ZIKA IN THE U.S.
by Kristin Bendikson, MD
The Zika virus is frightening to those women who are pregnant living in countries where the disease is rampant. Most pregnant women in the United States are fortunate not to be burdened with these worries and concerns. As of June 8th there have been almost 700 cases of Zika infection in the United States in almost every state in the union. The majority of these cases have been caused as a result of travel to an affected country, however there are 11 cases of Zika infection from sexual transmission.
The incidence of pregnant women with a known Zika infection is climbing. There are just over 200 pregnant women in the U.S. with a documented Zika infection and 166 women in the U.S. territories. In May, the first case of microcephaly linked to a locally acquired ZIKA infection in the United States was confirmed. A baby in Puerto Rico was diagnosed with severe microcephaly, though further details about the case are still unknown. Previously, a baby had been born in Hawaii with severe microcephaly. However, the mother had contracted the Zika virus while living in Brazil.
The current diagnostic tool for Zika is a blood test that should be performed during the first week of symptoms. In addition, a urine sample should also be collected within two weeks of the onset of symptoms that tests for the virus in a slightly different manner. The tests are not perfect in that they do not pick up the disease with 100% accuracy and other viruses can cause the test to be positive even when Zika is not present. These tests are not readily available in just any lab, and in fact samples have to be sent to state or local health departments. It takes at least 3 weeks to get the results back once the tests are performed. Thus, the tests are not appropriate for wide spread use and serve more to document and track the incidence of infection in the United States and detect Zika infection in pregnant mothers so that closer monitoring of the fetus can be performed.
HOW ZIKA IMPACTS PATIENTS TRYING TO CONCEIVE
The CDC has very clear recommendations about how the threat of Zika should be handled in women who are in the process of trying to get pregnant. Women who have had possible exposure to Zika via either travel to country where Zika is prevalent or through sexual contact with a man infected with Zika need to wait 8 weeks before they try to get pregnant, regardless if they have or do not have symptoms of the infection.
For men, if they have had a possible Zika exposure because of recent travel, the amount of time they need to wait to attempt pregnancy will depend on if they develop symptoms. If they have no Zika symptoms, they only need to wait 8 weeks after exposure, however if they have any Zika symptoms they need to wait at least 6 months before they start trying to get pregnant. Unfortunately, the Zika virus stays present in the semen longer than in the blood.
Testing for Zika upon return from travel to avoid a delay in trying to get pregnant is not an option as the tests are not 100% reliable, and the results take so long to get back.
WHAT MY PATIENTS ARE FACING
I have had several patients currently trying to get pregnant who have been impacted by the threat of Zika. With summer upon us, trips to countries with warm beaches and plenty of sunshine may be on the calendar for many couples considering starting a family. Unfortunately, many of those countries are rife with Zika outbreaks. Active Zika Virus outbreaks have spread to most of South and Central America, as well as the Caribbean and even as far as Fiji. I have had many conversations with patients recently weighing the pros and cons of traveling for a relaxing vacation to Mexico and the unfortunate consequences of delaying attempts at pregnancy for at least two months on their return.
The decision to travel and delay attempts at conception is even more complex for those suffering from infertility, whose dreams of starting a family are already taking longer than anticipated. The decisions are tougher, especially with women who may desperately need that vacation for their mind and body after numerous months of unsuccessful fertility treatments. Unfortunately in many cases for older women, time is of the essence and every month counts. For those patients, a delay of a just a few months can be costly.
Some couples have resorted to freezing sperm before they travel to a country with Zika. If only the male partner is traveling, by freezing sperm any delay in trying to conceive can be avoided as the female partner can be inseminated while the partner is away and once he is back. This way, they can avoid the automatic 2 month delay and the potential 6 month delay if he gets infected. When both partners are traveling, they will have to wait 2 months, but can at least know they don’t have to wait 6 months as long as frozen sperm is banked ahead of time.
What is the best way to handle Zika if you are trying to have a baby? Easiest method – Don’t travel to a country with Zika outbreaks. There are lots of amazing places to unwind and center yourself. Explore and be inspired by a new destination in the U.S. or Europe. If you and/or your partner have to travel to a Zika country, prepare ahead of time by freezing sperm and taking measures while you are gone to prevent mosquito bites. Seek help from a health care provider and fertility specialist if you have been trying to get pregnant or plan to get pregnant soon and have to travel to a country with Zika outbreaks.
To read more about Zika and it’s impact on patients trying to conceive and to learn more about the interesting story of one of my patients and how Zika affected them, please read the piece on ABC News featuring me and my patient.