AADMD Statement on Zika

What is Zika?
Zika is a mosquito-transmitted virus that generally causes mild symptoms in adults including fever, rash, joint pains, and muscle aches. It has received significant attention in the media recently due to its association with a variety of birth defects when contracted by pregnant women, the most well known one being microcephaly. In addition to the potential for birth defects, zika has been found to be associated with the development of Guillan-Barre syndrome. For more information about zika, please see the following links (in Spanish or English):

http://www.cdc.gov/zika/about/index.html
http://www.who.int/mediacentre/factsheets/zika/en/

Zika has been most prevalent recently in Central and South America. For more information regarding the prevalence of zika in different areas of the world, please see the following link:

http://www.who.int/emergencies/zika-virus/situation-report/10-november-2016/en/

How can Zika be Prevented?
Zika is a mosquito born illness, so the primary method for prevention is preventing mosquito bites. Methods for prevention include mosquito-repellent, wearing long sleeves, and using mosquito nets as appropriate. There are certain areas of the world where zika has been much more prevalent, so some individuals may choose to avoid travel to these locations to further help prevent contracting zika. Information about mosquito-prevention can be found at the two websites listed above.

Zika has also been found to be transmitted through sex. Standard safe sex practices including condom use can help to prevent zika transmission between sexual partners. As with other sexually transmitted infections, condom use is not 100% effective. It is unclear how long after initial infection the virus can be spread to partners. It is also unclear how common sexual transmission is. Additional information regarding sexual transmission can be found here:

http://www.cdc.gov/zika/hc-providers/clinical-guidance/sexualtransmission.html

There are no vaccines available for zika prevention at this time.

How is Zika Diagnosed?
As mentioned above, zika usually causes mild and non-specific symptoms in adults. Many people will never know that they have contracted the virus. There are both blood and urine tests available to diagnose the virus. Currently, testing is only recommended by the CDC for individuals who may have contracted the virus and have associated symptoms. They do not recommend testing in asymptomatic individuals to asseses their likelihood of transmitting the virus. Of note, there is no current treatment for zika. Therefore, a positive test can help patients to make reproductive decisions or to help prevent transmission, but not to obtain treatment. The available tests can be found here:

http://www.cdc.gov/zika/hc-providers/types-of-tests.html

For information regarding interpreting test results and reporting results, please see the following link:

http://www.cdc.gov/zika/hc-providers/testresults.html

Zika and Birth Defects:
When zika is contracted during pregnancy, it is known to cause microcephaly, and its association with other birth defects is still under investigation. Congenital zika syndrome is a syndrome associated with zika that has been found to have five features including microcephaly, decreased brain tissue, limited joint range of motion, damage to the back of the eye, and excess muscle tone inhibiting movement after birth. Note that not all infants born to mothers who have contracted zika will have birth defects.

http://www.cdc.gov/zika/healtheffects/birth_defects.html

Microcephaly is a condition where an infant is born with a small brain or that there is diminished or lack of brain growth after birth. Zika is not the only cause of microcephaly. Other causes include other infections during pregnancy, exposure to toxic chemicals in pregnancy, severe malnutrition during prenatal life, and hypoxic or traumatic injuries. Microcephaly is associated with developmental delay, intellectual disability, feeding problems, problems with movement and balance, and vision/hearing problems. Although there is not a specific treatment for microcephaly, early intervention programs can be very beneficial for children with microcephaly.

http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html
http://www.who.int/mediacentre/factsheets/microcephaly/en/

Living with Microcephaly:
Microcephaly presents differently and has a wide range of effects on children. Children will need varying levels of support as they grow up. Children with microcephaly can live full and meaningful lives. Some organizations that may be helpful in supporting children and families with microcephaly include:

Foundation for Children with Microcephaly: http://childrenwithmicro.org/
Special Olympics: www.specialolympics.org

As a healthcare provider for an individual with microcephaly, you should be prepared to counsel families regarding other support services provided by the state and national government for individuals with intellectual disabilities. Children with microcephaly will also likely need additional support from within their school system. Healthcare providers are important advocates for patients with microcephaly.

Ethics and Zika Virus:
The recent rise in the number of zika cases and associated microcephaly has ignited many conversations regarding the ethics surrounding women's rights, disability rights, and selective abortion. We recognize that all individuals and all health care providers will hold differing views on these challenging topics. Above all, it is important to approach each case with compassion and empathy. Counseling patients and families about zika and its associated birth defects can be challenging as it requires the healthcare provider to acknowledge their own biases and opinions regarding disability and reproductive rights. We recommend using a shared decision-making approach with patients rather than a paternalistic approach. This requires an intimate working knowledge of all the patient's available resources as they relate to reproductive health and supporting individuals with disabilities in the community. We recommend you continue to have ongoing conversations with your colleagues regarding these important ethical issues. We have provided a few articles for your consideration and discussion:

https://impactethics.ca/2016/03/15/zika-ableism-and-reproductive-healthcare/
http://www.huffingtonpost.com/entry/zika-virus-us-abortion-disability_us_56b2601be4b04f9b57d83192

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