Why Nonpregnant Women Aren’t Travelling To Countries With Zika

The World Health Organisation declared the Zika virus a global health emergency in early February just as many of us began to dream of escaping winter by boarding a plane for warmer destinations. Zika is similar to other tropical diseases like dengue fever or West Nile in that it is primarily transmitted by mosquitoes. For many years, no one worried about the virus — most people infected don't have any symptoms, and when they do they're usually minor: fever, aches, and possibly conjunctivitis (pinkeye). It's almost never fatal, and people rarely even need to be hospitalised (though there are recent reports that suggest a link between Zika and the neurological disorder Guillain-Barré syndrome). However, during the most recent outbreak in South America, experts noticed a troubling connection between the disease and microcephaly, a devastating birth defect that affects babies’ brains. As a result of the frightening headlines, many pregnant women are reconsidering their travel plans, with health professionals and the Centres for Disease Control and Prevention (CDC) recommending pregnant women avoid all areas affected by the outbreak. For pregnant women who have traveled to those areas before information about Zika was widespread, the agony of waiting to learn if they were infected can add a lot of upset to an already stressful time. But what about women who aren’t yet pregnant and are trying to conceive or considering having children in the near future. Should they cancel their trips to Zika infected destinations?

Ashley Onadele, 27, and her husband, were planning the trip of a lifetime to Machu Picchu in Peru this April, until she started hearing about the Zika virus last December. “When we first heard of [Zika], it was only really bad in Brazil,” Onadele says. In the months since, though, the virus has spread to several other countries in South America, Latin America, and the Caribbean. Onadele, a contract manager in Newark, CA, isn’t pregnant, but she hopes to be soon. “[My husband and I] want to start trying for a baby some time this year,” she says. The CDC is explicit in its recommendation that pregnant women postpone travel to any area where Zika is spreading, but its recommendation for women trying to get pregnant is less clear. The organisation’s website currently tells non-pregnant women (and their male partners) planning to travel to places with Zika outbreaks to talk to their healthcare providers. Based on the available evidence, a Zika infection won’t pose a risk to a future pregnancy. But there are still many unknowns about the disease, and that’s causing some women to think twice. As of this writing, Peru isn’t one of the countries with active mosquito-borne transmission of Zika, according to the CDC. But Aedes mosquitoes, the genus that carries the disease, are found there, and its neighbouring countries, Brazil, Bolivia, Colombia and Ecuador are all experiencing outbreaks. Puerto Rico and many Caribbean Islands are also on the CDC’s warning list. Onadele and her husband, who were also planning a vacation to the Caribbean, decided to play it safe and cancel both of their trips. “We just didn’t think it was worth the risk and promised we would make it to Machu Picchu and Puerto Rico another year.” Onadele may feel that she was being overly cautious cancelling a trip to a country without a listed outbreak, but Peter Hotez, MD, PhD, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, encourages the extra precautions. “The connection between Zika and microcephaly is quite real,” he says. And whether or not Zika exposure is a risk for women who aren’t yet pregnant, but might be considering conceiving in the near future, is hazy. Not many studies have been published yet on this particular Zika outbreak, Dr. Hotez says, but if it acts similarly to dengue fever, as previous outbreaks have, you can expect a three-to-seven day incubation period followed by about a week of illness. “By then you mount an immune response including neutralising antibody and then the virus disappears from your system,” Dr. Hotez says. However, in the cases when Zika has been transmitted sexually, it may be possible for the virus to persist for longer periods. The good news, according to The New York Times, experts say that once non-pregnant women are infected by the virus, they are immune from future infection.

Some women, however, think the risk is being overblown. Elsa (who preferred not to share her last name) will head to Hawaii next month with her husband to visit her best friend on Oahu. A 38-year-old paralegal from San Francisco, Elsa wants to conceive sometime this year and says that her healthcare provider told her Hawaii carries a Zika risk. “I’m traveling anyway,” she says. “I just find this whole Zika scare to be ridiculous. I know it is out there and carries the risk of birth defects. At the same time, you can’t just scare the entire world into a panic.” Some people are considering stateside travel in lieu of heading to South America or the tropics. However, the Zika virus threatens to affect more than just travellers seeking an overseas adventure. Dr. Hotez says the Gulf Coast of the U.S. is another area to watch closely. “It’s possible we’ll have American women living in an endemic area,” he says. This is a potential public health concern, and one that could affect the domestic travel industry. According to data from the travel booking site Expedia, four of the five most popular domestic spring break destinations this year are in Florida: Orlando, Miami, Fort Lauderdale, and Tampa — all spots that could potentially be affected by a Zika outbreak. Jennifer, 34, was planning a short trip to Miami with a friend this spring. She’s a working mother with a toddler, so she was definitely in need of a warm weather getaway. Then in February, when she started to hear more about the threat of Zika to tropical climates, she decided to cancel the trip. She hopes to get pregnant with her second child this year. “I really wanted to go to Miami, but I just had to tell my friend that I can’t in clear conscience go there right now,” she says. “The scariest thing for me is the fact that there’s just so little known about the disease. It’s hard to plan around that.” Regardless of whether you’re thinking about getting pregnant soon, Zika has certainly made travel a little more complicated. Dr. Hotez says there’s no real way to know how long outbreaks will last or where Zika will spread next. Sarah Gavin, a travel expert at Expedia recommends keeping an eye on government travel alerts and warnings through the U.S. State Department and the CDC if you have a trip booked or are thinking of one. Expedia keeps track on its travel alerts page. And if you are heading to a place that might have a Zika risk, Dr. Hotez says to protect yourself against mosquitoes. “There’s no 100% reduction in risk, but the best way to protect yourself is by using an EPA-registered insect repellant,” he says.

Booking a trip while things are still uncertain could prove to be costly. Onadele and her husband lost about $1,650 on deposits and change fees for both vacations. “I was very, very bummed about cancelling, but the more I’m learning about the virus, I’m at peace with our decision,” she says. While many airlines are providing refunds for trips booked to areas affected by the outbreak, Gavin, at Expedia, says to be sure to check those change fee policies ahead of time. Hannah Wagner, 32, was lucky enough to get deposits back for her April destination wedding in the Riviera Maya in Mexico. She had no idea when she started planning that an outbreak would cause her to drastically change her plans. But she wants kids soon, and two of her bridesmaids are pregnant, which made it too much of a risk, she says. Luckily, she and her Dutch fiancé were able to find a great new venue.

“His mother sweetly researched a venue for us and found a hotel on a beach [in Holland],” Wagner says. Holland in April isn’t exactly Mexico, but a Zika-free wedding in Europe is a pretty nice backup plan.