Understanding the Zika Virus and How to Protect Yourself
The CDC has issues an epidemic regarding the Zika virus. Though it has been around since the 40s, it was contained throughout specific tropical areas of the world and showed little signs of spreading. Recent cases though, have proven that the virus is reaching to all areas of the world, with the exception of Antarctica. Though it is in the news, many people are still at a loss for what exactly the details of the virus are and how they can protect themselves and their families. Here are the details on what you can do to keep yourself safe from this continued health threat.
What is Zika Virus?
The Zika virus is an infection that is transmitted by mosquitos and through sexual contact. It is equated to the West Nile virus, Japanese encephalitis and dengue fever in symptoms. It originally was discovered in the Zika Forest of Uganda in 1947 and was initially successfully isolated to that area. The origin was in a rhesus macaque that was indigenous to the area. After research, it was proven that the virus could not only infect macaques but also mice. Throughout the next few decades, Africa and Asia saw their own cases of the virus. Though research continued, for the most part it was contained and was not considered a medical epidemic.
In 2007 things changed with the spread. In Polynesia, it was estimated that more than 70-percent of the entire population was infected. This startling number once again began the research focus on the virus and how prevalent it really was throughout the world. Seven years later, in Latin America, the virus took hold and started spreading quickly. By late 2015, the World Health Organization and the Pan American Health Organization both recommended that all Latin American countries begin a strategy to manage the condition, recognizing that it would be a severe health issue in the near future. They noted the most in-danger areas were the Dominican Republic, El Salvador, Ecuador, Barbados, Brazil, Bolivia, French Guiana, Colombia, Guatemala, Haiti, Mexico, Paraguay, Guadeloupe, Guyana, Venezuela and Puerto Rico, among other countries.
Florida was the next location to positively identify the Zika virus. By October of 2016, a reported 180 cases had been confirmed. This information put the entire Gulf Coast at risk for continued spread. That includes Tampa-St. Petersburg areas of Florida, New Orleans and Houston. At the highest risk are locations that have a thriving mosquito population, or areas with hot tropical conditions. As of this time, the Center for Disease Control has noted more than 3,900 cases of travel-related cases of the virus and more than 28,000 locally acquired cases throughout the US. Despite the spread, it is important to note that most likely travelers are not bringing the virus back to the US with them. Mosquitos, though irritating, are in essence very fragile insects and harboring in clothing, luggage or other items is highly unlikely. Researchers note that most likely travelers get bitten by infected insects and then are bitten by local insects that continue its spread. There is also a segment of those infected who spread the disease through sexual contact.
The virus itself belongs to the Flaviviridae family and is within the Flaviivirus genus. It a single-strand, non-segmented genome. These genomes can transmit directly to viral proteins of the body. This protein then binds to the membrane of the host cell and tries to initiate endocytosis, or an engulfing of the healthy cell to utilize its energy. Researchers have found that there are two main lineages of the Zika virus, one from Asia and one from Africa. The strain spreading through the US is most closely related to the Asian lineage of development.
How Zika is Spread
Mosquitos act as the transmitters of the Zika virus. When you are bitten, it is by the female insect because they need human blood to lay their eggs. Male mosquitos only drink plant nectar. The transmission works like this:
- The insect bites someone who is infected with the virus
- The blood drawn by the insect goes to its gut
- From the gut, it travels to the insect’s circulatory system
- From the circulatory system it then advances to its salivary glands
- When the mosquito bites their next victim they first inject their infected saliva, which has an anti-coagulant within it to keep blood from clogging its proboscis
- They finish the bite and blood draw, leaving the virus behind and infecting their victim
It is a process that is natural to the mosquito and has no effect on its biology. The tainted saliva is what carries the virus to new victims every time they bite.
The Aedes genus of mosquito is particularly resilient because of the very makeup of the insect. They are characterized by black and white markings throughout their bodies and legs. These particular insects only bite during the daytime hours, with their peak activity early morning and right before dusk. Within the virus world, this genus of mosquito is known to be an active transmitter. They are also known to spread West Nile fever, eastern equine encephalitis, yellow fever, dengue fever chikungunya, and a host of other lesser known diseases. Though it was initially thought that the virus was only spread through the Aedes mosquito, it is now understood that it can also be spread through sexual intercourse and blood transfusions. The most notable sign is fever, with some cases escalating to encephalitis, which can be deadly. There is a vaccine to protect against yellow fever and various tools to ward off mosquitos. In addition to the Aedes mosquito, the virus has also been spread by other genus of the insect. The Asian tiger mosquito and the Aedes albopictus are both transmitters of the virus, though not as efficiently as the original carrier.
One of the main issues with the continued spread of the virus, is the global distribution of goods throughout the entire world. Thanks to both travel and global trade, more cases of the virus have been reported than ever before. A population of mosquito able to carry the Zika virus has been identified in Washington D.C. What is most interesting about the population is that they seem to have survived for more than four winters in the area. This suggests to entomologists is that the insect is adapting and changing its resilience in response to the colder northern weather. Also affecting the spread is the changing global temperature that is rising; this allows for the expansion of mosquitos and their livable territory.
What researchers were startled to find though is that the Zika virus can also be transmitted from men and women through sexual activity. Six different countries thus far have reported cases of transmission of the virus through sex. These cases were documented in Chile, Italy, New Zealand, Argentina, France and the United States. The CDC has go so far as to ask men returning from Zika-prevalent areas to abstain from sexual intercourse for at least six months post return, even if they show no signs of the symptoms.
It also has been proven that the Zika virus can be transmitted through blood transfusion. Brazil reported two different cases of spread through transfusion. In the United States, the FDA, or Food and Drug Administration, is recommending that blood donors are screened for the virus and for high-risk donors to go through a 4-week waiting period prior to donation. Throughout November 2013 to February 2014, there were 42 blood donors who were screened and found to have the virus. All donors had no symptoms at the time of their donations.
The various cases of Zika have created the need for a number of countries to issue immediate travel warnings and precautions. The outbreaks have had detrimental impacts on the tourism industry as a whole. Some countries have gone so far as to warn their residents about becoming pregnant, requesting that they delay child-bearing until more information is realized about the virus and its effects on the fetus. In 2016, the Olympics were hosted in Rio de Janeiro and came with a strict focus on the possible spread of Zika to athletes and tourists. It was estimated that of 100,000 tourists coming into the country, about 3.2 infections were highly likely.
What are the effects of Zika Virus
The effects of Zika virus vary, dependent on the person bitten. Here are the different issues and their severity:
- Adults and children. Adults and children usually walk away from an insect bite from a mosquito with minimal aftermath. Of course there is naturally a red mark and it can produce itching and minor swelling. For those who are allergic to the bite, they may see angry red welts that may be more troubling. With antihistamines these usually go away by themselves within a few days. In actuality though, it is not the bite that causes discomfort; it is the infected saliva that causes irritation. If the insect was infected with the virus, it then infects its new host. If a host is infected with the actual virus they can expect symptoms from three to fifteen-days, however the virus can lay dormant within a man’s semen for upwards of 2 months after infection. So far research points to the man’s testes or prostate as being a safe reservoir of sorts for the virus, shielding it from the body’s immune system.
- Pregnant women and the fetus. Pregnant women and infants are the highest risk categories for Zika virus. It can be spread from mother to child during delivery or any time throughout the pregnancy. The mother may see the normal presentation of the virus—fever, vomiting, soreness, etc.—but her symptoms most likely are minimal as with any other adult. The issue that creates the biggest hazard is transmitting it to the unborn fetus. What is known now is that the virus has the ability to attack the fetus’ nerve cells, namely those that are responsible for brain development. These cells create the skeletal form of the brain and when compromised, the full brain mass and timeline of natural growth is disrupted. Not only does this cause a startling visual effect for infants, but it also limits the brain development. For this reason, pregnant women and their fetuses are considered extreme high risk. When a baby is delivered from a mother who was infected with Zika virus, there can be very extreme effects. Usually babies are struck with microcephaly, which affects the size of the head making it extremely small. It usually accompanies intellectual disabilities, poor speech, abnormalities of the facial structure, dwarfism, seizures and poor motor function. Part of the startling visual effect is when the face continues to develop, however the size of the upper head does not. This creates a receded forehead with a wrinkled scalp. As the child’s body continues to develop, the inordinately small skull continues to become more obvious. Usually the child ends up being underweight and possibly dwarfed. It also can lead to convulsions and in some cases spastic quadriplegia. It was initially thought that infection during the first trimester was the only issue with pregnant women and Zika. It seemed that microcephaly was only possible during this time. A study later found, however that women who were infected with the virus in their second and third trimesters were at serious risk also. Infection during this time resulted in a large number of deaths of the infants still in-utero. Research suggests that even if babies are infected with the virus and show no signs of microcephaly may still have disastrous consequences such as deafness and blindness, along with behavioral and learning disabilities.
Because of the effects and spread of Zika virus, the World Health Organization and the US’s CDC, Center for Disease Control, have issued a health crisis regarding the issue. There have been other mosquito-transmitted illnesses in the past due to blood, however Zika is the one that affects cell development and limits quality of life for infants born with it. Health authorities are recommending that pregnant women, or women who are trying to become pregnant, avoid contact with men who have traveled into Zika-prevalent areas. Pregnant woman also are instructed to abstain from sexual intercourse with men who have traveled to areas known for the virus or to, at minimum, use a condom. Pregnant women are cautioned that when traveling, visiting areas of a 6,500-feet altitude or higher are much safer as mosquitos are usually not in these areas.
One characteristic result of the virus is the “Zika fever”. Although most people show little to no symptoms, there can still be redness within the eyes, headaches, joint pain, fever and a very common red splotchy rash. Most cases do not escalate to the point of needing medical care and pass quickly, with people being unaware of their infection. To properly diagnose the virus, a saliva, urine, or blood must be tested when signs of illness are present.
How to Know if you Have Been Infected
If you are a world traveler you may wonder if you have been infected. First of all, there are telltale physical signs that you were bit by a carrier. These are most commonly a red splotchy rash and a fever. If you note either of these post return, you should speak to your doctor immediately. There also are cases where no symptoms are present. At the extreme side you can experience the fever and rash, along with headaches, nausea and chills; on the lesser side you can experience no aftereffect. The safest thing to do if you are returning from a Zika-prevalent area of the world is to get a blood or urine test from your doctor. He or she can gather the specimen and then send if off to a lab for sophisticated testing. It is recommended that you get tested within two weeks or less after your return, or within two weeks or less of any symptoms presenting.
If you are pregnant and have returned from an area with Zika you should always get tested according to the Center for Disease Control. This warning goes out to women with symptoms of Zika and those without. All women who are pregnant and living in American Samoa or in Puerto Rico should be tested for the virus at minimum twice throughout their pregnancies—with or without any physical symptoms. If a pregnant woman is found to have the virus, she will then most likely undergo a battery of ultrasounds to check for microcephaly or for calcifications, small white spots showing possible cell death or brain inflammation of the fetus.
Why Hasn't it Been Studied Before
Many people wonder why since the Zika virus has been around since the 50s, nothing has been done about it research-wise. The truth is that for a long time the virus was considered to be isolated. This drastically postponed the time researchers started to recognize its prevalence and effect. Once they realized it though, they began focusing. The key change was when it suddenly started cropping up in different areas of the world where it was nonexistent formerly. It also threw up caution signs when it was discovered that it could be spread beyond insects. Once it was realized that it could be spread during sexual contact, this made things much more complex. Finally, researchers also prioritized it once they realized the devastating effect it had on infants. With microcephaly, not only is the child physically compromised, but the long-term prognosis is not a positive one.
How Can You Protect Yourself and Your Home
Despite the lack of a vaccine, there are ways to protect yourself from Zika Virus. The good news is that millions of dollars are being put into studying the virus and ways to prevent and contain it. So far there are effective vaccines to ward off the viruses that come from the flaviviridae family. In the mid-2010s, a vaccine was created for the dengue fever and it is hoped that there will soon be a similar vaccine for Zika. The World Health Organization is recommending that finding the vaccine should be prioritized in particular for women of child-bearing age and for pregnant women.
As of this time, more than 15 different companies are experimenting with developing the vaccine to fight against Zika. The World Health Organization released a statement, however, that even if a vaccine is developed, it would not be widely available for around 10 years. In mid-2016, the FDA reported it was moving forward with a human clinical trial for the vaccine. It is cautioned that the efforts for vaccine protection are in their very early stages and that testing will cost hundreds of millions of dollars in funding.
Beyond the creation of a vaccine, there are also other ways to protect yourself from Zika virus. If you are of childbearing age it is recommended that you do not get pregnant and use the proper birth control tools to avoid pregnancy. Upon return, you should get tested immediately—with or without symptoms—to ensure that you are not infected. If you already had the infection prior to getting pregnant, some nascent studies have shown that you will be immune in the future, and so with the fetus. The CDC does recommend that women wait for a minimum of eight weeks before trying to conceive. It is cautioned however that true immunity studies have not been thoroughly carried out as of this time.
In countries like Colombia, El Salvador, Jamaica, Brazil and Ecuador, officials are advising women to postpone pregnancy until more research is done on Zika virus and its effects on fetal development. Though this is extreme, it is also a cautionary tale for women. The hope is that in the time they delay pregnancy, researchers will have more information on how to protect fetal development. Both the CDC and the WHO are very cautious with their findings. The latter still suggests postponing pregnancy is the best option at this time.
For travelers who are moving throughout Zika-infected areas, it is important to know what precautions to take. Here are some of the most important:
- Prevent the mosquito bite. One of the most effective things you can do is prevent mosquito bites from happening in the first place. If you are an outdoor-lover, you can still protect yourself while you enjoy the outdoors. Always use an EPA-registered insect repellent. There are a lot of options available but you want to be sure that the Environmental Protection Agency is behind the one you choose for yourself and for your family. Not only are they effective, but they are safe for pregnant women, children and breastfeeding women. When you look at the options available, opt for solutions that contain one or more of the following ingredients: DEET, IR3535, picaridin (or KBR3023), icaridin (if outside the US), 2-undecanone, para-methane-diol (PDM) or oil of lemon eucalyptus (OLE). Remember also that the higher percentage of these active ingredients, the longer lasting your mosquito protection will be. Take into account your lifestyle also. If you are going to be spending hours outside in the early morning or before dusk (when the insects are most active) be sure to bring enough product with you to stay safe all day. If you're moving around a lot and sweating, continued application may have to be done more often. Also, if you are in water swimming you should never discount having the right amount of insect repellant. It is important to protect children also if they are outside for any length of time. They should be taught to return home to reapply repellant as needed throughout their time outside. Be sure that you follow all label instructions closely. If you use repellant concurrent with sunscreen, use the latter first and the repellant on top. Do not use repellent near food and avoid breathing it in. Also, avoid applying on any skin that has cuts, is already irritated or where there is a wound. Note also that repellant products marked “natural” are not tested with the EPA and therefore their efficacy is not proven.
- Control mosquitos around your home—inside and out. The other way to protect yourself is to always do a home inspection or an inspection of the place you're staying. You want to be sure that all screens—both windows and doors—are secure. Do a visual inspection for holes in either. Also, be sure that you look at the sides of the screens to be sure that they are not pulling away from their frames at all. You want to have a secure screen that does not allow for insects to work their way into the house or room. There also are some rental areas in the world where netting is used. This can be effective, but only if the netting is also completely sealed. Be sure that you inspect the net around your bed or room to be sure that it is not compromised. Remember that a mosquito only needs a few centimeters of space to come in. You also should check for any standing water in your area, such as planters, toys, birdbaths, pols, buckets, etc. Water can pool just about anywhere and this is a ripe breeding ground for insects. Mosquitos in particular, lay their eggs near water. Be sure that you do an inspection and clear out any standing water in your area. Once water is cleared out, you should scrub the receptacle to ensure that there are no insects with eggs left behind. If possible, use air conditioning rather than leaving your windows open throughout the day. Mosquitos are most active in the early morning hours to the just-before-dusk time. This is when you should be ready to fight them off, or at minimum keep them out of your area. You also can use chemical pesticides to kill mosquitos and their eggs. Be careful to use them explicitly as directed and read the labels. You want solutions that kill both the adult insect and the larvae.
- Plan your travels. Another thing you can do to protect yourself and your family is to plan your travels carefully. If you absolutely have to go to a Zika-prevalent area, be sure that you have the repellant you need and protect your body. Do the usual search of your room or the place you are staying to ensure that insects can’t get in. Once you do that, be sure that you also get tested when you return. Note that Zika can present with symptoms or it can be completely asymptomatic. You want to know for sure that you are safe and the only way to do this is to visit your doctor. When you return home, always schedule a visit to the doctor’s office for a urine or blood test that ensures you are not infected. Even if you don’t show any signs of the virus, you can still be harboring it. For this reason, even after testing, you should abstain from sexual activity until you know for sure that you do not have the virus. Remember also that if you are a male, it can lay dormant within your system for up to 2-months. The CDC recommends abstaining from intercourse for six-months to give your body time to get rid of any possible contamination. In the end though, the only real way to know is to get tested. If you are traveling for pleasure, then be flexible. If you hear reports of intense outbreaks in a country, try going somewhere else. Higher elevations are always safer because in general, mosquitos don’t survive in these areas. Use that knowledge to help keep yourself safe.
- Protect yourself when engaging in sexual activity. Now that studies have shown that Zika virus can be transmitted through sexual activity it is more important than ever to protect yourself. If you have been traveling, be sure to get tested for the virus whether or not you are showing symptoms. Yes- you can still be infected with no physical signs of it. This is why you want to know for sure what you're dealing with and how to protect those around you. Doctors stress the importance of creating a safe environment for yourself and your loved ones. You want to always use a condom during sexual intercourse, even if you are in a one-partner situation. For men this is very important because the virus can lay dormant within their system for a long period of time post-infection. This is especially important for those who are dealing with pregnant women, as they are the highest risk category due to the impact Zika has on the fetus’ development. Be sure that you are protected at all times. Pregnant woman should either abstain from intercourse with partners who have traveled, or insist that they are tested upon return. Even post a negative result for the virus, they should still use condoms at all times of sexual intimacy. Zika is most devastating to forming infants within the womb. It is critical for their health and long-term growth to keep them safe from the virus until some form of treatment is discovered.
- Create a Zika-protection kit. You want to come up with a Zika-protection kit that works for you and your family. First of all, treat all clothing with repellent. This includes pants, shirts, socks, boots, shoes and tent areas. Use an EPA-approved solution with an adequate active ingredient concentration. You also can look for clothing that is pre-treated with permethrin. This is a synthetic chemical that replicates natural extracts coming from chrysanthemums. It is used to protect crops from insects, on pets, livestock, buildings and on clothing. There are more than 1,400 different products that use the insecticide effectively. Beyond that, you also should have a go-to EPA-approved repellant to use. Be sure to apply it liberally and often—in particular if water sports or intense activity is being done. This is what will keep insects from biting you directly. Never spray it on your face- always spray your hands and then apply it to your face. You also should have a water treatment tablet in your kit. Standing water is where mosquitos breed so its treatment is necessary. These tablets will kill all larvae in standing water around your house. Always follow the package directions. If you do, you should not have problems with water your pets drink. In your Zika kit also have netting for a bed area. This is particularly needed if you are camping or sleeping somewhere outdoors. The net will keep the insects out- especially during the time you are resting. Finally, be sure that you follow up with your doctor on any notable rashes, fever or nausea. You want to be tested for Zika virus to ensure that if you do have it, you are getting the proper care and taking necessary precautions to avoid spreading it further.
- Limit travel. If at all possible, try to limit travel. Of course if the travel is for business, this may not be possible. If however it is for leisure, it may be possible to visit exotic locales with lower Zika virus numbers. Remember though that even if the numbers are lower, this isn’t a sure-fire method of protection. You want to always take the necessary steps to ensure that you are completely protected by using clothing, repellent and safe room inspections. Put together these are the best way to fight off any issues with infection. If you must travel, it is recommended that you visit locales that are at an altitude of 6,500-feet or higher. Mosquitos are unable to survive in these environments and are not usually found there. The good news is that there are plenty of locations that are beautiful and in the higher altitude category of visiting spots. You want to be sure that when you do go though, you still use your Zika-protection kit for added protection. It is never acceptable to assume that mosquitos will be completely missing from a location. Recall that they were not “supposed to” be able to survive in cold winters, but newest research has shown that they did survive—for four consecutive Washington D. C. winters. That means that the insects are quickly adapting to new environments which makes them a continued threat to places that formerly were thought of as “safe zone” areas. Regardless of where you are traveling, you should be prepared to protect yourself proactively. Even if the insect population is down, it only takes one to spread the Zika virus that much farther.
If you have small children, it is important to follow some additional guidelines for protecting them from the virus. Usually if a child is bitten by a mosquito, they will have little to no symptoms – much like an adult. They should still be protected at all times. Here are some tips for protecting children:
- Do not spray repellent on a child. Rather, spray it on your hands and then wipe it on the child’s face
- Do not use repellents containing para-menthane-diol (PMD) or oil of lemon eucalyptus (OLE) on children under 4 years of age
- Make sure that children’s arms and legs are covered when taking them outside
- If your child is in a stroller, baby carrier or crib, be sure that mosquito netting is secured over it and there are no holes
- Never use repellent on babies younger than 3 months old
- Instruct children to keep their hands out of their mouths
Children should also be educated on how the importance of repellent. Pay special attention to their care if they are swimming or engaging in water activities.
When to Talk to Your Doctor
It is also important to know when to speak to your doctor. Here are general guidelines:
- Whenever you travel to an area with Zika, your doctor should be notified when you return. Always get tested to make sure you don’t have the virus.
- Never go by whether or not you feel sick, or have symptoms. Remember that you can be infected and remain asymptomatic throughout.
- If you are pregnant and need to travel, alert your doctor. He or she most likely will want to test you when you return—possibly a few times throughout your pregnancy.
- If you are not pregnant it is suggested by a wide range of professionals that you postpone pregnancy while traveling or if you are in high-risk areas.
- If you live in an area with Zika, be sure that you tell your doctor the moment you find out you may be pregnant. He or she will test you during your first prenatal visit and then during your second trimester.
- If you show signs of a splotchy rash be sure to get tested.
- If you feel ill with fever, nausea or lethargy, bet tested.
- If you return from travels, abstain from sexual intercourse for 6-months or as recommended by your doctor.
Remember that there is no 100-percent sure way to know whether or not you have Zika virus other than testing via the blood or urine. Be sure that you talk to your doctor about your concerns so he or she can schedule the appropriate tests immediately. Testing is done at the CDC or at various territorial or state health departments. Your doctor can direct you to the right jurisdiction.
What is Being Done
As continued health scares escalate regarding Zika virus, the CDC is becoming actively involved in a number of research tasks. These include:
- Developing more tests to diagnose patients with Zika
- Conducting various studies to gain more information about the virus
- Monitoring individual outbreaks and studying the pathology
- Reporting on all details of outbreaks for future study
- Providing education and awareness to world travelers and American residents living in outbreak areas
- Providing support to countries with outbreaks
- Providing support to US territories experiencing outbreaks
- Developing vaccines to protect from the virus
The intent is to eventually develop a vaccine, much like the one for yellow fever. In the meantime it is critical for people and children to follow necessary steps to control the insects and avoid bites.
The Zika virus has been spreading throughout the world thanks primarily to global trade. Although it is a world-wide health concern, there are still things people can do to protect themselves from the virus. A vaccine is being researched, but until it is released, it is critical to understand the details of the virus, how it is spread and how to keep yourself and loved ones safe.