Zika

Over the summer the World Health Organization (WHO) declared an international health emergency because of the Zika virus. At the time, there was little known about the mysterious disease that originated in Uganda. Since then, the headlines have been dominated with information about Zika and the devastating birth defects it leaves in its wake. In late July, the Centers for Disease Control (CDC) announced that Zika had officially made its way to the continental United States raising legitimate concerns for pregnant women all over the county. Concerns and media attention have since dwindled, and while there is no need for widespread panic we should still be paying close attention. In North Carolina, where residents jokingly refer to the mosquito as the state bird, the Zika virus is a legitimate fear.

The CDC and the WHO have warned pregnant women against traveling to more than 45 counties in Florida where the virus has quickly spread. With pregnant woman and their unborn children at risk, residents in neighboring states have a real reason for concern. For the North Carolinians who aren’t that far from the Florida border, an even bigger concern is “are we at risk?”

Before we panic, however, it is important to be prepared and educated. Understanding this elusive disease and being knowledgeable about prevention is key in protecting ourselves and loved ones.

What is the Zika virus?

According to the CDC, the Zika virus is a mosquito-transmitted infection related to Yellow Fever and the West Nile virus. It was discovered in the Zika forest in 1947 and is believed to be common across Africa and Asia. There has been a recent spike in cases in 2013, but was not confirmed until 2015. Most victims have no symptoms and the recovery process usually takes five to seven days. Common symptoms are mild and can include a fever usually lower than 102 degrees, headaches and achy joints. Other telltale symptoms that hint to Zika include an itchy rash, conjunctivitis and sensitivity to light. Mosquitos of the Aedes genus spread this virus, and as with most mosquitos, they can breed in extremely small pools of water.

Who is in danger?

The general assumption is that only pregnant women should worry about Zika. This virus poses a huge risk for pregnant women, but unfortunately they are not the only ones at risk.

“Most people who get Zika get over it quickly but the virus can also cause neurological complications that could cause long-term consequences and even death,” explained Dr. Lee Norman, senior vice president and chief medical officer at the University of Kansas Hospital.

Zika is directly linked to Guillain-Barré syndrome (GBS), a debilitating autoimmune disorder. According to the CDC, “several countries that have experienced Zika outbreaks recently have reported increases in people who have GBS.

Studies have shown that women are more likely to contract Zika than men, with sexual transmission being the main culprit. Zika is primarily spread through mosquitos, but can also be transmitted through various forms of sexual encounters. According the CDC, “Zika has been detected in semen, vaginal fluids, saliva, urine, and breast milk.”

Pregnancy & Zika

If you are pregnant, planning to conceive or know someone who is, Zika is probably a top concern. As if sushi, back pain, caffeine limitations and weight gain didn’t give pregnant women enough to worry about. Previously, Zika, once limited to far-flung destinations, is now hitting a lot closer to home. As of Nov. 10, there have been “1,087 reports of pregnant women in U.S. and Washington DC,” the CDC states. While Florida has seen the most cases, the N.C. Dept. of Health and Human Services has reported 78 cases.

With the reported cases in our state, there is still a lot of good news for women who are expecting, or hope to become pregnant in North Carolina. The mosquito most commonly associated with the Zika virus, the Aedes aegypti, has not been identified in North Carolina this year, according to the N.C. Division of Public Health. In addition, the secondary vector, the Tiger mosquito is not transmitting locally either, said David Jenkins, health director/deputy director of human services for the Carteret County Health Dept.

"Pregnant women in North Carolina need to know that all of the cases of Zika that have been identified in North Carolina to date were from patients who traveled to Zika endemic areas," said Dr. Elizabeth Stringer, associate professor of obstetrics and gynecology at UNC's Maternal-Fetal Medicine department. "There have been no locally transmitted cases." So while it’s a positive outlook for our local women, it is still smart to be aware. The Zika virus can be passed from a pregnant woman to her fetus regardless of how it is acquired. Contracting this infection during pregnancy can cause many birth defects.

Microcephaly

Infection with the Zika virus can cause severe forms of microcephaly in infants. The CDC explains, “Microcephaly is a condition where a baby’s head is much smaller than expected. During pregnancy, a baby’s head grows because the baby’s brain grows. Microcephaly can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size.” Microcephaly is linked with, seizures, developmental delay, intellectual disability, problems with movement and balance, hearing loss and vision problems.

Treatment

Unfortunately, there is no treatment available for Zika. The CDC does not recommend any antiviral medication for its victims. The symptoms are usually mild and usually require only rest and nourishment. The best way to combat Zika at this point is prevention.

Prevention

Much is being done to combat this problem including vaccination trials, and potential genetically modified male mosquitos that will kill the offspring after mating. Unfortunately, there is no vaccination available to date. Since it is virtually impossible to prevent mosquito bites, the CDC has advised pregnant women to avoid going to regions where the virus is being transmitted. Travelers to these countries are advised to avoid or minimize mosquito bites by staying in screened or air-conditioned rooms or sleeping under mosquito nets. For locals who are still concerned, follow the same recommendations, use bug spray and eliminate all pools of water in your surrounding areas where mosquitos can breed.

What is North Carolina doing to combat Zika?

North Carolinas largest concern in the wake of Zika is education and prevention. The state's “preventative measures include educating its residents, surveillance and control of the mosquito population,” explained Jenkins. Surveillance includes observation and tagging of mosquitos around North Carolina. According to the N.C. Division of Public Health “agencies are working with local health departments, Western Carolina University, East Carolina University and N.C. State University to collect and identify mosquitoes across the state.”

Carteret County’s preventative efforts include spraying, or adulticiding, to kill adult mosquitoes, and larviciding, where chemicals are used in standing water to kill the larva. Larviciding is the most effective form of mosquito control as it handles the issue at the root. If mosquitoes are not hatched, they do not grow into adult mosquitoes that bite and transmit diseases.

What can North Carolina residents do?

As Jenkins explained, the best thing residents can do is be prepared, educated and aware. Search your property for standing water, which are breeding grounds for larva. Even a small amount of water can breed mosquitos, including birdbaths, tires, old toys and small puddles. The Health Department offers educational resources and mosquito dunks for standing water treatment. If you have traveled to Zika hot spots get tested and practice safe sex.

Amy Farmer, certified nurse midwife, who formally worked with the Onslow County Health Dept., recommends all women get tested for Zika whether they have traveled to these regions or not. However “they will only be tested if they meet specific criteria. With Zika spreading it is important to discuss prevention at each doctors visit.”

State funding

Unfortunately “mosquito control is now county funded, so the funds are not as strong as they used to be,” said Jenkins. The CDC is planning “to steer $25 million in recently approved funding to states and some cities for Zika preparedness and response efforts,” agency Chief Operating Officer Sherri Berger said. This funding is extremely important in mosquito control not only in the prevention of Zika but also West Nile and Eastern Equine Encephalitis. These funds help with “creating reading materials, sprays and treatments, research and surveillance and important tools such as microscopes and light traps,” explained Jenkins, which can all be costly but important necessities.

Chemical combat

When chemicals are sprayed into our air to eradicate these pesky and potentially deadly insects, there is an obvious cause for concern. In Florida, where infected mosquitos have been found, the chemicals are more aggressive than in North Carolina. There are natural fears about the effect these sprays are having on its residents and the local wildlife. In North Carolina, the chemicals are environmentally friendly and water or oils are added to dilute them. In addition, “the chemicals are sprayed at night and in the morning, not only does this target mosquitos when they are most active but that is when most people are inside their homes and other insects like butterflies and bees are not active,” said Jenkins. Recently millions of honeybees were killed after being sprayed with an insecticide targeting Zika-carrying mosquitoes. Jenkins explained that this is not a huge concern in our area.

“Honeybee farmers are required to register in Carteret County, this lets sprayers know to avoid these areas within a certain mile radius. Because of the bees patterns they are usually safe inside their hives during these community sprays.”

Thankfully, the WHO has recently announced that the Zika Virus is no longer an international emergency. However, this does not mean we are completely safe. They also stated, “they are not downgrading the importance of Zika. Instead it is being viewed as chronic problem, rather than a crisis.”

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