Sometimes as a travel medicine doctor you feel like Red Riding Hood’s mother.
Your patients come in asking for advice about upcoming travels. Much like Red’s mother you want to wrap your patients up in a protective cape and guide them on safe travels.
You want to teach them to avoid any wolves that may be lurking out there. Like impetuous teenagers, your patients don’t always listen.
And Zika virus just made it worse for women.
Which leaves you wondering: Are you an overprotective mom or a simply a pragmatic advisor?
I’m usually a calm person not prone to hyperbole. But Zika virus is big deal.
I know because I’m a pediatrician, and I’ve been through other emerging outbreaks before. I’ve never seen anything like this. I also know first hand how devastating a diagnosis of microcephaly can be.
What is Zika virus?
Zika virus is a member of the flavivirus family (as are West Nile, dengue, and yellow fever viruses) And similar to other flaviviruses it is spread by mosquitoes.
It’s odd: If you were infected with Zika, you most likely wouldn’t know it. In fact, only 1 in 5 get any symptoms. You might develop a rash, red eyes, joint pain, headache and fever which resolve in less than a week.
That is, unless you are pregnant. Then it is associated with miscarriages and microcephaly.
But what makes is so confusing is that this virus has been around since the late 1940s. It was discovered in the Zika forest of Uganda. It’s been in Africa, India, and Southeast Asia for decades and is not associated with microcephaly there.
Recently Zika spread to South and Central America. At the time that it invaded Brazil thousands and thousands of babies were born with microcephaly: a 1,900 percent increase!
Preliminary biopsy reports point to Zika virus as the cause.
There is a lot we don’t know about Zika virus, such as why this Brazilian strain is so problematic during pregnancy, but there are some things we do know.
Microcephaly is a devastating birth defect that causes severe mental and physical handicaps. It’ll turn a family upside down and stress health care systems.
You know how hard it will be for the families to provide the attention and care their babies will need every day for the rest of their lives.
And your heart feels heavy.
What will you recommend to your patients who travel to the tropics especially Brazil?
I for one, am specifically recommending that young women avoid travel to Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico.
Especially if they are planning or are currently pregnant.
It’s just not worth the risk. There are plenty other places to visit while we get this Zika thing figured out. The stakes are just too high.
The problem is that travelers most likely to be affected are long-term travelers. People going home to visit their friends and relatives. Or students studying abroad.
The exact age group most likely to get pregnant.
They are also the group least likely to get pre-travel advice.
So you, as their general medical provider, need to be aware of the potential of Zika virus to cause birth defects and advise your patients accordingly.
Wolves vs. mosquitoes
It’s hard to convey risk. Red’s mom had to warn her about wolves. You need to warn your travelers about mosquitoes.
The thing is with a wolf, at least you can see it before it attacks. You can beat it off with a stick or scare it away.
Not so with these Aedes mosquitoes. They are tiny and aggressive. You almost never see them. Instead, you need to envelop your patients in a cloak of mosquito repellant.
Give the right insect repellent advice
For travelers who are not planning a pregnancy, or who are going to the tropics anyway you’ll need to teach them to use insect repellents properly.
Aedes mosquitoes bite during the day. They reside in cities and towns everywhere that humans live. Remind your patients that they cannot judge their risk of being bit by the neighborhood; this insect thrives in elegant neighborhoods and in shabby ones too.
Each morning as they are dressing for the day ask your patients to wear as much protective clothing as is comfortable. Long pants and sleeves can be a problem in the tropics, but encourage them to wear them anyway. Then apply effective repellent on all exposed skin. And reapply according to the instructions on the label.
Effective repellents, in my opinion, are ones proven to work with a minimum of application, i.e., apply once every 8 to 12 hours. I’ve never heard of a traveler able to apply a product successfully every 2 to 3 hours when traveling.
I suggest 20 percent Picaridin or 30 percent DEET in a long-lasting formulation. Encourage your patients to treat their clothing with Permethrin for added protection. Fortunately, Permethrin lasts six weeks or 6 washings, which is very convenient for extended travel.
Whenever possible, advise your patients to stay in air conditioning or in buildings with screens and doors.
Our understanding of Zika virus is evolving
There are always risks to traveling; your patients are counting on you to be up to date so that you can help them make travel plans based on their health and preferences.
Zika virus is usually a mild infection that resolves on its own. Recently something has changed, and now it appears to cause terrible birth defects. We are awaiting more information from investigational scientists. But until we have more information we need to caution our travelers, especially our young women of childbearing years, about the potential risks of Zika.
What advice are you giving your patients about travel to the tropics? Share your comments below.
Sarah Kohl is pediatrician and travel medicine specialist who blogs at Travel Ready MD.
Image credit: Shutterstock.com