ZIKA: GLOBAL HEALTH CHALLENGES AND LONG TERM EFFECTS

On October 19th, IHAN was a co-sponsor of a program organized by the NGO HEALTH COMMITTEE to educate participants on the challenges and long term effects of Zika. The program was also co-sponsored by the Armenian Relief Society, and the NYU Rory Meyers College Of Nursing.

The program was moderated by PAULA DUNN TROPELO, RN, FNP, EdD [Dean, School of Nursing, Wagner College]. The speakers were

VINCENT R. RACANIELLO, PhD [Higgins Professor, Department of Microbiology and Immunology College of Physicians and Surgeons, Columbia University Virologist; Researcher on Zika Virus]

WAHEED BAJWA, PhD in Entomology [Executive Director, Vector Surveillance and Control Division of Environmental Health, NY City Dep’t. of Health]

RODNEY L. WRIGHT, MD, MS, FACOG [Associate Professor, Clinical Obstetrics, Gynecology & Women’s Health Division of Maternal-Fetal Medicine Montefiore Medical Center; Albert Einstein College of Medicine]

Summary of the meeting:

The NGO Health Committee Chair, Dr. Goodwin greeted participants and introduced special guest Dr. Arturo Brito, a pediatrician and Deputy Commissioner of the New Jersey State Department of Health’s Office of Public Health Services.

Co-Sponsors of the event were introduced to the audience. They were Dr. Sorosh Roshan, an Obstetrician-Gynecologist and Founding President of the International Health Awareness Network; Ms. Valentine Berberian, the UN representative of the Armenian Relief Society and Dr. Robin Klar, representative of the Rory Meyers College of Nursing of New York University. Dr. Paula Tropello introduced speakers and served as Moderator.

The nationally known virologist, Dr. Vincent Racaniello discussed the Zika virus as an almost sudden and recent phenomenon of concern. Although Zika virus was discovered in the Zika forest in Uganda in 1947 and is common in Africa and Asia, over a period of fifty years less than 20 cases of Zika infection were known there. The virus did not begin spreading widely in the Western Hemisphere until 2016, when an outbreak occurred in northeast Brazil. In the summer of 2016 a dramatic rise in babies born with microcephaly in northeast Brazil suddenly alarmed us. Via research and study of affected babies, the Zika virus was quickly determined to be the cause. The Zika virus is a mosquito-transmitted infection just as dengue, yellow fever and West Nile are also spread. Zika is spread mostly by the bite of an infected Aedes species mosquito (Aedes aegypti and Aedes albopictus). Dr. Racaniello pointed out that recent research has focused on identifying what kinds of cells in the brain the virus affects and how it crosses the placental barrier. An animal model using mice has been identified to facilitate ongoing research. A hoped-for outcome is ultimately the development of a vaccine against the virus.

Local mosquito-borne Zika virus transmission has been reported in the continental United States. Although Miami Beach has been an area of concern for local transmission with 139 cases, the vast majority of cases of Zika in the United States are found among those who have traveled to areas where Zika-infected mosquitos are more common.

Data available online from the Centers for Disease Control report, as of October 26, 2016, show 4,091 laboratory-confirmed cases of Zika viral infection in the USA. States with the highest number of cases are: NY with 886 cases (22% of US total) Florida with 708 cases (18% of total), California 309 cases (8% of US total) and Texas 232 (6% of US total).

While the Zika virus causes no symptoms in most people, there is also the possibility of development of flu-like symptoms and in more serious incidences, the Guillian-Barré syndrome. The disease burden of the Zika virus is most clearly stacked, as we now understand it, against pregnant woman, their babies and their families. In addition to microcephaly, there are severe joint contractures that may occur during fetal development. The effects of such occurrences are potentially devastating to families with immediate decisions, care and possible long-term care required. The health care system is also taxed with providing appropriate maternity care that supports families in decisions to be made and in care of mothers, babies and their families. Resources and economic stress on all concerned is a factor of concern.

One might ask why in Brazil one finds problem of microcephaly and beginning now in the US, though Zika has been present in Asia and Africa and we hear nothing about that problem there. It is thought that because there is, as Dr. Bajwa explained in his presentation, some population immunity, women of childbearing age have likely been exposed to the virus in childhood and have built up immunity to it. Thus Zika does not affect their pregnancy or the fetus.

CDC has issued special travel considerations for travelers to countries where Zika virus is endemic. Warnings are particularly aimed at pregnant women and those women who are anticipating becoming pregnant, as well as their sexual partners. Sexual transmission of Zika virus is an area of knowledge that is changing rapidly. Thus, checking latest information and recommendations on travel locations as well as pregnancy-related questions for women and men is a valuable health resource that can be life-changing.

Dr. Wright presented the problems of infection with Zika virus and its effects in pregnant women and the incubation period, the virus in seminal fluid and sexual transmission of the virus from women to men. Dr. Wright’s clinical practice in a large metropolitan health care system requires care of a number of pregnant women who are found by laboratory testing to have Zika viral infection. The concerns of the family and fetal development are carefully monitored. Both obstetric and pediatric care are adjusting to needed monitoring. Such care requires an informed and sensitive multidisciplinary health care team. Development in the fetus is monitored. Care of infants born to women with active Zika infection during pregnancy is being carefully approached and recorded since consequences are as yet not fully known.

Moderator Dr. Tropello opened the audience participation session. Several questions from audience members were triggered by presentations of the speakers. Health professionals in the audience asked clinical care questions based on information presented. Discussion was lively and sustained by an obvious desire to use information in clinical applications.

Dr. Bajwa, in response to several questions, discussed the preventive methods to eliminate breeding areas of mosquitoes. He emphasized that people, especially those in suburban and rural areas can do much to avoid standing water sources of mosquito breeding and using public health agency services to request drainage of standing water areas in the public domain. Larvicide and adulticide spraying by hand, truck and plane are resources that may be called upon to control mosquito growth. Answering a question if “spraying” against mosquitos might, in itself, be a health hazard for people, Dr. Bajwa emphasized the amount of bactericide or insecticide used in such spraying is not a health threat to humans since the amount of bacteria or insecticide is quite small. Use of repellants may also be useful for self-protection. It is helpful to remember the two species of mosquitos carrying Zika virus bite in daytime as well as night. In New York City the Health Department Vector Surveillance and Control program is fully operational from April 1 to October 31.

The program showed that Zika and its impact on society should be monitored into the future.