Aedes aegypti mosquito in Dar es Salaam, Tanzania, 2009. Photo by Muhammad Mahdi Karim, Wikipedia Commons
In July 2016 the CDC issued an advisory notice that warned pregnant women -or women planning to become pregnant- against traveling to 45 different countries. With the virus’s arrival in Florida, however, the public in that state is now wrestling with what this means for mothers and their partners. The issue is now becoming a topic in the election contest in Florida, as Mark Sumner described in a (not impartial) recent article in Daily Kos. In the piece he quotes Trump’s vice-chairman for Miami-Dade as saying that Zika was an “insignificant issue,” which was less important than building a wall “to keep the illegals out.” Yesterday Donald Trump himself declined to say that Congress should reconvene to vote on funding Zika research and prevention. …
Digital photo taken by Marc Averette. The downtown Miami skyline as seen from I-195 5/16/2008. Wikipedia Commons
Zika has already become a significant health issue in Puerto Rico, where there have been more than 5,500 infections. More than 600 of these infections have been in pregnant women. The outbreak has also set off massive public debates on the island regarding everything from insecticides to the structure of local government. It was inevitable that Zika would eventually appear in the mainland United States. Still, it couldn’t help but be surprising to see a CDC warning about travel by pregnant women to two counties (Miami-Dade and Broward) in Florida. It’s important to keep this news in perspective. So far only 14 people have been reported to have locally acquired Zika, in a very restricted geographic area in Miami. Mosquito control activities have gone into high gear in this area. One can hear an audio copy of the briefing about this news here on the CDC website. The CDC also has a dedicated webpage on Zika, which is a helpful site for information regarding the epidemic. …
Image of Zika virus from the CDC/ Cynthia Goldsmith (http://phil.cdc.gov/phil/details.asp?pid=20541) [Public domain], via Wikimedia CommonsThere is still so much that we don’t know about Zika. I was recently speaking with a medical historian who wondered if people in eastern Africa and Asia might have resistance to the disease, since it originated in those areas, or whether the epidemic will spread as explosively as it did in South America? Will the rate of birth defects be lower in newly affected countries, because mothers have more information to protect themselves? Which species of mosquito will be able to transmit the virus? How rapidly will the epidemic spread? What percentage of babies born to mothers infected with Zika will have neurological issues, even when they do not have microcephaly?
There are a few useful resources that I’ve found for Zika. Vincent Racaniello is a highly respected virologist, who has a popular podcast called “This Week in Virology” or “TWIV,” and a free online virology course. His lab spent decades working on polio, but recently shifted its focus on Zika. His new blog, Zika Diaries, give a sense of what science is like in an emerging field. Nothing is easy for the lab, from obtaining the virus, to acquiring permission to do experiments with mice.
One of the first tools that I try to create when working on an article is a timeline for events. With Zika, Ben Hirschler at Reuters has already done that work, and created a detailed timeline.
For anyone interested in the early history of Zika’s discovery in Uganda, I recommend Thomas K. Grose’s piece on NPR, which discusses a researcher studying Alexander John Haddow’s records in the University of Glasgow archives. Overall, NPR has outstanding coverage of the Zika outbreak.
Recently a Canadian professor, Dr. Amir Attaran, called for the Olympic games in Rio de Janeiro to be delayed or moved because of the risk that the wave of visitors will accelerate the spread of the Zika epidemic. The director of the U.S. Centers for Disease Control, Dr. Tom Frieden, has now weighed in to argue that the risk to the athletes is small, and many people are already traveling to areas affected by Zika. The Games should therefore move forward as scheduled. Still, it is remarkable that this close to the Games, people are suggesting that they moved, not only because of Zika, but also because of other concerns such as contamination of the waters in the bay of Guanabara. One recent study found that virus levels in the bay were 1.7 million times the permissible limit in California. I confess that when I read this figure my first thought was not for the athletes, but rather how many times I had swum in these waters myself. Sailors are also complaining about the sheer quantity of garbage in the bay, and are concerned that impacts with the trash may affect races.
In the end the games will move forward, and likely will be a success. In the future, however, the experience with the Brazilian games will likely change discussions about the venues for other Olympics. Perhaps more importantly, within Brazil, it will emphasize the point that many Brazilian critics of the games have long made: that the interests of Brazilian citizens have to come first in government decisions, and that basic needs -education, health and sanitation- should be prioritized over mega-projects.
Addendum: Immediately after posting this piece, I read that 150 health experts had written an open letter calling for the Games to be postponed because of Zika. You can read more about their arguments at USA today. What is most interesting in the piece is the argument that the World Health Organization (WHO) has a conflict of interest regarding the Games, given its partnership with the International Olympics Committee.
Smallpox has killed countless people over the last 12,000 years. It is difficult now to understand the terror that smallpox evoked in a pre-vaccination era. When smallpox was introduced into new populations the death rates sometimes could even exceed 90%, as was the case with the Mandans in the 1837 Great Plains Epidemic. The virus was finally wiped out in the wild through a massive vaccination program in the 1970s. The last infection took place in 1977. Now what should be done with the remaining stocks of the virus in Russia and the United States? I recommend a video by Errol Morris on the New York Times website “The Demon in the Freezer,” which examines this issue in detail. The interview with the Russian bioweapons scientist is particularly chilling. What I liked about the video was that it showcased voices from both sides of the debate.
In few countries is the current political, economic and social situation worse than in Venezuela. This is especially dispiriting given that the country faces an outbreak of the Zika virus at the same time that medicines and basic supplies are in short supply. The Institute for Tropical Medicine has been broken into 11 times in 2 months. The offices were cleaned out so completely that the institute was left without any microscopes or key equipment. The situation in Venezuela’s hospitals is catastrophic. The situation has grown so bad that international organizations, such as Human Rights Watch, are now trying to draw the world’s attention to the breakdown in the nation’s public health system. Given that the nation is failing to adequately prevent and treat other mosquito-born illnesses -such as dengue- Venezuela may be on the edge of repeating the disaster that has passed over Brazil. What is frustrating is that this disaster would be needless, because basic public health measures -eliminating mosquito breeding grounds, spraying, screens on windows, mosquito nets, and insect repellent- could do much to limit the damage. Venezuela also faces severe shortages in such common items, including those necessary for family planning, such as condoms. Couples will need these to delay pregnancies until after the epidemic has peaked. Health officials know what to do. Given the countless billions that the country has given away over the last decade, or which cannot be accounted for, it would be a tragedy if there was not a massive effort to stop Zika on the grounds that the country lacked funds. Still, there are grave doubts about even the validity of the health data that the Venezuelan government is sharing. One health group is providing information that suggests that 150 times more people have been infected by Zika in Venezuela than the government has stated.
“Rash on Arm due to Zika virus,” uploaded to Wikipedia by FRED on January 10, 2014. See https://commons.wikimedia.org/wiki/File:Zika.Virus.Rash.Arm.2014.jpg
The health news from Brazil is truly remarkable, as the Ministry of Health is advising women in the northeast not to become pregnant at this time because of the emergence of a new disease in the Americas called Zika fever. Historically, Zika fever has been a very rare disease, which until 2007 had caused only a small number of diagnosed cases in Africa and Asia. The Zika virus was native to the forest of Zika in Uganda, where it circulated amongst monkeys. The disease suddenly appeared in 2007 in Micronesia, then spread to French Polynesia in 2013, followed by Easter Island in 2014, before finally arriving in Brazil. The disease causes many of the same symptoms as dengue (high fever, headache, joint and muscle pain, nausea, stomach pain, exhaustion, pain in the back of the eyes, conjunctivitis, a maculopapular rash, and swelling of the legs). This is unsurprising because dengue and the Zika virus are members of the same viral family (flaviviridae), and are both spread by the same species of mosquitoes, particularly Aedes aegypti and Aedes albopictus. There is no treatment or vaccine for Zika fever.
When it first appeared in Bahia, in northeastern Brazil, in April 2013, it was not immediately obvious that this was a new disease. As patients were tested for dengue, however, and the results came back negative, the medical system soon realized that something unusual was happening. While worrying, the disease did not seem disastrous when it appeared in Brazil. People can be infected with Zika fever only once. The symptoms typically last four to seven days, then the patients recovers. In some cases, patients suffer from immunological or neurological disease (Guillain-Barre syndrome) as a result of their infection, but this is atypical. When it appeared, the disease seemed to be less serious than dengue. Very few people have died from it in Brazil. As the epidemic continued, however, doctors began to report a bizarre increase in the number of babies born with a serious birth defect, microcephaly. This disorder is characterized by a reduction in the size of the head of the baby. The rate of this disorder has increased sharply, perhaps ten-fold over the last year. Some doctors at Brazil’s Hospital Oswaldo Cruz are now suggesting that the problem is unrelated to Zika fever, but rather is tied to another emerging infectious disease in the region, Chikungunya. …
Photo of Korea from space by NASA, and obtained from the CIA World Factbook.
I have blogged about MERS before on this site, but this disease has faded from the news for the last year, until the most recent outbreak in South Korea. Middle East Respiratory Syndrome is an infectious disease caused by a corona virus, in the same manner as the SARS outbreak of 2003. The disease first appeared in Saudi Arabia in 2012, and has continued to circulate there since. In Saudi Arabia the virus has seemed to spread particularly well in a health care setting. While a number of infected people –many of whom have been health care professionals- have carried the virus to other countries, in every case the outbreak has been contained. The outbreak in Korea has been different because of its scale –eleven people have died and over three thousand have been quarantined- and speed.
South Korean citizens have criticized the government for responding too slowly to the outbreak. One person, for example, broke voluntary quarantine and traveled to China, where he ultimately fell ill. There is no question, however, that South Korea is now taking the outbreak seriously. Over 1,800 schools and daycares are closed, even though the World Health Organization (WHO) says that this measure is unnecessary. An entire small Korean village (approximate population 130) has been placed under quarantine with guards manning checkpoints. The authorities are tracking peoples’ cellphone location to make sure that they are remaining in quarantine, and health authorities are checking on people at their homes. At the time of this writing, it seems as though MERS may have peaked in South Korea, and hopefully will soon begin to fade. …
The Journal of International and Global Studies is an open access journal, which has just published my article: Whom do you trust: Doubt and Conspiracy theories in the 2009 Influenza Pandemic. The article examines how people in widely separated world regions responded to the pandemic with motifs based around trust and betrayal. While the article focuses on influenza, it also discusses other diseases such as polio and Ebola. Currently the Ebola in West Africa has been waning, and Liberia has finally been declared to be free of the disease. Even now, however, public health workers have to struggle against a powerful narrative of denial, which depicts Ebola as a tool created by the West to sell expensive medications. As I discuss in the article, such narratives have deep roots.
Shawn Smallman
Randall Munroe, XKCD Creative Commons Attribution and non-commercial use 2.5 license
As Americans and Canadians follow the threats posed by emerging infectious diseases they are accustomed to hearing news from distant countries such as Saudi Arabia or Liberia. While the threat posed by highly pathogenic avian influenza (HPAI) may move its focus from Indonesia to Egypt, events seem far from our borders. Yet the U.S. is now in the midst of a grave outbreak of HPAI, which is devastating flocks in the Midwest. While this is primarily an avian disease, there is always the risk that it may jump to humans. Even if it remains confined to poultry, the long-term economic effects are serious. The virus is unlikely to disappear or be eradicated at any time in the near future. As always, Maryn McKenna is one of the best observers of issues related to infectious disease. I highly recommend her recent article on this topic here. It’s important to note that there is no evidence that the virus is transmitting from birds to humans at the current time, and that the CDC is preparing a vaccine, just in case. As others have noted, the larger issue is the sheer number of HPAI strains circulating globally, which is very different from even a decade ago.
![By CDC/ Cynthia Goldsmith (http://phil.cdc.gov/phil/details.asp?pid=20541) [Public domain], via Wikimedia Commons](http://introglobal.wpengine.com/wp-content/uploads/2016/07/Zika_EM_CDC_20541.png)
