Zika Virus & Microcephaly: Family Planning

Aliases: Zika, Zika virus disease, ZIKV

Zika seems have to come out of nowhere, erupting from the ether to dominate the landscape of global health. The epidemic is an unhappy reminder that disease preys on the weak, an unwelcome addition to the discordant chorus of ailments plaguing those in poverty. That can make it dangerously easy to ignore.

Zika was discovered in Uganda in 1947. There were less than 20 reported cases in the following 50 years. During that time, Zika may have been hiding in plain sight. The symptoms of the disease are generally very mild, and many cases go unreported. When symptoms do occur, the disease looks a lot like dengue and chikungunya, and occurs in similar regions (because the same mosquitoes aid its spread), making accurate diagnosis of Zika a serious challenge2,4.

After this lull, Zika came back with a vengeance. In 2007, there was an outbreak of the disease on the Western Pacific island of Yap2,4. Six years later, in 2013, there was an outbreak of at least 30,000 cases in French Polynesia2. Smaller outbreaks broke out across the Pacific islands through 20144 and by late in the year, Zika reached Brazil4. From there, the disease has spread rapidly. As of this posting, the CDC has a travel notice in effect for Cape Verde, Mexico, and most of the Pacific Islands, Caribbean, Central America, and South America6.

zika virus
Ouch.

During the current outbreak, it has become clear that Zika can cause microcephaly in fetuses affected by their mother’s illness. Microcephaly is a malformation that results in an abnormally small brain and skull5. In the wake of this discovery, many health experts are advising that women living in affected areas delay pregnancy1,3. That seems like a reasonable suggestion, but it leaves a critical question unanswered: how?

The regions most affected by this outbreak, Central and South America, have notoriously strict regulations on the tools of family planning– contraception and abortion– especially for unmarried women. There are only 3 countries in the region where abortion is broadly legal (Uruguay, Guyana, and French Guiana)1, and birth control is generally difficult to come by1,3. The low rates of contraceptive use (some of the lowest in the world), along with high rates of sexual violence against women1,3, mean that 18% of births in Latin America are to teenage mothers, and an estimated 50% are unplanned1.

Without ready access to birth control, asking women to delay pregnancy isn’t just an unfair request, it is an impossible one. And it places the responsibility of stemming an epidemic squarely on the shoulders of a disenfranchised population: the women of Latin America. That is asking too much.

Cause: The Zika virus is usually transmitted by mosquitoes. It can be spread by several species of mosquito, including species in the troublesome Aedes genus that also transmitted the dengue and chikungunya viruses. There are several other possible means of spreading Zika. Four reports suggest sexual transmission. Blood transfusion, organ or bone marrow donation, and neonatal (from mother to newborn) transmission have all also be suggested as possible transmission routes4.

Consequence: Zika is generally a very mild or even asymptomatic disease. The most common symptoms are fever, rash, arthritis, conjunctivitis, and fatigue. Most patients make a full recovery; only four deaths have been attributed to Zika, in addition to the newborns that have died from microcephaly within a day of being born. Neurological complications, including microcephaly in infants and Guillain-Barré syndrome in adults, occur in a small number of cases4.

Cure: There is no specific vaccine or treatment targeting Zika. Symptoms are treated, and patients are given fluids. Prevention efforts depend on mosquito control and personal protection from mosquitoes to suppress disease spread4.

References

  1. Alter, Charlotte. “Why Women in Latin America Can’t Follow Zika Advice to Avoid Preganancy”. Time Online. 28 January 2016. Web. 5 June 2016.
  1. Ioos, S. H.-P. Mallet, I. Leparc Goffart, V. Gauthier, T. Cardoso, and M. Herida. 2014. Current Zika virus epidemiology and recent epidemics. Médecine et maladies infectieuses, 44:302-307.
  1. McNeil, Donald G. “Growing Support Among Experts for Zika Advice to Delay Pregnancy”. The New York Times Online. 5 February 2016. Web. 24 May 2016.
  1. Musso, D, and DJ Gubler. (2016). Zika Virus. Clincal Microbiology Reviews, 29:487-524.
  1. Persutee, W.H. 1998. Microcephaly- no small deal. Ultrasound in Obstetrics & Gynecology, 11:317-318.
  1. Zika Travel Information. Centers for Disease Control and Prevention. 26 May 2016. Web. 7 June 2016.

Image credit: Creative Commons, the image is in the public domain