By Dr Vijayan V MD (USM) MRCOG (London)
Consultant | Obstetrician & GynaecologistJesselton Medical Centre
What is Zika Virus Syndrome?
The Zika Virus Syndrome outbreak in Brazil has caught the eye of the world. It gained publicity not because it is causes serious infections or kills people but because of what it does to unborn babies. The virus is spread by mosquitos. The mosquito predominantly involved in the spread is the aedes mosquito, the same one that spreads the dengue virus that kills so many every day.
In adults, four of five infected people will not even know they got infected – a silent infection that came and went without any symptoms leaving the individual perfectly normal. In the remaining 20% there could a range of symptoms – fever, joint and body aches, headaches, red eyes and weakness of the limbs.
Should I in Sabah be worried about Zika?
We all should be concerned but there is no reason to panic. Zika was first identified in Malaysian mosquitos by WHO back in the 70’s. So infections have happened. What is still not known is if the Zika virus that caused Brasilian microcephaly outbreak is a strain that hurts the baby more.
Malaysia also has its own rate of babies born with microcephaly. It is simply that these have not been linked to Zika in the past. The general published rates internationally for the incidence of microcephaly is approximately 5 in 1000 babies. We do not have Malaysian figures yet but I am sure this is in the pipeline now.
How Zika causes microcephaly?
Microcephaly (head smaller than normal population by age) has many causes. The most common include Down syndrome and a whole list of other genetic and structural malformations much more common than Zika Virus Syndrome.
Infections other than Zika virus can also cause microcephaly – examples include cytomegalovirus – one of the more common infections causing problems for the baby. Zika virus is transmitted by its vector the aedes mosquito. Once the mosquito bites an infected victim, it becomes a reservoir. Upon biting its next victim it inoculates the individual who now can develop Zika infection symptoms. As mentioned, 4 of 5 inoculated victims will not develop symptoms at all in spite of being infected.
Once the pregnant woman is inoculated, the virus rapidly localizes in the placenta and penetrates through the blood placenta barrier. Once in the baby it rapidly attacks the organs that it is prone to – namely the brain. The brain of a baby, especially an unborn baby, has not fully developed. Its resistance mechanism – the blood brain barrier – is immature and this makes it vulnerable to viruses that particularly like to infect the brain.
Up to 25% of infected babies show brain changes. Once in brain cells, the cells degenerate and die, leaving less brain cells and more scarring. As the baby grows inside of the womb, the infected brain does not grow to its potential, appearing to be smaller than it should, hence the term microcephaly.
If I am pregnant and have fever what should I do?
You should seek medical attention. There are many causes of fever. The common cold is... common. However, there are some causes of fever that may harm the pregnant woman more than others. Viral flu is more severe in the pregnant women (the reason flu jabs are recommended in pregnancy). Urinary tract infections may cause preterm labour. So it is important to leave this basic preliminary issues to the doctors Once the doctor thinks it’s a viral fever – more worrying causes like chicken pox, dengue need to be considered as this may be life threatening. At the end of the list, once others have been excluded, Zika SHOULD be considered. Testing for Zika is available.
What should I do if I am confirmed to have the Zika virus syndrome during my pregnancy?
The risk of the baby getting infected ranges up to 25%. Not all infected babies get microcephaly. An amniocentesis can be considered to confirm if the baby is infected or otherwise. If this is confirmed, serial detailed neurosonograms (detailed ultrasound study of the fetal brain) are advised up to delivery and confirmed with postnatal ultrasound, or if necessary, ct scan of the brain.
If there is no microcephaly there is little chance of the baby being affected. If microcephaly is eventually seen – the parents must be warned of the possibility of mental retardation and to be prepared for it. Looking after a mentally retarded child is a life changing event for the parents and the whole family. The services that support these affected children are still rudimentary but available.
The problem with Zika infection is, once confirmed, does a mother wait for microcephaly to occur? There may be heightened anxiety to the issues that this may bring up. The short answer to the question – an expert consultation with the fetal medicine consultant becomes necessary.
Travel advice?
As with most outbreaks the Zika virus outbreak will also faze out. Until that point, all pregnant women are advised to avoid travelling to Zika hotspots. These hotspots are mainly in the Latin American countries and detailed listings are widely available on the WHO website. Thanks to cheap flights these days infections are getting global faster than we can imagine. Within 6 months of the Brazilian outbreak, Zika infections have been confirmed in the USA and Europe. We should worry if the Brazilian Zika arrives here. But I have a hunch it has.
I am planning a pregnancy. Should we test for Zika?
Zika virus infection is silent in the majority. Men can have Zika in their sperm fluids up to 6 months after an infection. We live in an aedes infested country. Putting the facts together, one can never be sure if they carry Zika or not.
There is a very low risk of microcephaly of 5 in 1000. If resources are strained – there is no need for routine testing unless there was a possible infection/fever that went undiagnosed in the past 6 months. To be certain test before pregnancy especially if either of the couple have had a viral fever in the past 6 months.
This needs to be confirmed with appropriate examinations. Most of the risks mentioned can be prevented, modified and reduced by proper pre-pregnancy consultations in the dedicated clinics at our fetal medicine clinic.
For more information, please contact Jesselton Medical Centre at 088-366 333 or
for Emergency at 088-366 399. Find them at Metro Town, Off Jalan Lintas.
Website: www.jmc.my
For the complete article about this subject can be read on this October to December 2016 issue of Parents Avenue Magazine.
*Disclaimer: All information is for your general reference only. We (Parents Avenue) do not accept any responsibility whatsoever in respect of such information.
