Public Health

Containing Zika: The urgent need for funds, pregnancy guidance

The Centers for Disease Control and Prevention’s (CDC) confirmation that the Zika virus causes microcephaly and other congenital brain abnormalities underlines how vital it is for physicians to understand the latest guidelines for conception and pregnancy care. Meanwhile, vector control will play a key role in combating Zika. Learn what experts have to say and why federal funding is so important.

The CDC counts 39 countries and U.S. territories that are reporting active Zika transmission. The agency reports that as of April 13, 833 people in the United States and its territories have been infected with Zika, including 68 pregnant women. The virus is expected to spread as its leading vector, the mosquito Aedes aegypti, expands its range during the warm weather months.

Containing Zika’s spread

A crucial component of battling Zika is curbing the spread of the mosquitos that carry the virus. The leading vector for the virus is Aedes aegypti, a mosquito that can be recognized by the white markings on its legs. It most often bites at dusk and dawn, and prefers to breed in stagnant water, such as buckets and discarded tires.

At an April 1 summit on Zika in Atlanta, Lyle Petersen, MD, director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for Zika Response, called for coordination among the various state and local agencies and private contractors responsible for mosquito abatement in communities across the nation.

In preparation for mosquito season, Dr. Petersen said, communities should develop communications strategies among agencies and engage communities in control plans, which should include removing standing water and using larvicide in water sources that cannot be removed.

Genetics might one day provide another tool to fight the spread of Zika. The U.S. Food and Drug Administration (FDA), the CDC and other agencies are considering a plan to fight Zika with genetically engineered mosquitos. The FDA is accepting public comments on the draft environmental assessment of the plan until May 13.

The urgent need for funds to fuel the Zika fight

Meanwhile, the AMA and other organizations are urging Congress to reinforce the fight against Zika by providing more resources. In an April 5 letter to Congress, the AMA and dozens of other organizations committed to public health urged lawmakers “in the strongest terms to immediately provide emergency supplemental funding,” especially considering the approach of summer and mosquito season.

President Obama has underlined the urgency of the eradication effort by asking Congress for close to $1.9 billion for the campaign against Zika.

Additionally, Congress approved a bill April 12 that calls on the FDA to make Zika a priority, which President Obama signed April 19. The law will add Zika to the list of diseases that qualify for an incentive program designed to spur the development of new drugs and other products. 

Guidelines for Zika care

In its updated guidelines, the CDC gives recommendations for physicians caring for women who may have been exposed to the virus and are interested in conceiving:

  • Postponing conception after exposure. Women and men who do not have the Zika virus but live in or have traveled to active-transmission areas should wait eight weeks after exposure to attempt conception. That period is bases on the estimated upper limit of the incubation period for Zika virus disease, 14 days, and the approximate tripling of the longest published period of viremia after symptom onset, which is 11 days.    
  • Postponing conception after illness. Women with Zika symptoms should wait eight weeks after the onset of symptoms to attempt conception. Men with symptoms should wait six months after onset. This interval is based on limited information on the persistence of Zika virus in semen.   
  • Counseling in active transmission areas. Physicians caring for patients in active-transmission areas should discuss patients’ reproductive plans and counsel them on the best ways to prevent unintended pregnancy.
  • Counseling outside active areas. Physicians should offer preconception counseling to women living outside active areas, including offering information on Zika symptoms.   
  • Testing for Zika infection. Testing for Zika should be performed on patients with possible exposure to the virus who have one or more of the most common symptoms.

The CDC does not recommend routine testing for women or men who are attempting conception and have possible exposure to the Zika virus but have no clinical illness. The performance of routine testing in asymptomatic persons is unknown, and results might be difficult to interpret.

The updated guidelines also include recommendations for couples undergoing fertility treatments, including timing guidelines for those attempting conception.

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