Cautions for pregnant women as Zika found locally

The mosquito-borne Zika virus is perhaps best known and most feared for causing severe birth defects in babies whose mothers contract the disease while pregnant. Now that Cayman’s Public Health Department has confirmed two cases of Zika contracted locally on Grand Cayman, doctors on the island are telling pregnant women and their spouses, and couples hoping to conceive, to be vigilant about not getting bitten by mosquitoes.

Dr. Suzanne Muise, an obstetrician and gynecologist in George Town, said she’s telling her pregnant and hoping to be pregnant patients, “Avoid mosquito bites in any way possible, short of moving to the Arctic.”

She said most of the advice people already know: wear bug spray and long clothes, do not go walking along a canal when the mosquitoes are prevalent.

Dr. Muise said she is giving patients all the information she can so they can weigh the risks themselves. But, she said, the virus has moved so quickly through the Americas that in many cases, the research is not there. “We don’t know so much of the information that would help us understand the actual risk.”

“I can’t think of any disease that we’ve had in recent times that has caused so much concern,” she said.

The World Health Organization in February declared an international Public Health Emergency, calling on researchers and doctors to focus their attention on the Zika outbreak that began last year and is now in 69 countries and territories, with the Cayman Islands being the latest addition to that list.

The WHO reports local Zika transmission in almost every country in South and Central America and the Caribbean. Public health officials in the United States announced recently that they found Zika transmitted locally in a neighborhood in Miami.

Dr. David Stone, an OB/GYN with TrinCay Medical Centre, said the first thing he tells patients is “they probably don’t have Zika.” But they should be aware that Cayman is now “an active transmission environment.”

He said there is some research, particularly a study of a Zika outbreak in Polynesia, that showed about 1 percent of pregnant women who became infected had babies born with microcephaly.

“We don’t have a concrete study with experience in the Caribbean or South America,” he said. But he stressed that few pregnant women who become infected have babies born with microcephaly. “The data doesn’t suggest 50 percent or 100 percent incidence,” he said.

Both Dr. Stone and Dr. Muise agree that patients need to judge the risks themselves, and those decisions can be hardest for couples trying to conceive.

Dr. Stone said he had some patients who have decided to delay trying to conceive.

For her part, Dr. Muise said, “I have lots of patients trying to conceive. I say, ‘It may not be a bad idea to consider delaying.’”

“It’s difficult to tell someone, ‘Sorry, you can’t start a family yet,’” she said.

Dr. Samuel Williams-Rodriguez, director of primary healthcare for the Health Services Authority and Cayman’s leading public health official, seconded what the other doctors said about bug spray and long sleeves.

Responding to questions by email, Dr. Williams-Rodriguez said, “Our advice is to avoid mosquito bites at home and abroad; there are countries in the region with major outbreaks of Zika, pregnant women should avoid traveling to these countries. Adopt safe sexual practices (wear a condom); for couples trying to conceive, [it] is even more important for them to avoid mosquito bites.”

Prenatal testing

There are currently two different standards for testing pregnant women for Zika. In the U.S., guidelines from the Center for Disease Control and Prevention say pregnant women in areas with active Zika transmission should be tested for the virus at their first prenatal visit, and again in the second trimester. WHO and Pan-American Health Organization guidelines, on the other hand, say that pregnant women should only be tested if they show symptoms of Zika.

The Cayman Islands falls under the WHO guidelines, but both Dr. Muise and Dr. Stone said they prefer the U.S. standard. Both said pregnant women can elect to get tested and have samples sent to a lab in the U.S., but many insurance companies will not cover that cost.

“I hope that will change,” Dr. Stone said.

Dr. Williams-Rodriguez, with the HSA, said he consulted with the WHO and its Pan-American counterpart and those organizations continue to advise testing pregnant women only when they show symptoms.

He said in an email, “The CDC in the USA is recommending tests for pregnant women with symptoms or a risk of exposure to the Zika virus; however, we are guided by WHO/PAHO and not CDC.”