and even more in our Caribbean territories. And the mosquitos that transmit ZIka, by mid-summer, will be found in a wide swath of the US, across the entire souther border, reaching up into Ohio and Missouri. It is only a matter of time before local mosquitos stare biting people with Zika infection, and then spreading it to other people.
Yikes. I’m glad I’m not a pregnant woman!
So are we. We’ve seen the quality of your questions here, and frankly it would be better if you didn’t reproduce.
I meant I’m glad only pregnant women need to worry about infections. Right?
Nope. Pregnant women, and their unborn babies, are clearly at the highest risk. It looks like about 25% of the time, infection during pregnancy results in fetal damage—though that’s an estimate based on preliminary data.
We do know that most infections in otherwise-healthy children and adults result in no symptoms whatsoever. Probably only 1 in 4 or 5 people with Zika develop symptoms, which include fever, joint aches, and rash. But a small number of people also go on to develop serious complications, which can include brain inflammation or Guillain-Barre Syndrome. Though these conditions after Zika infection are rare, we really don’t know exactly what the risk is, or who’s likely to progress to serious Zika-related illness.
What should I do if I think I have a Zika virus infection?
Testing is available through public health agencies, and is routinely recommended for pregnant women living in or traveling to areas with active transmission. For the rest of us, health-care providers can help decide whether testing is needed. Go see your doctor.
What’s the best way to prevent infection?
Right now, there’s no vaccine, though one is actively being developed. The best way to prevent infection is to avoid mosquito bites and travel to areas with high rates of infection. You can find maps and other resources through the CDC Zika Prevention site.
The bottom line with mosquitoes: wear long sleeves and long pants, keep mosquitos out of homes with nets, screens, doors, and air conditioning, and use a mosquito repellant that actually works. Those typically contain the active ingredients DEET, picaridin, or “oil of lemon eucalyptus.” Of these, DEET is the standard—it’s been around since 1957, and it works, and as long as you don’t drink the stuff it’s safe.
*I wrote about it weeks before the story was picked up by the so-called “mainstream media.” Yet, still, no Pulitzer. Am I bitter? Of course not.
**Some “journalists” say slapping together a blog post in Q&A format shows laziness and a lack of creativity. Those people should go stick their journalistic heads in buckets of icy cold water. It’s Saturday morning, it’s beautiful outside, and you guys are getting get what you pay for. Srsly.