By Lorrie Harris-Sagaribay, MPH, MotherToBaby North Carolina

Back when Zika was first sweeping the western hemisphere, the travel recommendations for pregnant women and couples who were planning pregnancy were clear: avoid any areas that had a risk of Zika infection. It was fairly easy to know where those areas were, as governments and public health organizations around the world worked tirelessly to identify and report cases. World maps showing areas of risk provided clear “yes/no” guidance. Was there any doubt about who shouldn’t travel where? Not really. Not back then.

But what about now? The number of Zika cases has fallen dramatically in the last year. Many countries still have sporadic cases that would not be described as outbreaks. Other countries have continuing cases in some regions, but no cases in other regions. Pair this with the fact that the accuracy of reporting can vary widely from country to country, and the once-clear world map of Zika can look like a jigsaw puzzle of undefined risk.

One of the most common Zika-related questions we get at MotherToBaby now is, “How likely is it that I’ll get Zika if I travel to Country X?” (Or a variation of the same: “We went to Country X. Do we really need to wait 3 months before we try to get pregnant?”) One resource to help answer that question is the interactive world map maintained by the Centers for Disease Control and Prevention (CDC) to illustrate areas with Zika risk. This month, the CDC has given the much-loved map a makeover. Visit the map now and you’ll find four colors, each indicating a different level of Zika risk and the corresponding recommendations for pregnant women, their partners, and couples who are planning pregnancy.  Let’s take a look at what the new colors mean:

  • Red areas have active Zika transmission. Travelers to red areas are at risk of Zika infection.
    • Pregnant women and their partners should avoid all unnecessary travel to red areas.
    • Couples and others who travel to red areas should wait at least 2 months (women) or 3 months (men) before trying to get pregnant, and have only protected sex during that wait time.
  • Purple areas have had active Zika transmission sometime in the past, and there could still be cases. Travelers to purple areas might be at risk of Zika infection.

(There is a sub-category of light purple, which shows higher elevations [above 6,500 feet] where mosquitoes that can transmit Zika don’t usually live. The chance of getting Zika in light purple areas is very low.)

  • Pregnant women, their partners, and couples planning pregnancy are encouraged to talk with their health care providers to make decisions about travel to purple areas. Careful consideration should be given to the risks and consequences of Zika infection in pregnancy, the nature of their travel, how much potential risk they are willing to accept, how soon they want to get pregnant (if they are not already), and any other factors specific to that couple at that time.
    • If pregnant women or their partners decide to travel to purple areas, they should take steps to minimize risk, including using insect repellent and considering the use of condoms for the rest of the pregnancy.
    • Couples planning pregnancy who travel to purple areas should also take steps to minimize risk, including using insect repellent and considering following the previously recommended wait times before trying to get pregnant (2 months for women, 3 months for men).
  • Yellow areas have mosquitoes that can transmit Zika, but have not had reported cases of Zika transmission. Travelers to yellow areas are at low risk of Zika infection.
  • Green areas do not have mosquitoes that can transmit Zika and have not had any reported cases of Zika transmission. Travelers to green areas are not at risk of Zika infection.
    • There are no Zika-related travel recommendations for green areas.

Given that many countries are still included in the purple category, how does this new map help you know what your risk really is if you travel to a purple area? The answer is that it doesn’t. Purple only tells you there is some level of risk. Here’s why purple—and we at MotherToBaby—can’t be more specific:

  • Reliable data for every country around the world simply does not exist. Since Zika virus is no longer considered a public health emergency, many resources that once helped support global data collection have moved on to other, more pressing issues.
  • The level of risk within a purple country could change without us knowing right away. The ability of any country to quickly identify and report cases depends on resources, logistics and other factors. This means there could be delays in detecting and announcing any new outbreaks.

The bottom line is that our post-Zika-epidemic world requires that we take the health of current and future pregnancies into consideration when planning travel. Ask ourselves how much potential risk we are willing to accept when we book our vacations and business trips. Does that mean that couples and individuals who want to have children should never go to areas that ever had Zika? Not at all! But if they are currently pregnant, or are not willing or able to effectively prevent pregnancy for at least 3 months after traveling, they might prefer to visit one of the many areas where there is low or no risk of Zika. (Think yellow! Think green!)

MotherToBaby is here to answer your questions about the new Zika guidance, and any other questions you may have about Zika or other exposures in pregnancy. Happy travels!

Lorrie Harris-Sagaribay, MPH is the coordinator of MotherToBaby North Carolina and a bilingual teratogen information specialist. As a member of the MotherToBaby Zika Task Force, she has a special interest in helping couples and individuals think through challenging questions related to Zika and pregnancy. After serving as a community health educator with the Peace Corps in Honduras, she earned her Master of Public Health at the University of North Carolina at Chapel Hill.  She has worked in the field of maternal and child health for over 25 years.

About MotherToBaby

MotherToBabyis a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.