The Zika virus has been making headlines and along with it have been the circulation of gratuitous remarks from some health-related professionals linking this viral infestation to autism. One investigator went as far as warning of an upswing in the prevalence of ADHD, autism, epilepsy and schizophrenia as a result of the Zika virus. The assertions are based on biased appraisals and extemporaneous remarks during press interviews in an attempt to use the yellow press as a way to attract attention to their own lines of research. There is nothing within the pathology of the Zika virus, (e.g., microcephaly) linking the same to autism. Causal assertions are unfounded, based on a concatenation of “if” statements, and clearly irresponsible. I once visited the headquarters of Autism Speaks where the person running the organization voiced a possible correlation. It was clear to me from this interaction at Autism Speaks that when you know nothing about autism it is easy to accept anything, even pseudoscientific rumblings. In terms of science, Autism Speak symbol should be a weathervane as its scientific backbone changes with regards to whosever public voice is heard the loudest. Slowly and painfully I have come to the realization that Autism Speaks main focus is on fundraising in order to pay their salaries rather than on autism per se.
Figure: Autism Speaks’ changing perspectives on science and its original mission or intent earns it a new symbol, that of a weathervane.
There is no denying, however, that the Zika virus is a major health problem and for those interested I will describe some of what is known about this infectious agent in the next few paragraphs:
Zika virus belongs to the same infectious agents that causes dengue and Chikungunua. It Is transmitted by a mosquito (Aedes) that is an aggressive daytime bitter. The mosquito lives around households and lays eggs in very small amounts of water. The virus can be transmitted in 2 cycles: sylvatic (jungle) or epidemic (urban). The latter uses humans as its mode of transmission. It can cross the placenta and can be transmitted through sexual intercourse, laboratory exposures, or through blood (Note: I could not find information about transmission through transplants or breast milk). The virus was probably converted from monkeys, approximately in 1947, in the Zika forest of Uganda. The first outbreak was reported in Micronesia (2007) and has since spread like wildfire. Active transmission is now evident in all of South America, Central America, and in the United States (primarily within Florida).
In the US, Zika virus infestation is associated with travel. However, the Texas Department of State Health Services has recently reported that a resident was “most likely infected” with Zika in the state within the past few months. If confirmed, this will be the first case of locally transmitted Zika in the continental U.S. this year. The patient did not have any risk factors for Zika exposure, including recent travel, so the virus was likely transmitted via a mosquito bite in southern Texas. Total cases are approximately 5,000 in the US but with higher numbers in associated territories like Puerto Rico. South Carolina, where I live, had 61 reported cases, almost all around the larger populations in the State.
Zika presents as mild symptoms usually lasting several days to a week. Symptoms include myalgias (muscle pains), fever, and a rash, but 80 to 90% of cases are aysmptomatic. Differential diagnosis includes dengue, chikungunya, malaria, rubella, measles, parvovius, enterovirus, etc. The Incubation period is 3-14 days. After symptom onset, the viremia period ranges from a few days to 1 week (note: viremia is the period wherein a mosquito may acquire the virus by biting an infected individual). There is no particular effective medication for treatment, but stay away from nonsteroidal anti-inflammatory drugs (NSAID) as Zika virus may be confused with dengue which has a hemorrhagic component. Best method for testing the Zika virus is PCR in serum or urine, if the patient is within 14 days from the onset of symptoms. After this period of time you have to rely on immunoglobulins (but the latter is non-specific and may also react also to dengue virus. There is commercial testing available (for urine and serum PCR) no commercial IgM available.
Congenital Zika syndrome refers to birth defects in babies born to a mom infected with the virus. Symptoms include severe microcephaly (small head size) -in some cases the skull may be partially collapsed-, damage to eyes, and increased muscle tone. Postnatal Zika virus can be seen and symptoms are the same as in the adult. No cases have been reported with breastfeeding. If a child has symptoms and test consistent with Zika virus, have him evaluated by a neurologist, ophthalmologist, assess their hearing, CBC, metabolic panel and other services as required (e.g., endocrinologist, physical therapist, nutritionist, etc.). Sexual transmission and prevention guidelines appear on the CDC website. Any mode of sexual intercourse may transmit the same, including sex toys. Have protected sex after traveling to an infested area.
As already stated one of the complications of Zika virus is microcephaly. There was a great increase in microcephaly after an outbreak in Brazil. If a pregnant woman is infected we do not know nor can we predict how the virus will affect her pregnancy. We also do not know whether a virus that passes through sexual intercourse will have the same effects as one transmitted by a mosquito.
The CDC has issued updated guidelines saying that routine Zika virus testing is no longer recommended for asymptomatic pregnant women who traveled to countries or regions where the virus is transmitted. However, pregnant women with possible Zika virus exposure and symptoms such as fever, headache, rashes, red eyes and joint pain should undergo testing immediately, according to the guidance.