Zika Virus: What You Should Know

mosquito

The Zika virus arrived in the United States last summer, with local transmission reported in and around Miami, FL, and Brownsville, TX.

The virus causes birth defects in babies born to some infected pregnant women, including microcephaly, where babies are born with underdeveloped heads and brain damage. Zika has also been linked to Guillain-Barre syndrome, a condition in which the immune system attacks the nerves. It’s mainly spread through mosquitoes, although some cases of sexual transmission have been reported.

The CDC is advising pregnant women to “consider postponing travel” to South Florida and Brownsville, TX, near the Mexican border.

In addition, the CDC has issued travel warnings for pregnant women in countries where the disease is spreading.

What is Zika? How can you avoid it? WebMD answers your questions.

What Is the Zika Virus? How Do You Catch It?

The Zika virus, first identified in Uganda in 1947, is transmitted by Aedes mosquitoes, the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific.

Zika has “never been thought of as a severe infectious disease until now,” says Amesh Adalja, MD, a spokesman for the Infectious Diseases Society of America.

The CDC has confirmed Zika can spread through sex, usually after a person traveled to an area where Zika has broken out, got the virus, and gave the virus to a sex partner who did not travel. Infected women and men can both pass the virus to sex partners -- even if they haven’t shown symptoms of infection, the CDC says. In addition, infected pregnant women can pass the virus on to their fetus.

Some studies have also shown the virus can be found in blood, semenurine, and saliva of infected people, as well as in fluids in the eye.

In Utah, a person got the virus without traveling or having sexual contact. The person was a relative and caregiver of an elderly Zika patient who died in late June -- the first Zika-linked death in the U.S. The deceased man had traveled to an area where Zika is spreading, and lab tests showed high amounts of the virus in his blood -- more than 100,000 times higher than that seen in other samples of infected people, the CDC says. He also had an underlying medical condition that has not been disclosed.

Health officials believe the caregiver got Zika by coming into contact with the older man’s tears and sweat.

What Are the Symptoms of Zika?

The disease can cause fever, rash, joint pain, and redness in the whites of the eye (conjunctivitis, or pinkeye). But most people won’t know they have it.

“Only about 1 in 5 people with the virus will exhibit symptoms,” says Adalja. “The vast majority have no symptoms at all.”

Symptoms can appear anywhere from 3 to 14 days after a bite from an infected mosquito, according to the CDC. They can last from several days to about a week.

Call your doctor if you develop symptoms and you live in or have visited an area where Zika is spreading, the CDC says -- especially if you are pregnant. Pregnant women who have Zika symptoms at any point during their pregnancy should be tested for Zika.

Once a person has been infected, scientists believe they are probably protected from future infections.

Is Zika Similar to Other Mosquito-Borne Illnesses, Such as Dengue Fever, Chikungunya, or West Nile Virus?

All can cause a variety of flu-like symptoms that range in severity and can last from a few days to more than a week. As with Zika, few people infected with dengue or West Nile will show any symptoms. While the same type of mosquitoes that spread Zika also spread dengue and chikungunya, many different types of mosquitoes spread the West Nile virus.

Zika is also the only one of those viruses known to be spread through sexual contact.

How Is Zika Treated?

There’s no treatment, but Adalja says most people with symptoms do well with over-the-counter medications for aches and pains. The disease usually runs its course within a week or so.

The CDC recommends infected people get plenty of rest, drink fluids to prevent dehydration, and take acetaminophen for fever and pain. Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) should not be taken until dengue is ruled out, to reduce bleeding risk, the agency says.

There is no vaccine against Zika, but the National Institutes of Health is testing one in humans.

What Is the Connection Between Zika, Microcephaly, and Pregnancy?

Zika causes microcephaly in babies born to infected pregnant women, the CDC confirmed this year. Microcephaly stunts a baby’s head growth, causing devastating, sometimes fatal brain damage, and it can result in miscarriage or stillbirth.

The virus has caused panic in Brazil since it first appeared there in May 2015. More than 2,100 babies in Brazil have been born with microcephaly or other birth defects linked to Zika. Brazil and several other nations have advised women to postpone pregnancy.

Although there are many causes of microcephaly in babies, including infections during pregnancy, genetic problems, and exposure to toxic substances during pregnancy, the CDC says research has provided enough evidence to show that Zika is among those causes. Research has suggested that infection during the earliest stages of pregnancy, when a baby’s organs are still forming, seems to be linked to the worst outcomes.

However, some studies are showing that fetuses can be harmed by infection later in pregnancy,

and evidence is emerging that microcephaly isn’t the only birth defect linked to Zika. In a November report, the CDC describes five types of birth defects, including severe microcephaly, that are unique to Zika or rarely occur with other infections in pregnant women. They are:

  • Decreased brain tissue with calcium deposits indicating brain damage
  • Damage to the back of the eye
  • Limited range of motion in joints, such as clubfoot
  • Too much muscle tone, which restricts movement

Those effects in babies are called congenital Zika syndrome.

As of Feb. 21, the CDC had confirmed Zika infections in more than 1,500 pregnant women in the U.S. and more than 3,200 pregnant women in U.S. territories. Forty-seven U.S. babies have been born with Zika-linked birth defects, and five pregnancy losses have been linked to the virus. In May 2016, the agency set up registries in the U.S., including Puerto Rico, to track pregnant women infected with Zika.

The agency advises that women and men who have lived or traveled in areas with Zika infections and have a pregnant sex partner either use condoms or abstain from sex during the pregnancy. People who live in South Florida or near Brownsville, TX, or must travel there should protect themselves from mosquito bites, the CDC says.

All pregnant women in the U.S. should be evaluated for possible Zika exposure during each prenatal care visit, the CDC says, and all pregnant women with possible exposure should be offered Zika testing.

Which Countries Are in the CDC Travel Warning for Pregnant Women?

The CDC has warned pregnant women in any trimester to "consider postponing travel" to a number of countries and territories where Zika transmission is ongoing:

  • American Samoa
  • Angola
  • Anguilla
  • Antigua and Barbuda
  • Argentina
  • Aruba
  • The Bahamas
  • Barbados
  • Belize
  • Bolivia
  • Bonaire
  • Brazil
  • British Virgin Islands
  • Cape Verde
  • Cayman Islands
  • Colombia
  • Costa Rica
  • Cuba
  • Curacao
  • Dominica
  • Dominican Republic
  • Ecuador
  • El Salvador
  • Fiji
  • French Guiana
  • Grenada
  • Guadeloupe
  • Guatemala
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Jamaica
  • Kosrae
  • Maldives
  • Marshall Islands
  • Martinique
  • Mexico
  • Montserrat
  • New Caledonia
  • Nicaragua
  • Palau
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Puerto Rico
  • Saba
  • Saint Barthelemy
  • Saint Lucia
  • Saint Martin/Sint Maarten
  • Samoa
  • Singapore
  • Solomon Islands
  • St. Eustatius
  • St. Kitts and Nevis
  • St. Vincent and the Grenadines
  • Suriname
  • Tonga
  • Trinidad and Tobago
  • Turks and Caicos
  • U.S. Virgin Islands
  • Venezuela

In addition, the CDC has issued a “special travel consideration” for 11 Southeast Asian countries that have either reported the spread of the Zika virus or are next to countries with known transmission. There is no travel warning for these countries, but pregnant women are told to “consider postponing nonessential travel to these countries because of the uncertain risk of Zika virus infection”:

  • Brunei
  • Burma (Myanmar)
  • Cambodia
  • Indonesia
  • Laos
  • Malaysia
  • Maldives
  • Philippines
  • Thailand
  • Timor-Leste (East Timor)
  • Vietnam

Pregnant women who must travel, as well as women who are thinking about becoming pregnant, should talk to their doctor first and "strictly follow steps to avoid mosquito bites" during their trip, the CDC says.

Couples planning pregnancies “in the near future” should consider avoiding areas with active Zika transmission.

Scott C. Weaver, PhD, director, Institute for Human Infections and Immunity, University of Texas Medical Branch at Galveston, is particularly concerned about pregnant women travelers.

“Especially in the first trimester or early second trimester, going to an area with Zika virus circulating is pretty risky,” he says. “... I certainly would not recommend that pregnant women travel to areas where epidemics are ongoing.”

Couples who are trying to have a baby should wait a few months to get pregnant if either partner has traveled to an area where Zika is spreading -- even if they did not have a confirmed infection, the CDC says. The agency advises women to wait 2 months and men to wait at least 6 months after possible exposure, even if the man did not have symptoms.

Men and women who have traveled to areas where Zika is spreading are advised to practice safe sex or abstinence for 6 months upon returning. The recommendation applies whether or not they are trying to get pregnant and whether or not they showed symptoms of Zika.

What if I'm Pregnant and I've Traveled to These Areas?

Talk to your doctor. She'll check on your baby's health, and you'll be screened for symptoms of the virus. If you have symptoms, other diseases such as dengue or chikungunya can be ruled out.

Pregnant women who have traveled to an area with Zika can be offered testing 2 to 12 weeks after returning, even if they have not shown symptoms, the CDC says.

Pregnant women with Zika should get ultrasounds every 3 to 4 weeks to monitor the baby's growth, the agency says.

What if I’m Not Planning to Get Pregnant?

To reduce the risk of sexual transmission, women who have possibly been exposed to Zika should use condoms in addition to their regular birth control method or abstain from sex for at least 8 weeks, the CDC says.

Men with possible exposure, even if they didn’t have Zika symptoms, should use a condom or abstain from sex for at least 6 months.

Where in the U.S. Are We at Risk?

Through late November, only the areas in Miami-Dade County showed evidence of active Zika transmission. The Texas cases near Brownsville were reported in late November and December. Other infections in other states were travel-related.

Experts had predicted Zika's arrival in the U.S. but have said that mass outbreaks are unlikely.

As of March 8, more than 5,100 travel-associated cases of Zika and more than 220 locally transmitted cases had been reported in the U.S., according to the CDC. Forty-five cases were sexually transmitted, and 28 were from congenital infection (mother-to-baby transmission).

The CDC says that detecting local spread of Zika is difficult, as a person may not show symptoms for up to 2 weeks after infection, if at all. In addition, diagnosis and investigation of cases can take weeks.

Aedes mosquitoes, which spread Zika, are found in every country in North, Central, and South America except for two: Canada and continental Chile, according to the WHO's Regional Office for the Americas. The agency "anticipates that Zika virus will continue to spread and will likely reach all countries and territories of the region where Aedes mosquitoes are found."

How Are You Tested for Zika?

There are two ways to test for Zika. One test looks for pieces of the virus’s genetic code in people with active infections. But after the body clears the infection, which takes about 2 weeks after symptoms appear, that test won’t work.

The FDA has OK'd the emergency use of a more advanced version of this test that can distinguish whether a person has dengue, chikungunya, or Zika, rather than having to do three different tests. The new version will be sent to qualified labs, the CDC says.

Since 80% of people with Zika don’t have symptoms, many people don’t know when they were infected and would not be eligible for this test.

Another test looks for proteins called antibodies made by the immune system to fight the virus. It can find antibodies in the blood up to 3 months after a person is infected.

But this test isn’t very specific. It may mistakenly show a person has had Zika if they’ve been infected with other viruses, including dengue and chikungunya. A positive or inconclusive test result means a follow-up test is done by the CDC or a CDC-authorized lab.

The FDA has approved the first phase of the second test, and the CDC is distributing it to qualified labs.

Testing of amniotic fluid in pregnant women can also be done, although it's not clear how well this test would work for Zika, according to the CDC.

Can Zika Lead to Other Health Conditions?

In rare cases, Zika has been linked to Guillain-Barre syndrome. That disorder can cause partial or complete paralysis, usually starting in the legs, most often temporary. An increase in that illness has been seen in areas such as French Polynesia and Brazil, where a Zika epidemic has taken place. Studies increasingly show a link between the syndrome and Zika.

The U.S. Zika case count on the CDC’s website lists 13 cases of Guillain-Barre. But CDC Director Tom Frieden, MD, MPH, noted earlier this year that Guillain-Barre can also follow the flu or other infections.

There may be a link between Zika and an autoimmune disorder called acute disseminated encephalomyelitis (ADEM), according to research presented at the American Academy of Neurology conference. The immune system of a person with the disorder attacks the myelin coating around nerve fibers in the brain and spinal cord, similar to multiple sclerosis.

Doctors in March reported the first case of brain swelling linked to Zika, in an 81-year-old man who was on a South Pacific cruise. The man ran a fever and lapsed into a coma. He was diagnosed with meningoencephalitis, or swelling of the membranes that cover the brain and spinal cord. The Zika virus was found in his spinal fluid. The man recovered after 38 days in the hospital.

In April, the CDC announced the first Zika-linked death in Puerto Rico, of a 70-year-old man who died in February from severe thrombocytopenia, which causes a low blood platelet count that can lead to internal bleeding.

How Can I Prevent Zika?

If you plan to travel in affected areas, avoid mosquito bites by using repellent throughout the day. Also, wear long-sleeved shirts and long pants, indoors and out.

The mosquitoes that spread Zika are aggressive daytime biters often found indoors, which we’re not used to in the U.S., says Weaver, the Institute for Human Infections and Immunity director.

“You need to protect yourself all day long,” he says.

The CDC recommends using Environmental Protection Agency-registered insect repellents with DEET, picaridin, IR3535, oil of lemon eucalyptus (para-menthane-diol) or 2-undecanone. If you’re using sunscreen, apply that first and repellent second.

Around your home, use screens on windows and doors, and get rid of standing water -- in tires, buckets, planters, and flowerpots, for example -- as mosquitoes lay eggs near water.

Even those who don’t know they have Zika can spread the disease. Weaver says that people who have traveled to affected regions should be extremely vigilant against mosquito bites when they return home. The CDC also recommends using condoms or abstaining from sex for 8 weeks for women or 6 months for men to avoid sexual transmission.

WebMD Article Reviewed by Hansa D. Bhargava, MD on October 14, 2016

Sources

SOURCES:

Amesh Adalja, MD, spokesman, Infectious Diseases Society of America; senior associate, UPMC Center for Health Security.

Scott C. Weaver, PhD, director, Institute for Human Infections and Immunity, University of Texas Medical Branch at Galveston.

News releases, CDC.

News conferences, CDC.

CDC: "Morbidity and Mortality Weekly Report."

Pan American Health Organization.

CDC.

Press briefings, World Health Organization.

World Health Organization Zika virus updates.

News release, Florida Department of Health.

News release, Florida Gov. Rick Scott.

News release, National Institutes of Health.

News release, Texas Department of State Health Services

News release, American Academy of Neurology.

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