Zika infections have been confirmed in nine pregnant women in the United States, including one who gave birth to a baby with a rare birth defect, health officials said.
Underlying brain damage
The Centres for Disease Control and Prevention said it's investigating 10 more reports of pregnant travellers with Zika. All got the virus while visiting or living in places with Zika outbreaks.
Also, the CDC issued a caution to people planning to attend the Olympics this summer in Rio de Janeiro.
The U.S. cases add to reports out of Brazil. Officials there are exploring a possible link to babies born with unusually small heads, a rare birth defect called microcephaly, which can signal underlying brain damage.
Read: Surge of Brazilian babies born with small heads
Zika has become epidemic in Latin America and the Caribbean since last fall. The virus, mainly spread through mosquito bites, causes mild illness or no symptoms in most people.
Since August, the CDC has tested 257 pregnant women for Zika. Eight were positive, and a state lab confirmed a ninth.
- Three of the women have delivered babies. Two of the newborns are apparently healthy, and one was born with microcephaly.
- Two had miscarriages, but it's unknown if the Zika infection was the cause.
- Two women had abortions, one after scans showed the foetus had an undeveloped brain. Details were not provided for the second case.
- Two pregnancies are continuing with no reported complications.
Read: Microcephaly: Zika virus highlights birth defect
Five of the women had Zika symptoms in the first trimester, including the miscarriages, abortions and newborn with microcephaly.
In its report, the CDC did not give the women's hometowns. State health officials said there were two pregnant women with Zika in Illinois, three in Florida and one in Hawaii, who gave birth to a baby with microcephaly. The latter lived in Brazil early in her pregnancy.
Trips need to be postponed
The CDC said all are U.S. residents, but it declined to answer a question on their citizenship.
The health agency said the nine women had been to places with Zika outbreaks: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico and Samoa.
Those destinations are among the 30 places now on the CDC's travel alert. It recommends that pregnant women postpone trips to those areas.
Read: Zika virus spreads to more tropical destinations
While the link between Zika and the birth defect has not been confirmed, the possibility has prompted health officials to take cautionary steps to protect foetuses. That includes advice that Zika-infected men who have pregnant partners use condoms or abstain from sex.
In new guidance issued, the CDC addressed people planning to travel to Brazil for the 2016 Olympic Games in August and the 2016 Paralympic Games in September. The agency again advised that pregnant women consider not going and that their male sexual partners use condoms after the trip or abstain from sex during the pregnancy.
Women who are trying to become pregnant should talk to their doctors before making the trip, the CDC advised.
The CDC also recommends that all travellers use insect repellent while in Zika outbreak areas and continue to use it for three weeks after travel in case they might be infected but not sick. That's to prevent mosquitoes from biting them and possibly spreading Zika to others in the U.S. The type of mosquito that spreads Zika is in parts of the South.
The CDC has set up a voluntary registry to collect information about Zika-infected women and their babies. Officials also have made Zika a reportable disease.
Read: Brazil's Zika-related abortion debate sparks backlash
Research also is underway into a possible link between Zika and a paralysing condition in adults called Guillain-Barre.
The CDC also updated its investigation into 14 cases of possible sexual transmission of Zika from male travellers to their sex partners in the United States. Two cases have been confirmed, four more are probable and two have been dropped, the report said.
Zika is primarily spread by mosquito bites, and transmission through sex was thought to be extremely rare. It's been surprising that this many instances appear to have happened in the United States, CDC Director Dr Tom Frieden noted during a call with reporters.
Similarly, the number of U.S. cases involving evidence of microcephaly or brain abnormalities "is greater than we would have expected", said the CDC's Dr Denise Jamieson.
So far, 107 travel-related Zika infections have been diagnosed in 24 states and the District of Columbia, including the pregnant woman.
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Image: Pregnant portrait from iStock