Zika Virus: All you need to know
The World Health Organisation has declared the outbreak of the Zika Virus a global health emergency. With a growing number of people being infected, The Barbados Fertility Centre answer all the key questions.
What is Zika virus and how is it transmitted?
Zika virus is a single-stranded RNA virus of the Flaviviridae family, first identified in 1947. Zika is primarily transmitted through the bite of infected Aedes mosquitoes. It can also be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth. It is not known in how many cases Zika is transmitted from mother to baby during pregnancy or around the time of birth.
Who is at risk of being infected?
Anyone who is living in or traveling to an area where Zika virus is found, is at risk for infection if bitten by an infected mosquito. People can be infected by the virus only once, Zika virus infection provides lifelong immunity to the same virus.
What are the symptoms of Zika virus infection?
Only one in five people infected with Zika will get sick. For people who get sick, the illness is usually mild. The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito, and may last for between 2-7 days.
The risks of the Zika virus
The biggest concern with Zika infection is not the presented symptoms of the actual illness (which typically involves no (80%) or mild symptoms) but that there has been an alert raised in Brazil that an increased rate of congenital anomalies including microcephaly have been noted during/following the Brazil epidemic of Zika infection.
N.B. Brazil, a population of 206 million persons, with 3,000,0000 (three million) babies reported births annually, has had in the year 2015, 4000 (four thousand) cases of microcephaly reported in birth.
The WHO held a meeting on February 1, 2016 and declared the Zika virus a Global Health Emergency, which means it now has top priority for the fast tracking of research and will now have the global response from experts that it needs. They stated, “The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven.”
WHO also stated, “The Committee found no public health justification for restrictions on travel or trade to prevent the spread of Zika virus.”
To date there have been 3 confirmed cases of Zika infection in Barbados by the Ministry of Health, Barbados.
Currently work is underway to evaluate this link between the abnormalities and the virus and to characterize if indeed there is an association, and if so, what stage of pregnancy does Zika infection pose a risk to adverse pregnancy outcome. It is difficult to make a definitive correlation as many healthy babies have also been born when Zika infection was present but no symptoms were displayed by the mother.
In January 2016 CDC has issues guidelines “in an abundance of precaution” for patients KNOWN to be pregnant to postpone travel to countries where the Zika virus has been identified. They also recommended that patients not pregnant, but who wish to become pregnant wait two weeks from returning from travel prior to attempting pregnancy simply to protect that if they were exposed they are outside the infection window.
What does this warning mean for Patients travelling to Barbados for IVF and currently trying to get pregnant?
Thankfully the incubation period (bite to symptoms) and illness period for Zika infection is short. Each being between 2-7 days. After which the patient has life long immunity.
Given the timing of IVF – initially for stimulation and monitoring, then egg retrieval and subsequent Embryo Transfer if a patient was to be bitten during this time frame the impact, from what we know the fetus is limited due to the improbability of blood circulation between mother and fetus.
It is also noted that even after Embryo Transfer, implantation does not start for a few days.
Most importantly to our IVF patients, fetal circulation is not present until day 28 following conception (egg retrieval) and therefore the transfer of the infection to fetus is extremely low.
Prior to fetal circulation it is probable that Zika infection would either have no impact (the most likely case), or could result in miscarriage, rather than an ongoing pregnancy with a congenital anomaly.
Here are some frequently asked questions we hope to answer for you:
What happens if I test positive for Zika infection before I start IVF treatment at Barbados Fertility Centre or while I am trying to get pregnant?
If before you start the IVF process or if before you are pregnant and you test positive for the Zika antibodies you are immune and can proceed knowing that you have life long immunity to the infection and no concern to your upcoming pregnancy.
What happens if I develop symptoms of the Zika infection whilst undergoing IVF treatment at Barbados Fertility Centre?
Until more is understood should you exhibit signs of a Zika infection during the IVF process, you should report this to your nurse coordinator/ Physician immediately. Depending where you are at in the IVF process, you will discuss with your IVF physician if it is necessary to avail of the option to freeze your embryos and subsequently transfer them at a later date after the symptoms have settled and life long immunity is in effect. A blood test will be required to note if the antibodies are present in the patient.
How will we know if we have contracted Zika?
For all Barbadians, and any patients living in a Zika affected country visiting Barbados and undergoing IVF with Barbados Fertility Centre, Zika blood testing is available for free to our patients.
I am considering IVF at Barbados Fertility Centre but returning home to a country where the Zika infection is present. What do I do?
Worldwide authorities are still working very hard to try to evaluate the report of potential adverse pregnancy outcome related to Zika infection.
Zika infection outbreaks are not new and even in countries where Zika is prevalent the vast majority of the population will not get Zika. For those that do, most infections symptoms are mild and in fact many totally asymptomatic.
The IVF process does not predispose you to getting Zika. However, while someone may not have taken precautions normally it would be best advised that heightened mosquito precautions are taken to prevent the likelihood of infection during pregnancy.
While advising avoiding pregnancy is one option - until more is known and understood from the analysis in Brazil, this doesn’t appreciate the risk of waiting for pregnancy and infertility. If you are positive for Zika you can pursue IVF as you have lifelong immunity.
Your options are:
Freeze your eggs as a safeguard for fertility preservation.
Freeze embryos for subsequent use. The Zika virus will continue to spread as the months go on through the Americas. It is currently present in some states in the USA, the Caribbean and South America. Women globally need to continue to take precautions – but ultimately worldwide procreation cannot just stop! Patients need to evaluate the risks and putting their chances of having a family on hold. As each month passes the impact to the female patient is a deterioration in her egg numbers and egg quality which impacts the success of her chances of having a family.
Avoid pregnancy. However with female age remaining the biggest factor for success in IVF, caution is always advised not to delay too long.
Proceed with heightened mosquito prevention as per CDC guidelines.
Alert your OB/GYN if you are pregnant as per CDC guidelines.
Are there any other risks to consider?
The balance to be considered by persons wanting to get pregnant is that delaying pregnancy itself for a potential low risk infection could lower chances and may have a significant impact of pregnancy for women of advanced age even a few months of delay. Discuss your concerns with your IVF Physician at Barbados Fertility Centre to decide the best treatment plan for you.
There are still some questions we do not know the answers to yet, and they are:
How likely is it that a mosquito bite would result in infection? (inoculation probability)
Is Zika infection associated with adverse outcome in pregnancy? Although it has been known since 1947 only recently has this question been raised?
How does the time of the infection correlate with congenital anomaly – it is most logical from data from other infections which are known to have impacts that this is greater if after 8 weeks and prior to full brain development.
What percentage of infections in pregnancy result in problems?
Does level of symptoms correlate with this probability – are the 80% with no symptoms far less likely to incur risk?
What we do know:
Avoidance of mosquito bites by using DEET, and dressing in light clothing, which covers arms and legs reduces the chance of the bite.
Aedes Mosquitos are prevalent during the day and during dry season.
Active reduction of mosquito populations has been used effectively by local health agencies in Barbados for decades, as a means of reducing other infections for mosquito borne diseases such as dengue, chikungunya and now Zika. This practice will continue and has been intensified by the local Health agencies. Barbados Is now entering its “Dry Season” reducing the ability of the mosquitos to procreate at a faster rate than other times of the year.
The Zika virus is a concern globally and we will continue to monitor .
Please see the World Health Organization link for more questions and answers: www.who.int/features/qa/zika/en/
Barbados Fertility Centre is a leader in information and education for their patients and all couples trying to get conceive.
Centre for Disease Control and Prevention (http://www.cdc.gov/zika/index.html)
World Health Organization (WHO) (http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/
Ministry of Health, Barbados – Press release dated Jan 15 2016 (http://gisbarbados.gov.bb/index.php?categoryid=9&p2_articleid=15336)
This article was written by Barbados Fertility Centre, a leading JCI accredited infertility clinic in Barbados. The well regarded Centre combines a range of high quality fertility treatments, including IVF, a donor egg programme, egg freezing and frozen embryo transfer, with on-site spa therapies, counselling and nutritional advice.