September 14, 2016

Zika: Women and Children Are At Risk

By Clarissa K. Wittenberg, former senior communications officer at the National Institutes of Health
Since its outbreak in early 2015 in Brazil, the Zika virus has spread across South and Central America and now into the United States, devastating thousands of women who are pregnant or who have given birth to a child with irreversible birth defects, including microcephaly. Even infected babies born with mild problems can develop more severe issues as they grow.
What is the risk?
We need a new definition of risk with attention to the degree of devastation in vulnerable members of our society. It is a terrible risk if even one baby is born so incapacitated that they cannot swallow, think, walk and grow.
Estimates range from one to 13 percent (and much higher depending on the study) that a child born to a Zika-infected woman will have birth defects [1]. Certainly protection of pregnant women from environmental hazards such as mosquitoes is an imperative. As things stand now, the women most affected are among the poorest and least able to protect themselves via safe homes and access to services. But even a woman with air conditioning, screen windows, and the means to spray to eradicate mosquitoes is at risk. If you have to walk on a hot day to reach your prenatal clinic, you are in outright danger. If one of us can be infected, we are all at risk.
What do we know?
Zika is spread primarily by infected Aedes aegypti mosquitoes, which are known to bite indoors and out, day and night and have distinctive white bands on their legs and markings on their body [2]. These are the same mosquitoes that transmit yellow fever, dengue fever, and chikungunya virus [2]. Testing for Zika should also rule out these illnesses, as their symptoms can be similar. An infected woman or man can transmit the virus sexually so experts advise condoms be used for all sexual contact or sex avoided altogether. Because the virus can be found in blood, Puerto Rico (which is in the middle of a serious Zika epidemic) has been using blood supplies from the U.S., and the Food and Drug Administration (FDA) has now ordered that donated blood be tested for Zika.
Are there vaccines or treatments?
There are several high-complexity diagnostic tests for Zika, but they are scarce. Clinicians should contact the Centers for Disease Control and Prevention (CDC) or the FDA for the most recent advice on testing. Ultrasounds, to help with assessing head development of the fetus, are recommended. Because of the dire effects of Zika on pregnant women, testing is recommended as early as possible. Currently, there is no preventive vaccine for Zika, although one candidate vaccine began testing in humans in August 2016 [2]. There also are no treatments that can stop the neural damage caused by the Zika virus, although there are symptomatic treatments that can make patients more comfortable. The symptoms of Zika may be so mild as to go unnoticed but generally they include rashes, muscle and joint pain, malaise, headache and conjunctivitis [2].
Zika is also linked to Guillain-Barré Syndrome, a rare neurological disorder that can cause breathing problems, paralysis, and even death. Women and men can get Guillain-Barré, and a pregnant woman who has Guillain-Barré can miscarry or give birth prematurely.
What can be done?
The CDC currently provides a great deal of effective information and materials in a wide variety of languages. Every effort should be made to make this information visible to the public.
It is important for women who are pregnant or who want to become pregnant to learn the basic facts about the Zika virus and to check with trustworthy sources for information. The CDC, NIH, and World Health Organization (WHO) have a wealth of information on their websites. The March of Dimes and other private foundations can also be helpful resources.
What is the funding status?
Drs. Tom Frieden and Anthony S. Fauci, Directors of the CDC and the National Institute of Allergy and Infectious Diseases at NIH, argued for Congress to act on funding for Zika [3]. To date, they cite 16,800 cases of Zika infection reported to the CDC — with updates being made consistently on the organization’s website – in the U.S. and its territories, including 2,700 across this country and 8,746 in Puerto Rico.
Two neighborhoods in Florida have been given travel warnings and Puerto Rico is in a full-fledged emergency despite the fact that the CDC has been working with the Puerto Rico Department of Health for almost a year. They have a comprehensive program of clinics, diagnostic labs, and health messages, and still the Zika infections are spreading. Puerto Rico is also struggling with another Zika problem: how to safely but effectively eradicate mosquitoes.
Additionally, just like with Ebola, all healthcare workers, cosmetic care workers, and personal caretakers should be aware if their clients have recently traveled in Zika-infected areas and take all precautions for their own safety.
What happens if Congress doesn’t adequately fund Zika programs?
Drs. Frieden and Fauci argue that the cost of not funding Zika programs will not only end in misery and death, but huge economic costs for lifelong care [3]. Programs to help parents with Zika-infected children are barely in the planning stages. But they also argue that if funds are borrowed from current programs, other important research will be endangered or ruined. Previous research on viruses similar to Zika (namely dengue fever research) helped accelerate the efforts to create a Zika vaccine. And taking “leftover” Ebola funds is unwisely gambling that Ebola is not coming back.
In February, President Obama requested $1.9 billion in funds to confront the threat [4], but political response has been late, ambivalent, and remains tangled in political arguments about women’s reproductive health. It is time for the Congress to act.
The Society for Women’s Health Research (SWHR®) has been advocating for more than 25 years to bring more awareness to understanding sex differences in infectious diseases, leading to personalized treatment and prevention. Click here to learn more about the Society’s work on infectious diseases.
About The Author
Clarissa K. Wittenberg has served as a senior communications officer at several NIH Institutes: the Office of Global Health, Office of the Director, and Office of Health and Human Services. She has also worked as a consultant on mental and overall health of underserved populations to the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center and was on a select volunteer health issues committee for the first Obama campaign.