Zika Virus and Maternal Health Amrit Ahluwalia, Charlotte Berry, Sydney Kamen

Zika Virus Single stranded RNA Virus Genus Flavivirus, Family Flaviviridae Closely related to dengue, yellow fever, Japanese encephalitis and West Nile viruses Transmitted to humans primarily by Aedes (Stegomyia) species mosquitoes

Zika Virus Transmission Cycles

What is Zika Virus? Disease spreads primarily through the bite of an Aedes mosquito infected with Zika virus. 4 out of 5 people don’t even know they have Zika. Symptoms are mild and last for several days to a week.

Where is Zika Virus? Prior to 2015, Zika outbreaks occurred in Africa, Southeast Asia, and the Pacific Islands. Currently outbreaks are occurring in many countries in the Americas.

How is Zika Transmitted? Zika can be transmitted through: Mosquito bites From a pregnant woman to her fetus Sexual intercourse Blood transfusion

How Zika Affects Pregnant Women Zika infection during pregnancy can cause microcephaly and other severe fetal brain defects. Previous infection will not necessarily affect future pregnancies. No reports of infants getting Zika through breastfeeding.

What is Microcephaly? Clinical finding of a small head when compared to infants of same sex and age Reliable assessment of intracranial brain volume Often leads to cognitive and/or neurologic issues Difficult birth defect to monitor because of inconsistent definition and use of terminology

What We Do Not Know Sexual transmission How long virus persists in men who had Zika If asymptomatic men can have Zika virus in their semen and transmit Zika through sex Zika & Microcephaly Magnitude of risk between maternal Zika virus infection and microcephaly Impact of timing of infection in pregnancy or severity of illness on microcephaly risk

Current State of Zika in Nicaragua Confirmed presence of Zika infected mosquitos First cases confirmed on Jan. 27 First child born with microcephaly on Aug. 27 2,005 confirmed cases of Zika infection 1,083 confirmed cases of Zika in pregnant women -No complications, including death, reported “The virus is spreading geographically to previously unaffected areas” -WHO

Prevention from Vector Transmission -Currently no vaccine for Zika -Remain at elevations above 6,500 ft. -Cover exposed skin with long shirts/pants -Best if neutral in color (light brown, grey) -Insect repellent -Approved for use by pregnant women, although caution should be exercised in the case of children under the age of three -Equip houses with screens and beds with nets Map detailing regions of nicaragua below 6,500 feet

Prevention from Sexual Transmission Use condoms, other contraceptive barrier methods Can be transferred vaginally, orally and anally Practice abstinence while in areas affected by Zika Contradictory to previous understanding, transmission is possible both from women to men and vice versa

Prevention from Blood-borne Transmission -Wear personal protective equipment if you come into contact with blood -Could include mask, gown, or gloves - Avoid getting blood transfusions in Zika infected areas

Special tips for travelers -Many do not feel sick or display symptoms when infected -It is possible to remain contagious for up to 3 weeks -Avoid mosquito bites to minimize spread of disease -Remember to continue using barrier contraceptive methods even after return Approximate map of Zika transmission worldwide

Plan for Nicaragua

Zika in Hormiguero: What We Know No regional data on Zika incidence in Nicaragua Talked to Dr. Eileen Granahan Last year treated similarly to Chikungunya and Dengue Diagnosis may be given at the clinic and then patient referred to hospital in Siuna for confirming tests Locals have knowledge about these viruses because they live with them

3 Steps Compile research and information to bring to Nicaragua Administer surveys and collect/analyze data Ethnographic interviewing to explore areas of interest in survey data 3 Steps

Step 1: Infographic http://sites.dartmouth. edu/ahluwalia_lacs20_f a16/about- nicargua/infographic/

Step 1: Handout (translated to Spanish)

Step 2: Survey for Clinic What do you know about Zika Virus? Where did you learn about Zika Virus? Do you know how Zika Virus is transmitted? Are you taking any precautions regarding mosquitoes or sexual health due to risk of Zika? What is your preferred method of contraception? Are you concerned about contracting Zika? Do you know anyone who has contracted Zika? What questions do you have about Zika virus?

Step 2: Survey for Casa Materna What do you know about Zika Virus? Where did you learn about Zika Virus? Do you know how Zika Virus is transmitted? Do you know how Zika affects women and their babies? Are you taking any precautions regarding mosquitoes or sexual health due to risk of Zika? What is your preferred method of contraception? What are your thoughts on abortion? Have you ever considered or undergone an abortion? What changes do you want to see regarding women’s health in Nicaragua/the Casa Materna? What questions do you have about Zika virus or women’s health?

Step 3: Ethnographic Interviewing Analyze survey data to find areas of further interest Disconnect between facts and locals’ knowledge Shared concerns or curiosities Various notable trends or comments Use interviewing to uncover reasons for the responses Delve into topics to get personal stories and opinions Access to viewpoints that are rarely represented Could provide insight in how to better present and educate rural populations Also how to better treat them and instill healthy practices

Sources http://wwwnc.cdc.gov/travel/notices/alert/zika-virus-nicaragua http://www.cdc.gov/zika/about/needtoknow.html https://www.iamat.org/country/nicaragua/risk/zika-virus http://www.who.int/csr/don/8-february-2016-zika-americas-region/en/ http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=35217&Itemid=270 https://www.globalfundforwomen.org/is-zika-a-tipping-point-for-reproductive-rights-in-latin- america/#.WCNOcHeZPVo http://espanol.cdc.gov/img/cdc/ES_49225.pdf http://espanol.cdc.gov/img/cdc/ES_47631.pdf