Zika from the Front Lines

Q & A with Nahida Chakhtoura, M.D., Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development

The National Institutes of Health, along with researchers in Brazil, began a multi-country study last month in Puerto Rico to examine the health risks of Zika virus on pregnant women and the developing fetus. The Zika in Infants and Pregnancy (ZIP) study aims to enroll as many as 10,000 pregnant women ages 15 years and older at up to 15 sites across Latin America and the Caribbean.

Dr. Chakhtoura, who oversees the ZIP study for NICHD, recently returned from Puerto Rico, where she met with women who have enrolled in the ZIP study at the at the University of Puerto Rico Medical Sciences campus. Investigators hope to enroll 400 pregnant women there by the end of the year.

Launching the Zika in Infants and Pregnancy (ZIP) Study

Read the Launching the Zika in Infants and Pregnancy (ZIP) Study text alternative

Q: What was the purpose of your visit?

A: The visit gave us a first-hand look at possible obstacles and challenges of conducting the ZIP study in Zika-endemic areas. This was a chance for me to meet pregnant women who have been infected with Zika virus. I also had the opportunity to meet with the investigators overseeing the research in Puerto Rico.

Q: What did you learn?

A: There is a rapid increase in new Zika cases among pregnant women in Puerto Rico. The U.S. Centers for Disease Control and Prevention estimates there are about 115 new cases of Zika among pregnant women each week. We encouraged our two main investigators to expedite enrollment in the study and expand the number of clinics where women can enroll. I also was happy to see that more information is available to pregnant women. The women we spoke with said they didn’t believe Zika was actually an illness, at first. There was mistrust because they didn’t know anyone who had it. With an increase in reported cases, the women are now more informed.

Q: What was your impression from visiting the clinic?

A: For me, listening to the women enrolled in the study made this research very real. I’ve been working on Zika for over 6 months now, but hearing the women speak about their fears, their experiences, the unknown, gave me a close-up view of their worries. It was palpable. One woman spoke about trying to remain positive throughout her pregnancy, despite being told initially that she might have dengue infection, only to find out she had Zika. She was induced after doctors noticed complications with her amniotic fluid. A long, arduous delivery filled her with multiple hours of anxiety.  Finally, when her baby’s head emerged, she exhaled with relief as there were no signs of microcephaly, or an abnormally small head.

Q: As you move ahead with studies in other countries, will you implement any changes based on your experience in Puerto Rico?

A: Our visit certainly reinforced the need to incorporate Zika-related education and counseling support of women, partners, and families every time they interact with the medical system.

Q: What’s next?

A: On September 22 -23, the experts in the field and researchers from around the world and here at NIH will gather in Bethesda, Maryland, to discuss the long-term effects of Zika on child development. It’s so important that the scientific community identifies gaps in our understanding of the effects of Zika on pregnancy, pregnancy outcomes, and the best way to care for the generation of children exposed to the virus in the womb.

For more information about this meeting, visit https://www.nichd.nih.gov/about/meetings/2016/Pages/092216.aspx

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