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Zika Virus in Pregnant US Travellers

2016-02-28

Morbidity and Mortality Weekly Report (MMWR) has released a report about nine pregnant travellers from the US who had Zika virus.  Of these, one child was born with severe microcephaly.  Two live births were normal.  Two pregnancies are continuing and appear normal.  The rest were terminated, either spontaneously early in pregnancy (two cases), or by elective abortion(two cases).  Evidence of Zika infection was found in the tissue examined after one spontaneous abortion.  In one case, the fetus was found to have brain atrophy by ultrasound at 20 weeks gestation; this pregnancy was terminated by abortion and evidence of active Zika virus replication was found in the tissue.

The child who was born with microcephaly was discharged to home with a gastrostomy (feeding tube inserted in the stomach.)  The mother gave a history indicating that she had been infected with Zika virus symptoms at around 8 weeks gestation.  It is not known if there is a vulnerable period during pregnancy, or if the fetus is vulnerable regardless of gestational age when the mother is struck by the virus.

It is very important to determine the likelihood of fetal infection and brain damage when the pregnant mother is infected with Zika virus.  So far, although the risk is significant, no definite number can be attached to that risk.  Of the approximately 250 women who were evaluated for Zika virus, all but nine were found to be uninfected.  Those infected, listed above, had variable outcomes, but of those, at least three of the nine had fetal involvement, and four were spared.  With risks of this magnitude, the availability of elective abortion for women whose fetuses are involved is crucial to humane survival for these women.

In addition, it must be noted that children who are born apparently normal may be at increased risk of later mental disorders according to a New York Times report, including autism, schizophrenia, and learning disorders.  For all of these reasons, the development of a vaccine against Zika is important to long-term protection of women and children.

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