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The World Health Organization (WHO) reports that the Zika virus has now spread through both South and Central America and expects 3-4 million people to be infected in 2016.
So what is the Zika virus and what steps can you take to protect yourself? Answers below.
What is the Zika virus?
The Zika virus is a mosquito-borne infection, which isn't harmful in most cases. However, it may be harmful for pregnancies, as it's been potentially linked to birth defects – specifically, abnormally small heads (microcephaly).
It was first detected in the Zika forest of Uganda in 1947, and has circulated in Africa and South and South East Asia without many documented outbreaks reported. In the last few years, Zika outbreaks have been reported in the Pacific region, and the virus has now spread to South and Central America, and the Caribbean. WHO has warned that Zika virus is likely to spread to all countries in the Americas where the climate is suitable for the affected mosquitoes. Currently, this is thought to be all the countries in the Americas (including the Caribbean) with the exception of Chile and Canada.
ZIKV does not occur naturally in the UK. However, as of 10 February 2016, a total of 7 cases have been diagnosed in UK travellers.
What symptoms does the virus cause?
Most people don't have any symptoms. If symptoms do occur, they are usually mild and last around two to seven days. Commonly reported symptoms include:
How does the Zika virus spread?
Most cases of the Zika virus are spread by infected mosquitoes biting humans. Unlike the mosquitoes that spread malaria, affected mosquitoes (the Aedes mosquito) are most active during the day (but especially during mid-morning and late afternoon to dusk).
There has been one case where Zika virus may have occurred through sexual intercourse and a small number of cases have occurred by transmission from an expectant mother to her unborn child via the placenta.
How do I reduce my risk of contracting the Zika virus?
Before travelling, seek travel health advice from your GP/practice nurse or a travel clinic ideally six to eight weeks before you go. Detailed travel health advice for your destination is also available from the National Travel Health Network and Centre (NaTHNaC) website or the Scottish travel health service fitfortravel.
To reduce your risk of infection with Zika virus, you should avoid being bitten by an Aedes mosquito. The most effective bite prevention methods, which should be used during daytime and nighttime hours, include:
What risks does the Zika virus pose in pregnancy?
There is evidence to suggest that pregnant women who contract the virus during pregnancy (at any trimester) may have an increased risk of giving birth to a baby with microcephaly (this means an abnormally small head and can be associated with abnormal brain development).
Current advice is that women who are pregnant or planning to become pregnant should discuss their travel plans with their doctor and if already pregnant to consider postponing travel to any region where a known outbreak of the Zika virus is occurring. If travel is unavoidable then they should take scrupulous insect bite avoidance measures.
Public Health England (PHE) provides regular updates about the current spread of the disease.
I am pregnant and have visited a country where there is an ongoing Zika virus outbreak. What should I do?
If you are pregnant and have a history of travel to a country where there is an ongoing Zika virus outbreak, see your GP or midwife and mention your travel history even if you have not been unwell. Your midwife or hospital doctor will discuss the risk with you and will arrange an ultrasound scan of your baby to monitor growth.
If you have experienced Zika symptoms either during or within two weeks of returning home, see your GP or midwife or mention your travel history. Your midwife or hospital doctor will discuss the risk with you and will arrange an ultrasound scan to measure your baby’s growth and brain development. If there are any problems you will be referred to a specialist fetal medicine service for further monitoring. If you are still experiencing Zika symptoms your GP will arrange for you to have a blood test to check for Zika virus.
I am trying to get pregnant and have visited a country where there is an ongoing Zika virus outbreak. What should I do?
If you are trying to get pregnant and have a history of travel to a country where there is an ongoing Zika virus outbreak, see your GP or midwife and mention your travel history even if you have not been unwell. It is recommended that you take folic acid supplements for 28 days before trying to conceive.
If you have experienced Zika symptoms either during or within two weeks of returning home it is recommended that you wait at least six months after full recovery before you try to conceive.
Even if you have not been unwell, it is recommended that you wait at least 28 days after you return home from a country where there is an ongoing Zika virus outbreak before you try to conceive.
My partner has visited a country where there is an ongoing Zika virus outbreak. What should I do?
Sexual transmission of Zika virus has occurred in a small number of cases, but the risk of sexual transmission of Zika virus is thought to be very low. If your partner has travelled to a country where there is an ongoing Zika virus outbreak, condom use is advised:
For advice on the options available to you on other methods of contraception, speak to your GP or community sexual health clinic.What if I am worried that my baby has been affected by the Zika virus?
Speak to your midwife or doctor for advice. If you are still concerned after receiving assurances from your healthcare professional and feel anxious or stressed more than usual, you can ask your GP or midwife for referral to further counselling.
How is the Zika virus diagnosed and treated?
The Zika virus can be diagnosed with a blood test in people who are currently/actively displaying symptoms of Zika virus infection.
There is no specific treatment for the symptoms of the Zika virus. Drinking plenty of water and taking paracetamol may help relieve symptoms. The use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is not recommended, as there is a potential risk they could trigger excessive bleeding.
If you feel unwell on return form a country with an ongoing outbreak of Zika virus, but which also has malaria, you should seek urgent (same day) advice to help rule out a diagnosis of malaria.
If you remain unwell and malaria has been shown not to be the cause, seek medical advice.
"Babies given paracetamol are nearly a third more likely to develop asthma," the Mail Online reports.
The study the news is based on also found a link between maternal use of the painkiller in pregnancy, and childhood asthma.
Pregnant women are advised not to take medicines if possible, but paracetamol is recommended as the best option if painkillers are needed to reduce a fever, because there is little evidence it can cause harm to the baby. Paracetamol is also recommended if painkilling or temperature reduction medicines are needed for babies.
However, recent research has found a potential link between paracetamol and asthma. This study set out to investigate the link further.
The researchers found paracetamol was linked to childhood asthma, both in cases when it had been taken by the pregnant woman and by the young baby (less than six months old). The study estimated that infant exposure to paracetamol increased the asthma risk by 29% and exposure in pregnancy led to a 13% increase; though this estimate was borderline significant.
They also found that the reason for taking the medication did not affect the chances of asthma. This suggests the increased chance of asthma may be due to paracetamol, not to the illness it is used to treat.
The results of this study will probably need to be replicated in larger populations before official advice on paracetamol use in pregnancy and infancy are changed.
Where did the story come from?
The study was carried out by researchers from the Norwegian Institute of Public Health, the University of Oslo and the University of Bristol and was funded by the National Institutes of Health, the Norwegian Research Council and the Norwegian Extra Foundation for Health and Rehabilitation.
Most of the UK media reported the study's findings accurately, but as is so often the case, the headline writers overstated the findings. A link between paracetamol use and asthma has only been suggested, not proven.
What kind of research was this?
This is a cohort study, which is a good type of study for investigating links between factors – in this case, between taking paracetamol in pregnancy or infancy, and children developing asthma. However, cohort studies cannot prove that one thing causes another. They can only show there is a link, and investigate factors that may or may not have affected the results.
What did the research involve?
Researchers took information about 114,761 children born in Norway between 1999 and 2008, and analysed it to look for links between paracetamol use and childhood asthma at the ages of three and seven.
They adjusted their figures to take account of the illnesses that paracetamol had been used to treat, and other factors that might have affected the results. They then calculated the relative risk (RR) of the child having developed asthma.
The researchers included data on:
Women in the study were asked about their own paracetamol use, and the reasons for it, at 18 and 30 weeks of pregnancy. When the child was six months old, the women were asked whether they had given paracetamol to the child, and if so what for.
The researchers checked whether the type of illness people took paracetamol for – pain, high temperature or chest infection/flu – had an effect on the child's chances of getting asthma. They also adjusted figures to take account of the mother's age, whether she had asthma, whether she smoked during pregnancy, antibiotic use, weight, education level and number of children.
They also looked for any effect from the father having taken paracetamol, or the mother having taken paracetamol when not pregnant. This is to see whether something else, such as the parents' attitudes to health and medicines, might affect the results.
What were the basic results?
About 28% of the children were born to mothers who had used paracetamol during pregnancy only, and 15% had taken paracetamol in the first six months of life only. A further 19% had been exposed to paracetamol both in the womb and in the first six months of life. A total of 5.7% of children had asthma at three years of age.
The researchers found "modest associations" between the use of paracetamol and childhood asthma, both for use during pregnancy and use by the child during the first six months of life.
Women who used paracetamol during pregnancy but did not give it to their infant were 13% more likely to have a child with asthma by age three (relative risk (RR) 1.13, 95% confidence interval (CI) 1.02 to 1.25).
A child was 29% more likely to have asthma at age three if the child had been given paracetamol before six months of age but was not exposed to it during the pregnancy (RR 1.29, 95% CI 1.16 to 1.45). While they were 27% more likely to have asthma with exposure during pregnancy and the first six months of life (RR 1.29, 95% CI 1.14 to 1.41). Results were similar for asthma at age seven.
The researchers said their results did not change when they adjusted them to take account of the reason for the medication. They found no link between the father's use of paracetamol or mother's use outside of pregnancy, and asthma in the child.
How did the researchers interpret the results?
The researchers say their study "is by far the largest study to provide evidence that prenatal and infant paracetamol exposures have independent positive associations with asthma development" – in other words, that the study found paracetamol was linked to a higher chance of getting asthma.
They go on to say their findings "suggest that the associations cannot be fully explained" by other factors, such as the illness that the mother or baby was taking paracetamol for.
"Paracetamol is the most commonly used analgesic among pregnant women and infants, and uncovering potential adverse events is of public health importance," they say.
This study tells us more about a potential link between paracetamol and childhood asthma. Other studies have suggested that taking paracetamol in pregnancy, or giving it to babies, might increase the risk of the child getting asthma, but this study gives more detail.
One strong possibility before this study was published was that the problem was not paracetamol, but the reason for taking it – for example, that the baby's asthma was linked to the mother or baby having a chest infection, not to the medicine they took to relieve it. However, this study tests that possibility and finds that it cannot completely explain the link to paracetamol.
There are some weaknesses in the study. It relies on the mother's report of paracetamol use and whether their child has asthma, which might not be reliable. It is possible that women who decided to take paracetamol while pregnant might have been more ill than women who had that illness but didn't take medication, which might have affected the results. Another major limitation is that the study did not determine the amount or frequency that paracetamol was taken either by the mother or the infant, so we do not know how this might affect the risk.
However, it is a large study and the researchers carried out checks to make their findings as reliable as possible. While a cohort study can never confirm that one thing causes another, it does seem likely that there is a link between asthma and paracetamol.
It's important to remember that the relative increase in risk of asthma, especially for women taking paracetamol during pregnancy, is quite low. The researchers say that advice on paracetamol use for pregnant women and babies does not need to change as a result of their study.
Women in the UK are advised that paracetamol is the preferred choice to treat mild or moderate pain, or high temperature. They are advised to take paracetamol at the lowest effective dose, for the shortest possible time.
Babies can be given paracetamol to treat high temperature or pain if they are over two months' old. Check the packet or information leaflet for information about the correct dose.
Ibuprofen can be given for pain and fever in children of three months and over who weigh more than 5kg (11lbs) and, again, check the recommended dosage.
Links To The Headlines
Babies given paracetamol are nearly a THIRD more likely to develop asthma. Mail Online, February 10 2016
Pregnancy health warning: Paracetamol could cause asthma in unborn babies. The Sun, February 10 2016
Pregnant women who take paracetamol more likely to have babies with asthma. Daily Mirror, February 10 2016
Links To Science
Magnus MC, Karlstad Ø, Håberg SE, et al. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study. International Journal of Epidemiology. Published online February 9 2016
"No safe way to suntan, new NICE guidance warns," BBC News reports. The guidelines, produced by the National Institute for Health and Care Excellence (NICE), also stresses the benefits of moderate sun exposure.
This will help prevent vitamin D deficiency; which is more common in the UK than many people realise. It is estimated that around one in five adults and older children (aged between 11 and 18) have low vitamin D status. The figure is around one in seven for younger children.
What are the risks of overexposure?
Sunlight contains ultraviolet A (UVA) and ultraviolet B (UVB) radiation, both of which can be harmful to the skin. (The guidelines do not discuss artificial sources of UV light, such as sunbeds, but these are also thought to be harmful).
Risks of overexposure to sunlight include:
Non-melanoma is a leading cause of disfigurement, with an estimated quarter of a million cases occurring each year in the UK. Melanoma is a leading cause of cancer deaths in younger adults. More than 2,000 people die every year in the UK from melanoma.
Overexposure can also cause premature ageing of the skin, which can lead to signs and symptoms, such as :
Groups of people particularly vulnerable to overexposure include:
Preventing overexposure Avoid strong sunlight
Avoid spending long periods of time in strong sunlight. The sun is at its strongest from 11am to 3pm from March to October. It can also be very strong and have potentially damaging effects at other times. Even if it is cool or cloudy, it is possible to burn in the middle of the day in summer.Wear suitable clothing
Skin should be protected from strong sunlight by covering up with suitable clothing, finding shade and applying sunscreen.
Suitable clothing includes:
When buying sunscreen, make sure it's suitable for your skin and blocks both ultraviolet A (UVA) and ultraviolet B (UVB) radiation.
The sunscreen label should have:
Most people do not apply enough sunscreen. The amount of sunscreen needed for the body of an average adult to achieve the stated sun protection factor (SPF) is around 35ml or six to eight teaspoons of lotion.
If sunscreen is applied too thinly, the amount of protection it gives is reduced. If you're worried you might not be applying enough SPF15, you could use a stronger SPF30 sunscreen.
If you plan to be out in the sun long enough to risk burning, sunscreen needs to be applied twice:
Sunscreen should be applied to all exposed skin, including the face, neck and ears (and head if you have thinning or no hair), but a wide-brimmed hat is better.
Water-resistant sunscreen is needed if sweating or contact with water is likely.
Sunscreen needs to be reapplied liberally, frequently and according to the manufacturer's instructions. This includes applying straight after you've been in water (even if it is "water-resistant") and after towel drying, sweating or when it may have rubbed off.Advice for babies and children
Take extra care to protect babies and children. Their skin is much more sensitive than adult skin, and repeated exposure to sunlight could lead to skin cancer developing in later life.
Children aged under six months should be kept out of direct strong sunlight.
From March to October in the UK, children should:
To ensure they get enough vitamin D, children aged under five are advised to take vitamin D supplements even if they do get out in the sun. Find out about vitamin D supplements for children.Avoid tanning
There is no healthy way to tan. Any tan can increase your risk of developing skin cancer. Getting a tan does very little to protect your skin from the harmful effects of the sun. The idea that there is such a thing as a healthy tan is a myth.
The British Association of Dermatologists advises that people should not use sunbeds or sunlamps.
Sunbeds and lamps can be more dangerous than natural sunlight, because they use a concentrated source of ultraviolet (UV) radiation.
UV radiation can increase your risk of developing melanomas. Sunbeds and sunlamps can also cause premature skin ageing.
If you do want browner looking skin then fake tan is the way to go.
Sunlight and vitamin D
Vitamin D is essential for healthy bones, and we get most of ours from sunlight exposure.
We need vitamin D to help the body absorb calcium and phosphorus from our diet. These minerals are important for healthy bones and teeth.
A lack of vitamin D – known as vitamin D deficiency – can cause bones to become soft and weak, which can lead to bone deformities. In children, for example, a lack of vitamin D can lead to rickets. In adults, it can lead to osteomalacia, which causes bone pain and tenderness as well as muscle weakness.
Most people can make enough vitamin D from being out in the sun daily for short periods with their forearms, hands or lower legs uncovered and without sunscreen from March to October, especially from 11am to 3pm.
A short period of time in the sun means just a few minutes – about 10 to 15 minutes is enough for most lighter-skinned people – and is less than the time it takes you to start going red or burn. Exposing yourself for longer is unlikely to provide any additional benefits.
People with darker skin will need to spend longer in the sun to produce the same amount of vitamin D.
Groups of people who have little or no exposure to the sun for cultural reasons or because they are housebound or otherwise confined indoors for long periods, may be vitamin D deficient and may benefit from vitamin D supplements.
How long it takes for your skin to go red or burn varies from person to person. Cancer Research UK has a useful tool where you can find out your skin type, to see when you might be at risk of burning.Vitamin D and pregnancy
Pregnant and breastfeeding women should take a vitamin D supplement to make sure their own needs for vitamin D are met, and their baby is born with enough stores of vitamin D for the first few months of its life.
You can get vitamin supplements containing vitamin D free of charge if you are pregnant or breastfeeding, or have a child under four years of age and qualify for the Healthy Start scheme.
Read more about vitamins and supplements in pregnancy
Links To The Headlines
No safe way to suntan, new NICE guidance warns. BBC News, February 9 2016
Don't go out in the sun for over 10 minutes warn health chiefs: Sunseekers told there is no such thing as a healthy tan as they are urged to slap on EIGHT teaspoons of sunscreen. Daily Mail, February 9 2016
No such thing as a safe tan, warn health officials. The Daily Telegraph, February 9 2016
Millions of British sun-worshippers warned there is "no safe way" to get a tan. Daily Mirror, February 9 2016
There's no safe way to get a natural sun tan, says official health guidelines. The Independent, February 9 2016
"'Bionic spine' could enable paralysed patients to walk using subconscious thought," reports The Guardian.
In a study using sheep, Australian researchers have developed a device that can record movement signals from the brain. It's hoped this will eventually lead to these signals being transmitted to other parts of the body.
The spine – specifically, the spinal cord – is essentially a signal cable. It transmits electrical impulses from the brain to other parts of the body. Damage to the spine can result in paralysis.
Restoring this signal process in humans has been described as the "Holy Grail" of bionic medicine, which uses technology and engineering to improve or restore bodily functions.
The researchers implanted the device, called a stentrode, via a blood vessel in the neck and guided it into position in a blood vessel overlying the part of the sheep's brain responsible for movement.
They found the device was able to record signals as the sheep moved around for a period of up to 190 days. These recordings were comparable to the recordings taken from electrodes implanted directly on to the brain.
Accurate recordings may mean this device can be used for people with paralysis to control bionic limbs and exoskeletons in the future.
While this technology is exciting, the usual caveats about early-stage research apply.
The first tests in humans are planned for 2017, and the results will give more of an indication about whether the device could be effective if implanted in humans – and, importantly, whether it would be safe.Where did the story come from?
The study was carried out by researchers from a number of institutions, including the University of Melbourne and the University of Florida, and was funded by grants from the US Defense Advanced Research Projects Agency (DARPA) Microsystems Technology Office, the Office of Naval Research (ONR) Global, and a National Health and Medical Research Council of Australia (NHMRC) Project Grant and Development Grant.
It was published in the peer-reviewed Nature Biotechnology.
The UK media has not reported the technical details and findings of this animal study at length, but the implications of the findings and the direction for future research has been discussed appropriately.What kind of research was this?
This was an animal study where a type of device or stent able to record brain activity (stentrode) was positioned in a blood vessel overlying the motor cortex. This is the part of the brain responsible for muscular activity.
This type of study is useful for the first testing stages of new devices or technologies, but it is not certain these findings will be replicated in humans.
However, the researchers did look for an animal model with blood vessel structures in the brain similar – but not identical – to humans, eventually settling on sheep.What did the research involve?
The researchers used human samples to investigate blood vessel structures in the human brain, and chose an animal model considered to have a comparable structure to human vessels.
The stentrode, or "bionic spine", is a small device fitted with electrodes that can detect signals coming from the motor cortex.
Usually, inserting a device into the brain would require advanced brain surgery to open the skull, which carries the obvious risks of complications, such as postoperative infection.
However, in this study the device was inserted via a blood vessel in the sheep's neck, and was then guided under imaging through a thin tube called a catheter to its target position in a blood vessel overlying the motor cortex in the brain.
This could then record signals for movement. The movement signals coming from the device were validated by comparing them with electrodes implanted on to the brain surgically.What were the basic results?
In brief, the researchers were able to successfully position the stentrode within a blood vessel overlying the motor cortex of the brain, and record brain signals coming from freely moving sheep for a period of up to 190 days.
The content of these recordings was comparable to the recordings taken from electrodes implanted directly into the brain.How did the researchers interpret the results?
The researchers concluded that stentrodes may have wide-ranging applications in the treatment of a range of brain conditions.Conclusion
This early-stage study was conducted in sheep, and aimed to test whether a stentrode could be inserted into a blood vessel overlying the brain using a non-surgical method. Researchers then wanted to see whether the device was able to accurately record movement signals.
Overall, the results were promising. Implanting devices into the brain normally requires surgery to open the skull, which carries the associated risks of trauma, infection and inflammation. Also, devices positioned in brain tissue can be rejected by the immune system.
However, this device could be inserted through a blood vessel in the neck, and was successfully guided into the correct position in a blood vessel overlying the brain. As the results demonstrated, it was then able to record brain signals.
The hope is this device could be used in the future for people with a spinal cord injury – such as those with paralysis – to control bionic limbs and exoskeletons with thought alone.
These signals are still present in the brain, but cannot be transmitted to the limbs. The stentrode would in effect bypass this problem, which is why it has been referred to as the "bionic spine".
A sheep model was used to replicate the structures found in humans as closely as possible. The stentrode technology used is currently in clinical use, which should allow easy transfer from animal models to humans.
However, the sheep used in this study weren't paralysed, so the big test now is whether these signals can actually be transferred into movement instructions.
The Guardian reported the researchers are now set to trial this device in humans at the Austin Health spinal cord unit. The device will similarly be inserted via one of the neck veins and, once implanted, will feed brain signals to another device positioned at the person's shoulder.
This will then translate signals into commands, which will be fed to the bionic limbs using Bluetooth wireless technology to tell them to move.
This technology is exciting and could provide hope for people with a spinal cord injury. But the research is still in its very early stages, and it is too soon to know when, or if, it will become available.
The researchers have planned the first tests in humans next year, and the results will give more of an indication about whether the device could be effective – and safe – in humans.
Links To The Headlines
'Bionic spine' could enable paralysed patients to walk using subconscious thought. The Guardian, February 8 2016
Australia scientists develop 'bionic spine' which could help paralysed patients walk. The Daily Telegraph, February 9 2016
Links To Science
Oxley TJ, Opie NL, John SE, et al. Minimally invasive endovascular stent-electrode array for high-fidelity, chronic recordings of cortical neural activity. Nature Biotechnology. Published online February 8 2016