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Traveling this summer? Beware of Zika

Zika virus

For most of us, mosquitoes are an annoying summer pest. But in other countries, mosquitoes can carry diseases such as dengue, chikungunya or malaria. Best case scenario, you’ll win some general itchiness. Fortunately, for us living here in the United States, our minds rest easy knowing that the risks of catching any mosquito-borne disease are slim. First-world luxuries such as air conditioning and screened windows can prevent mosquito infestations. Most U.S. streets lack standing pools of water, the beloved nests of mosquito larvae, and when the threat of being bitten is imminent, we liberally spray plumes of OFF! mosquito repellent.

Yet, recently, our mosquito concerns have amplified. On May 31, 2016, a child was born in a New Jersey hospital with Zika virus-related microcephaly. This child’s birth marks the very first Zika-related birth defect on the mainland of the United States, preceded only by another baby born in Hawaii earlier this year.

Zika virus is a flavivirus transmitted by the Aedes mosquito (species stegmoyia, aegypti, albopictus), which populates some of the eastern states, majority of the southeastern states, and all countries south of us and across the Atlantic. The virus was identified in 1947 in Uganda, but prior to 2007, had only been seen sporadically throughout Asia and Africa. Zika’s travel across oceans to the Americas is a very recent occurrence and it was only in February 2016 that the World Health Organization declared Zika a public health emergency.

But what makes Zika so bad? Zika is an entirely different beast than malaria and targets specific subpopulations: primarily pregnant women, their infants/children and residents of landfill area or areas of abandoned housing (high prevalence of standing water). The virus induces microcephaly or congenital brain abnormalities in infants of pregnant women and is also associated with increased incidence of Guillain-Barré syndrome. As of May 12, 2016, there have been 279 reports of pregnant women residing in the U.S. with laboratory-confirmed evidence of a possible Zika infection.

The Center for Disease Control and Prevention (CDC) has mobilized in full force against Zika. I was fortunate enough to attend a presentation on June 1, 2016, by Chris S. Kochtitzky, MSP, the Associate Director for Program Development/Public Health Advisor for the Division of Emergency and Environmental Health Services, a division of the CDC. In his talk, he detailed the CDC’s top priorities and multifactorial approach, in which vector control plays the primary role. Using an integrated pest management strategy, the CDC believes that stringent control of mosquito populations through management of cultural factors like sanitation, use of physical/mechanical barriers, and application of biological and chemical agents (larvicides and insecticides) will lead to successful prevention and reduce spreading the virus. Other top priorities are public health surveillance and laboratory testing support for infected individuals.

You may ask, “What can I do?” Zika does not have any oral manifestations, and so, as dentists, our work with the virus is rather limited. Of course, it’s possible that a patient could present with fever, rash, arthralgia and conjunctivitis, the hallmarks of Zika and tell you that he or she has been in or slept with someone from a high-risk Zika virus area, but that seems unlikely. What you should be careful about is summer trips to South and Central America, Mexico, the Pacific Islands, the Caribbean or Africa.

Consequently, to do your part in prevention, the CDC recommends traveling prepared and avoiding bites. Pack a “Zika Prevention Kit,” consisting of a bed net, insect repellent, permethrin spray, standing water treatment tabs, and condoms. Condoms? On April 15, 2016, the CDC reported a total of 6 cases of sexually-transmitted Zika virus infection in published literature. While Zika can be transmitted sexually through infected semen and saliva, the risk of transmission via this route is difficult to quantify and studies are still ongoing. Either way, better safe than sorry.

What is more important is to avoid being bitten and know when you are infected. Current diagnostic laboratory tests are limited and the virus is sneaky. While studies have shown that Zika virus RNA can be quantified in urine, serum, saliva and semen using real time reverse-transcription polymerase chain reaction, approximately 80% of infected patients are asymptomatic and infectious during the first 6-8 days post-infection. You may not make it to a laboratory in time to even realize you’ve been bitten!

So, if you do happen to travel to a high-risk area this summer, get bitten, and fall ill, see your doctor and avoid getting more mosquito bites during your first week of illness. If you are unwittingly infectious, you can pass the Zika virus from your blood to another person through mosquitoes. 

~Kelly Chuang, Pennsylvania ’19, chapter contributing editor

Kelly Chuang

Kelly Chuang is a second-year dental student at the University of Pennsylvania School of Dental Medicine. She is passionate about treating disease and understanding the many pathologies that affect dental patients. Currently, Kelly is Contributing Editor of the Penn ASDA chapter.

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