During the past year you have probably seen, read or heard the news about ZIKA virus and its devastating effects upon the unborn child. Two years ago, if you would have asked your doctor about ZIKA virus, most likely he/she would have had no information and probably thought your information came from a TV series! ZIKA virus was not on the medical radar at that time. Today, things have changed.
ZIKA virus is not a newly discovered virus. It was first described in 1947, in Uganda, Africa. It was limited to Africa and Southeast Asia and was known to produce some fever, may be a skin rash, some malaise and some people didn’t even know they had it. The ZIKA virus was known to be transmitted by a mosquito bite. In US it was practically unknown.
In mid 2015, a report from Brazil changed all that. An unusual increase in the number of microcephalic babies was, for the first time, associated with infection of the mother with the ZIKA virus. Literally, overnight, from a neglected virus ZIKA became an epidemic which extended from Brazil to South and Central America, the Caribbean including Puerto Rico and US Virgin Islands. The CDC issued a travel warning advising that pregnant women and those intending to get pregnant, should avoid those areas. Nonetheless the virus is already in the US and has been detected in many states.
Frantic research is ongoing at the NIH, CDC and numerous research centers around the country, attempting to learn about the virus and a race has started to find a vaccine. The World Health Organization (WHO) estimates that millions will be affected in the Western World, where the virus was virtually unknown. They declared the epidemic “a public health emergency of international concern” (February 1, 2016)
The effect upon the fetus seems to be significant, although not fully understood how it works. It seems to center on a malformation known as microcephaly. This is a congenital anomaly where the head is small and the brain fails to develop properly, with devastating consequences. Early miscarriages and stillbirths have also been reported. Investigation is currently carried out to understand what other, if any, abnormalities may occur.
In adults it has been reported that, in addition to the known minor symptoms, it may cause a neurologic condition known as Guillain-Barre Syndrome (GBS). In GBS there is muscle weakness, and possible paralysis or permanent damage. Most people recover, but in rare cases it may lead to death.
Although it is known that the virus is transmitted by a mosquito bite, sexual transmission has been reported. Already alerts have been issued suggesting that, if a woman’s male partner travels to epidemic areas, she should avoid intercourse or use condoms, until the partner has been proven not to harbor the virus. Studies are looking if the virus can be also be transmitted from person to person, like the flu, for example. All in all, much needs to still be understood and the scientific research is far from over. We can fully expect that, with time, a clearer picture will emerge and hopefully a vaccine and a specific treatment, will be developed.
Ultrasound examination of the pregnant uterus may detect the brain abnormality in the fetus. A normal ultrasound study is reassuring but we don’t know what other abnormalities may occur that are not detectable by ultrasound. A rapid test to detect the disease is not available. Blood must be drawn from the mother to find out if she is infected. CDC is, at this time, the only place where such a test is performed. Other Centers will become available, I am sure.
ZIKA is a virus known as flavivirus. It’s the same virus family as the West Nile virus, Dengue and Yellow Fever. Antiviral medication specific to ZIKA is not yet available. Physicians are hard pressed to properly counsel patients because of so many uncertainties or unknowns. With viruses, one can say that anything is possible.
This virus, discovered some 70 years ago, spared the Western World until now. Since it was considered not a serious threat. It disappeared from the medical radar of the World Health Organization and local public institutions like the CDC. Suddenly, and without warning, it exploded thousands and thousands of miles away from where it was considered to be its known habitat, with an epidemic of worldwide proportion. Did its effects go unnoticed until now, because of the virus’ mild symptomatology in the adult? Were the pregnancy effects not associated with the virus because their occurrences were considered pregnancy complications and therefore they were missed? Did the virus mutate to a higher virulence in the process of its transplant to another area?
These are questions that sometime will have to be answered. If all of the above turns to be true, than we better reassess our understanding of other viruses considered not to be a threat.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so at: firstname.lastname@example.org
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