As we continue to learn more about the effects of Zika on the newborn, a new series of abnormalities are making clear the implications of infection for pregnant women.

Zika is a member of the Flavivirus family that includes Yellow Fever, West Nile, and other mosquito-borne illness. The main concern is Zika’s predilection for attacking brain cells, causing some infected fetuses to have poor brain development and head size. The condition, known as microcephaly, can cause lifelong disabilities costing millions of dollars in care over a lifetime.

Now, a new study from researchers in Brazil suggests that Zika causes damage to other nerve cells as well. Seven babies born with microcephaly were studied. Six of these were found to also have a rare condition called “arthrogryposis”.

Usually seen in only one of 3000 births, arthrogryposis causes multiple malformed, stiff joints. The abnormalities may be caused, not by damage to the joints themselves, but by weak nerves that don’t allow passion flexion and extension during the pregnancy. The joint then becomes fixed and deformed, a condition known as a “contracture”.

Damage to the nerves that control vision and hearing are also thought to occur as a result of Zika infection in the womb.

The news comes as the 25th case of locally-transmitted Zika infection is reported in South Florida, where warm weather allows a robust population of Aedes mosquitoes, the species most associated with transmission of the disease. State health officials also announced 14 new cases of travel-related Zika, bringing the total in Florida to 382, of which 57 are pregnant women.

Aerial spraying of an area north of Downtown Miami is the latest effort on the part of the state of Florida to combat spread. Storm drains are also being targeted as possible hotspots for mosquito breeding activity. Although the insecticide Naled appears to be lowering the mosquito count in traps set in the neighborhood, it is also a possible danger to honeybees and other natural pollinators.

A separate local case was reported further north in Palm Beach County, but it’s uncertain at present whether it represents the beginning of a second outbreak.

In other news, a baby born in Texas has died from Zika-related complications, including microcephaly.

Despite the concern of health officials about the virus, a recent WaPo-ABC News poll finds that less than half of Floridians and Texans consider themselves worried about Zika. Apathy may stem from the fact that the acute illness itself is mild, with only 20 per cent reporting symptoms such as fever, joint pain, rashes, and sometimes, red eyes. Another factor may be that Zika is mostly a major issue only for pregnant women or couples that are considering pregnancy.

Protecting against mosquitoes is just common sense. In addition to Zika, West Nile virus, Yellow Fever, Dengue fever, and other diseases are risky. Wearing light-colored, long pants and sleeves while outside and using mosquito repellent is good policy.

EPA-approved products contain DEET, picaridin, or oil of lemon eucalyptus. When using mosquito repellent, don’t forget to:

• Only use small amounts, but reapply if you’re sweating heavily, swimming, or outside for extended periods.
• If you’re using sunscreen and mosquito repellent, apply the sunscreen first. Wait 20 minutes before applying mosquito repellent.
• Avoid spraying near eyes and mouth; spray on your hands and apply. Do the same for children.
• Avoid applying on cuts or areas of skin inflammation.
• Wash the repellent off treated skin once you’ve gone inside; especially, wash your hands before touching food.

DEET, the most common ingredient, should not be used in infants 2 months old or younger.

Joe Alton, MD