Zika Virus in Brazil: Still Unsafe for Pregnant Women?
November 7, 2018 5:34 PM   Subscribe

We just found out that my wife is pregnant! Yay! The tricky part: She has a work trip to Rio coming up next week (the trip has been scheduled for awhile now). We’re not sure if she should cancel (which would cause a non-trivial amount of issues for her company) or forge ahead and be careful to avoid mosquito bites! Any advice?

The CDC’s website is very clear: pregnant women should not travel to any portion of Brazil. That said, along with Brazil they’ve blacklisted about 40 other countries, which feels super conservative.

The trip will be short (only two nights) and entirely focused on work (no sightseeing or fun stuff planned). She’ll be in hotels and conference rooms most of the time. If she goes, she plans to buy the CDC recommenced mosquito repellent, wear long sleeves/pants, and stay indoors as much as possible.

Right now my wife is leaning towards going. Does that sound reasonable, or are we taking on too much risk?

(Side note: Complicating this a bit more, we’re not really telling people yet about the pregnancy, since it’s so early. As a result, we’re somewhat hesitant to announce to her company that she’s pregnant right now.)
posted by JPowers to Travel & Transportation around Brazil (27 answers total) 3 users marked this as a favorite
How is your relationship with your doctor(s)?

If it’s good, you might ask for the blood/urine test that your wife can take when she gets back to confirm that she’s still Zika free.

However, from what I’ve been told, some doctors will absolutely forbid even considering this kind of travel and be sort of judgey about it.
posted by tinymegalo at 5:47 PM on November 7, 2018 [2 favorites]

People are different, but if I went to Brazil while pregnant, fear would nag at me until my kid hit puberty (apparently even kids not born with microcephaly can have other serious problems down the line). I am fully aware that the risk is small, but I'm the kind of person who stressed out about small risks. It sounds like you and your wife aren't, but if I'm wrong and you're worriers, I wouldn't do it. The risk of zika may be small, but the risk of years of nagging fear could be much larger.
posted by If only I had a penguin... at 6:01 PM on November 7, 2018 [9 favorites]

Meghan Markle just traveled to Fiji (also on the CDC ban list) while pregnant with what's probably the most popular fetus in the world at the moment. That implies to me that going wouldn't be the worst-thing-ever, but Fiji != Brazil, so look into it more.
posted by serelliya at 6:03 PM on November 7, 2018 [3 favorites]

Are you wanting to plan against worst case or optimize for expected outcomes?

Hazard management is a field that people spend their lives researching, and debating what is best practice based on use case and goals.

But to me, it comes down to the first question. If preventing worst case is your goal, don’t go. Ignore CDC at your peril.

If you are fine with gambling bit based on expected outcome and good prophylactic practice, then sure have fun.

Only you know your risk tolerance, only you know how you may respond to a preventable illness with lifelong implications, only you know how much you value serving your company.

Personally, I might go for my own reasons, but I would not risk the health of my potential future offspring for corporate profits, Ymmv.
posted by SaltySalticid at 6:13 PM on November 7, 2018 [14 favorites]

Personally, I wouldn't chance it. Get a doctor's note for work that forbids her from traveling to zika countries.
posted by Brittanie at 6:38 PM on November 7, 2018 [3 favorites]

I’d say don't go if the CDC advises not to. I've always tended to put work first and later found in several instances that all my concern amounted to nothing.
posted by bonobothegreat at 6:38 PM on November 7, 2018 [2 favorites]

There are two components to evaluating risk: the probability of something happening, and the magnitude of the effect if that thing does happen.

So, make sure you're considering both factors. I'm not at all telling you what to do, just giving a framework for thinking about your decision. Bad things that could happen include stuff at work and the repercussions of that, as well as stuff with the pregnancy.
posted by amtho at 6:47 PM on November 7, 2018 [3 favorites]

Zika is so horrific on the fetus that I can't imagine any work justification worth the risk. The CDC doesn't issue such statements casually. I suggest cancelling the trip.
posted by blob at 7:13 PM on November 7, 2018 [21 favorites]

I'm a doctor

If your wife gets Zika, there's a 6-7% chance she'll miscarry or give birth to a child with severe (neurological) birth defects.

Listen to the CDC. Cancel the trip
posted by BadgerDoctor at 7:16 PM on November 7, 2018 [27 favorites]

Amtho makes a very good point. There are competing nomenclatures and controlled vocabularies; here’s a relevant passage from Wikipedia:

Hazards can be dormant or potential, with only a theoretical probability of harm. An event that is caused by interaction with a hazard is called an incident. The likely severity of the undesirable consequences of an incident associated with a hazard, combined with the probability of this occurring, constitute the associated risk. If there is no possibility of a hazard contributing towards an incident, there is no risk.

In that view, the risk aggregates the hazard, the chance of incident, and the expected severity. There are other ways of laying out the terms and concepts, but this framework may be helpful.
posted by SaltySalticid at 8:32 PM on November 7, 2018 [1 favorite]

I might consider thinking about it this way--which would make her feel worse?

1. Cancelling the work trip and having the worst case scenario happen (her company gets VERY upset at her about the cancellation and penalizes her financially or fires her) < -- illegal!


2. Going through with the trip and having the worst case scenario happen (your unborn child either ceases to exist because of a miscarriage or is born with severe health problems that persist for life)

Since both of these worst case scenarios are, if not likely, extremely possible, I would say that you need to be VERY prepared for either.
posted by leafmealone at 9:20 PM on November 7, 2018 [2 favorites]

Even considering the worst possible job outcome (I guess getting fired, although that's illegal)... it's not as bad as losing a wanted pregnancy due to a preventable problem. Or having a baby with no brain. Those two baby-related worst case scenarios really are awful.

Personally I'd take all possible steps to avoid that risk. And I speak as someone who also recently declined a trip to Central America due to my travel companion's pregnancy.
posted by pseudostrabismus at 9:29 PM on November 7, 2018 [2 favorites]

She doesn't have to announce to her company. She should be able to give a vague doctor's note to the boss in private and arrangements should be made without ANY personal medical information being released to anyone outside the need-to-know circle. Again, firing her or demoting her for pregnancy related reasons is illegal.
posted by Crystalinne at 9:46 PM on November 7, 2018 [2 favorites]

I wouldn’t. I’ve been on a trip to Milan before and it was just for work and I mainly stayed in offices and a hotel. I got 3 bites on my legs while checking in and then a whole bunch of bites on my arm in the hotel room. It just takes one of those fuckers.
posted by like_neon at 11:33 PM on November 7, 2018 [4 favorites]

Risking your unborn child’s health for the sake of two nights, for someone else’s (the company’s) benefit? She doesn’t owe her employers that much. Cancel. Her company is not a person whose feelings will be hurt, it’s an institution which deals with the unexpected all the time, and will deal with this and move on. Why would she even consider going? (Not rhetorical, I’m really not clear what the pros are for her of going).
posted by penguin pie at 1:16 AM on November 8, 2018 [22 favorites]

I'm not sure why your wife would consider going. The risk is nonzero that you will be supporting a child with significant special needs for the rest of your lives. As a parent who does this everyday, I'd give a lot for my child to just be healthy and not struggle.

Or try to make work happy? Just as a data point, my boss tells me I need to do stuff for the company all the time. But I know if I quit no one will do any part of my job for 1-3 years while they look for another suitable fit. So I just consistently say no to things. People respect people with boundaries. And my child is totally not going to die or be seriously harmed - I just find those things inconvenient.
posted by Kalmya at 1:21 AM on November 8, 2018 [8 favorites]

This is the first of many parenting decisions you’re going to be making for years to come. What you’ll find is that there are a lot of things that are simply out of your control. But this? This is one risk you can completely avoid! So why wouldn’t you?

If your wife had the flu or resigned your company would have to cope. It would be a minor distruption, then life would go on. Could you say the same if she went to Brazil and actually got the Zika virus?
posted by Jubey at 1:33 AM on November 8, 2018 [1 favorite]

Source: I am an epidemiologist who worked on these warnings. This is not medical advice.

As mentioned above, the risk is the likelihood times the severity. The likelihood that your wife gets Zika is small. The severity is huge. Exposure to Zika virus in the first trimester can lead to miscarriage and a host of other severe and minor complications.

CDC is super conservative on Zika because the severity of the consequences are so high. The likelihood, as you've correctly sussed, is lower. But it's because the consequences are so high that they are so strong about this one.
posted by quadrilaterals at 2:09 AM on November 8, 2018 [30 favorites]

I wouldn't go, but for slightly different reasons than the people above:

we’re not really telling people yet about the pregnancy, since it’s so early.

Right. And if I personally later miscarried, the chances that I wouldn't blame my decision to go to Brazil would be nil. Miscarriage is horrendous and self-blamey enough without the complicating factor of not being able to say it actually wasn't one's own fault.
posted by DarlingBri at 2:14 AM on November 8, 2018 [9 favorites]

I have had a child who had she lived, would have had profound challenges. So I don’t know what it’s like to parent in that situation day in and day out but I do know what it’s like to have to make decisions around that. We removed my daughter from life support. I would at the very least be sure that as a couple you have the following discussions:

- would she get a blood test on return? How reliable is it?
- what would your decision be if that test came back positive? If it would be termination, what are the laws and practicalities in your area? This is your wife’s body so she gets the most say, but there are consequences for you both.
- how would you feel if you continued the pregnancy and later tests showed Microcephaly or other issues? (Note: this is always possible anyway)
- how do you each cope with grief?
- how well-positioned are you (financially, emotionally) to handle any issues arising from diagnosed or undiagnosed Zkia exposure?
- how much sleep will you lose for the next 3 years if she goes?

It’s early but it’s the first of many times that as parents you are going to struggle with balancing your responsibilities. I personally would not go. A 6-7% risk to my child’s lifelong health and abilities after one mosquito bite, plus all the worry, does not feel right to me.
posted by warriorqueen at 3:31 AM on November 8, 2018 [9 favorites]

forge ahead and be careful to avoid mosquito bites!

I don't think that's a thing that you can control 100%. Please listen to the epidemiologist! Even if the risk is small, if Zika were to be contracted you would never, ever feel like it was a risk you should have taken. Save yourself this mental arithmetic. Every single person at the workplace who is a decent person will completely understand. I would actually feel sick myself if I knew a co-worker risked a trip to Brazil while newly pregnant.
posted by LKWorking at 7:29 AM on November 8, 2018 [3 favorites]

If this is your first, be mindful that a change is about to happen to you after your child is born. You will worry about everything all the time. I was not a worrier before our child was born, but the first 100 days of our little guy's life was the most emotionally intense thing I've been through. And he was a healthy, thriving little guy from day one.

Had my wife exposed herself to zika on a business trip, I would have had an additional layer of worries to agonize over. Zika has been around for a while, but the research is pretty sparse. There's a lot we don't know. Why subject yourself to that?

It's hard to know how prevalent Zika is, since people don't often seek treatment for it. But just because the headlines have died down doesn't mean the risk has.

Your wife should put a bit of thought into how she might be helpful to her employer, if she decided not to go. She should inform them as soon as possible, offer to help get her replacement up to speed, and be available at the office, or by phone or videochat or whatever should she be needed by her replacement in Brazil.

Here is a pretty fair article about what's going on with Zika in the Caribbean now. "Dr. Jennifer Butt, who owns a small private practice on Manhattan’s Upper East Side says, “It’s too premature for me to change my recommendations,” she told me, citing that no reputable group—not the American College of Obstetricians and Gynecologists, not the Society for Maternal and Fetal Medicine, nor the CDC—has changed its stance on Zika."
posted by thenormshow at 7:47 AM on November 8, 2018

I've literally never been glad, in the long run, about sacrifices I've made that cost me personally and benefitted my employer. Every time, it was the wrong decision.

Even just the worry is enough of a cost here to make this the wrong decision; and that's not even factoring the potential actual horrific cost.
posted by fingersandtoes at 7:59 AM on November 8, 2018 [17 favorites]

Also, I may be speaking in ignorance and we have experts on this thread, but if I remember, part of why Zika was initially so devastating was that it moved into an area where people hadn't been exposed as children, and so women contracted the virus for the first time while pregnant.

So I can see the risk going down in countries where it's now endemic, because as women sort of age through the process they will have contracted it prior to pregnancy. But if you are coming from an area where Zika isn't something you would catch, then your own risks would be higher than people living in that region.

I hope that makes sense.
posted by warriorqueen at 8:00 AM on November 8, 2018 [3 favorites]

What's the risk of a child with microencephaly would you guys be willing to take for any reason? If it's zero, she shouldn't go. Microencephaly is a common result in zika infection (30% of infected pregnancies), more likely to happen in the first 3 months of pregnancy, and 80% of zika cases are asymptomatic. There were more than 7,000 reported cases this year in Brazil but nobody knows how many for sure (see asymptomatic above). (ref in Portuguese)

I can't even imagine how unpleasantly scary this trip would be.
posted by TheGoodBlood at 9:27 AM on November 8, 2018

Guyagonalize went to Brazil on a work trip while I was pregnant and my doctors were super anxious about that. He was armed to the teeth with heavy duty insect repellent and in a reasonably low risk area, but my doctors only relaxed a little after reassuring them multiple times that not only was I not going, I would not even be in the same state as him for awhile after he returned. Even then we endured ongoing earnest reminders to only engage in protected sex until well after the baby was born. Our baby was perfectly fine, but it was definitely an unwelcome layer of stress to the whole experience.
posted by Diagonalize at 10:08 AM on November 8, 2018

Response by poster: Update: We canceled the trip, largely due to the feedback here. Thanks to everyone for the thoughtful comments.
posted by JPowers at 5:42 AM on November 10, 2018 [3 favorites]

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