February 18, 2016
Facing the same question raised by some of her patients, Dr. Jenny Graber followed her own advice.
An obstetrician pregnant with her first child, Graber and her husband canceled an upcoming trip to Mexico due to the Zika virus outbreak affecting most of Central and South America.
Zika itself is a mostly benign disease that does not always become symptomatic. But its connections to microcephaly, a condition causing babies to be born with small heads and underdeveloped brains, has forced local pregnant women to reconsider trips to any of the 30 countries and territories with active Zika transmission.
Many women, like Graber, are heeding the advice of the Centers for Disease Control and Prevention by avoiding any unnecessary trips to areas affected by the mosquito-borne disease. Yet, local travel agents say the Zika outbreak has had little impact on their bookings.
"If I didn't, I knew I'd be anxious the whole time about mosquitoes and not enjoy myself," said Graber, an obstetrician at Main Line Health's Riddle Hospital in Delaware County. "This is my baby's entire life and future that I'm talking about. I don't want any regrets."
Graber said she receives one or two calls each week from patients inquiring about trips to places affected by the disease.
"I think a lot of people have an attitude of better safe than sorry," said Graber. "They're like, 'Thanks for confirming what I was thinking. I really want to go on this trip, but I don't want to feel guilty the whole time.'"
Graber did not know of any patients who ended up taking a trip to a Zika-affected area. Nor did a pair of medical professionals at Cooper University Health Care and the University of Pennsylvania Health Systems.
"The last few weeks there were patients who had trips as early as the following week," said Katherine Schmidt, a Penn Health Systems nurse practitioner. "I personally have not had a single woman not cancel."
Dr. Richard Fischer, head of Cooper's Maternal and Fetal Medicine division, said obstetricians have received more calls from women who traveled to Zika-affected countries in the last three months than those with questions about future trips.
In those cases, Fischer said, the CDC recommends patients submit a blood test to determine whether they contracted Zika. But the accuracy of those tests is questionable. If the sample tests positive, Fischer said there is little he can do to determine whether the fetus has microcephaly beyond ultrasound monitoring.
"Unfortunately," Fischer said, "It's a wait-and-see, which I know is not very reassuring."
"I'm booking the Caribbean for families for future trips. They don't seem to be even asking me questions." – Suzanne Shank, owner of Atlas Travel
Much about Zika's association with microcephaly remains unknown. The Zika outbreak in Brazil coincided with a dramatic increase in microcephaly cases, but other countries have not reported upticks in microcephaly. Earlier this week, a report circulated connecting microcephaly to larvicide used to control mosquitos, but it quickly was rejected.
If Zika indeed is causing microcephaly, doctors still do not know the likelihood that an infected mother gives birth to a child with microcephaly. Plus, Zika has no known cure.
"There's just so much that we don't know," Schmidt said. "It is very fluid. Things could change drastically in the next couple of months based on new findings. We just have no idea."
That's partly why the CDC cautions pregnant women against traveling to affected areas.
Many airlines, including American, Delta, Southwest and Spirit, are offering refunds to pregnant women and their companions. But both Southwest and Spirit officials described Zika's impact on their bookings and cancellations as minimal.
For people who are not pregnant or trying to get pregnant, Zika seemingly poses little risks.
Despite the outbreak encompassing many of the destinations popular for mid-winter vacations, travel agents said people are booking vacations and cruises to affected areas at rates consistent for the season.
"We have not experienced cancellations, but we have alerted our clients to the notices about the Zika virus," said Lee Rosenbluth, chief executive officer of Rosenbluth Vacations. "We certainly don't want anyone who is pregnant to go to an affected area. We certainly advise against that."
Suzanne Shank, owner of Atlas Travel, said her only travel alteration came from a pair of student groups that are considering traveling to Europe instead of Costa Rica.
"I'm booking the Caribbean for families for future trips," Shank said. "They don't seem to be even asking me questions."
Mitch Gordon, director of leisure services for Wings Travel Group, said his agency recently booked a Caribbean cruise that initially included two pregnant couples. He advised them of the associated risks.
"One went. One didn't go," Gordon said. "It's a very up-in-the-air situation."
Another couple seeking to get pregnant on their honeymoon went ahead with a trip to Costa Rica, he said.
For those pregnant couples who travel to Zika-affected destinations, Fischer urged them to wear pants, long sleeves and expose as little skin as possible. He also suggested travelers spray their clothing with Permethrin and apply bug repellent that includes diethyltoluamide, better known as DEET.
Any man with a pregnant partner who travels to an impacted area should wear a condom during sexual intercourse for the duration of the pregnancy, Fischer said.
But given the severity of microcephaly and its link to Zika, Fischer said he wonders why any pregnant woman or her partner would risk it.
Graber asked herself that question. She and her husband instead will trade the warmth and sunshine of Mexico for the snowy slopes of Lake Tahoe.
"At least there's not going to be any mosquitoes in Lake Tahoe," she said. "We'll go sledding and snowshoeing and things like that."