Response to the Letter to the Editor

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We appreciate Dr. Wiwanitkit’s commentary and strongly agree that Zika virus infection can be difficult to diagnose given that patients typically present with mild or no symptoms (2). The U.S. Centers for Disease Control and Prevention (CDC) continues to recommend that patients with Zika virus symptoms or asymptomatic pregnant women who are living or recently have traveled to an endemic area be tested for the disease. Patients with symptoms of Zika virus infection or asymptomatic pregnant women not living in an endemic region, but who have had unprotected sex with a partner living or who traveled to an area with Zika, also should be tested. There is no current recommendation for testing asymptomatic non-pregnant patients. It is important to follow these recommendations on testing due to the serious congenital anomalies on the developing fetus associated with Zika virus infection. To determine endemic regions, the CDC continues to update maps (https://www.cdc.gov/zika/geo/) assisting in identifying areas of transmission (1).
Although evidence to prevent Zika virus infections in competitive athletes is lacking, protective clothing and travel avoidance to endemic areas is the best way to decrease transmission. Continued education on avoiding mosquito bites is paramount, and athletes should use insect repellents and wear light-colored clothing that covers as much of the body as possible. We realize and agree that athletes must often practice outside where mosquitoes are prevalent, but with proper education on Zika virus transmission, athletes can make informed decisions about their health and travel. Uniform modifications would be a way to decrease transmission, but there is limited evidence on what methods would be most effective at preventing mosquito bites (3).
Mosquito prevention in sports stadiums and training camps has not been addressed directly. Enclosed stadiums and practicing at nonpeak mosquito hours (dawn and dusk) would help reduce transmission. Luckily, the Rio Olympic Games took place during Brazil’s wintertime, which also likely resulted in fewer cases of Zika virus infection in athletes and attendees.
It is the responsibility of the team physician to identify the possible risk of Zika virus and alert athletes, but it is ultimately up to the athlete to determine whether the potential risk of disease outweighs the benefits of competition. Until an effective vaccine is developed, research about Zika virus prevention should continue.

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