Travel: Family friendly and Zika-free

By Dr Jennifer Sisson*

Are you pregnant or do you and your partner plan to start a family soon?
If so, do you intend to travel overseas this year?
If you answered ‘yes’ to both of those questions the list of places considered safe for you to visit is shrinking rapidly due to the Zika virus.
Worrying developments continue to keep the mosquito-borne virus firmly in the headlines.
Evidence is becoming stronger that the virus is linked to a sharp increase in cases of microcephaly among infants born to Zika-infected mothers in tropical Latin America and the Pacific islands, along with other neurological conditions.
Microcephaly causes babies to be born with a smaller-than-normal head and is likely to result in lifelong brain damage.

Pregnant? Avoid Zika–infected regions

In recent weeks, news of other possible severe outcomes from Zika and the potential for person-to-person transmission during sex has also surfaced, while the virus continues to spread to new countries across both regions.
As a result, the WHO and experts from around the world now advise pregnant women to postpone non-essential travel to the 37 countries or territories with active Zika virus transmission in South and Central America, the Caribbean, and the Pacific islands.
There is no Zika vaccine or prevention medication. The best way to avoid any potential health risks associated with Zika is simply to avoid places where it’s occurring.
Don’t visit them and you can’t get bitten by mozzies that might pass on Zika (not to mention dengue, chikungunya, malaria or any of the other diseases spread by mosquito bites in tropical and sub-tropical areas of the world).

Three Zika-free travel ideas

But, the news isn’t all bad for pregnant women, their partners, or couples looking to start a family, wishing to travel overseas.
In fact, we have some travel ideas for them and anyone wanting a holiday free from the threat of Zika.
Pick a country with no Zika – There are plenty of Zika-free destinations, including the USA and Canada, any of the countries of Europe, New Zealand, and, perhaps surprisingly, even a few parts of Asia (Taiwan, Japan, or China anyone?). Some of these countries are reporting traveller-imported Zika cases and some even have seasonal dengue and chikungunya, too. But, most have only isolated populations of Aedes mosquitoes, so that local transmission is limited to certain areas and times of the year. Given their high levels of disease monitoring and surveillance, along with rigorous mosquito control measures, Zika may yet be kept at bay. We’ll keep you posted.
Head for the high country – Some of the countries where Zika is occurring may still be safe to visit. For instance, local cases of Zika are occurring in Mexico, but not in Mexico City. Similarly, Ecuador has recorded local cases, just not in its capital, Quito. The reason? Both Mexico City and Quito are well above 2000m, which is pretty much the upper limit for Aedes aegypti, the main Zika-transmitting mosquito species. America’s national health authority, the Centres for Disease Control and Prevention, last week updated its travel advice on Zika, removing destinations above 2000 meters. After analysing 50 years of dengue outbreaks, the CDC’s scientists found that only 1% of cases occurred above that elevation. As a result, for the 37 travel destinations for which the CDC had already issued Level 2 travel alerts – meaning visitors should practice enhanced illness prevention precautions – the agency added elevation maps. They show areas above 2000m that are now exempt from level 2 precautions, including Mexico and Ecuador. (In some areas you can fly directly in to these higher altitude areas, such as Quito. Others require you to fly into a low altitude area – where there could be potentially at risk of Zika – before connecting with flights to a higher altitude. Further, some lofty destinations, particularly those above 2500m, may present other potential risks for the pregnant traveller: Discuss these with your GP, obstetrician or travel doctor.)
Take an island cruise (without leaving the ship) – right now, the safest cruise destinations for pregnant women or couples trying to fall pregnant are those with no risk of Zika, such as southern regions of Australia, New Zealand, Alaska, the Mediterranean, or other parts of Europe. At any of these you could safely go ashore. Pacific cruises are extremely popular with Australians, but destinations such as Fiji, Marshall Islands, New Caledonia, Samoa, and Tonga are among those island nations with current active Zika transmission. However, it may be possible to include them on your Pacific cruise itinerary if your ship anchors well offshore and you don’t leave the vessel. Mosquitoes only travel up to 200 metres from where they hatch, making ships anchored well offshore safe from the blood-sucking predators. Staying aboard the vessel is the safest solution for both you and your partner. Even a quick excursion ashore could be risky: the daytime-feeding Aedes aegypti and Aedes albopictus species are capable of transmitting Zika, dengue, and chikungunya, and they’re found around docks and in nearby commercial and urban areas – basically, anywhere people live or work.

Advice on timing your pregnancy

If travel to a Zika-infected area is unavoidable, British experts advise women who are not pregnant to avoid becoming pregnant while there and for 28 days after their return home. This allows for a maximum 2-week incubation period (the time between exposure to an infection and the appearance of the first symptoms) and a possible 2-week period of viraemia (the presence of the virus in the bloodstream).
Public Health England (PHE) recommends that men who return from a Zika-infected region with no symptoms should not father a child for a month, while a man with symptoms should avoid doing so for 6 months to avoid any potential complications.
Public Health England and the National Travel Health Network and Centre have been carefully monitoring the evolving Zika virus outbreak, especially in South and Central America and the Caribbean, and have issued updated travel advice for pregnant women and advice on preventing sexual transmission.
It is must-read information for pregnant women, their partners, or couples planning a family and overseas travel in the near future.
For the time being, the best advice is to put countries with active Zika travel on your travel Bucket List to visit once the present danger has passed.

* Dr Sisson is the acting Medical Director of Travelvax Australia.


Find out if Zika or other mozzie diseases could be a health risk at your destination by calling Travelvax Australia’s travel health advisory service on 1300 360 164 (toll-free from landlines). You can also make an appointment for a pre-travel medical consultation, any vaccinations needed for the trip and personalised advice from medical professionals experienced in travel medicine.
Read more on insect-borne viruses commonly found in the tropics, including denguechikungunyamalaria and yellow fever.