Anna-Lisa Paul
Eight months after the Zika virus was first diagnosed in T&T, brain abnormalities have been detected in five unborn babies whose mothers contracted the virus during various stages of pregnancy.
Dr Karen Sohan, medical chief of staff at the Mt Hope Women’s Hospital (MHWH), said “four of these cases were in keeping with anomalies caused by the Zika virus,” whereas in the fifth case where the mother also contracted Zika it might be as a result of “multiple abnormalities in keeping with a genetic syndrome.”
Sohan, who leads the antenatal arm of the national Zika screening programme, confirmed that the pregnant women were infected before the 18th week of pregnancy and at least one of the cases had been detected as late as 25 weeks.
Sohan confirmed that the abnormalities had been detected in the first 100 pregnant women seen at the hospital.
She said the detection of brain abnormalities represented a four-fold increase in the number of central nervous system abnormalities per 100 pregnant women.
Sohan, however, declined to comment on the further management of the affected pregnant women as she cited doctor/patient confidentiality.
“As you can imagine, this is a highly emotional and difficult time for these couples who now have to deal with the news that their most wanted babies are very sick. It is important that we stay focused on the task at hand, which is providing the best healthcare for these most vulnerable women.”
Asked why she had chosen to publicise the information now, she said she was hoping that by sharing the information it will drive home the reality that the Zika virus does affect a developing baby, and citizens need to do their part in eradicating the breeding sites.
This country has recorded 621 Zika cases so far. Of that figure, 392 were said to be pregnant patients. These figures, however, only reflect the diagnoses done in the public health sector and may not include Zika-positive pregnant patients accessing private healthcare.
Following confirmation of the country’s first Zika case in February, Health Minister Terrence Deyalsingh mandated a specialist committee headed by Sohan to develop specific processes and procedures to respond to the diagnosis of the virus in patients, with special attention being paid to pregnant women and developing foetuses.
Pregnant woman testing positive for Zika or displaying symptoms of the virus were referred to the Mt Hope Women’s Hospital for Foetal Medicine Services by Sohan, who performs between 50 and 60 assessments per week, free of charge to patients.
Last week, Sohan sought to reassure the public that every possible measure has been put in place to ensure patients receive the necessary treatment for the virus. Zika symptoms include a rash, fever, generalised pains, and conjunctivitis.
Pointing to countries such as Colombia, Puerto Rico, and Florida, where the authorities have focused on source reduction and organisation of services for affected pregnant patients, Sohan said: “They did not respond by using the epidemic to call for a change in abortion laws in the country.”
On the topic of whether or not couples should delay pregnancy, Sohan said: “As clinicians, we do not have the right to tell a couple not to get pregnant but we are responsible for providing up-to-date information.”
Sohan said it appeared that there is lifelong immunity to the virus, although this is still being studied.
She added: “Couples who choose to delay pregnancy may consider using contraception until the last recorded case, which based on the data from Yap and French Polynesia should be no later than mid-2017.”
Applauding the efforts by the Pan American Health Organisation (Paho) to arrange technical support for the Foetal Medicine Unit, Sohan revealed that the first set of sonographers will be arriving in the country today, and will be in Trinidad for at least a month in the first instance.
Describing them as “suitably qualified ultrasound technicians who are accustomed scanning the babies in utero, including the foetal brain,” one health official said training sessions have been organised to cover gaps exposed by the Zika epidemic such as cranial ultrasounds of the newborn.
Assuring that these training sessions will represent the start of an ongoing programme to ensure local technicians meet international standards, Sohan said Paho had also arranged for a consultant radiologist at the University of San Francisco to provide a second read for suspicious ultrasound images where indicated.
Praising Sohan for her dedication to the patients and the public at large, one senior medical official said: “Dr Sohan performs scans on her personal ultrasound machine on a cupboard outfitted with a single mattress in a very small space.”
Admitting there were drawbacks in the public health system, the official added: “We try not to let these things get in the way we administer care and treatment to patients. At the end of the day, we all have the patient’s care and well-being at heart and delivering the best quality service possible.”
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Facts about microcephaly
According to scientists at the Centres for Disease Control (CDC), microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age.
Babies with microcephaly often have smaller brains that might not have developed properly.
During pregnancy, a baby’s head grows because the baby’s brain grows.
Microcephaly can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size.
Microcephaly can be an isolated condition, meaning that it can occur with no other major birth defects, or it can occur in combination with other major birth defects.
Severe microcephaly is a more serious, extreme form of this condition where a baby’s head is much smaller than expected.
Severe microcephaly can result because a baby’s brain has not developed properly during pregnancy, or the brain started to develop correctly and then was damaged at some point during pregnancy.
Babies with microcephaly can have a range of other problems, depending on the severity of microcephaly.
Microcephaly has been linked to problems such as seizures; developmental delay regarding speech, sitting, standing, and walking; intellectual disability; problems with movement and balance; feeding problems such as difficulty swallowing; hearing loss; and vision problems.