Zika, Rubella, and the Procedure That Shall Not Be Named

By way of Scary Disease Lady (aka ‘Maryn McKenna’), we come across the CDC’s recommendations for pregnant women who might have been exposed to the Zika virus, which has been linked to a twenty-fold increase in microcephaly. This is the part that might cause, to put it bluntly, a political firestorm (boldface mine):

Zika virus RT-PCR testing can be performed on amniotic fluid (7,9). Currently, it is unknown how sensitive or specific this test is for congenital infection. Also, it is unknown if a positive result is predictive of a subsequent fetal abnormality, and if so, what proportion of infants born after infection will have abnormalities. Amniocentesis is associated with an overall 0.1% risk of pregnancy loss when performed at less than 24 weeks of gestation (19). Amniocentesis performed ≥15 weeks of gestation is associated with lower rates of complications than those performed at earlier gestational ages, and early amniocentesis (≤14 weeks of gestation) is not recommended (20). Health care providers should discuss the risks and benefits of amniocentesis with their patients. A positive RT-PCR result on amniotic fluid would be suggestive of intrauterine infection and potentially useful to pregnant women and their health care providers (20).

It’s the phrase “potentially useful to pregnant women and their health care providers” that makes it bureaucratic art; that’s as about as ambiguous as one could get (useful for what purpose?). The other interesting thing is that footnote #20 is just a reference to guidelines for perinatal care, which suggests very little.

In case you’re missing my veiled hints, here’s a clue: it rhymes with Joe b. Made. Here’s what I mean:

In a sense, it’s analogous to rubella in the 1950s and 1960s. The rubella virus, when it infects pregnant women in the first six months of pregnancy causes birth defects. Usually this is deafness accompanied by vision problems and heart defects, though even more serious problems often occur including mental retardation. Today, abortion is recommended in those exceptional circumstances where it does happen. While rubella fortunately isn’t a concern anymore–it’s the “R” in the MMR vaccine–in the pre-vaccine era, it was a terrifying prospect and led to underground acceptance of abortion–it was the circumstance, even though rare, where most people would ‘allow’ an abortion.

For those of you in the slow political implications group, here’s some more:

I find it incredible that the NY Times story–or any of the other coverage I’ve read–doesn’t mention that abortion is illegal in Brazil. It’s not an option at all, even if a woman were to be seropositive for Zika virus. If Zika virus isn’t stamped out, and given the particular mosquito vector that spreads it, that doesn’t seem likely, this disease very well could change Brazil’s no-abortion policy.

Postscript: Zika virus has now been found in Puerto Rico, and doctors there are also discouraging women from getting pregnant. This isn’t just a Brazilian issue any more. Maybe this should be a presidential debate question. Just saying.

As someone last night in the Mad Biologist’s Far-Flung Network of Correspondents noted, imagine if the only healthcare services a woman has access to–and in the era of healthcare consolidation, this is a real concern–is a Catholic-affiliated hospital. Or suppose, in light of the burdens many states place in the way of getting an abortion (and don’t forget the conservative efforts to push the limit in Roe v. Wade back to twenty weeks from twenty-four), that a woman ends up bumping up against the 24 week limit? What then?

Keep in mind, the health of the mother really isn’t an issue (or at least, not any more than most pregnancies). The issue revolves around the possibility of severe birth defects.

You also have to feel bad for the CDC: any guidelines it issues will come under attack.

This could make the Schiavo controversy look civilized. Because a presidential election year always calms things down.

By the way, maybe we could make sure mosquito control efforts are fully funded?

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  1. Pingback: How the Zika Epidemic Could Change Latin America’s Relationship with Abortion | Beautyhealth.science

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