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Miscarriages in 3 American women with Zika virus


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Zika virus has been discovered in the placentas of at least three American women who contracted the virus while traveling and miscarried after their return to the United States, the chief pathologist at the Centers for Disease Control and Prevention told STAT on Wednesday.

The finding adds to a growing mound of evidence that Zika infection during pregnancy can pass from the mother to the fetus she carries. It is believed that in some such cases, the virus attacks the developing brain, triggeringmicrocephaly, a condition in which newborns have abnormally small heads.

There have already been reports, from the United States and Brazil, of traces of Zika virus being found in amniotic fluid and placentas from women who were discovered to be carrying fetuses with microcephaly.

Read moreObama seeks $1.8 billion to fight Zika virus

And last month the CDC reported it had found the virus in brain tissues from two microcephalic infants from Brazil who died shortly after birth. Those findings, initially reported via the media, were published Wednesday in CDC’s in-house journal Morbidity and Mortality Weekly Report.

Also on Wednesday, researchers from Slovenia reported a supporting finding in the New England Journal of Medicine.

Together, the new reports lend additional weight to the recommendationsfrom public health authorities at the CDC and elsewhere that women who are pregnant should avoid traveling to places where Zika virus is spreading.

Health officials have speculated that infection in pregnancy can also lead to an increased rate of miscarriages. The United States has not previously reported miscarriages in American travelers who have contracted the virus, but Dr. Sherif Zaki, the CDC’s chief pathologist, said the agency was now aware of at least three such cases. He said they miscarried early in their pregnancies but did not say where the women lived.

The Slovenian team that found Zika in brain tissue, from the University of Ljubljana and the University Medical Center Ljubljana, performed an autopsy on a fetus with microcephaly.

A woman from Slovenia who had been employed as an aid worker in Brazil for the past couple of years became pregnant in February 2015. A few months later, she contracted Zika and later decided to return to Slovenia.

An ultrasound at 29 weeks of her pregnancy revealed possible brain anomalies in the fetus. Microcephaly was later confirmed and she chose to terminate the pregnancy.

Analysis of the brain tissue showed profound brain abnormalities, said Tatjana Avšič Županc, senior author on the paper. The group also found high concentrations of viral particles in the brain tissue — but no evidence of Zika anywhere else.

“We think that this really represents the most compelling evidence to date that congenital CNS [central nervous system] malformations are associated with Zika virus,” Avšič Županc said.

Dr. Albert Ko, who has been working in Brazil investigating the rise in microcephaly cases, said the Slovenian findings are consistent with what is being seen in that country.

Ko, a professor at Yale’s School of Public Health, said the condition of the fetal brain described in the Slovenian paper was very concerning. He suggested the type of damage seen would likely translate into a poor prognosis for a child.

Ko and some colleagues reported Tuesday in the journal JAMA Ophthalmology that a number of Brazilian babies born with microcephaly suspected to be linked to Zika infection also have damage to their eyes. Ko said he fears there will be a spectrum of birth defects associated with this virus, some of which remain to be identified.

As for the questions of whether Zika infection is causing microcephaly in some infants, Zaki said that while it is important to gather more evidence, finding Zika virus in the tissues of a growing number of malformed brains is very persuasive.

“To me as a pathologist, this is undoubtedly evidence that it’s causing it,” he said.

 
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Miscarriages reported in 2 U.S. women with Zika virus, CDC says

 
   

Two U.S. women who contracted the Zika virus while traveling out of the country miscarried after returning home, and the virus was found in their placentas, a spokesman for the Centers for Disease Control and Prevention said Thursday.

Federal health officials have not previously reported miscarriages in American travelers infected with the mosquito-borne virus while abroad. But there have been miscarriages reported in Brazil, the epicenter of a Zika epidemic that now spans nearly three dozen countries.

The STAT website first reported Wednesday that at least three U.S. women had suffered miscarriages, based on information from the CDC's chief pathologist. The pathologist told STAT the women miscarried early in their pregnancies but provided no additional details.

CDC spokesman Tom Skinner said he was aware of only two miscarriages.

Last month, officials said a baby born in a Hawaii hospital was the first in the country with a birth defect linked to Zika. Hawaii officials said the baby's mother likely contracted the virus while living in Brazil last year and passed it on while her child was in the womb. Babies born with this rare condition, known as microcephaly, have abnormally small heads and brain abnormalities.

The Zika virus, explained

 
Play Video2:52
 
Everything you ever wanted to know about the Zika virus and its spread across North and South America. (Daron Taylor,Claritza Jimenez/The Washington Post)

In testimony before Congress Wednesday, CDC Director Tom Frieden reiterated that the agency is learning more about Zika every day, including how it can be transmitted from mother to fetus. Increasing evidence in Brazil also is linking Zika to microcephaly and other suspected neurological complications.

More than four dozen Zika cases have been confirmed in 14 states and the District of Columbia -- six involving pregnant women -- with at least another 21 cases in U.S. territories, the CDC said last Friday. Frieden also said that one U.S. case of Guillain-Barré syndrome may be linked to Zika.

It was unclear whether the two miscarriages were counted among the six cases involving pregnant women.

Global health officials are closely monitoring the spread of the virus and the incidence of suspected neurological complications. Frieden has said the link between Zika and Guillain-Barré, which can lead to paralysis in adults, is growing stronger. Several South American countries have identified cases of the syndrome.

The World Health Organization, which has designated the outbreak a "global public health emergency," issued guidance Wednesday on how women should protect themselves against possible sexual transmission of Zika. It said that until more is known, "all men and women living in or returning from an area where Zika is present -- especially pregnant women and their partners -- should be counseled on the potential risks of sexual transmission and ensure safe sexual practices."

Those include the correct and consistent use of condoms, the WHO said.

Last week the CDC issued its own detailed recommendations for preventing sexual transmission of the virus, including the suggestion that men who have traveled to Zika-affected regions consider abstaining from sex with their pregnant partner for the duration of the pregnancy. The guidelines came after a Dallas resident was infected by having sex with a person who had contracted the disease while traveling in Venezuela.

https://www.washingtonpost.com/news/to-your-health/wp/2016/02/11/miscarriages-reported-in-2-u-s-women-with-zika-virus-cdc-says/

 

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HEALTH
 
ZIKA VIRUS OUTBREAK
 

Did the Zika Virus Cost This Woman Her Baby?

 
Image: A health worker stands in the Sambadrome

A health worker stands in the Sambadrome as he sprays insecticide to combat the Aedes aegypti mosquitoes that transmits the Zika virus in Rio de Janeiro, Brazil. Leo Correa / AP

Samantha Mejia was elated when she discovered she was pregnant during a family visit to Honduras over the Christmas holiday.

Less than two months later, she's lost the baby and she is wondering if Zika is to blame.

Mejia, who lives in Romeoville, Illinois, tested positive for Zika after her visit, and says tests on the placenta from the pregnancy she lost show evidence of the virus.

A spokesman for the Centers for Disease Control and Prevention told NBC News on Thursday that the placentas from two U.S. women who miscarried after visiting Zika-affected areas have tested positive for the virus. It doesn't prove the virus caused the miscarriages, but it adds to concern that the spread of Zika is a major threat to pregnant women.

"It really could be a weird coincidence. Miscarriage is so common, it may not be Zika at all," Mejia told NBC.

 Zika Virus on the move: How to protect yourself 3:22

Zika's spreading across much of Latin America and the Caribbean and many more cases are expected. Health experts say the evidence is growing daily that the once-obscure and seemingly harmless virus is causing severe birth defects that can cause miscarriages, stillbirths or a lifetime of disability for babies that survive.

CDC's reported more than 50 cases of U.S. travelers coming back with Zika. Last month, a baby born in Hawaii with a birth defect tested positive for Zika.

"We're discovering more literally every day. This is a new phenomenon," CDC Director Dr. Tom Frieden told a Senate subcommittee hearing Thursday.

"Right now, the most important thing for Americans to know is if you are pregnant, not to travel to a place where Zika is spreading."

Mejia didn't know this when she and her husband Omar took off for his family's home in La Paz, in western Honduras. The warning hadn't even been issued yet.

"When we were there a couple of years ago, they were talking about dengue," Mejia said. "They were talking about Zika this time, but we didn't think too much of it. I didn't hear much about pregnancy and microcephaly while I was there."

Dengue virus is a close relative of Zika. Both are spread by the Aedes aegypti mosquito and until January, dengue was considered the much bigger threat.

Image: Honduran Mother Zika
 
Norily Mejia de Cornejo of Honduras, who is five months pregnant and became infected with Zika in January. So far her ultrasounds look fine, but she is worried. Her sister-in-law, Samantha Mejia of Illinois, miscarried after visiting Honduras and the placenta has tested positive for the virus Family Photo

In January, CDC scientists found evidence of Zika in the brains of two babies who died hours after birth in Brazil. They both also had microcephaly, a severe birth defect in which the brain is underdeveloped and the head is too small.

Brazilian authorities had been saying they feared Zika was causing a rise in microcephaly, but the evidence was thin. As more and more babies and pregnancies and being tested, the evidence is getting much more substantial.

On Wednesday, doctors in Slovenia detailed the case of a fetus with severe microcephaly that was aborted after the mother had symptoms of Zika. They found the virus in the very badly damaged brain.

It's a smoking gun to the CDC. "The link to microcephaly is unprecedented," Frieden said.

Mejia, a 30-year-old office manager, went in for testing when she started showing symptoms of Zika.

"It was so mild," she said. "I stayed home one day feeling fluish, chills, very tired. Later that day, I felt much better, but next day I got a rash that spread across my entire body. That was when I was first alarmed -- maybe this is not the flu."

These are classic symptoms of Zika, which is usually so mild that 80 percent of people never even realize they are infected. The rash is the most telltale symptom.

This was all happening as alarm bells were just starting to go off around the world about Zika.

"Once I knew it was Zika for sure, I spent some time talking with my (obstetrician)," Mejia said. She went for an ultrasound at nine weeks of pregnancy.

"That's when we learned there was no heartbeat," Mejia said.

"(My) doctor was very compassionate and told me that the miscarriage may not be Zika-related, because early miscarriage is so common. It might just be a coincidence," she added.

"Now I am trying to get some peace. Maybe this is nature's way of taking care of it. Maybe this is what was supposed to happen. "

Related: How Worried Should You Be About Zika?

Frieden says it will take months to know for sure. Teams of scientists are studying pregnant women and babies in Brazil to see if those known to have been infected with Zika are more likely to have microcephaly than those who were not. They'll also follow hundreds of women in Colombia infected at different stages of pregnancy to see if and when anything happens to the babies.

Cases like Mejia's help answer questions, also.

"They did testing on the placenta," she said. "There was evidence of Zika virus in the placental tissue, but they couldn't say definitively if it was in the baby, as well. "

But now there is another worry.

"My sister in-law is pregnant right now, five months pregnant. She also contracted Zika while pregnant," Mejia said.

Norily Mejia de Cornejo got sick in early January.

"She is worried, hearing more reports about other defects, worried about other things besides Zika," Mejia said. Zika's also suspected of causing a rare but sometimes severe paralyzing condition called Guillain-Barre syndrome.

"She is getting ultrasound and her doctor says everything looks normal, but s that still doesn't give you that much peace of mind. We are optimistic and praying."

The World Health Organization has released advice for women who are pregnant and develop Zika but it doesn't offer many answers.

Doctors don't yet know what the risk is to the unborn baby, or whether there's a way to know when in pregnancy is the most dangerous.

 Obama Requests $1.8B From Congress to Fight Zika Virus1:43

"Pregnant women infected with the Zika virus should seek counselling and antenatal care from a medical practitioner. WHO recommendations on this topic are currently under development," Who says.

There's no treatment that can help protect the fetus and it's not easy to know for sure if a developing baby has microcephaly until late in the pregnancy.

CDC and WHO both recommend that everyone in Zika zones protect themselves from mosquito bites by using insect repellant, wearing long sleeves and pants, getting rid of water where mosquitoes can breed and using screens and air conditioning.

"Whether and when to become pregnant should be a personal decision, on the basis of full information and access to affordable, quality health services," WHO says.

"Women should have access to a comprehensive range of contraceptive options. The range of contraceptives available should include long-acting, short-acting and permanent methods to meet women's individual preferences and needs. They include diaphragm, cervical cap, male condom, female condom, spermicidal foam, sponges and film." 

http://www.nbcnews.com/storyline/zika-virus-outbreak/did-zika-virus-cost-woman-her-baby-n516791

 

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