My pregnancy began in March 2016, just a month after the World Health Organization declared Zika an international public health emergency. Although I work in health care as a nurse, I have felt uncertain about the course of this epidemic.
Clear information about Zika has been hard to come by as both a patient and a health care provider. At a prenatal appointment in June, I expressed concern about Zika to my midwife and told her that even though I was following recommended preventative measures, with screened windows and access to bug spray, I was still getting bug bites every day. She assured me that Zika was not stateside and then gave me a Zika prevention kit. The prevention kit, made by Baltimore City Health Department, contained a can of bug spray, a few condoms, and an informational sheet on Zika transmission and mosquito control. A couple weeks later while I was working at clinic, I saw a handful of these same kits stashed beneath a workstation computer.
As far as I can tell from both experiences as a patient and provider, the kits have been the only Zika-related information I have seen disseminated, and the process for dissemination has not been systematic. At best, I see the kits as a stand-in for a real conversation about Zika prevention. In part, this is likely because patients and providers assumed that Zika has not reached Baltimore yet. But it has, particularly among travelers to Zika-affected areas. This lack of perceived risk coupled with the limited amount of time allotted for doctor’s appointments means Zika is largely not a priority – at least from my experience.
Another challenge is that guidelines for care are changing rapidly. I recently attended a lecture given by Dr. Jeanne Sheffield, the director of the Division of Maternal-Fetal Medicine and professor at Johns Hopkins University School of Medicine. Her lecture gave a broad overview of what we currently know about Zika and how this is guiding current clinical care. Many basic questions about Zika still remain. Current case reports indicate that Zika can affect a developing fetus at any point in the pregnancy even in the late third trimester. Also, we still don’t know if there is a risk of transmission through breastfeeding or to what extent Zika can affect the development of infants after birth.
With the possibility that Zika may become more of a local threat next summer, conversations about Zika prevention will inevitably become more important in Baltimore and elsewhere. Fortunately, sites like the Zika Communication Network (ZCN) can connect both clinicians and patients with up-to-date resources. In epidemics characterized by uncertainty, accessing current information about disease prevention is a critical tool for the health and safety of our communities.