Dr. Rebecca M. Reece joined University Medicine’s Division of Infectious Diseases in January 2015. Her clinical and research interests include tick-borne diseases, HIV adherence and retention, and health disparities. She serves as lead physician for the Lifespan Center of Excellence for Tick-borne Diseases at Newport Hospital.
After graduating from the West Virginia University School of Medicine, she completed her residency at West Virginia University Hospital and fellowships at Rhode Island and The Miriam hospitals. Reece talked with Providence Business News about the risks of Zika and her role as an infectious disease specialist.
PBN: Can you explain the role of University Medicine Foundation’s Division of Infectious Diseases, its scope of expertise and your position there?
REECE: The mission of the Infectious Diseases Division is to provide state-of-the-art care for all patients with any type of infectious disease, teach and mentor medical students, house officers and fellows in the art and science of infectious diseases, and pursue clinical and basic research that investigates the manifestations and treatment of infectious diseases. The division has a number of areas of expertise, including bacteriology, global health, HIV/AIDS, infection control, virology and sepsis research. Active in clinical, translational and basic science research, the division receives nearly $15 million in research funds each year. I work in the Lifespan hospitals on the inpatient consultation service, as well as in multiple outpatient clinics covering HIV, TB and tick-borne infections.
PBN: Without any augmentation of federal funds being appropriated to address the Zika crisis, how can communities and health care providers respond, either to prevent or manage the spread the Zika-infected mosquitoes?
REECE: Although Congress has not passed the “global Zika bill,” the R.I. Department of Health has received some federal funding to address Zika here. Those federal funds are supporting things like rapid surveillance of microcephaly and other central nervous system birth defects, public education, mosquito and human disease surveillance, case management and laboratory activities.
Prevention is the key for Zika virus, given that no vaccine or treatment is available at this time. The first step is continuing to educate our patients and their families about the risk of Zika infection with travel, the routes of transmission, and the preventative steps to take during travel and upon returning. One way to do this is to make sure that we ask our patients about any upcoming travel plans and inform them of mosquito-prevention methods if they are traveling to a Zika-affected area, which now includes recently-identified areas in Florida, where local Zika transmission is occurring.
Women who are pregnant or planning to become pregnant should be aware of the current travel advisories, at cdc.gov/zika, and avoid travel to Zika-affected areas whenever possible, due to the risk of microcephaly and other birth defects with infection during pregnancy. Because the Zika virus can be transmitted sexually, sexual partners of women who are pregnant or trying to become pregnant also should avoid travel to Zika-affected areas, as well. If travel cannot be avoided, then precautions should be taken.
PBN: Do you anticipate Zika spreading to Rhode Island; what are the best ways to prevent infection either here at home or while traveling?
REECE: The greatest risk for Rhode Islanders remains traveling to areas that are affected by local transmission of Zika virus. These are areas where the predominant mosquito vector (Aedes aegypti) as well as the Aedes albopictus, which can also carry the disease, are common. In Rhode Island, we have found few individual Aedes albopictus mosquitoes. However, because Rhode Island winters have thus far been cold enough to kill most eggs of this species, mosquito experts don’t expect the species’ population to grow large enough to effectively spread the disease locally. The primary vector, the Aedes agypti, has never been found in Rhode Island and is limited to tropical and sub-tropical regions. The recommendation for travelers returning from Zika-affected areas is to take precautions to prevent any mosquito bites for three weeks after returning from such areas, even if they do not have symptoms of Zika.
The best way to prevent infection is to prevent mosquito bites: Cover exposed skin by wearing long sleeves and long pants; use EPA-registered insect repellents containing DEET (or picardin, oil of lemon eucalyptus or IR3535); wear permethrin-treated clothing and stay in places with air conditioning and window/door screens (or use a mosquito bed net). In addition, around our homes and yards, remove any containers of any size where standing water can collect and serve as a mosquito breeding ground, such as car and truck tires, bird baths and pool covers.
PBN: Beyond risks of birth defects, what other medical outcomes are likely to impact someone bitten by a Zika-infected mosquito?
REECE: First, the majority of Zika infections actually result in no symptoms; only one in five people infected will show symptoms. For that 20 percent who do, the usual symptoms are fever, rash, conjunctivitis and joint/body aches, similar to other viral illnesses, which last about a week. However, during this current international Zika virus outbreak, an increasing number of cases of Guillain-Barré syndrome have been reported. Guillain-Barré syndrome is a neurologic disorder that causes progressive muscle weakness and paralysis that can last for several weeks to months. It has been seen with several other infections in the past and, in most cases, full recovery is seen. Our knowledge in this area is still evolving.
PBN: If someone – male or female – of childbearing age is bitten by a Zika-infected mosquito, how much time should elapse between infection and attempts to conceive a child. Is there a “safe window of opportunity”?
REECE: There are ongoing epidemiologic studies through the CDC to try to identify how long the virus is capable of being transmitted through different body fluids. Based on what is known to date, the CDC has recommended that women or men who want to attempt to conceive a child should wait for at least eight weeks after the last possible exposure to Zika virus (i.e., after returning from a Zika-affected area) if they have no symptoms of infection. For women who develop symptoms of Zika, the wait is eight weeks after symptoms start.
For men who develop symptoms of Zika, the timeline is much longer, as the recommendation is to wait at least six months before attempting to conceive. In addition, men returning from a Zika-affected area who have a pregnant partner should abstain from all sexual intercourse (including oral and anal) or use condoms every time they have intercourse for the duration of their partner’s pregnancy.
