Is Zika taking a bite out of your travel plans this winter?

Dr. Jay Keystone See Bio

Dr. Jay Keystone C.M. is the Director of the Medisys Travel Clinic in Toronto, a professor in the Department of Medicine at the University of Toronto. He is also a world-renowned travel physician and an expert in tropical and infectious disease. In 2015, his work earned him to be recipient of the Order of Canada.

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Dr. Jay Keystone, Director of Travel Health at Medisys, answers your burning questions about Zika and travelling south of the border this winter.

Q: Is there a risk of contracting Zika in Florida?
A:
Yes, there is a risk of Zika in Florida.

Q: What areas in Florida are associated with the highest risk?
A:
The highest risk regions of Florida (at the time of publication of this article) are a 1-square-mile area of the Wynwood neighborhood in Miami, and a 4.5- square- mile section of Miami Beach. That said, the state of Florida is still associated with a risk of Zika, mosquitoes don’t respect linear boundaries all that well.

Q: Should I postpone or cancel my Florida trip this year?
A:
If you are not pregnant and not planning a pregnancy in the next 2 months there is no reason to cancel your trip to Florida. If you are travelling with a male partner who develops a symptomatic Zika infection, it is strongly recommended to wait 6 months before trying to become pregnant.

Q: I’m traveling to Florida, how do I protect myself from Zika?
A:
Zika virus infection can be prevented by avoiding being bitten by the Aedes mosquito, whose peak biting time is the early morning and late afternoon. Insect repellents containing DEET (25-30%) and Picaridin (20%) can be effective for up to 12 hours and are safe for pregnant women and children over two months of age. In children over 2 months of age, these repellents are safe, but should be used sparingly (i.e. no sheet-dipping!). Long-sleeved shirts and pants may also be helpful, weather permitting particularly when engaging in outdoor activities in the early morning and late afternoon. Screened accommodations and air conditioning are helpful. Travellers to vacation resorts are likely to be better protected because of local insecticide spraying (this should be confirmed by communicating with the resort directly).

Q: I’m not travelling to Florida myself, however I am in close contact with someone has or will be travelling to Florida. What is my risk?

A: Recently there has been some concern over non-mosquito transmission of Zika, specifically transmission through bodily fluids. Pregnant women should avoid contact with individuals who are infected with Zika virus or who have travelled to an endemic area AND report symptoms consistent with Zika virus disease (including acute onset of fever, maculopapular rash, arthralgia and conjunctivitis). Attempts to conceive a child should wait for at least eight weeks after being in close contact with individuals who are infected with Zika virus or who have had a potential exposure and symptoms. Since male-to-female transmission has been documented, for a woman whose partner has had a potential exposure to Zika including caring for or being in close contact with a family member or loved one who has been infected with Zika or who presents with symptoms consistent with Zika, abstinence or condoms should be used for at least six months before trying to conceive.

Q: What is the danger of Zika during pregnancy?
A: Zika virus infections have been confirmed in a number of infants born with microcephaly in Brazil. The time frame and geographical location of reports of infants with microcephaly have coincided with the outbreak of Zika virus infections in Brazil. Microcephaly can be diagnosed during pregnancy with ultrasound, most easily late in the second trimester of pregnancy or early in the third.

 Q: I am pregnant or am trying to get pregnant and I can’t avoid travelling to a location where Zika is present, what should I do?
A:
The highest risk to the fetus is during the first 24 weeks of pregnancy, especially the first 12. Pregnant women should avoid travelling to areas where Zika virus is transmitted but where travel plans cannot be changed, scrupulous insect protection measures should be used.

Q: I recently traveled to an area where Zika is present, and now I am pregnant, what should I do?
A:
Pregnant women with a history of travel to an area with Zika virus transmission and who report symptoms consistent with Zika virus disease (including acute onset of fever, maculopapular rash, arthralgia and conjunctivitis) during their trip or within two weeks after it should be tested. Pregnant women with a history of travel to an area with Zika virus transmission and who have ultrasound findings of fetal microcephaly or intracranial calcifications should also be tested for Zika virus infection. Women who have travelled to an endemic area and have no symptoms of Zika infection should inform their obstetrician or midwife of travel so that their pregnancy can be closely monitored with fetal ultrasound.

Q: Outside of the risks to an unborn fetus, what are the dangers of Zika?
A:
Guillain Barre Syndrome, a rare neurological condition associated with Zika infection, is always a risk in Zika endemic regions.

Q: Is there a risk of contracting Zika in the Caribbean?
A: Yes. Mosquito-borne transmission of Zika virus has been reported throughout the Caribbean. There are no guarantees that any location in the Caribbean is Zika-free. If you are pregnant or planning a pregnancy in the next 2 months or if you want zero risk, travel to areas that are known to be free of the virus.

Q: Where can I find an up to date list on areas with active Zika virus transmission?
A:
The Centres of Disease Control and Prevention keeps an up to date list of all the countries and territories globally with active Zika virus transmission.

Q: I am pregnant, where is the safe to travel to avoid Zika?
A:
There are many popular sunny destinations in the United States and globally where cases of locally acquired Zika transmission have not been reported. Some examples of “Zika-Free” alternatives to Florida (as of the date this article was published) include: Arizona, San Diego, South Carolina, & Hawaii.

Q: At what point is it safe to commence trying to get pregnant after returning from a destination where Zika is present?
A:
Since the virus can only be transmitted to the fetus during the first week of illness, and taking the incubation period into consideration, attempts to conceive a child should wait for at least 8 weeks after leaving an endemic area for a woman travelling alone with no partner, who has had a potential exposure. Since male-to-female transmission has been documented, for a woman whose partner has had a potential exposure to Zika, abstinence or condoms should be used for at least six months after returning from an endemic area. No future pregnancies will be affected after a woman, pregnant or otherwise, has been infected with the virus.

Q: Can I be vaccinated to protect myself from Zika?
A:
No. There is no vaccine for Zika is available.

Q: What exactly is the Zika Virus and how is it transmitted?
A:
Zika virus is a flavivirus related to yellow fever, West Nile virus, dengue fever and Japanese encephalitis. It is a mosquito-borne virus transmitted primarily by the mosquito Aedes aegypti. Zika virus is transmitted by the bite of the day-biting Aedes mosquito. A number of reports have begun to emerge of women becoming infected through sex with infected males recently returned from endemic areas.

Q: How do I know if I have Zika?
A:
Only 20% of those infected with Zika virus become symptomatic. Characteristic clinical findings include acute onset of fever, maculopapular rash, arthralgia, myalgia and conjunctivitis. Clinical illness is usually mild, with symptoms lasting several days to a week.

Q: How can I be tested for Zika?
A:
Zika virus infection can be confirmed by DNA testing (RT-PCR) on serum specimens collected within the first week of illness. Zika antibodies do not develop until at least four days after the onset of acute illness. Antibodies to Zika virus may linger in the body for many years.

Q: If I become infected with Zika what is the treatment?
A:
Treatment is generally supportive and can include rest, fluids and use of pain medication and drugs to reduce fever. However, because dengue fever and Zika virus often circulate in the same areas and have similar symptoms, non-steroidal anti-inflammatory drugs (NSAIDs) such as ASA (Aspirin), ibuprofen (Advil) and naproxen (Naprosyn) should be avoided because of the increased risk of hemorrhage in dengue fever patients. Pregnant women who have a fever should be treated with acetaminophen (Tylenol).


Dr. Jay Keystone C.M. is the Director of the Medisys Travel Clinic in Toronto, a professor in the Department of Medicine at the University of Toronto. He is also a world-renowned travel physician and an expert in tropical and infectious disease. In 2015, his work earned him to be recipient of the Order of Canada.

 

 

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