Read this before you travel to a Zika hot spot
The Zika virus first arrived in the Americas in 2013. That's when the virus, which has been around for decades, began to mutate from a mild flu like illness to something potentially more devastating. I found that out when I visited Ground Zero in Brazil for The Current last year.
Zika has been reported in 76 countries – including Mexico, Cuba and many of Canada's favourite sun destinations. Today, the Canadian Medical Association Journal reported on the first wave of Canadian travellers to Zika hotspots.
The study looked at returning travellers who visited seven travel medicine clinics across Canada. The clinics, based in Quebec, Ontario, Manitoba, Alberta and British Columbia, are part of the Canadian Travel Medicine Network — a consortium of infectious disease specialists from across Canada.
Eleven hundred and eighteen travellers visited one of these clinics for assessment of a travel-related illness contracted in the Central or South America or the Caribbean. Of these, 41 were infected with the Zika virus, 41 had dengue, and 23 had chikungunya — all three viruses from the same family that are spread by infected mosquitoes. All but one of those who got Zika were infected by a mosquito while travelling abroad. One case was sexually transmitted.
Eighty-eight per cent had a rash, and 80 per cent had fever, and half complained of headache, or aching muscles and joints. One in six got pink eye. Two of 41 infected had Guillain-Barré syndrome or GBS — a potentially life-threatening condition causing paralysis and sometimes requiring admission to an intensive care unit on a ventilator. One adult got viral meningitis. Three women infected with Zika were pregnant. In two of the pregnancies, the infection was transmitted to the unborn child.
Here is my take on the study. It's a small sample size and it was also likely biased by the fact that travel medicine clinics tend to get referrals of patients more severely affected than those who visit their family doctors.
Still, I went to Brazil, and I am not surprised by the fury of this virus. I saw at least a dozen babies with microcephaly caused by Zika. The most disturbing finding to me is that the infection was transmitted to the fetus in two of three pregnant Canadian travellers who got Zika. Last year, researchers at Harvard reported that the risk of microcephaly in the baby is as high as 13 per cent when the mother is infected with Zika during her first trimester.
We think of dengue as a serious illness and Zika as mild. From what I've seen, I think it's the other way around. As of last month, Health Canada was reporting close to 500 travel-related cases, three of which were sexually transmitted. Included in the 500 or so are 27 pregnant women
I'm not sure Canadians are as well prepared as they should be given the shifting course of the outbreak. Early on, travellers to South America were contracting the disease — places that relatively few Canadians visit. More recently, the outbreak has shifted to Caribbean countries that are often frequented by Canadians.
In November 2016, the World Health Organization (WHO) lifted its global health emergency status for Zika. There was widespread misinterpretation of that announcement as an "all clear." However, in an article posted in healthydebate.ca, the status change was not because the spread of the virus has slowed, but because its spread has become an ongoing threat that requires long-term thinking and planning.
I see growing complacency among travellers to hot spots — including women of childbearing potential. That puts unborn children at risk.
Do not trifle with this infection, especially if you are pregnant or planning to get pregnant. There's no antibiotic and no vaccine for Zika virus, so prevention is key. Pay attention to Zika hot spots by visiting the CDC Zika Travel Notices web page. I like the CDC site because it's comprehensive.
If you travel to a Zika hot spot, you need to avoid areas where there are mosquitoes, to wear clothing and to use DEET and picaridin insect repellent to reduce mosquito bites. Women who are pregnant or planning to get pregnant should avoid or defer travel to affected areas. Because of the risk of sexual transmission, barrier methods of protection such as condoms, diaphragm, cervical cap, male condom, and spermicidal foam should be used.
Keep your ear to the ground for updates — since the story of this outbreak keeps evolving.
Dr. Brian Goldman is and ER physician and host of White Coat Black Art. He reported on "Brazil's Ground Zero for Zika" for The Current.