by Dr Sarah Morton, MBBS
With the Rio Olympics now upon us and Rio being one of the major transmission zones of Zika, we’ve put together a short document outlining key points for medical professionals with some links to live updating documents to help you keep on top of what you need to know.
How widespread is Zika?
Zika was declared an international public health emergency on the 1st February 2016. Predominantly Zika has been found in Central and South America but has also been found in Indonesia and Africa.
What is the Zika virus?
Zika is a virus which is part of the flavivirus family. It is transmitted via the Aedes mosquitoes but it may also be transmitted sexually. Many people who contract Zika do not know they have it or presume they have a cold as symptoms are non-specific and seen in many other conditions. Symptoms include headache, malaise, fevers, arthralgia and myalgia. The disease itself is therefore of minimal concern. However what is of concern is the increase in congenital microcephaly (abnormal smallness of the head associated with incomplete brain development) seen in areas where the Zika virus is widespread. Associations and causality have not been proven at all stages (i.e. it cannot be confirmed that if you get Zika virus and then get pregnant your baby will get congenital microcephaly) but this continues to be re-evaluated and there is “strong scientific consensus” according to the World Health Organisation that Zika virus is the cause. Indeed the Centres for Disease Control and Prevention have concluded there is casual relationship between prenatal Zika virus infection and microcephaly. Public Health England have issued advice that if any pregnant women has a history of travel to the area affected by Zika then even if they are not symptomatic they should have repeat ultrasound scans to look for abnormalities. Assessment PDF download available here.
The other condition that medical staff should be aware of is that Zika virus appears to have seen an increase in Guillain-Barre syndrome (GBS). Guillain-Barre is a condition that can occur after a variety of different infections that results in an ascending paralysis of the body and can cause patients to be intubated and ventilated as their respiratory muscles fail. Treatment of GBS is with support and intravenous immunoglobulins and plasma exchange to try and remove the antibodies that appear to cause this paralysis. More information available here.
With Rio being in the heartland of the Zika transmission zone, it has attracted a lot of media attention. The advice issued by the World Health Organisation to try and prevent acquiring Zika is to avoid mosquito bites and to also avoid sexual transmission if someone has travelled in that area for up to six months if infection confirmed.
Some reactions of Olympic contenders to Zika
At the end of May 2016 100 scientists wrote an open letter to the World Health Organisation saying it would be unethical for the Olympic Games to go ahead in Rio this year. The World Health Organisation has rejected these calls and the International Olympic Committee has stated there is no reason to move or delay the games, read more here.
Some athletes have been very open about their views on Zika: Vijay Singh, the golfer, has stated he will not be attending Rio because of it, along with Jason Day, Jordan Spieth, Rory McIlroy and Dustin Johnson. Greg Rutherford, the long jump gold medal winner in London 2012, said he’d had his sperm frozen as himself and his partner are concerned about the risk. Others such as Hannah Mills, a British sailor, have spoken out saying that they will attend despite Zika.
Points for discussion
- If you are working at the Rio Olympics have you thought about Zika? Has it impacted your decision to attend? Will it stop you considering having children for six months?
- Should a public health issue affect a sporting event? At what stage should we say it is “unethical”?
- If a female athlete came to you saying she was planning pregnancy in the 6 months following the Olympics (potentially a natural break in her career) what would you advise her?
- Up to date map available from: http://spxj.nl/2aWkHcW
- The BMJ has published a clinical guide to Zika that it continues to update available at: http://spxj.nl/2aUpiJP
- The BMJ has also produced a document: Zika virus: management of infection and risk. Some example scenarios of what patients may ask are also available here: http://spxj.nl/2byg1g4
- Further information is available here: http://spxj.nl/2bhLvXn