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The San Juan Daily <strong>Star</strong><br />

Monday, March 21, 2016 27<br />

HEALTH<br />

1% Chance of Microcephaly in Zika Outbreak, Scientists Estimate<br />

Study suggests relatively low risk of birth<br />

defect but big numbers as virus spreads.<br />

by Beth Mole<br />

Based on data from a past Zika outbreak, researchers estimate<br />

that there’s a one-in-100 chance that women infected<br />

during the first trimester will give birth to a baby<br />

with microcephaly—a birth defect that leaves infants with<br />

small and malformed brains and skulls.<br />

There’s still not a definitive link between microcephaly and<br />

the mosquito-borne virus, which is currently blazing through<br />

Central and South America. But the data coming in has only<br />

strengthened the connection. For instance, a recent study<br />

found that Zika virus can kill off developing brain cells.<br />

With the new estimate on the rate of microcephaly in Zika<br />

infections from an outbreak in French Polynesia starting in<br />

2013, researchers are relieved that it appears the birth defect<br />

is relatively rare.<br />

“It means you have a 99 percent chance of having a normal<br />

baby,” Dr. Laura Rodrigues, a professor of infectious disease<br />

epidemiology at the London School of Hygiene & Tropical Medicine,<br />

told The New York Times.<br />

By contrast, birth defects from other in utero viral infections<br />

can have far steeper risks. Pregnant women infected<br />

with the rubella virus, for example, have at least a 38 percent<br />

chance of having a baby with congenital rubella syndrome,<br />

which can lead to heart disease, developmental delays, and<br />

hearing loss.<br />

To come up with an estimate for Zika, researchers sifted<br />

through medical records from the outbreak of Zika in French<br />

Polynesia between 2013 and 2015, which sickened 66 percent<br />

of the 270,000 residents. The researchers also established the<br />

baseline of microcephaly in the population, which was two cases<br />

in 10,000 births. During the outbreak, there were eight total<br />

cases, the researchers reported recently in The Lancet.<br />

While the rate is relatively low, health experts are not sure<br />

if it would be the same in different populations. Even if it is,<br />

the virus is still spreading to millions throughout the dozens<br />

of countries.<br />

“If you apply a one percent risk to a large number of women,<br />

it’s still a large public health problem,” said Simon Cauchemez,<br />

the study’s lead author and the director of mathematical<br />

modeling for the infectious diseases unit at the Pasteur<br />

Institute in Paris.<br />

Women Who Brought Zika Fears Home With Them<br />

By LAURA BEIL<br />

In December, Ami Levy and her husband, Jason, left frigid<br />

Washington, D.C., for a two-week vacation in Argentina.<br />

Once there, they headed north to the Brazilian<br />

border for a couple of days, lured by Igauzu Falls.<br />

She recalls the excitement when their phones’ GPS indicated<br />

they finally were in Brazil, and the awe-inspiring<br />

walls of water, some more than 24 stories tall.<br />

And, she remembers, everywhere there were mosquitoes,<br />

leaving bites on her thigh.<br />

Back home the first week of January, Ms. Levy learned<br />

she was four weeks pregnant.<br />

Her first pregnancy had ended in miscarriage in September,<br />

so it was with some hesitation that she left for another<br />

trip, this time to Puerto Rico for a rendezvous with her<br />

aunt and sister.<br />

As soon as she arrived, local news broadcasts began<br />

warning pregnant women about the dangers of infection<br />

with the Zika virus, carried by mosquitoes and suspected<br />

of causing devastating birth defects in infants born to infected<br />

women.<br />

She booked the first available flight home.<br />

“I was on the beach for a few hours and didn’t put on<br />

any bug spray,” said Ms. Levy, a 35-year-old psychotherapist.<br />

“I had two bites when I got home Sunday.”<br />

“I think I would have been more panicky if I hadn’t told<br />

myself I needed to keep it together for my baby.”<br />

The Zika virus is not yet known to be circulating in the<br />

continental United States. But already, fear of the infection<br />

has come home for many pregnant women and their families<br />

who journeyed abroad before the risks were known.<br />

The Centers for Disease Control and Prevention recently<br />

reported that nine pregnant women were known to have<br />

become infected while traveling. Yet many more are coping<br />

with the possibility of exposure, reaching out to their doctors<br />

for blood tests and ultrasounds, obsessing on news coverage<br />

and trying to manage their worry.<br />

The C.D.C. recommends that pregnant women receive<br />

blood tests two to 12 weeks after travel to an affected area<br />

to detect whether they may have been infected with the<br />

Zika virus.<br />

Those who may have been exposed are urged to consider<br />

having extra ultrasounds to look for birth defects in the<br />

developing fetus.<br />

Nothing is guaranteed; the antibody test has its limits.<br />

Ultrasounds often do not detect fetal microcephaly, the disease<br />

causing misshapen heads and brain damage that has<br />

been linked to infection with the virus.<br />

According to the C.D.C., the scans are most accurate at<br />

the end of the second trimester or early in the third.<br />

“The risk is small, but the effects are tragic,” said Craig<br />

Forest, 37, an associate professor of bioengineering at Georgia<br />

Tech in Atlanta.<br />

He and his wife, Roxanne, 32, spent Christmas vacation<br />

in Costa Rica just as she was entering her second trimester<br />

of pregnancy.<br />

They chose that destination because of all the countries<br />

in the region, it seemed to offer the safest environment for<br />

a pregnant woman.<br />

After 10 days of rain forest hikes and lazy sunsets on the<br />

beach, Ms. Forest was covered with insect bites.<br />

Back home in January, the couple began hearing news<br />

reports about the Zika virus. Costa Rica was not mentioned.<br />

“I’m looking at the list and thinking, ‘That’s all of Costa<br />

Rica’s neighbors; we dodged a bullet on that one,’ ” Mr.<br />

Forest said.<br />

On Feb. 1, Costa Rica was added to the list of countries<br />

in which Zika is circulating. The virus had been in the<br />

country since at least December.<br />

Ms. Forest’s doctor did not order a blood test for the infection,<br />

because she had not had any symptoms. Her most<br />

recent ultrasound appeared normal, and the couple say<br />

they will ask for another at the cutoff time for an abortion.<br />

They have lain in bed at night discussing the possibility,<br />

something that would have been unthinkable a couple of<br />

months ago.<br />

They know the risks are remote — first that she might<br />

have been bitten by an infected mosquito, and second that<br />

the infection might lead to a birth defect.<br />

“As analytically minded people, we’re trying to calculate<br />

the odds,” said Ms. Forest, who is also an engineer.<br />

But when they try to figure the likelihood of a birth defect<br />

related to the Zika virus, all they can come up with is<br />

“not zero.”<br />

There is nothing to do but wait. “I actually tried to stop<br />

reading the news,” Ms. Forest said.<br />

Even when a pregnant woman is found to have been<br />

infected, tests of blood or amniotic fluid cannot definitively<br />

tell if the fetus was affected, said Dr. W. Ian Lipkin, an expert<br />

in infectious diseases at Columbia University’s Mailman<br />

School of Public Health, who is working to develop a<br />

more reliable alternative.<br />

Microcephaly seems to be a relatively rare complication.<br />

But it’s also possible that the virus may cause “more subtle<br />

damage that we can’t yet appreciate,” Dr. Lipkin said.<br />

Sydney Silverstein, 35, an Emory University doctoral<br />

candidate, has been living in Iquitos, Peru, since July. She is<br />

eight and a half months pregnant.<br />

There is no widespread epidemic of Zika virus in Peru,<br />

but the virus is present in Lima. Moreover, she spent time<br />

on the Brazilian border in late fall, early in her pregnancy.<br />

She has had extra ultrasound scans from her doctor, and<br />

her fetus looks unaffected.

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