C.D.C. May Warn Pregnant Women Against Travel to Countries With Zika Virus

Aedes aegypti mosquitoes in a Petri dish at the Institute of Biomedical Sciences, part of the University of São Paulo in Brazil. Credit Nelson Almeida/Agence France-Presse — Getty Images

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Federal health officials are debating whether to warn pregnant women against travel to Brazil and other Latin American and Caribbean countries where mosquitoes are spreading the Zika virus, which has been linked to brain damage in newborn babies.

Officials say it could be the first time the Centers for Disease Control and Prevention advises pregnant women to avoid a specific region during an outbreak.

Some infectious disease specialists say such a warning is warranted, although it could have a devastating effect on travel and tourism. A spokesman for the C.D.C. said the agency hoped to make a final announcement Thursday or Friday.

“We can’t make these decisions in a vacuum,” said the spokesman, Thomas Skinner. “We’re consulting with other experts outside.”

The virus first appeared on the South American continent in May. Although it often causes only mild rashes and fevers, women who have had it, particularly in the first trimester of pregnancy, appear to be much more likely to have children with small heads and damaged brains, a condition called microcephaly.

Dr. Lyle R. Petersen, director of vector-borne diseases for the C.D.C., said Wednesday that the agency had found Zika virus in tissue from four Brazilian infants, two of whom had microcephaly and died shortly after birth, and two of whom died in the womb.

Microcephaly has several other causes, including genetic defects or rubella or cytomegalovirus in the mother during pregnancy. Samples from the fetuses “looked like what you’d see if an infection was the cause,” Dr. Petersen said.

Previously, Brazilian scientists had found the virus in tissue or amniotic fluid from three malformed fetuses. “This certainly provides much stronger evidence of the linkage,” Dr. Petersen said.

Although the travel advice would most obviously apply to Brazil, which is struggling with an alarming surge in newborns with microcephaly, it could soon apply to much of tropical Latin America and the Caribbean.

Local transmission of Zika virus has been found in 14 Western Hemisphere countries and territories: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Suriname and Venezuela.
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Zika’s Expanding Range

The Zika virus was confirmed in Brazil in May 2015 and has spread northward to other countries in the Americas, including Mexico. The virus is carried by mosquitoes, in particular Aedes aegypti, the yellow fever mosquito.

Alarm Spreads in Brazil Over a Virus and a Surge in Malformed InfantsDEC. 30, 2015

Global Health: Zika Virus, a Mosquito-Borne Infection, May Threaten Brazil’s NewbornsDEC. 28, 2015

A few isolated cases have been found in the United States, including one in Texas last wee k. However, all were in people who had just returned from overseas. No transmission within the 50 states has been found. Only one case has been confirmed in Puerto Rico, but because testing is rare and many cases involve mild or no symptoms, doctors assume there are many more there.

Some American virologists are already warning women who are pregnant or trying to have children to avoid such areas. “If my daughter was planning to get pregnant, I’d advise her not to go the Caribbean,” said Dr. Peter J. Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine.

“This is going to decimate Caribbean tourism,” he added. “But we can’t wait to act until nine months from now, when congenital defects turn up in the labor and delivery suites.”

Press officers at three cruise lines — Royal Caribbean, Carnival and Princess — said this week that they had never heard of Zika virus and referred a reporter to their trade group, the Cruise Lines International Association.

An association spokeswoman, Elinore Boeke, said travelers should check with public health officials about destinations they planned to visit and cited the C.D.C.’s current travel advisories, which suggest only that all visitors avoid mosquito bites by using repellent and long clothes.

Cruise ships publish daily fliers on health and safety and instruct passengers on how to avoid bites, Ms. Boeke added.

Reports of surging rates of microcephaly have already unnerved some travelers. On Tuesday, Ashley D’Amato Staller, 33, a lawyer in Haddonfield, N.J., who is pregnant with her fourth child, backed out of a planned February trip to Puerto Rico with 17 members of her extended family after reading articles about Zika arriving there.

“Part of me feels you have to live your life, so let’s go,” she said. “I could skip going and still get hit by a car or catch West Nile, or someone could sneeze on me. On the other hand, this is my baby, and nothing’s more important.”

Officials in Brazil said Tuesday that they were investigating more than 3,500 cases of microcephaly in newborns. Until last year, the country normally had about 150 cases of microcephaly each year.

There is no vaccine for Zika, but the National Institute of Allergy and Infectious Diseases has been working on one for the past month, said Dr. Anthony S. Fauci, the institute’s director.

Dr. Stanley Plotkin, a leading vaccine inventor, said a Zika vaccine “should not be extremely difficult to make” because the disease is closely related to yellow fever and Japanese encephalitis, for which there are effective vaccines.

Epidemiologists estimate that more than 1.5 million Brazilians have been infected. The alarm about microcephaly was raised in October, when doctors in the northern state of Pernambuco noticed unusual numbers of small-headed babies.

Although Brazil has strongly advised all pregnant women to avoid mosquito bites, a leading health official went further two weeks ago, suggesting that women in the hard-hit northeast region postpone having children.

“If she can wait, then she should,” said Cláudio Maierovitch, the ministry’s chief of infectious disease surveillance.

On Tuesday, the health minister of the Dominican Republic reportedly advised women there not to have children. Later, another ministry official clarified that statement: If local transmission of Zika is detected in the country, he said, the ministry would give that advice.

Sandra E. Garcia contributed reporting.

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