Zika Virus Symptoms in Pregnancy, Diagnosis and Treatment

Zika Virus, also referred to as Zika fever is a Flaviviris which is relatable to dengue, West Nile, yellow fever and Japanese encephalitis viruses and are all transmitted to human through mosquito bites, resulting in a disease that lasts from days to weeks.

History of Zika virus outbreaks

Zika virus first came under observation in Zika Forest of Uganda when humans living in that area of Africa started being infected by the virus. From 1951-1981, blood tests showed evidence of Zika virus infections in many other African countries and Indonesia (Tanzania, Egypt, Sierra Leone, Malaysia, Thailand, and the Philippines). The virus was detected in Yap Island in 2007, and continued to spread to North, Central, and South America, Mexico, Columbia, Brazil, and into the Caribbean islands. In US the first person infected by Zika returned from Texas but at that time the virus was not documented as the other states had two mosquito strains (Aedes aegypti and Aedes albopictus) that could be capable of transmitting the viruses. The number soon increased and effected people with multiple symptoms.

Congenital Zika Virus Syndrome

Congenital Zika Virus Syndrome is used to refer to the range of manifestations, in addition to congenital microcephaly, that has been reported following exposure to the Zika virus in utero19. The risk of birth defects in some studies appears low compared with other viral infections such as CMV and rubella; however, the incidence of Zika virus infection can be comparatively very high during outbreaks. There have been differing reports of the rates of adverse outcomes in the offspring of women who test positive for Zika virus during pregnancy. The period of gestation at which the infection is acquired may be important. A fetus infected in early gestation is more likely to be affected compared to infection later in pregnancy.

How Zika Virus is transmitted?

Zika Virus is transmitted through several means like;

Through mosquito bites

Similar to the aforementioned diseases, Zika virus is a mosquito-borne viral disease that is spread by the Aedes species of mosquito, most commonly Aedes aegypti and Aedes albopictus. Aedes mosquitoes also transmit dengue and chikungunya viruses. A mosquito becomes infected when it feeds on the blood of a person infected with the Zika virus. The mosquito is then capable of spreading the virus to other people through its bites.

Through semen

Zika virus has also been isolated in semen and many cases of sexual transmission have also been observed. It is transmitted to developing babies through pregnant women and the infection developed during it may cause microcephaly and other serious birth defects. Microcephaly is a rare birth defect in which a baby’s head remains smaller than expected and directly affects brain development. Other possible outcomes which might be developed are

• the hearing problems
• Impaired growth in the newborn.
• problems with hearing and vision
• joints with limited range of motion
• seizures
• too much muscle tone, restricting body movement
• swallowing abnormalities
• possible developmental delay

Through infected blood and body tissues

Zika virus also spreads through body fluids, like blood and semen.

Through sex with an infected person

If you are pregnant or trying to be pregnant already, avoid visiting any Zika infected place already unless necessary. It is far better to get protection from mosquito bites.

If your male or female partner may be infected with Zika, it is better to use a barrier method (like a condom) every time you have sex or don’t have sex at all. If you’re pregnant and think you may have been exposed to Zika virus, see your health care provider right away. Pregnant women who develop symptoms of Zika virus infection should be closely monitored by a healthcare professional.

Zika Virus Symptoms in pregnancy

Zika virus is found to have similar symptoms like a mild case of fever which may last from several days to a week but only 10 to 20 percent of people will actually become ill. However, for pregnant women, the time is uncertain as it is unknown at what time a pregnant woman is likely to develop the symptoms if infected by Zika virus.

The Zika virus symptoms in pregnancy might also be similar to those of dengue fever and chikungunya which also possess a similar source of mosquito and are found in the same geographical area. There is no evidence that pregnant women are more vulnerable to acquiring Zika virus infection or that this infection causes more serious illness in pregnant women. Serious complications from Zika virus infection are rare. WHO has concluded that Zika virus infection during pregnancy is a cause of congenital brain abnormalities, including microcephaly; and that Zika virus is a trigger of Guillain-Barre syndrome. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected.

Other symptoms may include,

• low-grade fever
• rash
• headache
• muscle and joint pain
• conjunctivitis (pink eye)

Testing for Zika Virus

There is still no commercially approved testing for Zika virus but every woman who gets pregnant must be assessed for Zika at their prenatal visit, as recommended by CDC. If you may get exposed either during travel to active infection area, you live in that area or if you get it while your exposure to any sexual contact, it is better to visit a doctor as he will order for a blood or urine test to see whether you are positive for the virus or are depicting only the symptoms.

At times the women who are pregnant show no signs to Zika and are asymptotic as they have been to places with known ongoing Zika transmission which must be tested between 2 and 12 weeks after they’ve returned or right away if the symptoms are present. The CDC also recommends that pregnant women without symptoms but who live in a Zika-affected area be tested for the virus at the start of prenatal care as well as later on, at the midpoint of the second trimester. Even if you don’t show signs, your unborn baby should be examined, usually via ultrasound. If there are concerns following an ultrasound, amniocentesis may be the next step.

Federal health officials also urge mothers to be tested if they have visited an affected area and exhibit symptoms of Zika virus. If they don’t show any signs them the baby must be tested and examined which is done usually through ultrasound. Still, if there are concerns following an ultrasound, amniocentesis may be the next step.

How Zika Virus must be prevented?

Currently there is no vaccine or drug available for treating Zika virus or to prevent the infection. The Aedes aegypti mosquito, the primary vector for Zika virus, is active predominantly during daylight hours; bites are most common during the mid-morning and late afternoon to dusk, when the mosquito is most active. In contrast to what Anopheles mosquito does for transmitting malaria, it seem to be far more active at night. Travelers who tend to travel to such areas with increased number of risks to Zika virus must be urged to take every possible masseurs for minimizing the mosquito bite chance. This includes wearing light-colored clothes that cover as much of the exposed skin as possible. Clothing can be treated with an insecticide (e.g. permethrin) which kills insects, including mosquitoes, on contact. N, N-diethyl Meta toluamide (DEET) based repellents are the most effective available insect repellents and have been widely used for over 50 years.

Concentrations of DEET up to 50% are commonly available and are safe in pregnant and breastfeeding women, also for children under the age of 2 months. Care should be taken for enduring the insect repellents and must be avoided to make them come in contact with the eyes or mouth.

Travelers should also use insect repellents as per manufacturers’ instructions and reapplied regularly, in particular after swimming or washing, and in hot humid conditions when they may be removed by perspiration. When both sunscreen and insect repellents are required, the insect repellent should be applied over the sunscreen.

Travelers staying in accommodation without screening should sleep under a mosquito net, particularly in malaria risk areas. Those sleeping or resting during the day in an area with Zika virus should do so either in a well-screened room, air-conditioned room, or under a mosquito net. Ideally, nets should be impregnated with permethrin or another contact insecticide. Retreatment after six months of use is necessary.

Travel Advice for Pregnant Women and Couples Considering Pregnancy

In UK, the National Travel Health Network and Centre and Health Protection Scotland provide advice for pregnant women regarding potential travel to areas with risk for Zika virus transmission.

Some of the countries still find evidence for the widespread of Zika virus with a significant number of transmission rate, there every mother to be must postpone nonessential travel until pregnancy.

In other countries where there have been reported recent outbreaks, the reintroduction of the Zika virus, or endemic transmission but not the current outbreak, pregnant women are advised to consider postponing non-essential travel until after the pregnancy.

Pregnant women and their partners should take the precaution thing seriously and consider it. They should consistently use barrier methods for vaginal, anal, and oral sex during and after travel to reduce the risk of the developing fetus being exposed to the Zika virus. Barrier methods should be continued for the duration of the pregnancy and should be used even in the absence of Zika symptoms. As screening for such effected people is not available in NHS, hence, couples like these should consider whether to avoid travel to a country or any area with an increased risk for Zika virus rather than delay conception for the recommended period after travel, particularly the couples in assisted conception programs.

Treatment for Zika Virus

There is no0 specific antiviral treatment available for the affected patients of Zika Virus till now, however, Zika virus itself does not require any treatment as the infection is termed usually mild and short-lived. Supportive nursing care and relief of symptoms are the standard treatment. Symptomatic pregnant women are advised to get adequate rest, drink fluids, and manage fever and pain with paracetamol and other cooling measures.

Recommendations for pregnant women and those considering pregnancy

People who are pregnant or are considering pregnancy must adopt the following scenarios while having a partner who has traveled to a country or had been exposed to any area effected with Zika virus, everything should be brought under management, exclusively for the pregnant women with CURRENT symptoms, PREVIOUS symptoms or NO symptoms at all.

Couples considering pregnancy:

The couple who are ready for conceiving or are considering pregnancy should avoid becoming pregnant if they have planned for traveling already or in an area that is full of Zika virus. If a couple is considering pregnancy, several of the barrier methods are recommended to carry out like condom use. They are also advised during vaginal, anal, and oral sex to reduce the risk of conception and the developing fetus being exposed to Zika virus.

Following measures must be taken while traveling:

If both the partners traveled

The aforementioned precautions must be taken while traveling for up to 3 months after returning from an area with the risk higher for Zika virus transmission.

 If only male partner traveled

3 months after return from an area with risk for of Zika virus transmission, or last possible Zika virus exposure

If only female partner traveled

2 months after return from an area with risk for Zika virus transmission, or last possible Zika virus exposure

Any pregnant woman with possible exposure to Zika virus, presenting with fetal ultrasound findings consistent with microcephaly

Any pregnant women in whom a small fetal head, which includes the head circumference more than 2 standard deviations below the gestational age or brain abnormality which includes intracranial calcifications is diagnosed on ultrasound, should be referred to a maternal-fetal medicine service for further assessment. Although babies, in the majority, who have the head circumference more than 2SD below the mean, are considered to be normal with no microcephaly.

Microcephaly is characterized by baby’s Head Circumference is even smaller than this, and usually together with structural abnormalities of the brain that can be diagnosed with specialist imaging. Those who are not considered fatal for microcephaly or intracranial calcification do not need to be assessed for Zika virus. If fetal microcephaly or brain abnormality, such as intracranial calcification is diagnosed, consideration should be given to performing an amniocentesis to test for the virus using RT-PCR. This decision should be taken only after careful counseling.

When brain abnormalities are identified on ultrasound scan, consideration should be given to performing fetal brain MRI which may detect further abnormalities that have not been detected on ultrasound. When a significant brain abnormality or microcephaly is confirmed in the presence of Zika virus infection, the option of termination of pregnancy should be discussed with the woman, regardless of gestation.

Remember…

Your health matters!

Any pregnant woman with positive laboratory diagnosis, spontaneous abortion/stillbirth, or anticipated TOP or live birth should be discussed with a local Infection Specialist and considered serious. For those couples who want to have a baby with a male partner who’s recently traveled or lived in an exposed area, ask your doctor for advice. A Zika test may be possible but priority will first be given to women who are already pregnant.

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