By Nicole Graham, Humanitas Global
Since the beginning of the outbreak in Brazil, the Zika virus has spread to most other countries in Latin America. Zika disproportionately affects women; particularly women who are pregnant, women who could become pregnant, or even women engaging in sexual activity. Symptoms of the disease are mild, yet the impact of the virus on a pregnant woman is much more serious.
In a Center for Disease Control and Prevention (CDC) report released in April 2016, researchers announced that having the Zika virus during pregnancy results in an increased risk of having a baby with microcephaly – a condition where newborn babies are born with a small head or the head stops growing after birth. Although some women infected with the virus have delivered babies that appear to be healthy, the environment in all impacted Latin American countries is one of panic. A sense of urgency to contain the infection has spread to the United States, as the first baby with Zika-related microcephaly in the U.S. was born in Florida this past week.
Months ago, the CDC began examining a handful of female Zika infected patients where it was believed that sexual activity led to contraction of the virus. In all fourteen investigated cases, women had engaged in sex with men who had traveled to countries where the virus was circulating. As of last week, recent findings suggest that intimate contact may account for more Zika infections than was previously believed. These reports are disputed, but new evidence suggests that women are much more likely to be infected by Zika in Latin America than men, although all individuals are assumedly exposed to virus-carrying mosquitos the same amount. The gender difference in infections is particularly striking around the age where sexual activity begins.
As of March 2016, no research was being conducted to determine if females could reciprocally transmit the virus to their sexual partners. Scientists still do not know whether the virus is passed through semen or general sexual activity, whether it can be passed through saliva, and whether sexual transmission poses different risks for birth defects than mosquito-borne transmission. With these developments, Zika has revealed itself to be “scarier than we once thought”. The CDC has not released any recommendations for how women can protect themselves besides avoiding mosquitos, using a condom, avoiding sexual activity with a Zika-infected partner, and frequent Zika testing.
Like so many other aspects of Zika, it is undetermined whether or not breastfeeding can transmit the virus. The Lancet has introduced research that Zika does in fact appear in breastmilk, but more information is still needed. Breastfeeding is an essential practice for infant and young child health and development, especially in the developing world. The World Health Organization (WHO) recommends that infants begin breastfeeding within one hour of birth, and then are exclusively breastfed for at least six months, with appropriate and gradual introduction of complementary foods.
Regardless of the recent revelations that Zika can be transmitted outside of mosquito bites, WHO breastfeeding recommendations remain in place during the Zika context. The organization states that mothers who suspect they are infected should receive “skilled support from health care workers to initiate and sustain breastfeeding”, and that mothers should also continue to breastfeed if it is confirmed that she or her baby are infected.
Yet the research gaps that currently exist in understanding Zika infection are frightening, particularly for women and infants because the true nature of the disease remains unknown. The given recommendations by international institutions are only in place until actual solutions are developed. But unlike past outbreaks, much more research is necessary to determine how threatening Zika truly is.
A year after Brazil reported a suspicious skin rash in its northeastern states, the WHO responded with a Public Health Emergency of International Concern. Although human trials were recently approved for an experimental vaccine for Zika, it seems unlikely that a viable vaccine will be released to the public anytime soon. Uganda’s Virus Research Institute (UVRI) is examining ways to contain outbreaks though no focus is given to treatment or cures. A US bill to provide $1.1 billion to fight Zika was blocked by Senate Democrats because it involved riders related to controversial issues such as restrictions on use of funds for birth control services, further delaying needed research.
With limited understanding of Zika, family planning is an essential tool to fighting the virus’ tendency to cause birth defects. In Brazil, the country hit hardest by Zika, increased funding for education and contraception have lowered birth rates and created a more knowledgeable population and a lower birth rate. These efforts should be scaled up in the face of Zika. Because women seem hardest-hit by the virus, females should take initiative to educate themselves and others about family planning to avoid infection and curb Zika rates. Thanks to recent efforts, 88.9 percent of the female population in Brazil is literate, and 80 percent of women of reproductive age report using some form of contraception. This indication of a knowledgeable and empowered population could facilitate a decline in Zika infection if the effort was coordinated by pointed policy.
Researchers maintain that the general, non-pregnant public has little to fear from Zika. But until researchers determine how long Zika remains in the body, exactly how it is transmitted, and how at risk women and babies are, women have reason to be cautious and adopt practices to prevent infection.