Zika, travelling and pregnancy – everything you need to know before departure

What is Zika?

Zika is a viral infection that is transmitted through the Aedes aegypti mosquito, which is active mostly during the daytime but may also be active during the nights.
What is important to know, and also very relevant to this chapter, is that in addition to the mosquito bite, this virus can be transmitted through sexual contact.
In most cases the infection is mild and may even be asymptomatic, but when it comes to pregnancy, it’s a different story.
Getting infected with the zika virus during pregnancy can lead to severe congenital defects, primarily microcephaly (a head circumference that is smaller than average), and also neurological problems, hearing problems, vision issues and abnormal development of the skeleton in babies.
Similar to the CMV virus that we try to avoid during pregnancy.
Similar to many other intrauterine infections, the consequences on the fetus are especially severe when the infection in the mother occurs during the first trimester but can also occur later on during the pregnancy.

What do you need to know about zika and pregnancy?

There are several points that I will expand on later in this chapter, but these are the important ones:
a. If you, as a couple, are planning to get pregnant and are travelling abroad, take into account whether or not Zika is present at your destination
b. Infection in a woman who is not currently pregnant but hoping to get pregnant soon, is also significant. This chapter will also address pregnancy planning.
c. The husband must also be aware of this – we do not want to get to a point where the partner gets infected and transmits the infection to the wife through sexual contact (through sexual intercourse for example, 2 months after returning from the travel), when they are trying to get pregnant or during the beginning of pregnancy.
d. A blood test can be performed once you return form a destination known to potentially have Zika, in order to prove that you are negative, and practically disregard everything I have explained here.
I will now expand on each one of these points.

Where in the world is Zika common?

The level of risk for Zika is classified into 3 subcategories, depending on the prevalence in the region:
# High risk – countries with a documented outbreak
# Medium risk – countries with a previously known transmission of virus
# Low risk – countries where the mosquito is known to be present but there have not been any documented active cases

Several points to emphasize:

a. Areas that are 2500 meters or above sea level are not considered dangerous, even if they are in countries that are considered to be at high risk.
b. You can find updated maps of areas at risk in the CDC, in the following link.
c. When it comes to pregnancy and planning pregnancy, moderate and high risk countries should be considered equally dangerous for both partners.

How can one avoid the Zika infection?

a. If you are pregnant or planning to get pregnant – avoiding countries that are considered high risk is recommended and strongly considering not visiting countries that are at moderate risk is also recommended.
b. Avoid mosquito bites – Zika is transmitted more during the daytime, but also during the night, and therefore:
# Use mosquito repellants
# Wear long sleeved clothes
# Minimize the duration of time you spend outdoors, as much as possible
# Make sure you are sleeping and staying in air-conditioned rooms with nets protecting doors and windows.
I remind you that this is not the only disease that is transmitted through mosquitos in these areas. Find out more about Dengue fever and the new vaccination against it here.

Is there a vaccine against Zika?

No. Not yet.

Wait a second – can I not tell whether I had the Zika infection during my travels?

No. often the infection is asymptomatic.
If you develop symptoms I recommend you undertake a test to assess whether you had the infection.

How do you summarize your recommendations to an asymptomatic pregnant woman?

a. As mentioned above, avoid visiting high risk countries/areas
b. Make sure you are having protected sexual intercourse if your partner had Zika or visited a country that is considered at high or moderate risk for Zika for a period of 3 months following their travel.
c. If the pregnant woman was not tested for antibodies after returning from a region that is at high risk (as you will see below) she will need to be referred to high-risk pregnancy monitoring.

What is your summary of recommendations for an asymptomatic woman who is planning a pregnancy soon?

Pregnancy should be deferred to two months following return from high or moderate risk areas.

What are the recommendations to a man whose partner is pregnant?

a. Avoid unnecessary travel to areas considered at high risk
b. Following travel to high or moderate risk areas, make sure sexual intercourse is protected for a duration of 3 months following return.

What are the recommendations for an asymptomatic man whose wife is planning to get pregnant?

Defer pregnancy for 3 months following return from high risk or moderate risk areas.

Is there a way to find out whether your had the infection so that you can resume regular activities?

That’s an excellent question.
You can test for the presence of antibodies (serological testing) to detect IgM or IgG antibodies at least 14 days following return. If your antibody test, performed at a validated laboratory, is negative, then you did not have the infection and you can forget all the instructions I listed above in terms of planning for pregnancy.

Prior to and following travel, make sure you check with your primary healthcare provider for any local/regional guidelines that may differ from what I described above.

In summary, if you are pregnant or planning to get pregnant, stay safe, consult with your doctor and choose your destination wisely. The virus may be small, but its effect on your pregnancy can be massive.
Find out more here about vaccinations during pregnancy. I wish you safe and pleasant travels!