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CDC issues new Zika guidance; state, federal efforts targeting fetal tissue donation could thwart Zika research

March 31, 2016 — CDC on Friday issued guidance advising men and women who have been exposed to the Zika virus to delay pregnancy, the New York Times reports (Tavernise, New York Times, 3/25).

Background

The Zika virus is a mosquito-borne disease that has spread across Latin America over the past year. Researchers recently learned that Zika can also be transmitted through sexual activity. The virus is not easily diagnosed, and it does not have a cure or vaccine. It also might be linked to the birth defect microcephaly, a condition in which an infant is born with an abnormally small head and brain. The condition is fatal for some infants, while others experience permanent disabilities.

Officials in Brazil and Honduras have issued guidance recommending that women avoid pregnancy. El Salvador's recommendation is that women not get pregnant until 2018. However, many countries in Latin America restrict access to contraception and often ban abortion. In addition, women have been advised to protect themselves against mosquitos, but insect repellant can be unaffordable for low-income women.

The World Health Organization has declared the outbreak and its suspected link to a congenital condition in infants a public health emergency of international concern. Separately, the United Nations High Commissioner for Human Rights issued a statement directing nations affected by the Zika virus to remove bans on access to reproductive health care services (Woman's Health Policy Report, 2/18).

In previous guidance, CDC said women who are pregnant should abstain from sex or use condoms during vaginal, anal or oral sex with male sexual partners who have traveled to a country affected by the Zika virus. CDC also advised pregnant women not to visit affected countries and said women who are trying to become pregnant should talk with their physicians before visiting those locations. In addition, the agency recommended that all pregnant women -- even those without symptoms -- should be tested within two to 12 weeks of returning from an area affected by the virus (Women's Health Policy Report, 2/8).

Latest advisory

CDC last week said a woman infected with Zika or displaying symptoms of the virus should delay attempts to conceive for at least eight weeks after she first presented with symptoms. Men who have been infected or present with symptoms should wait at least six months after the initial symptoms appear before having sex without protection, the agency said.

CDC also advised that men and women who have traveled to Zika-infected regions but who have not been infected or displayed symptoms should postpone trying to conceive by eight weeks. In addition, the agency recommended that people who live in Zika-infected regions discuss the risks of a Zika infection with their physicians. CDC did not advise such women to postpone pregnancy.

Denise Jamieson -- leader of the pregnancy and birth defects team in CDC's Zika response efforts -- said, "We're learning more every day, and evidence of a link between Zika and a spectrum of birth outcomes is becoming stronger and stronger" (New York Times, 3/25).

Advisory spotlights danger in Puerto Rico

CDC on Friday also underscored the risk women in Puerto Rico face of contracting the virus. Researchers said about 138,000 Puerto Rican women who do not want to become pregnant are unable to access effective contraception, which exposes them to unintended pregnancy and possible Zika infection. In Puerto Rico, according to the Washington Post, roughly two-thirds of pregnancies are unintended.

The Post reports that Zika is spreading more quickly in Puerto Rico than in any other U.S. territory. Overall, officials have confirmed 261 cases of Zika infection in the territory, 24 of which involved pregnant women (Sun, Washington Post, 3/25).

Laws targeting fetal tissue donation could restrict Zika research

In related news, medical researchers say federal and state efforts in the United States to prohibit or restrict fetal tissue donation could hinder research into the Zika virus, Politico reports.

According to Politico, Arizona, Florida, Indiana, North Dakota, Ohio and South Dakota are among the 18 states that are considering or have passed measures targeting fetal tissue donation or banning fetal tissue research. Politico reports that Florida, the latest state to pass such legislation, is one of the states most at risk of the virus. Moreover, the Florida regulations also could limit non-Zika research, such as HIV research being conducted at several universities in the state.

At the federal level, conservative lawmakers in a House subcommittee investigating abortion providers recently issued 17 subpoenas seeking identifying information about people involved in abortion care and fetal tissue research, drawing criticism from liberal lawmakers who say such information could expose individuals to antiabortion-rights violence.

Efforts could thwart Zika research

According to Politico, the "clearest evidence yet" of a link between the Zika virus and fetal anomalies came from research conducted on fetal tissue resulting from an abortion. In that research, scientists found that brain damage in fetuses exposed to the Zika virus resulted from the virus, rather than from the reaction of the woman's placenta to the virus.

CDC has not issued an official statement on how measures targeting fetal tissue research might affect efforts to learn about the virus. However, CDC did recently release guidance urging the donation of fetal and infant tissue for Zika research. According to Politico, researchers might require the tissue to discern how the virus affects fetal development and how they might develop tests and treatments for infection.

Patrick Ramsey, an obstetrician at the University of Texas Health Science Center in San Antonio, said, "Basically the only insights we've had so far on Zika is with patients who have either lost a pregnancy or had miscarriages." He added, "This is a situation where the vaccine is going to have to protect" the woman and fetus, so "[f]etal tissue is going to be needed to look at the effects."

Separately, Georges Benjamin, executive director of the American Public Health Association, said, "I think if we're serious about making sure that babies are not affected by the Zika virus, we need to know all we can, and we learn a lot from fetal tissue, as we do with other human tissues."

Alta Charo, a bioethicist at the University of Wisconsin, added, "Given the uncertainty around the effects of exposure while pregnant, halting fetal tissue research might slow efforts to prevent those effects or at least let women know if chances are high or low of serious birth defects."

Robert Golden -- dean of the University of Wisconsin School of Medicine and Public Health, who helped defeat a state initiative to prohibit fetal tissue research last year -- said, "With the horrors of the Zika virus and its almost certain spread to Florida, to me it's unfathomable that anyone there would want to restrict this research ... And this in turn might actually lead more women to choose abortions, out of fear of terrible birth outcomes" (Norman, Politico, 3/27).

Brazil seizes medication abortion

In other related news, the Canadian abortion-rights group Women on Web has temporarily stopped providing medication abortion to women in Brazil after learning that the Brazilian government has been confiscating the drugs, the Los Angeles Times reports (Simmons/Rigby, Los Angeles Times, 3/27).

Women on Web offers advice and medication for women seeking abortion care in countries where the procedure is banned, such as Brazil (Women's Health Policy Report, 2/18). The group said it received 9,500 emails in 2015 from women seeking medication abortion, primarily from Brazil, and another 10,400 emails from Spanish-speaking countries in the Americas. According to Women on Web, the demand for medication abortion has increased as the Zika virus has spread.

The group has been providing medication abortion at no cost to women in Brazil and other Zika-affected countries since Feb. 1. However, Women on Web announced that it was suspending services for Brazil after learning that only two of several dozen medication abortion packages mailed to women in the country had reached their destination. According to the group, the Brazilian government has confiscated 95 percent of the packages. Officials with the Brazilian government confirmed the seizures.

Women on Web is recommending that, if possible, women should arrange to have the medication abortion packages delivered to P.O. boxes in neighboring countries. However, according to the Los Angeles Times, such a strategy is out of reach for most low-income women.

Leticia Zenevich, a spokesperson for Women on Web, called the situation "very tragic."

Abortion-rights advocates in the country also have voiced concerns that women unable to access medication abortion will seek out unsafe abortion care. Sonia Coelho, a spokesperson for the National Campaign for the Legalization of Abortion, said, "We have a situation here in Brazil in which women are having clandestine abortions, and in which women are dying." She added, "This brings consequences ... particularly for [low-income] women and black women, who lack the means to have an abortion in a safer place" (Los Angeles Times, 3/27).