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Mothers and mothers-to-be assess the risk from Zika, take precautions

Pregnancies often bring a mix of joy and worry, and this year there is one more thing keeping women up at night: Zika. The virus found to harm fetuses' brains is making its way north from Central and South America via mosquitoes and has expectant couples arming themselves with equal measures of information and bug repellent.

After marrying six months ago in Aruba, Laura and Rob Cancelliere planned to return for their first anniversary, but the Severna Park couple canceled the trip and even put thoughts of a baby on hold after learning about the emerging threat of the Zika virus.

Transmitted through mosquito bites and spreading rapidly through South and Central America, Zika in pregnant women has been linked to the devastating birth defect microcephaly, which stunts the brains and skulls of their fetuses.

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"Sadly, will be holding off our plans for a family until we are certain that neither of us have any reason to believe we contracted or carry the virus," Rob said.

With warm-weather mosquito season on the horizon and expectations for Zika to spread into the United States, many local couples who are already pregnant or who want to be are scrapping travel plans, scouring the internet for medical advice and stocking up on repellent to stave off a disease few had heard of before this year. Doctors meanwhile are racing to understand the disease and develop a vaccine to prevent the infection.

So far there have been 544 confirmed U.S. cases of Zika, 17 of them in Maryland. Pregnant women, who are more likely to seek testing, accounted for 157 of the cases and one from Maryland, a sharp increase reported Friday by the U.S. Centers for Disease Control and Prevention, reflecting a change in how it counted them. All the U.S. cases were determined to be travel-related. Ten cases nationally were sexually transmitted.

"Zika is the first vector-borne virus that appears to cause infection in fetuses, the first reliably spread by sexual transmission and now is a widespread epidemic," said Dr. Lyle R. Petersen, director of the CDC's Division of Vector-Borne Diseases. "We must move extremely quickly. We have thousands of infections every single day in the Americas, and we must be prepared."

As fears rise, public health officials at all levels are trying to provide consumers with as much information as possible about the danger posed by Zika and how it spreads. Some Baltimore-area health departments are offering repellent and condoms, while mosquito control plans are being developed. In Maryland, state agricultural officials plan to treat any area where a case of Zika is recorded.

At the same time, informal efforts targeting pregnant women have sprung up on social media and online as health columnists and mommy bloggers weigh in on Zika and try to provide helpful information.

Local women who are pregnant or want to become pregnant say the information has helped quell some anxiety, but they note that there is a lot the experts don't know.

"When I first heard about Zika, probably five or six months ago in countries to the south, it wasn't really a concern," said Kaysha Curro of Edgewater, who is eight months pregnant. "When I started hearing about cases in the United States, it really started to hit home. All of a sudden it was here and present, and the questions started coming."

Because the virus is expected to spread more actively in the United States during the summer, many women are looking for information and talking to their doctors about all things Zika.

"We aren't specifically getting a lot more calls into the office from our patients, but more women who are seeing us for prenatal care are asking us while they are there for their appointment — main concerns are travel to the south and should they postpone," said Dr. Jeanne S. Sheffield, director of the Division of Maternal-Fetal Medicine at Johns Hopkins Medicine.

"I am also getting more calls from private physicians about how they should counsel the patients regarding summer travel," she said.

The CDC says the first line of defense is avoiding travel to places where Zika is actively spreading, a list that includes about three dozen countries mostly in South and Central America and the Caribbean, including the U.S. territory of Puerto Rico.

Women of child-bearing age, or who are pregnant, who travel to these areas should avoid going outside, and cover their skin and use repellent if they do to avoid mosquitoes. They also should refrain from sex or use contraception during the trip and for two months after. They should also avoid sex or use contraception with men who have traveled to these areas for six months.

Even with the precautions, Zika "is something of a moving target," said Dr. Roberta DeBiasi, chief of the Division of Infectious Disease for the Washington-based Children's National Health System.

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"When advice changes, people may say the CDC doesn't know what it's doing, but the advice changes because we analyze more cases and update recommendations," she said. "This is not a disease like malaria where we have 100 years of experience."

DeBiasi points to CDC advice to cover up this summer, stay in air-conditioned or screened rooms and use repellent approved by the Environmental Protection Agency. Products with DEET and picaridin are safe for pregnant and breast-feeding women and children older than 2 months. Oil of lemon eucalyptus is an alternative to conventional repellent but is not recommended for children under 3. The CDC advises applying sunscreen and then repellent.

Health officials also urge clearing standing water where mosquitoes can breed in trash receptacles, flower pots and other containers every five days. Cover drains and rain barrels with netting or even stockings.

DeBiasi added that border states like Florida are likely to have the first cases of locally transmitted Zika, so it's "reasonable" to avoid them, too.

The Aedes aegypti mosquito, the main carrier of Zika in affected countries, has not been found yet in Maryland this year, according to state agriculture officials. Aedes albopictus, the tiger mosquito, is more common in the state. They are considered less-efficient Zika carriers, "but there's no reason we could not have spread in the U.S. from them," DeBiasi said.

Dr. Leana Wen, the Baltimore health commissioner, is more pointed, saying Aedes albopictus poses a real threat because it needs so little water to breed — an upturned bottle cap is large enough. Baltimore, which sees 9,000 pregnancies a year, could be hard-hit, she said.

"It's not the Eastern Shore that will really be affected when it comes to Maryland," Wen said of Zika. "It's going to be Baltimore."

For now, Zika infections are limited to people who have traveled, and those afflicted may or may not exhibit symptoms. Most people don't even realize they are infected, but in about one in five cases develops symptoms such as rash, fever, red eyes and joint pain.

The full extent of the epidemic is unknown because of spotty testing in some countries. In the United States, testing is done in labs at the CDC and in some states, including Maryland. Local health departments are helping doctors determine whom to test, said Dr. David C. Rose, deputy health officer for the Anne Arundel County Department of Health.

The CDC said Friday that officials have changed the way they count infections in pregnant women by including those with any laboratory evidence of a recent Zika infection even if they have no symptoms or complications. That significantly increased the number under surveillance because most of the infected don't recall symptoms.

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Fewer than a dozen women suffered miscarriages or delivered babies with birth defects nationally, though many of the women are still being monitored because they remain pregnant, said Dr. Margaret Honein, chief of the birth defects branch of the National Center for Birth Defects and Developmental Disabilities, part of the CDC.

Early detection through blood tests and monitoring of fetuses through imaging can help women not only prepare for a disabled child but give them time to decide whether to end the pregnancy, DeBiasi said.

DeBiasi uses specialized equipment for monitoring fetuses and newborns and already has seen women with Zika. She and others outlined in the New England Journal of Medicine an early case of a woman who was infected while traveling when she was 10 weeks pregnant.

She developed symptoms and went for testing. Six weeks later there was evidence her fetus was brain-damaged. The woman terminated the pregnancy at 21 weeks when the severity of the damage became clear. Such cases, she said, are "putting fear in pregnant women."

While the prospect is scary, many local women said they are remaining calm and focusing on prevention.

"It's a risk, but there are other things that are risks that we encounter in our daily lives," said Tracy Schoenbauer, an Arnold women who is 27 weeks pregnant.

She attended a recent Anne Arundel County Health Department seminar on Zika with her husband, Brad, and is using a pregnancy app on her phone to collect more information.

"Everyone pregnant now wants to know at what point, what trimester, are you safe — is the second or third safer?" she said. "They still don't know. I just want to prevent it now. I'm using lots of bug spray and staying inside. I won't be going to Florida or Puerto Rico or the Virgin Islands."

Nikki Whelley, a Crownsville women who is 29 weeks pregnant, said she also is staying informed. She and her husband, Patrick, checked to ensure their neighborhood would be sprayed for mosquitoes.

"It's good to get information from people who know," said Whelley, who also attended the Health Department seminar. "We'll try not to worry and try not to get bit."

While Laura and Rob Cancelliere canceled their Aruba trip, they still plan to travel to Antigua in July for their honeymoon. There have not been cases of Zika reported there yet, but they plan to stay up on the news and stay in touch with their doctors.

Kaysha Curro said she'll do the same, monitoring for developments about Zika and other mosquito-borne diseases. She believes she'll deliver her baby before the virus begins transmitting here widely.

"I'm not hugely concerned at this point," she said. "But there's so much they don't know about Zika."

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