Paging Dr. Frischer: Zika virus
The Obama administration intends to spend some $600 million, originally earmarked to fight Ebola, to combat the spread of the Zika virus. And, that looks to be just the beginning; Congress may authorize $1.8 billion more.
Just three months ago, the World Health Organization (WHO) declared the Zika virus infection an international public health emergency. It has been seen in at least 55 countries and territories between 2007 and March of this year. Just what do we know about Zika?
The scariest news about the Zika virus is that a pregnant woman can transmit it to her developing child. It has been shown to be the direct cause of microcephaly (the development of an abnormally small head), and is linked to a range of other serious developmental problems, including issues with hearing and vision. Less frequently, in adults, the virus is linked to Guillain-Barré, a severe autoimmune reaction.
Because 75%-80% of those infected with Zika show no symptoms, it is difficult to know how many cases actually exist, and extremely challenging to control its spread. In one out of four or five cases, however, those infected develop a flat pinkish rash, bloodshot eyes, fever, and joint pain.
The virus is most often spread by mosquitoes, but by sexual contact as well. It was first isolated in 1947 in a rhesus monkey and is named after the Zika Forest in Uganda. Until 2007, there were only 14 human cases of Zika documented. This current outbreak began in 2015 in Brazil. It is possible that the virus was brought to Brazil during the 2014 World Cup, by an infected traveler who had been exposed in French Polynesia. That person may have then been bitten by a mosquito, which subsequently infected others. A baby was born in Hawaii with microcephaly due to Zika, but the mother likely contracted the virus when she was in Brazil. The first case of Zika contracted on the United States mainland was through sexual transmission, when a person exposed outside of the United States had sexual contact with a partner in Texas.
The infection is potentially so devastating that the Centers for Disease Control and Prevention has issued travel notices, with huge consequences for tourism. As of April 18th, countries with active Zika transmission in the Americas that pregnant women are urged to avoid are: Aruba, Barbados, Belize, Bolivia, Bonaire, Brazil, Colombia, Puerto Rico, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad and Tobago, U.S. Virgin Islands, and Venezuela. The World Health Organization warns that the virus is likely to spread throughout most of the Americas by the end of this year.
In addition, travel notices have been issued for a number of the Pacific Islands, as well as Cape Verde in Africa. Refer to the State Department or CDC website for more details.
Note that the upcoming summer Olympics are to be held, of all places, in Brazil. A number of athletes face a tough decision over whether to attend. Several countries have advised their own citizens to delay pregnancy for now, until more is known about the virus.
How is the diagnosis made? The general symptoms of Zika can appear similar to other viral infections, so the first question asked is whether there was a reasonable chance of exposure to Zika. If so, there are both blood and urine tests that can detect the virus.
There is no specific treatment for the Zika infection. There is no vaccination to prevent it, or medicine to treat it. Like the virus that causes the common cold, recommendations are to treat the symptoms, get lots of rest, and to drink plenty of fluids.
The virus is not considered dangerous to anyone other than pregnant women. It is not clear yet at what stage of pregnancy the fetus is the most vulnerable to infection. At this time, the best advice is if you are pregnant or planning to become pregnant, take extra precautions to avoid mosquitos, avoid sexual contact with a partner who could possibly have been exposed to the virus, and do not travel to the countries listed above. If you are pregnant and suspect that you may have Zika, consult your doctor as soon as possible.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.