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    The Zika Virus: What you need to know


    Concern is growing about the possibility that intrauterine transmission of a previously little-known mosquito-borne virus closely related to West Nile may lead to fetal brain abnormality. Two new case reports from Brazil about Zika virus and an editorial in NEJM underscore the need for ob/gyns to counsel pregnant women about the virus if they are planning to travel to areas where it is endemic.

    Detailed guidance from the Centers for Disease Control and Prevention (CDC) on precautions for pregnant women and those trying to become pregnant who are traveling to such areas is available at http://wwwnc.cdc.gov/travel/page/zika-travel-information. CDC’s Level 2 travel alert about Zika virus was issued on January 15 and pertains to 14 countries and territories in Central and South America and the Caribbean where transmission of the virus is ongoing. On January 22, more countries were added to the list. Interim guidelines for pregnant women were issued by the CDC on January 19 and can be viewed here.

    Writing in Ultrasound in Obstetrics & Gynecology, physicians from Brazil describe what may be the first 2 cases of documented intrauterine transmission of Zika virus. In one case, fetal ultrasound at 30.1 weeks’ gestation showed anomalies limited to the brain; in the second case, fetal ultrasound at 29.2 weeks’ gestation showed markedly asymmetric hemispheres and absence of the thalami; the eyes were also involved. Both mothers had symptoms of the virus but negative blood tests, whereas amniocentesis and polymerase chain reaction were positive for Zika virus.

    Contemporary OB/GYN Editorial Board member Joshua A Copel, MD, said, “We don’t know the absolute risk of fetal effects if a woman contracts Zika virus in pregnancy from this report, but it certainly raises our concern for detectable prenatal effects of Zika virus in pregnancy.”

    Click here to see Dr Copel's comments to NBC news

    Unlike West Nile virus, Zika virus is transmitted by aedes mosquitos, and particularly Aedes aegypti. Said Gustavo Malinger, co-author of the case reports, “As shown in the map published in NEJM, until now Zika virus has been reported in countries between the Tropics. This is due to the fact that the aedes mosquito prefers a hot and humid climate. For this reason the risk of spreading of the disease to more temperate regions is, in my opinion, low. In places where Dengue fever is prevalent, cases of Zika are to be expected.”

    “Particularly during the first half of pregnancy,” Dr Malinger said, “women need to be counseled regarding the danger and possible measures of prevention mosquito bites when traveling to Dengue and Zika endemic zones. According with our experience in the fetus examined and verbal reports from Brazil, the fetal Zika virus infection is expected to produce a wide range of anomalies involving not only the brain but also other systems; the expected spectrum of disease will range from mild cases to severely affected newborns and even stillbirths. Microcephaly in affected fetuses and newborns is most probably produced by a severe and widely spread insult to the whole brain."

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.


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