Sarah McAnaw, MPH(c), Siena Easley, MPH(c), Jackson Mesick, MPH(c), Paola Peynetti, MPH(c), Monica Adhiambo Onyango, RN, PhD

**All the authors are affiliated with Boston University School of Public Health**

Zika virus has arguably become the topic of discussion over the past few months and continues as a disease of concern to the public health community.  Although relatively unheard of by most of the general public until recently, Zika virus was first isolated in 1947 in the Zika Forest of Uganda. Zika was previously diagnosed across western, central, and eastern Africa as well as in South and Southeast Asia, where it remained until 2007 when it began spreading across the South Pacific. The current outbreak of the virus was first detected in mainland South America in Brazil in March of 2015.  The virus has since rapidly spread across 26 countries throughout South and Central America including Barbados, Bolivia, Brazil, Colombia, Costa Rica, Curacao, the Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haití, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Maarten, Suriname, the U.S. Virgin Islands, and Venezuela.

Zika virus is spread by the Aedes mosquito, the same mosquito genus that carries dengue and chikungunya.  Although symptoms of Zika are similar to those of dengue, only 1 in 5 people infected with the virus become symptomatic and those who do typically experience a mild illness.  For this reason, it is not the illness itself that is causing widespread concern.  It is what we largely do not know about the virus and other potential consequences of infection that have raised global alarm.

Beginning roughly around the same time as the Zika outbreak in Brazil, a significant increase in suspected cases of microcephaly were reported in Brazil.  Microcephaly is a birth defect characterized by newborns having an unusually small head circumference, and can cause or occur in conjunction with a variety of significant developmental delays.  Due to the timing of these two outbreaks, many government and health officials have drawn a possible correlation between mothers infected with Zika virus during pregnancy and microcephaly in their unborn children.  However, no evidence has yet been found to demonstrate a clear causal link between Zika and microcephaly.  In fact, a number of alternative explanations for such a sudden increase in suspected microcephaly cases have been circulating within the scientific and medical communities as of late, including one suggesting a link between a new larvicide targeting mosquitoes that was introduced into Brazil’s water supply late in 2014. Nonetheless, the World Health Organization (WHO) is calling the relationship between Zika virus and microcephaly “strongly suspicious” and “deeply alarming”, and declared the outbreak a global public health emergency on February 1, 2016.

These concerns have subsequently led the governments of Colombia, El Salvador, Honduras, Ecuador, and Jamaica to recommend that women either delay or avoid getting pregnant at all for time periods ranging from six months to two years, or until 2018.  Not only are such recommendations impractical from a public health viewpoint, they raise important issues around reproductive rights for women living in these countries.  Women’s rights groups have begun to highlight that governmental policy in many of the affected countries – including those that have issued warnings against pregnancy thus far – often limit access to contraception as well as deny women and girls the necessary information and ability to make informed decisions regarding their reproductive choices.  Additionally, high levels of gender-based violence in many of these countries are important to consider. Partner violence in Latin America and the Caribbean is, unsurprisingly, significantly associated with unintended pregnancies.  With access to emergency contraception and safe abortions impeded by policies and legal codes, women are denied the means of making and acting on vital decisions regarding their reproductive health.  Further, reproductive health access is often striated along socioeconomic lines, with wealthier women bypassing stringent policies and laws through travel or private care, and poorer women lacking that capacity. For these reasons, it is starkly insufficient, even hypocritical, for certain governments to simply warn women to “not get pregnant” for any period of time.  The governments of the affected countries must provide the general population, and women in particular, a robust education regarding reproductive health and rights, the best updated information currently available on the nature of the virus, the prevalence of the disease (both Zika and microcephaly), the risk posed to pregnant women, and the options that are available to women who are pregnant or may be planning to become pregnant.  In order for such precautions to be successful, it is imperative that governments also provide meaningful and timely access to comprehensive reproductive services throughout the country, including abortion. Whether in the throes of a public health crisis or managing business as usual, governments should prioritize the reproductive autonomy of the public, communicate reasonable public health messages with transparency, and increase access to essential reproductive health services.

Given the lack of concrete scientific evidence for a causal association between Zika and microcephaly as well as the great limitations of the Latin American and Caribbean anti-pregnancy campaign in response thus far, focus on preventative measures for Zika virus would be much more effective.  Nurses in particular will play a pivotal role in promoting these prevention measures including: recommending mosquito nets, safe mosquito repellents for pregnant women, and tactics for minimizing mosquito breeding sites; screening and making referrals for those at risk of contracting Zika virus and providing supportive care for those who become infected with the virus.  Nurses will also be crucial in continuing to provide reliable and essential reproductive health services, selected by the patient rather than the policy-maker or politician.

Additional resources and information:

Advance Healthcare Network for Nurses. Nursing Management of the Zika Virus.

Pan American Health Organization. PAHO Director calls for political commitment and more resources to fight Zika in the Americas.

Pan American Health Organization. Zika Resources: For Health Authorities.

Physicians for Human Rights. Priority Actions in the Zika Virus Response.

Tech Times. Larvicide Manufactured By Monsanto Partner, Not Zika Virus, True Cause of Brazil’s Microcephaly Outbreak: Doctors.