A guide to help pregnant women reduce their zika risk

Zika has a foothold in the continental United States now that mosquitoes in parts of Miami-Dade County, Florida, have infected people with the virus. Zika can cause harrowing brain damage in the developing fetus of a woman who is infected during pregnancy, so it is vital that pregnant women minimize that risk. Here’s some advice on how to do that.

Q: If you’re pregnant and living in Miami-Dade, what should you do?

A: First, avoid the section of the Wynwood neighborhood and the stretch of Miami Beach where health officials say mosquitoes have infected people with the Zika virus.

Try to stay inside during the day. Going out at night is safer than during the day because the Aedes aegypti mosquitoes that can carry the Zika virus are primarily daytime denizens.

If you do go out in the daytime, cover up. Wear “long-sleeve shirts, pants, socks, maybe a scarf,” said Dr. Charles Lockwood, dean of the medical school at the University of South Florida in Tampa. And, he added, “embed your clothing with permethrin, which you can get at a sports store.”

But don’t forget to apply bug repellent. Use ones recommended by the Centers for Disease Control and Prevention. Those include repellents with DEET, which has been shown to be safe in pregnancy and not to impair a baby’s development. Two other types of repellent, those with picaridin and IR3535, are also recommended; studies on animals have found they have no negative effects on fetuses.

If you want to use a lower-dose repellent, apply it more often. As Dr. Sarah G. Obican, a maternal fetal specialist, told The New York Times in April, “Using a 6 percent DEET product will last you two hours, and a 20 percent one will last close to four hours.”

Q: Should you think about going away for a while, if possible?

A: If you can get away, and if you think it would be too stressful to stay in Miami, then that’s certainly something to consider. Some women have decided to relocate temporarily, moving in with relatives or staying at a vacation home.

But most don’t have that option or can’t afford to leave. And there are other things to consider, such as the burden on other family members or finding a doctor you like in the new location for prenatal care.

Q: How can you rid a home of the mosquitoes that carry the Zika virus?

Remove all standing water. Aedes aegypti like to lay their eggs in stagnant water, and they need only a thimbleful left behind in a dog bowl, a puddle in a shower drain, or the drops that pool on potted plants.

These mosquitoes also lurk in dark humid places — in closets, under beds, and in other nooks and crannies. The CDC recommends using indoor insect foggers or sprays to kill mosquitoes and treat the spaces where they might hide. It says, “these products work immediately, and may need to be reapplied.”

To keep mosquitoes from entering your home, close windows, use air-conditioning and make sure that screens are secure.

Q: If your children or spouse is infected, are you at risk?

A: Children and spouses can be infected if they are bitten by infected mosquitoes, so they should protect themselves with repellent, too. The main risk to you would be from unprotected sex with your spouse, so practice safe sex throughout the pregnancy.

More generally, anyone who becomes infected could theoretically serve as a blood meal for a random Aedes aegypti mosquito that comes along and bites them. That mosquito could then become infected and bite a pregnant woman. That is why all people in a place like Miami-Dade should do what they can to protect themselves and prevent mosquitoes from breeding in homes and workplaces.

Q: If you’re pregnant, is it safe to visit Miami-Dade?

A: It depends on whether you can take the steps needed to protect yourself from mosquitoes, and whether you feel comfortable going there.

There are reasons the CDC has made a two-tiered recommendation for pregnant women: One, don’t go to the two areas in Wynwood and Miami Beach where active Zika transmission has taken place; two, consider not going to the rest of Miami-Dade County.

Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Disease, said the recommendation was based on the assessment of the risk of getting the virus in the continental United States, which has much better mosquito control than much of the Latin American and Caribbean region where Zika has been rampant.

It’s also based on the experience with two other viruses spread by Aedes aegypti, dengue and chikungunya, he said. When those viruses have appeared in the continental United States, including in Florida, the majority of the cases were “singular,” he said, meaning that nobody else in the person’s household or workplace became infected. That is probably because the infected mosquito bit only one person before dying.

For roughly every nine individual cases, there were about two clusters, areas where two or more people became infected. That pattern seems to be playing out with the Zika virus in South Florida, experts say.

“You’re often asked why you are talking about a section of a state when you have guidelines advising people not to go to an entire country,” Fauci said. “It’s because the conditions in different countries are much different than what we’re seeing in Florida.”

So, he said, the CDC decided to tell pregnant women not to go to the sites of the two Florida clusters, the areas of confirmed risk. And for the rest of Miami-Dade, “since there is some uncertainty, the decision was to at least tell the people that there’s some risk there.”

The public health authorities also want to factor in the realities of people’s lives and the difficulties that travel warnings can impose, including economic and personal hardship if they have to sacrifice jobs or family needs to leave or avoid a Zika zone.

“You have to be very careful in not seeming like you’re dictating to people what they should do with their lives,” Fauci said. “But you have to give people enough information to make decisions to protect themselves.”

It’s a balancing act — for public officials and for pregnant women.

Asked if pregnant women should travel to Miami-Dade, Scott Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch, said, “I don’t think it’s a simple black-and-white thing. If someone really needs to travel there for work, something that can’t be postponed or canceled, then take extreme precautions, stay inside a hotel room, apply repellent a lot.”

But, he said: “I think certainly that pregnant women who have a choice whether to travel there should be postponing their trip. Certainly to the outbreak areas, but even in the entire region of South Florida.”

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