Physicans play ‘waiting game’ on Zika threat

The mosquitoes that spread the Zika virus are not found in Rhode Island. But because so many Ocean State residents have family in affected areas, and have traveled in recent months, the implications of the virus have become an issue for local physicians.

Part of the challenge in responding to patient concerns about the virus is that much remains unknown, said several physicians, contacted recently about how they respond to emerging health issues.

The best course is to be clear with patients about what is known and not known, said physicians. Last year, the emerging threat was Ebola. In previous years, the bird flu and other viruses were on the radar.

With Zika, what is known is that the virus transmitted by mosquitoes has resulted in an unusual declaration of a public health emergency of global concern by the World Health Organization. The organization announced that status on Feb. 1, shortly after the U.S. Centers for Disease Control and Prevention issued an advisory, identifying more than a dozen countries in Central and South America, as well as Mexico and islands in the Caribbean, as locations of active transmission.

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The greatest concern relates to pregnant women. Although the nature of the connection is not yet clear, the emergence of the virus in Brazil has correlated with a recent spike in babies being born with a severe birth defect called microcephaly. More than 3,500 cases of microcephaly, in which babies are born with unusually small heads, were reported between October 2015 and January 2016, according to the CDC.

As soon as the CDC issued its advisory, travel and tourism to the affected countries were affected. In the U.S. most air carriers have agreed to provide rebates or credits for travelers who are pregnant.

The Rhode Island Department of Health has not issued an advisory for the general public on Zika, but has made the CDC travel advisory available on its website. “Pregnant women are the biggest concern at this point,” said spokesman Joseph Wendelken. “These women are being discouraged from traveling to areas where there is active transmission. For all other people, there is much less concern.”

For now, health professionals advise pregnant women to not travel to the identified countries.

After appearing in Brazil, the virus has since been found in 14 countries identified by the CDC: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela and Puerto Rico. In a Jan. 26 update, the CDC reported the Dominican Republic also had active transmission.

Given the close cultural ties of Rhode Islanders to several of the affected countries, obstetricians and gynecologists here are reporting numerous phone calls and inquiries from pregnant women who have traveled to the affected areas. Rhode Island has a significant population with ties to the Dominican Republic, Puerto Rico and Guatemala.

Local women who had visited the affected countries before becoming aware of the virus have since called their doctors and are concerned, according to Dr. Brenna Hughes, a specialist in high-risk pregnancy as well as infectious diseases at Women & Infants Hospital.

Transmission in Rhode Island is not a concern, given the local mosquito species, she said. “What we do have is a significant concern with our patient population, with families that are based in the areas that are affected and so we do have a fair [number] of patients that normally would travel to those areas during the course of their pregnancies,” Hughes said.

Hughes, who helped to develop guidelines on responding to the virus for the American Congress of Obstetrics and Gynecology and the Society for Maternal Fetal Medicine, said individual practices should develop a mechanism for screening women for their travel histories at the time of their prenatal visits.

Unfortunately, unless someone is acutely ill, there is no reliable blood test, Hughes said.

Women who have traveled to any of the affected countries during their current pregnancy are then to be referred for ultrasounds, which over time can detect the growth of the fetus’ skull.

Dr. Christine Brousseau, an OB-GYN at Women & Infants, has not had any patients who have traveled to the affected countries. But there certainly is concern being expressed, she said.

For some women, they may have heard something about the virus, but need reassurance about how it is transmitted. In adults, the virus generally has fairly mild symptoms.

Women who have traveled to the affected areas will be referred for ultrasounds, she said, per the guidance.

Nevertheless, the lack of a definitive answer, on initially contacting the physician, is unnerving to many affected women, according to Hughes.

“Most people want to know for sure whether or not they’ve been exposed,” Hughes said. “And unfortunately, we don’t have the capacity to be able to test women. At this point, it’s sort of a waiting game.” •

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