When pregnant women come to Capital Women’s Care in Silver Spring and air their fears about the Zika virus, Carol DePrato, supervisor of medical assistance, said her office follows state protocol.
Women increasingly are asking whether the mosquito-borne virus will harm their fetuses, DePrato said. But the practice does not have a protocol yet for the Zika virus, which is suspected of causing birth defects in Central and South America.
That may change soon. On Feb. 1, the World Health Organization declared the Zika virus a public health emergency of international concern.
And this week, the Obama administration announced that it plans to ask Congress for more than $1.8 billion in emergency funding. If approved, the money would be used to expand mosquito control programs around the world, accelerate vaccine research and diagnostic development, and educate health care providers and patients.
Still, misinformation and partial information abound about the virus that until recently was unknown to most Americans. Now, many wonder whether all that itching and scratching come mosquito season will be an annoyance or something more serious.
The Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito, the same insect that spreads the dengue and chikungunya viruses.
Mosquitoes become infected when they bite a person already infected with the virus. An infected mosquito infects others through its bites. The virus also can be spread through blood transfusions and sexual contact. Symptoms include fever, rash, joint pain and conjunctivitis. The illness is mild, with symptoms lasting about a week, according to the Centers for Disease Control and Prevention.
But of tremendous concern is that it also may be transmitted from a pregnant mother to her baby, according to the Centers for Disease Control and Prevention and cause developmental defects.
Yet, the fear about Zika — that it causes microcephaly — is not proven.
According to the WHO, “a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven.”
Microcephaly is a congenital condition associated with a small head and incomplete brain development.
Dr. Hagai Levine, head of the Environment and Health Track at Hebrew University-Hadassah Medical Center School of Public Health, said “there is strong reason to suspect that the main cause for the increase in microcephaly is Zika virus,” but the jury is still out. That is why it is important to continually monitor everyone who has been infected, looking for other variables, he said.
“You modify your hypothesis as you go along,” Levine said.
Diseases and other problems mutate or increase due to environmental changes, like El Nino, he said. Warming in the Pacific Ocean “changed significantly the spread of mosquitoes,” he said.
Zika in the D.C. region
Three cases of people ill due to Zika virus have been confirmed in the District of Columbia by the D.C. Department of Health, one in 2015 and two this year. All three people were infected in either South or Central America. Only one of the cases involves a pregnant woman, according to DOH spokesman Ivan Torres.
A Virginia resident, who was not bitten in the United States, also has Zika virus. “This is the first reported, laboratory-confirmed case in a traveler returning to Virginia,” according to state Health Commissioner Marissa J. Levine.
“Because it is not mosquito season in Virginia, this individual with Zika virus infection poses no risk to other Virginians,” she said.
No cases have been reported in Maryland. As of Feb. 8, there have been 50 laboratory-confirmed cases among United States travelers since December 2015, according to the CDC.
Zika virus is not new. It was first identified in Uganda in 1947, said Hagai Levine.
Anyone traveling or living in an area where the virus is present is at risk of being infected. That includes much of Central, South America and the Caribbean. According to the National Institutes of Health, the virus has been found in 30 countries.
NIH considers research on Zika virus a priority and wants to learn what role it plays in microcephaly cases and whether the virus is present in reproductive fluids.
There is no vaccine or specific medicine to treat the infection. Instead, the CDC recommends that travelers wear long-sleeved shirts and long pants, stay in air-conditioned buildings, use insect repellents and sleep under a mosquito net.
Zika virus “is spreading. We think this is the tip of the iceberg,” said Levine, who is an adjunct professor in preventive medicine at Mount Sinai Hospital in New York.
Challenge and opportunity
Zika virus may become a problem parents must deal with “for years to come” or it may be kept in check by the removal of standing water and the use of insect repellent, according to Professor Levine.
Levine is concerned that the increased use of pesticides could create environmental issues.
“Spraying is a possible tool, and indeed, in the current situation, we will need to use pesticides, but we need to use them judiciously,” he said. It is possible to solve the mosquito invasion “by creating another problem by exposing humans and animals to pesticides.”
It also may be possible to create genetic solution to controlling the spread of these mosquitoes, he said.
What is likely to happen when the weather gets warm?
NIH Director Francis Collins wrote that researchers have calculated that “about 200 million Americans —more than 60 percent of the population — reside in areas of the United States that might be conducive to the spread of Zika virus during warmer months through biting mosquitoes, including areas along the East and West Coasts and much of the Midwest.”
That research also showed that “22.7 million people live in humid, subtropical part of the country that might support the spread of Zika virus all year round, including southern Texas and Florida.”
Levine considers the threat of widespread infection both “a challenge and an opportunity.” He frowns at the advice for travelers to avoid particular countries, noting, “We really need to work together as humankind.”
Jeanne Sheffield, director of the division of Maternal-Fetal Medicine at Johns Hopkins Medicine in Baltimore, recommends that anyone who is pregnant or thinks she may be and has traveled to an infected country should notify her obstetrician.
Only one in five infected women will develop symptoms, Sheffield said. The best way to manage symptoms is rest, fluids and acetaminophen, Sheffield said.