February 8, 2016
Dr. Virender Sodhi MD (Ayurved), NMD, Priya Walia MS (Ayurveda), NMD
A Newfound “Zika Virus” and the Potential Correlation to Microcephaly
Recent health reports regarding this new found Zika virus have created waves in the United States and Latin American countries. This flavivirus is transmitted by Aedes aegypti mosquitoes.
Aedes aegypti is also responsible for causing dengue and chikungunya fevers. While about 80% of those infected are asymptomatic, common symptoms of the Zika virus include: acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. Such symptoms last up to one week, where hospitalization is not common and fatality is rare.
However, recent health news reports have made claims regarding the potential link between Zika virus and fetal danger in the development of microcephaly.
Microcephaly, a decreased head circumference, is often the result of abnormal brain development and leads to long-term developmental delays including mental and motor defects such as cerebral palsy. Other causes of microcephaly include chromosomal abnormalities, drug/alcohol exposure, environmental toxins, premature fusion of skull bones (known as craniosynostosis), and other metabolic conditions.
Zika virus gets its name from Zika forest in Uganda, where this virus was accidentally discovered while studying Aedes aegypti for yellow fever. Zika virus is known to infect monkeys.
In early 2015, a Northeast Zika virus RNA strain was found in the amniotic fluid of two pregnant women in Northeast Brazil. The fetuses had shown development of microcephaly in prenatal ultrasounds. Could there be a correlation to this virus and the development of fetal maldevelopment?
It should be noted that historically, the prevalence of microcephaly in Brazil was about 0.5 cases per 10,000 live births. More than 3,000 suspected cases (approximately 20 cases per 10,000 live births) of microcephaly were reported to the Brazil ministry of health during the second half of 2015. This sudden increase in microcephaly warrants further investigation of the cause.
After investigation by the Brazil Ministry of Health, out of the 35 infants with microcephaly born during August and October 2015, 25 (71%) had severe microcephaly, 17 (49%) had at least one neurologic abnormality, and all 27 infants had neurological abnormalities. This poses a possible correlation between the Zika virus and pregnant women.
The CDC tested two samples from pregnancies that resulted in miscarriage and two cases with microcephaly for the presence of the Zika virus. These four cases were positive for the Zika virus, indicating that infants are exposed to the virus in the womb. The mothers of these infants reported having a febrile rash during pregnancy; two of which resulted in fatality.
Recently, 20 countries have confirmed the transmission of Zika virus in the Americas. There is also a competent vector of Aedes aegypti, present in Uruguay and Argentina that poses the potential risk of spreading the virus.
Reducing exposure to mosquito bites reduces the potential for contracting the Zika virus. These include:
- Avoid traveling to areas where Zika virus is prevalent
- Eliminate mosquito breeding areas (ie. standing water)
- Wear clothing to cover as much skin as possible (ie. long sleeve shirts and pants)
- Use mosquito nets
- Stay in air conditioned rooms
- Prevent bites by applying insect repellents
Caution should be advised in pregnant and lactating mothers when using insect repellents. EPA registered insect repellents are advisable. Those that contain DEET, picardin, and IR3535 are considered safe for pregnant women.[3,4,5,6]
Duke University pharmacologist Mohamed Abou-Donia found that, in studies on rats, frequent and prolonged DEET exposure led to diffuse brain cell death and behavioral changes, concluding that humans should stay away from products containing DEET.
In a 2002 re-evaluation, Health Canada barred the sale of insect repellents for human use that contained more than 30% DEET, citing human health reasons. The agency recommended that DEET-based products only be used on children between the ages of 2 and 12 if the concentration of DEET is 10% or less and that repellents be applied no more than three times a day. Children under 2 should not receive more than one application of repellent in a day. DEET-based products of any concentration should not be used on infants under 6 months.[8,9]
- Watch for symptoms such as: acute onset fever, maculopapular rash, arthralgia, or conjunctivitis during or within 2 weeks of travel.
- Testing should also be done if microcephaly or intracranial calcifications are found on prenatal ultrasound.
- Once infected, pregnant women should have serial ultrasounds to monitor growth and development of the fetus every 3 to 4 weeks. Refer the mother to maternal-fetal medicine or an infectious disease specialist.
- Aside from supportive care (rest, fluids, pain and fever management), no specific antiviral treatment is present for Zika virus. The CDC further recommends the use of acetaminophen for fevers. Aspirin and nonsteroidal anti-inflammatory drugs are not to be used in pregnancy, and should be avoided especially until dengue fever has been ruled out to avoid the risk of hemorrhage.[1,10,11]
Ayurvedic and Naturopathic Approach to Prevention and Treatment:
A Small Introduction to Ayurvedic Philosophy:
With the constant change in our environment, whether that be in our food production or air quality, we are constantly exposed to the beauty of change. Change occurs even at the most subtle form, often as a surprise. In Ayurveda, the concept of Prakriti (genetic constitution) and Vikriti (current state of balance) exemplifies this, as we are constantly in flux with what is around us and how that affects us—whether that is a positive or negative effect.
We are constantly interacting with the micro- and macro- existence in this world and developing into new and different beings from when we first arrived from our mother’s womb. In health and disease, this translates to constant changes or mutations of “bugs,” that have the ability to impact our beings. Such bugs, like everything else, are constantly interacting with us and can invade our system, leading to imbalance in our bodies.
Coming back to the Zika virus, while the Western medical community offers minimal treatment for viral infections, the Eastern and alternative medicine approaches include a plethora of tools for prevention and treatment during infection. These approaches can be used in conjunction with what the CDC recommends.
In considering herbal application of treating mosquito-borne illnesses, we look at herbs that contain anthelmintic, antiprotozoal or anti-malarial properties. Anthelmintic herbs are known to help kill parasites, while antiprotozoal herbs effectively target protozoa, and anti-malarial herbs target malaria producing species to effectively eradicate them. The term larvicidal is also often applied, meaning to kill the larvae of such organisms.
Neem, or Azadirachta indica, is the main herb in Ayurveda recognized for its wide range of medicinal properties, particularly for its bitter action on purifying the blood and detoxification. Neem oil extracted from the leaves and seeds have antiseptic and insect repellent properties (including anti-malarial properties). Although, caution should be used in those that tend towards low blood sugar, as neem has a hypoglycemic effect, and thus, should be taken with food. Topical application is known to be safe even during pregnancy without toxicity potential, but internal intake should be avoided during early pregnancy.
Several studies have highlighted the strong insecticidal potential of neem. One study of soaked wood scrapings in various concentrations of Neem oil diluted with acetone, found that the growth and breeding was controlled of Anophele stephensi and Aedes aegypti mosquitoes in water storage over a period of 45 days.
A study assessing neem oil’s larvicidal efficacy found that in natural field conditions, neem oil was 100% effective larval control up to day 7, with 95.1% and 99.7% reduction on day 1 and day 2, respectively against the Aedes larvae. 
Such neem formulations may be effective in the control of mosquito related illnesses. Another study assessing the specific parts of the neem tree for most effectiveness against Aedes aegypti found that 100% mortality of the larvae was achieved with the leaf acetone and root chloroform extract were more effective at 48 hours.
Dr. Sodhi’s Insect Repellent Protocol
To deter, prevent and treat, take 500mg Neem extract three times a day 10 days before traveling to an infested area, during exposure, and 10 days after leaving an infested area. Neem can also be used as an external spray repellent.
Also known as the Cananga tree, or Cananga odorata, is a tropical tree originating from the Philippines. Often regarded for its pleasant fragrance, the essential oil has a number of medical applications and is considered safe in food amount during pregnancy and in breast-feeding women.
One of importance is against the particular vector Aedes aegypti. A recent study comparing the effect of various essential oils against Aedes aegypti, Anopheles dirus, and Culex quinquefasciatus found that 10% concentration of ylang ylang flowers showed effective repellency against oviposition (99.4%) to Aedes Aegypti, 97.1% to Anopheles dirus, and 100% to Culex quinquefasciatus.
Essential oil of ylang ylang may serve to effectively prevent against Aedes Aegypti, Anopheles dirus, and Culex quinquefasciatus.
Sweet wormwood, or Artemsia annua, has been renowned in the herbal community for its effectiveness against malaria due to its sesquiterpene lactone content. In fact, several drugs have been formulated with this herb as a base for the treatment of malaria; however, resistance to Artemsia is a concern as of late.
During the first trimester of pregnancy, Artemesia should be avoided internally, as it may have potential for teratogenicity. It should be used with caution during the other terms of pregnancy. A recent study assessing the impact of Artemisia on malaria and dengue causing vectors found that the leaf chloroform extract exhibited strong mortality/larvicidal activity against both vectors, Anopheles stephensi and Aedes aegypti, respectively.
Another study found that dry Artemisia extracted with hexane was more effective against Aedes aegypti and Anopheles sinensis compared to Culex quinquefasciatus in a dose dependent manner. Artemisia has potential for management against the Aedes aegypti vector.
It is apparent that natural remedies may be an effective technique for preventing and treating mosquito-borne viruses, as they also pose less adverse effects and are typically safe during pregnancy with external application. However, be cautious during pregnancy; consult your physician.
-  Staples JE, Dziuban EJ, Fischer M, et al. Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–5. DOI: http://dx.doi.org/10.15585/mmwr.mm6503e3er.
-  Schuler-Faccini L, Ribeiro EM, Feitosa IM, et al. Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65 (Early Release):1–4. DOI: http://dx.doi.org/10.15585/mmwr.mm6503e2er.
-  Petersen EE, Staples JE, Meaney-Delman, D, et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30–33. DOI: http://dx.doi.org/10.15585/mmwr.mm6502e1.
-  CDC. West Nile virus: insect repellent use & safety. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/westnile/faq/repellent.html.
-  CDC. Travelers’ health: protection against mosquitoes, ticks, & other arthropods. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods.
-  Nasci RS, Wirtz RA, Brogdon WG. Protection against mosquitoes, ticks, and other arthropods. In: CDC health information for international travel, 2016. New York, NY: Oxford University Press; 2015:94–9. http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods.
-  Duke Medicine News and Communications, Duke Pharmacologist Says Animal Studies on DEET’s Brain Effects Warrant Further Testing and Caution in Human Use. 2016. DOI: http://corporate.dukemedicine.org/news_and_publications/news_office/news/5500
-  "Insect Repellents". Healthy Living. Health Canada. August 2009. Retrieved 2010-07-09.
-  "Re-evaluation Decision Document: Personal insect repellents containing DEET (N,N-diethyl-m-toluamide and related compounds)" (PDF). Consumer Product Safety. Health Canada. 2002-04-15. Retrieved 2010-07-09.
-  CDC. CDC health advisory: recognizing, managing, and reporting Zika virus infections in travelers returning from Central America, South America, the Caribbean and Mexico. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://emergency.cdc.gov/han/han00385.asp.
-  European Centre for Disease Prevention and Control. Rapid risk assessment. Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré syndrome. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2015.http://ecdc.europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf.
-  B.N. Nagpal, A. Srivastava, and V.P. Sharma, “Control of mosquito breeding using wood scrapings treated with neem oil, Malaria Research Centre, Delhi, India,” Indian J Malariol., June 1995, 32(2):64-69.
-  Dua VK, Pandey AC, Raghavendra K, Gupta A, Sharma T, Dash AP. Larvicidal activity of neem oil (Azadirachta indica) formulation against mosquitoes. Malaria Journal. 2009;8:124. doi:10.1186/1475-2875-8-124.
-  Nour AH, Sandanasamy J, Nour, AH. Larvicidal activity of extracts from different parts of Neem (Azadirachta indica) against Aedes Aegypti mosquitoes’ larvae. Scientific Research and Essays 7(31),2810-2815, 9 Aug 2012.
-  Ylang ylang oil: Side effects. http://www.webmd.com/vitamins-supplements/ingredientmono-697-YLANG%20YLANG%20OIL.aspx?activeIngredientId=697&activeIngredientName=YLANG%20YLANG%20OIL, retrieved January 29, 2016.
-  Siriporn P, Mayura S. The effects of herbal essential oils on the oviposition-dterrent and ovicidal activities of Aedes aegypti (Linn.), Anopheles dirus (Peyton and Harrison) and Culex quinquefasciatus (Say). Trop Biomed 2012 Mar;29(1):138-50.PMID: 22543614
-  WHO-World Health Organization. Assessment of the safety of artemisimin compounds in pregnancy. Geneva: WHO, 2003.
-  Sharma G, Kapoor H, Chopa M, et al. Strong larvicidal potential of Artemisia annua leaf extract against malaria (Anopheles stephensi Liston) and dengue (Aedes aegypti L.) vectors and bioassay-driven isolation of the marker compounds. Parasitol Res 2014 Jan; 113(1):197-209. Epub 2014 Oct 25. PMID: 24158647
-  Cheah SX, Tay JW, Chan LK, Jaal Z. Larvicidal, oviposition, and ovicidal effects of Artemisia annua (Asterales: Asteraceae) against Aedes aegypti, Anopheles sinensis, and Culex quinquefasciatus (Diptera: Culicidae). Parasitol Res 2013 Sep;112(9):3275-82. PMID: 23835922