Q TRAVEL – The holiday travel season is here and Costa Rica is a very popular destination for many from around the world. Should you be worred about the Zika Virus?
The ZIKA VIRUS IS SCARY because it targets the most vulnerable among us — its sudden, rapid spread across the Americas would not have been recognized by the general public had it not been linked to birth defects like microcephaly in unborn babies.
Because of this horrific side effect to the otherwise fairly mild virus, travelers have good reason to be concerned when they travel. But a lot of the panic has been unnecessary, and often, the true risk of Zika has been overstated. To try and fight panic and inform travelers, we’ve created this resource page to try and break everything down for you.
The Zika Virus in Costa Rica
What is the current situation? The Ministry of Health (Ministerio de Salud) Epidemiological Bulletin No. 40-2016 on Zika, Chikungunya and Dengue (November 30, 2016), there are 1,518 confirmed cases of Zika (534 men / 984 women), the majority of cases (208) in the Punaternas canton (county). Click here for the Salud bulletins.
The Centers for Disease Control and Prevention (CDC) on Costa Rica says mosquitoes that spread Zika usually do not live at elevations above 6,500 feet (2,000 metres) because of environmental conditions. Travelers whose itineraries are limited to areas above this elevation are at minimal risk of getting Zika from a mosquito.
The following map shows areas of Costa Rica above and below 6,500 feet.
The following is a great resource article from the Matador Network. A great read.
What is Zika?
Zika is a mosquito-borne virus that is related to dengue, West Nile, and yellow fever. The virus was first discovered in the Ugandan Zika forest in the late 1940’s, and for about 60 years, it remained in the equatorial regions of Africa in Asia. In 2007, it started spreading across the Pacific Islands, and in April 2015, it had its first outbreak in Brazil. Shortly after this outbreak, public health experts noticed a rise in cases of microcephaly (a birth defect which can results in an underdeveloped brain) among newborns and a rise in cases Guillain–Barré syndrome (an immune disorder) in adults in the areas most affected by Zika. Further research was done, and in 2016, Zika was definitively linked to both of these conditions.
What are the symptoms?
For most people, Zika is not a very severe illness. That is why, in fact, it hadn’t been extensively researched prior to 2016: it was not considered a severe enough illness to merit attention when other much more severe mosquito-borne diseases, like malaria, yellow fever, and dengue, where out in the world.
Only one in five people who get Zika will develop symptoms. Those symptoms aren’t particularly pleasant — they include fever, rash, headaches, joint pain, muscle pain, and red eyes.
Zika’s scariest aspect is that it may be linked to microcephaly in babies. Microcephaly is abnormal brain development that can cause a disproportionately small head in the child, which may, in some circumstances, lead to death. There is also growing evidence of what’s being called Congenital Zika Syndrome, which is a pattern of certain other birth defects in children exposed to Zika in the womb. These birth defects include, according to the CDC:
- Severe microcephaly where the skull has partially collapsed
- Decreased brain tissue with a specific pattern of brain damage
- Damage to the back of the eye
- Joints with limited range of motion, such as clubfoot
- Too much muscle tone restricting body movement soon after birth
A small percentage of adults who get infected with Zika may develop Guillain-Barré syndrome, or GBS. This is a rare condition where the immune system attacks the nervous system, causing weakness and sometimes paralysis. Most people fully recover from GBS, and few ever die. Usually, it lasts for a few weeks to a few months. The CDC has not discovered a direct link between Zika and GBS, but it does say they are strongly associated.
Who should be worried?
The largest danger is to pregnant women, and as such, if you are pregnant or are trying to become pregnant, then you should avoid going to the countries or areas where Zika outbreaks are currently occurring. Because the virus is mosquito-borne, the level at which it spreads depends heavily on the seasons. So while it will likely spread further north into the United States at some point, it will be likely to naturally spread during the summer months.
The virus is still mostly transmitted through mosquitoes, but it can also be sexually transmitted. If a man were to get Zika and then have unprotected sex with a pregnant woman in a Zika-free country, he could pass it to her and infect the baby.
Should I change my travel plans?
If you are pregnant (or are trying to get pregnant) and are planning on traveling to those countries, the safest option is probably to cancel your plans. If the travel is unavoidable, or if you live in a place where the outbreak is happening, don’t panic: just try to avoid mosquito bites, and remember that Zika may be linked to microcephaly: it is not an inevitability. The CDC is simply advocating caution, certainly not panic.
If you are a woman, are not pregnant, and you get Zika, don’t worry: the virus typically leaves the system after a week, meaning it won’t infect future babies you may have.
If you are a man and are trying to get pregnant with a partner, or if you are a woman who is trying to get pregnant, you can still travel to a country with Zika, but you should take precautions to avoid infection (we’ll discuss those below), and you should put off trying to get pregnant for a period of time. Here’s what the CDC suggests:
- If you are a woman:
- If exposed to Zika through travel to an area with Zika, or sex with someone who has traveled to an area with Zika, wait 8 weeks after exposure to start trying to get pregnant.
- If positively diagnosed with Zika, wait 8 weeks after symptoms start.
- If you are a man:
- If exposed to Zika through travel to an area with Zika, or sex with someone who has traveled to an area with Zika, wait 6 months after exposure to start trying to get pregnant. This extra time is because Zika can last longer in semen than it can in the rest of the body.
- If positively diagnosed with Zika, wait 6 months after exposure to start trying to get pregnant.
If you went to an area with Zika and experience no symptoms for a few weeks after the trip, there’s an okay chance you never contracted Zika. That said, most people who get Zika do not experience symptoms. And as of yet, the only tests for the virus are positive tests — meaning that they can prove that you have it. There are no tests that can prove that you don’t have it. So while you likely don’t, there is no way to prove it.
It’s also worth pointing out that scientists are not yet sure what percentage of infected newborns develop microcephaly — current ranges estimate between 1 and 13 percent of fetuses exposed in the first trimester will develop microcephaly. But we’re not sure yet.
Ultimately, if you’re trying to get pregnant and want to travel to (or possibly live in) an area with Zika, you should talk to your doctor. If you are not trying to get pregnant, travel away — just protect yourself against mosquito bites and practice safe sex or abstinence.
What should travelers do to avoid Zika
Since Zika is mosquito-borne, prevention largely comes down to avoiding mosquito bites. The mosquito that carries Zika is the female Aedes Aegypti, and it is most active during the day. This means that mosquito nets are less effective than they are with diseases like malaria, which are carried by more nocturnally active mosquitoes. This isn’t to say that if you have a mosquito net that you shouldn’t use it: it’s just to say you should take further steps as well. Those steps are:
- Wear long sleeve shirts and pants, preferably made of thick material.
- Use mosquito repellent that contains deet.
- Stay indoors as much as possible.
There is, as yet, no vaccine against Zika. Doctors have developed successful vaccines for similar diseases in the past, but vaccines take a long time to develop. If you do get Zika, there’s also no medicine for treatment. Doctors suggest getting plenty of rest, staying hydrated, and taking acetominophen or paracetomol (NOT aspirin) for any aches, pains, or fevers. Most importantly, if you do get it, make sure you still work to prevent further mosquito bites. If you get bitten while infected, the mosquito can then infect others.
A second precaution, if you’ve traveled to Zika-prone countries, is to practice safe sex. Men, this does not fall exclusively on women: It lasts far longer in male semen (up to 6 months) than it does in a woman’s body, and it’s much easier to transmit from male-to-female than it is female-to-male. So this responsibility should fall on men, to a large extent.
An important note
Most travel insurance policies will not cover cancellations for Zika. As such, if you’re worried you’ll need to cancel your trip, you may want to spring for Cancel for Any Reason travel insurance. It’s a bit more expensive, but may be worth it in this case.
For a while, several airlines were offering refunds for travel that had to be canceled because of the virus. The deadlines for these have passed for the most part, but it may be worth checking the airline’s cancellation policies prior to booking.
Where is Zika?
It’s important to note that the vast majority of the cases shown on this map were cases resulting from travel, not from local transmission. As of November 30, 2016, 185 cases have been transmitted locally in the United States. 184 have been in Florida, and most of these in Southern Florida. The CDC suggests pregnant women do not travel to Miami Beach. Cases in the United States. Via The CDC
This is obviously not a very specific map — Alaska, for example, while part of the US, does not have active mosquito transmission. The same is true for many other countries. The CDC suggests pregnant women not travel to any active transmission zones. They have a specific country-by-country guide here.
Here are some useful sites, if you’d like to know more:
- The Center for Disease Control’s Zika resource page.
- Short Answers to Hard Questions About Zika Virus from the New York Times.
- The World Health Organization’s Zika resource page.
Ultimately, we recommend the following attitude towards Zika: inform yourself, but don’t panic. For the vast majority of people, it is not a reason to stop traveling.
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