You try not to fall under the trap of discussing the panic de jour here on Healthcare Triage, but sometimes people are concerned about things they should be concerned about.  For many viewers, the Zika virus holds pretty much no threat at all, but that's not true for everyone.  It's really a problem and we want you to be informed.  The Zika virus is the topic of this week's Healthcare Triage.

(Intro)

Let's start with some basic facts.  The Zika virus is an arbovirus, or one transmitted by arthropods, like mosquitoes.  Similar viruses include dengue, yellow fever, and West Nile virus.  It was first discovered almost 70 years ago in the Zika forest in Uganda.  Most Zika is spread by the Aedes albopictus and Aedes (?~0:46) mosquitoes, which exist in tropical regions of the Americas, North and South, including Florida, the Gulf Coast, and Hawaii.  What happens most of the time is that a mosquito bites an infected person, sucks up the virus, and then gives it to someone else when it bites them.

Unlike, say, ebola, where you know you're sick, most people who are infected with Zika have no idea.  Only 20% of people who are infected show any symptoms at all.  Before now, no one cared much about whether they had the virus.  Because of that, we have no easy test for the Zika virus.  Why would we go look for it?  There's almost no treatment.  We weren't worried about it.

Until recently, it was pretty much contained in the Eastern hemisphere.  That changed last spring, when outbreaks started getting noticed in Brazil.  Some people think it might have been brought over en masse during the World Cup.  What caused the panic, though, was the uptick in babies born with particular birth defects starting in the fall.

From 2010 through 2014, about 150 babies each year were born in Brazil with microcephaly, which is a congenital condition where a baby is born with a small head and incomplete development of the brain.  In 2015, though, more than 3500 babies were born with microcephaly.  Now, those cases aren't all proven to be because of Zika.  Once the media coverage highlighting an outbreak like this ramps up, more cases get reported, which could account for some of the increase.

More and more though, it appears that this uptake is related to the Zika virus.  Scientists found the virus in the amniotic fluid of women who gave birth to babies with microcephaly.  They found Zika in the brains of babies born with microcephaly who died.  They also found Zika while looking into pregnancies that ended in miscarriage.  It's possible that Zika isn't the cause, possible.  We don't understand the connection between Zika and microcephaly at this point, but researchers are concerned enough that they're asking people to be really careful.  Fetuses appear to be at most risk when they're young or when women are in the first trimester of pregnancy.

Complicating things, many women don't even know they're pregnant at that point.  It's impossible to prevent mosquito bites completely.  Because of this, groups like the CDC are recommending that pregnant women not travel to places where Zika is becoming more common.  It's even advised that women who could become pregnant, which is a lot of them, talk to their doctor before traveling. 

The alerts are widespread.  As of the time of this taping, they included El Salvador, Guatemala, Honduras, Panama, Mexico, Puerto Rico, Barbados, Guadalupe, Haiti, Martinique, St. Martin, Bolivia, Brazil, Colombia, Equador, French Guiana, Guyana, Paraguay, Suriname, Venezuela, Cape Verde, and Samoa.  More countries are being added all the time.

Groups are also advising women to stay indoors in screened rooms.  Air conditioning can help, too.  Other advice includes wearing long pants and sleeves, shoes and hats, and using insect repellant.  In heavily affected areas, mosquito nets for sleeping are a must.  That's prevention, though.  What do you do if you're pregnant and you've already traveled or have to travel?  The CDC says you should talk to your doctor.  If you have any symptoms, including fever, rash, joint pain, or other arbovirus sickness symptoms, which we covered extensively on our episodes on parasites, you should have a blood test for Zika.

Some have raised concerns that this will miss a ton of women, because 4 in 5 won't have any symptoms at all.  That's true.  The problem is that we don't have the capacity to test all women for Zika.  We're not prepared.  People in Latin America are so concerned that officials have advised that women should hold off on getting pregnant for potentially years in order to avoid birth defects.  

For instance, El Salvador has urged against pregnancy until 2018.  More than 5,000 cases of Zika were detected there in 2015, and they worry that 96% of pregnant women could have contracted the virus. 

Even if we could test everyone at risk, the tests aren't that great.  Moreover, there's not much we can do.  We can look for microcephaly by ultrasound and we can look for the virus through amniocentesis, but we have no treatment at this time.  There are no cases of transmission in the US yet, although people have traveled to the US with Zika, of course.  That will likely change this spring or summer.  Because we have plenty of good housing, common use of screens, and plenty of air conditioning, it's hoped that outbreaks in the US can be held to a minimum. 

That will fail to comfort many of you.  People are certainly now working on a vaccine, but that can take time.  For now, take precautions.  There's reason to be worried, but keep your panic in check.  There are lots of risks all around you all of the time.  It's important to keep this one and others in the proper perspective.

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