Zika Archives - ��ϳԹ�� News

Invasive Mosquitoes Plunge Deeper Into California

Harriet Blair Rowan — Fri, 20 Sep 2019 09:00:16 +0000

Two invasive species of mosquitoes that can carry Zika, dengue, yellow fever and other dangerous viruses are spreading in California — and have been found as far north as Sacramento and Placer counties.

There are now 16 counties where , commonly known as the yellow fever mosquito, has been detected, according to the state Department of Public Health. Five of those counties have also detected Aedes albopictus, the Asian tiger mosquito.

These mosquitoes, distinguished from other species because they primarily sip human blood during the day instead of at night, can spread the Zika virus, which infected more than 1 million people during that began in 2015 in Brazil. The virus also can spread during sex.

babies were born with in Brazil during the epidemic. Microcephaly is a condition in which a baby’s head is much smaller than expected, and can occur because the baby’s brain has not developed properly.

In California, these invasive mosquitoes were detected in 2011 in Los Angeles County, and since have spread northward into the Central Valley.

Although the invasive mosquitoes now inhabit a large swath of the state, authorities have recorded no cases of “” of the dangerous viruses, which means there’s no evidence these Aedes mosquitoes in California are carriers. The California residents who have fallen ill with the dangerous viruses became infected during international travel to areas where the viruses are endemic.

But the potential for in-state transmission remains.

“We do have people in California traveling abroad and bringing back those viruses every year, and now that the mosquito is spreading across the state, the risk has increased, but it’s still very low,” said Jeremy Wittie, president of the Mosquito and Vector Control Association of California.

The number of reported travel-associated cases of Zika has dropped from 509 in 2015 and 2016 combined to 25 so far this year, according to the California Department of Public Health.

Public health officials work with people who were infected overseas to minimize the risk that they will spread the virus in the state.

While state and local vector control agencies keep a close eye on these species of Aedes mosquitoes, their biggest concerns are still West Nile virus and St. Louis encephalitis, which are spread by different species of mosquitoes, more common in California. This year, there have been 89 human cases of West Nile virus reported in 15 counties, including two deaths, .

Vector control officials also stress the need for public awareness about how Californians can protect themselves and prevent mosquitoes from proliferating. “It’s simple for people to make a few changes to their lifestyle that would limit the spread of these mosquitoes,” Wittie said.

Wittie recommends people check their properties weekly and drain any standing water to limit the places where mosquitoes can reproduce.

Though these mosquitoes can travel only short distances on their own, they can be transported via international and local trade, or even in a car. They thrive in urban and residential areas, unlike other species, because their eggs can survive in dry conditions for months and require just a tiny amount of standing water to hatch.

“These mosquitoes are adept at living in tight spaces with humans,” Wittie said.

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article/public-health/invasive-mosquitoes-plunge-deeper-into-california/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=998921&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Hurricane’s Health Toll: A Texas Doctor Taps Lessons From Katrina

Shefali Luthra — Wed, 06 Sep 2017 09:00:34 +0000

Dr. Ruth Berggren (center) and other staff from Charity Hospital in New Orleans were evacuated to Fort Worth, Texas, six days after Hurricane Katrina hit Louisiana in August 2005. (Courtesy of Ruth Berggren)

As Dr. Ruth Berggren digests the calamity affecting her new home state of Texas, she admits to some PTSD.

In 2005, she was an infectious-disease doctor at the nearly 3,000-bed Charity Hospital in New Orleans, one of a small number of physicians left managing patients and performing triage in the wake of Hurricane Katrina. She spent weeks and months dealing with the aftermath, before moving to Texas, where she heads the University of Texas-San Antonio’s Center for Medical Humanities and Ethics, part of its Health Science Center.

As Houston begins assessing Harvey’s impact, she’s “constantly comparing and contrasting,” she said. After all, Berggren remembers the power outages and the lack of clean drinking water. She knows firsthand the trauma suffered by the medical personnel trying to keep people healthy under devastating circumstances.

“I remember what it was like to be standing on the balcony of the ninth floor of Charity Hospital looking out over the floodwaters,” Berggren reflected.

This time around, she has been volunteering at a makeshift clinic in a San Antonio middle school, once again treating victims of the storm — elderly patients who had lost their walkers, and people who in the rush to evacuate had forgotten medicines (or perhaps lost track of when they last took a dose).

Storms such as this place a heavy burden on the local health system. Hospitals such as Houston’s Ben Taub Hospital, a Level 1 trauma center, patients, even as and flooded streets for people trying to deliver refuge .

But Berggren has also seen improvements. Harvey is the first major storm since the federal government revised emergency preparedness standards for hospitals, to Katrina and 2012’s Superstorm Sandy. Now, health care providers that receive Medicare or Medicaid dollars disaster preparedness plans for at-risk patients and mechanisms to maintain basic power.

Berggren shared her distinctive perspective last week, drawing on her knowledge of Texas, her memories from New Orleans and knowledge as one of the country’s leading bioethicists. The following transcript has been edited for length and clarity.

Q: What kind of burden does a storm like this one place on local hospitals, and on the health care system?

The first responders are always the people there locally. They’re being affected by the disaster at the same time as the population is. You have sort of a dual role.

Where I saw this burden take its biggest toll was two or three days into the post-Katrina storm, at Charity. The people who had the hardest time were the folks who didn’t know the safety or whereabouts of or well-being of their loved ones.

All the health care providers in Ben Taub now, and other hospitals caring for patients that had to be left behind — this is a very stressful and difficult time.

Q: Does that affect what kind of care they give, while seeing potentially increased need?

You have to start working with much more limited resources. There’s going to be limitations in communications. We’ve already heard about looming limitations for food. Water has been OK, power has been OK — so those are two factors that weigh heavily in Houston’s favor. After Katrina, we lost power. We really didn’t have the ability to use our water supply. It was, in that respect at least, more dire.

However, as the days go by, the rains continue, the flooding continues — supplies are going to run out. There are going to be a lot of logistical hurdles.

Q: Hurricane Katrina shone a spotlight on some of these challenges that can arise at a hospital navigating a natural disaster — are there lessons you think people learned that we’re maybe seeing applied here in Harvey?

Dr. Ruth Berggren (Courtesy of UT Health-San Antonio)

It does look like they were far better prepared, with regard to having protection for their power supply and for water in these hospitals.

You can never really be fully prepared. What I recall before Katrina is there was kind of a set of misplaced priorities. We had to all undergo about four hours of training about sexual harassment in the workplace because Tulane was worried about that that year in particular — and had had exactly zero hurricane preparedness. We didn’t even know what Code Gray was.

I think that whole region along the Gulf Coast is much more attuned to the fact that we have to prioritize educating health professionals about disaster preparedness. I see better preparedness in the medical community and I like to think that’s part of the Hurricane Katrina legacy.

Q: What challenges should we expect in the storm’s wake?

There are always going to be vulnerable people, disenfranchised groups of people. If they’re not gotten out and they become further deprived of food and shelter and having their basic needs met, you’re going to see, unfortunately, I fear, the potential for violence. We had the experience at Charity Hospital of getting shot at by snipers, and we never knew who they were. We assumed they were disenfranchised people who had become desperate and been deprived of food or perhaps medication.

It’s going to be very hard to get regular services back up and running. I would say mental health is going to be a big problem. We saw a number of suicides in New Orleans after Katrina. People have a bit of a sense of despair when they become aware of the scope and scale of the disaster.

Post-Katrina it took many, many, many months to see the mental health counselors and psychiatrists return. I would hope that in the intermediate-range and long-range planning for disaster recovery that mental health is given a really high priority.

Next, I would worry about some infectious-disease issues. There’s a lot that’s been written about Houston’s risk for a Zika outbreak. Of course, the way you combat Zika is you get rid of standing water — and what does Houston have right now?

Q: Lots of standing water?

Lots of standing water! They have had a superb proactive public health response up until now. I only hope the state continues to support that.

We have a lot of people living with chronic illness in general. When it’s tuberculosis, when it’s HIV, those people need their medications on a regular schedule, without interruption.

There were a lot of logistical hurdles in New Orleans, post-Katrina, in keeping patients on their full HIV regimens and full tuberculosis regimens. My patients with AIDS and tuberculosis, who were evacuated without their medications — it took a long time before they could get to a place where they really felt they could confidently tell their health care providers what their needs were.

I had AIDS patients contacting me and saying, “Is it OK if I take my pills every other day to make them last longer?” And that’s exactly what you don’t want to do.

Q: With people saying recovery will take months and even years — what sort of long-term impact might we see on the health system in Houston, and on local public needs?

Physical infrastructure will take time to repair, but you can still provide funding to help people access care.

One vulnerable group that I would like to highlight is pregnant women. Between 2010 and 2014 we saw a 79 percent increase in maternal death [in Texas].

Houston doesn’t have to have all the floodwater evacuated and the buildings pristine to provide health care to vulnerable people.

Q: Having moved from Louisiana to Texas, what is it like for you watching another hurricane play out in your new home?

I’m comparing and contrasting constantly. I’m always checking the news. I’m checking in with my resident who’s assigned at Ben Taub. I’m seeing things that are being done a lot better and I’m seeing things that I wish could be done differently. …

Disasters bring out the best and the worst in people. We always want to look to criticize and identify the mistakes, but these are also opportunities to see how good we really can be.

The capacity of our people to take care of one another and to rise to the occasion and to go beyond themselves is just so inspiring.

This article/mental-health/hurricane-redux-a-doctor-tending-to-texans-taps-lessons-learned-from-katrina/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=765025&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

A Clinic Mix-Up Leaves Pregnant Woman In Dark About Zika Risk

JoNel Aleccia — Wed, 21 Jun 2017 09:00:16 +0000

Hospital officials in Washington state have apologized after failing for months to inform a pregnant woman she was likely infected with the Zika virus that can cause devastating birth defects.

Andrea Pardo, 33, of Issaquah, Wash., was tested for the virus in October, after becoming pregnant while living in Mexico. The results were ready by December, but Pardo wasn’t notified until April — 37 weeks into her pregnancy, just before she delivered her daughter, Noemi.

So far, the baby appears healthy. But the delay, blamed on a mistake at the University of Washington clinic where Pardo received care, deprived her of the chance to make an informed choice about her pregnancy, she said.

“Nothing would have changed for me,” she said. “But if I had found out around 20 weeks, I guess I could have made some decisions there.”

Dr. Timothy Dellit, a UW Medicine infectious-disease expert, told Kaiser Health News he called Pardo to explain the error.

“I apologized for the fact that test results were not given to her back in December,” he said. “It was just an unfortunate way those tests were handled.”

The incident adds to questions about careful tracking of Zika tests and the potential consequences of delayed or inaccurate results, even as recommendations for surveillance have expanded.

In the wake of the Zika outbreak that began in early 2015 in Brazil, there have been reports of botched or delayed tests in the U.S., health officials said.

In February, nearly 300 Zika tests for pregnant women conducted by the Washington, D.C., public health laboratory after the discovery that technicians skipped a necessary step, causing all results to be negative. One pregnant woman later tested positive for the virus, and another 25 pregnant women had inconclusive results, said LaShon Beamon, a spokeswoman for the district’s Department of Forensic Sciences.

Although it’s “not the norm,” said Dr. Kelly Wroblewski, director of infectious diseases for the Association of Public Health Laboratories, she has heard of several recent instances of patients not receiving Zika test results promptly.

“The reports aren’t getting to the right clinicians,” she said. “Where and how that breakdown is happening, I can’t say from where I sit.”

Health officials in the U.S. and beyond have conducted hundreds of thousands of tests as Zika spreads. The CDC alone has sent out 400,000 tests in U.S. states and territories and more than 700,000 worldwide, spokesman Tom Skinner said.

In May, officials with the Centers for Disease Control and Prevention to include not only pregnant women who might have been exposed to the virus but women with risk factors who are thinking of becoming pregnant.

The Zika virus, which can be passed from a pregnant woman to her fetus, can cause potentially severe birth defects, including microcephaly, characterized by a small head, vision and hearing problems and developmental delays. After news that the virus was spreading in Latin America, , researchers found.

Andrea Pardo holds daughter Noemi. The mix-up over her Zika virus test raises concerns about the backlog of testing for pregnant women with Zika infections. (Dan DeLong/for Kaiser Health News)

Pardo said she probably wouldn’t have terminated her pregnancy had she known earlier that she was infected with Zika — but she would have wanted accurate information.

Dellit said clinic staff knew that Pardo had been exposed to Zika and cared for her appropriately. Officials have revamped the test protocols, double-checking that results from outside labs make it into medical files and are communicated to patients, he added.

Pardo traveled to Las Guacamayas, Mexico, last June to be with her husband, Hector Pardo, 28. He originally came to the U.S. as a teenager without documentation and had to leave the country while his immigration status was resolved. He returned to Washington state in December and now works for a furniture company.

Andrea Pardo is on maternity leave from her job as an academic counselor in the University of Washington’s microbiology department. The couple also have a 3-year-old daughter.

Andrea became pregnant last August. At the same time, she developed what she thought was a heat rash and other symptoms of illness, but a doctor there downplayed any risk of Zika infection, she said.

It’s a stealthy virus; 4 out of 5 people never know they’re infected, while others might show mild symptoms, such as fever, rash, joint pain, muscle aches and red eyes. The effects in unborn fetuses, however, can be devastating, experts say.

A blood test in Mexico was negative for Zika. Pardo returned to the U.S., when she was 16 weeks pregnant, and tested positive for dengue, which, like Zika, is a flavivirus. Because the two viruses can cross-react in tests, doctors couldn’t tell for sure whether she had a Zika infection, too.

Pardo’s samples were sent for additional tests, which were processed promptly by the state health department and by a CDC-approved laboratory in Minnesota. But the results weren’t sent to Pardo.

She learned of the results only when she received a letter in late April from UW scientists recruiting patients with Zika for a research trial. It said she had tested positive for Zika.

“I thought I was negative,” she said. “I was really upset about it. How dare they give me a diagnosis that wasn’t true?”

Pardo pressed her doctor for answers — and learned then she was presumed infected.

She took her baby to Seattle Children’s Hospital, where Noemi was seen by experts in microcephaly.

Dr. Hannah Tully, a pediatric neurologist, confirmed that the baby appears healthy, with no sign of a Zika infection.

But Pardo said she’s haunted by the positive results of her test. She worries her daughter could still develop problems — one of the many unknowns of the Zika scourge.

“It was shocking just because I didn’t know how to advocate for my baby,” she said. “Thankfully, she was developing normally, but even without microcephaly, they don’t really know.”

This article/public-health/a-clinic-mix-up-leaves-pregnant-woman-in-dark-about-zika-risk/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=740315&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Zika In America: One Mother’s Saga

JoNel Aleccia — Tue, 13 Jun 2017 09:00:17 +0000

Can’t see the audio player? Click here to download.

LACEY, Wash. — When her daughter was born at Providence St. Peter Hospital in January, the first thing Maria Rios checked was the baby’s head.

She’d seen the terrifying photos on the internet — infants in Brazil and in Puerto Rico whose skulls were misshapen, even collapsed, ravaged by the Zika virus that has engulfed Latin America.

Days earlier, U.S. doctors had told Rios — a 20-year-old, first-time mother — that she was infected with Zika, likely spread by a mosquito bite at her parents’ home in Colima, Mexico, last summer.

Rios desperately wanted them to be wrong.

“I saw that the babies had flat heads,” she recalled. “And they had problems eating, seeing, talking, walking. They had seizures. I was just like, ‘Oh, God.’”

But when Aryanna Guadalupe Sanchez-Rios arrived — 5 pounds, 10 ounces, with a cap of straight, dark hair — it was clear that Rios’ fears had been realized. The baby’s head was far smaller than normal — 27 centimeters instead of the typical 35 centimeters — a condition known as microcephaly. An early ultrasound of the baby’s brain showed extensive calcium deposits, more signs of Zika damage, doctors said.

Maria Rios, 20, holds her daughter Aryanna Guadalupe Sanchez-Rios, who was born with microcephaly, on May 3, 2017. Maria, a U.S. citizen, was infected with the mosquito-borne Zika virus while she was living with her husband in Colima, Mexico, last year. (Heidi de Marco/KHN)

Still, Rios refused to lose hope. To her, Aryanna’s head “wasn’t really flat,” just small, she said. Eye exams showed scarring in the center of the retinas, a likely sign of vision loss caused by the virus. But Rios is certain her baby’s wide, brown eyes already track light and motion.

“I just want her to be OK,” Rios said.

Despite doctors’ warnings and medical facts, the young mother remains optimistic, relying on a deep Catholic faith to build a life for her daughter. As of May 23, Aryanna was born in U.S. states and Washington, D.C., with Zika-related birth defects.

Another eight pregnancy losses have been attributed to Zika infections, according to the Centers for Disease Control and Prevention, which updates counts regularly.

Aryanna, who was born in late January, and the other infants are now at the center of efforts by U.S. officials to monitor the lasting effects of the devastating outbreak, even as another dangerous mosquito season begins.

“A lot of people ask for miracles,” said Rios, who keeps a beaded bracelet with an amulet of the Blessed Virgin Mary on her daughter’s left wrist. “I feel like you have to ask deep from your heart.”

To date, Rios is among nearly in U.S. states and the District of Columbia with laboratory evidence of possible Zika virus infections, according to the CDC. Nearly 1,600 have completed their pregnancies.

Of those with confirmed Zika infections, 1 in 10 women in at least 44 states have had a baby with brain damage or other serious defects,

Three-month-old Aryanna Guadalupe Sanchez-Rios rests on her mother’s lap on May 3, 2017. At birth, Aryanna weighed 5 pounds, 10 ounces and her head was almost 10 centimeters smaller than average. (Heidi de Marco/KHN)

Rios was tested twice for Zika and told that she was free of infection. But days before Aryanna was born, a third test came back positive.

“A doctor told me, ‘You have Zika. That’s why your baby has microcephaly,’” Rios recalled. “She could have said it a little bit nicer.”

After birth, Aryanna tested positive for the virus, too.

The news was devastating for Rios, a U.S. citizen who had been living with her husband and her parents in Colima, a city of more than 700,000 on the Pacific coast of Mexico. She had returned to the U.S. last fall to stay with family in Lacey, 90 minutes south of Seattle.

“I said, ‘How could that be possible?’ I didn’t have any symptoms,” said Rios.

She found out only later that 4 of every 5 people infected with the Zika virus show no signs of the disease.

Even now, she finds it hard to believe that anything’s wrong. When Aryanna wakes from a nap, sleepy and warm, Rios swaddles her in a pink polka-dotted blanket and cradles her on the couch.

“Hi, Stinky! Hi, pretty girl!” she croons, kissing Aryanna’s chubby cheek. “I look at her like a normal baby.”

Rios and Aryanna are enrolled in the , where state and local health departments are tracking women and infants with laboratory evidence of infection.

Even in Washington, a low-risk state where the Aedes aegypti and Aedes albopictus mosquitoes that spread Zika aren’t found, 18 pregnant women have been identified with lab evidence of the virus since last year, said Hanna Oltean, an epidemiologist tracking Washington’s cases. All appear to have acquired the virus through travel, though Zika can be transmitted through sex as well.

Of those local women, three have delivered babies with microcephaly, including Rios.

“There’s been a definite learning curve in public health,” Oltean said. “This is the first mosquito-borne disease that has been anything like this.”

Maria Rios, 20, watches over her baby, Aryanna Guadalupe Sanchez-Rios, on May 4, 2017. (Heidi de Marco/KHN)

Dr. Hannah Tully, a pediatric neurologist at Seattle Children’s Hospital, examined Aryanna five weeks after birth and again this month. An expert in microcephaly, Tully has seen many children with the disorder, but Zika is different, she said. The damage appears to be greater than that typically found when microcephaly is caused by other conditions, including infections and premature birth.

“Zika triggers this catastrophe of inflammation and cell death,” Tully said.

Scientists now know that Zika, a once-obscure virus, targets and attacks neural stem cells in the developing fetal brain. Babies born with often have severe microcephaly, diminished brain tissue and eye damage, as well as restricted joint movement and rigid muscle tone. Recent research suggests they also might suffer hearing problems and seizure disorders, such as epilepsy.

“It’s critically important that these babies be evaluated early,” said Dr. Margaret Honein, chief of the CDC’s birth defects branch. “We don’t yet know the full range of health problems these babies might have.”

It’s a crucial question, Honein added. Every week, another 30 to 40 cases are added to the pregnancy registry.

The full costs aren’t clear, either. In September, Congress allocated about to federal agencies for the Zika crisis. CDC has already spent about $300 million in redirected funds and has designated about $394 million more, according to an agency spokeswoman.

The White House budget released in May proposes to pay for responses to emerging outbreaks like Zika. But it also would cut $1.3 billion from the CDC and $838 million from the National Institute of Allergy and Infectious Diseases, where scientists are working on a vaccine to prevent Zika infection.

And none of that funding covers what it may take to raise children like Aryanna.

led by researchers at Yale University and the Johns Hopkins Bloomberg School of Public Health pegs the medical and other expenses for a Zika-affected child at $4.1 million over a lifetime. Previous CDC estimates have been as high as

The thought scares Rios, who shares a modest, two-bedroom apartment with her sister and brother-in-law. Aryanna’s condition means Rios can’t return to her former job as a receptionist for a packaging firm, so she relies on family for rent, food, diapers, clothes and transportation.

Jessica Rios holds niece Aryanna as a technician measures her skull at Seattle Children’s Hospital on May 5. At 3 months, her head was still smaller than average. (Heidi de Marco/KHN)

Dr. Timothy Brei examines Aryanna during her checkup. (Heidi de Marco/KHN)

Michelle Cabrera, a pediatric ophthalmologist, uses a toy to get Aryanna's attention during her eye exam. (Heidi de Marco/KHN)

That assistance is precarious, too. Rios’ sister, Jessica Rios, 21, has been providing rides to medical appointments in Seattle. But her car broke down in May, forcing Maria Rios to scramble for last-minute transportation.

Rios gets formula from the federal , WIC, and Aryanna’s medical care is covered by Medicaid, the state and federal program for poor and disabled people. Rios has applied for Social Security disability benefits, but the process is long and the assistance hasn’t come through.

“Where would I get $4 million?’” she said.

Rios was born in Auburn, Wash., and raised there until age 15, when she moved with her parents to Mexico to help take care of her ailing grandmother. She returned at 18 to finish high school. That’s when she met her husband, Julio Sanchez, 26, who was working in the U.S. as a landscaper on a temporary visa.

The pair dated, fell in love and married in September 2015. They moved to Colima three months later, in December, after his visa expired, just after the first three cases of Zika infection were reported in Mexico.

Rios discovered she was pregnant in April 2016; doctors initially thought she had a cyst on an ovary. Sudden bleeding put Rios on bed rest for five months, and she spent that time worried more about miscarriage than any mosquito-borne virus.

Even when an ultrasound at six months showed that the baby’s head lagged in development by two weeks, doctors weren’t concerned.

“They said, ‘Oh, don’t worry,’” Rios recalled. “In Colima, I didn’t see anybody alarmed about Zika.”

In February, Mexican health officials reported that Colima is now one of four states in the country with the highest incidence of Zika infections, with from 2015 through March 2.

Rios wanted to give birth in the U.S. to ensure that her daughter would be a citizen and to receive proper care, even though it meant leaving her husband behind. She texts him constantly, sending photos of Aryanna in a flower-print onesie and Minnie Mouse pajamas.

Jessica Rios holds her niece, napping between exams at Seattle Children’s Hospital in May. (Heidi de Marco/KHN)

“I just hope he gets some sort of permission to be in the U.S.,” Rios said. But, with a new president opposed to immigration in the White House, she said, she doubts that will happen soon.

Her husband met Aryanna in April, when Rios traveled with the baby back to Colima.

“He didn’t even know what Zika was,” Rios recalled. “I said, ‘Look it up.’”

Rios’ parents, both in their early 40s, couldn’t hide their concern for their daughter and their first grandchild.

The family drove straight from the airport with the baby to a church in Talpa de Allende, where Rios’ father walked on his knees from the back to the altar, a gesture of faith aimed at keeping Aryanna safe from harm.

“My mom just keeps telling me, ‘Everything’s going to be fine,’” Rios said.

Sometimes, Rios is not so sure. Her days revolve around Aryanna, who receives weekly visits from a public health nurse and a physical therapist and has doctors’ appointments lined up six months in advance.

The baby endured a nine-hour round of medical tests on a recent Friday, including neurological and eye exams and an MRI. Aryanna was patient while a technician measured her head – 33.2 centimeters. At 3 months, it was still smaller than a typical newborn measurement of 35 centimeters.

But the child screamed in outrage as Dr. Michelle Trager Cabrera, a pediatric ophthalmologist, shined a bright light and peered deeply into her dark eyes.

“There’s a chance her vision could be quite impaired,” concluded Cabrera, who saw scarring on the baby’s retinas.

“I just want to know if she could wear glasses?” Rios asked.

“This is a relatively new problem that we don’t understand well,” Cabrera said, adding gently: “I don’t think glasses are going to help.”

That news worried Rios. So did the results of the MRI, which confirmed Aryanna had brain damage from the effects of the Zika infection, Rios said.

At the hospital, Rios asked her sister to watch the baby for a minute and stepped outdoors into a hospital atrium. She sat down at a table, placed her head in her hands and started to cry.

“I try to be strong for her,” Rios said, between sobs. “I’m really scared. It’s hard.”

The worst thing about Zika, she said, is that no one, not even the doctors, can tell her what’s next.

“I still have my hope,” she said. “I’m trying everything for my girl to be OK.”

This article/public-health/when-zika-hits-home-one-american-moms-saga/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=736984&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

A New Zika Threat Hovers As Summer’s Mosquitoes Get Bzzzzy

Shefali Luthra — Tue, 30 May 2017 09:00:48 +0000

Zika, the mosquito-borne virus that triggered public health alarm bells last summer, has receded from the spotlight. But, experts say, expect the virus to pose a renewed threat this year.

How great of a threat? That’s where it gets tricky.

No locally acquired cases of the virus have been reported in the United States this year. But as public health agencies gear up for mosquito season, uncertainty remains around what resources states may need and whether they will receive adequate federal support. In addition, researchers still have questions about how the virus works and its long-term effects. These forces could complicate efforts to track outbreaks and provide accurate information about prevention and disease management.

“We still have much to learn. And much remains to be done,” Lyle Petersen, director of the Centers for Disease Control and Prevention’s Division of Vector-Borne Diseases, said last week at a House Energy and Commerce hearing.

Zika, which can cause birth defects if contracted by pregnant women, is primarily transmitted by a mosquito more commonly found in southern areas of the country such as the Gulf Coast. Texas, Florida, Southern California and Louisiana were all deemed high-risk areas last year. It hit the and reached the United States via infected travelers.

Last year, with the disease — most contracted the virus while traveling in South and Central America. Sixty-four babies in the U.S. have been affected since the government began reporting outcomes last June. In rare cases, people who had not traveled abroad contracted Zika through a local mosquito or through sexual contact. Puerto Rico, a U.S. territory, had cases in 2016.

Again this year, determining if areas are experiencing active Zika transmission will require active surveillance and testing — both of mosquitoes and of people potentially exposed. Most people who contract the virus don’t show visible symptoms.

Implementing that testing is challenging, experts said.

“Should you begin universal screenings in communities that are at risk?” asked Jeff Engel, executive director of the Council of State and Territorial Epidemiologists, which represents the specialists working in public health departments. “That is a tough resource question and probably is not feasible.”

Last year, Congress appropriated $1.1 billion toward fighting Zika. That among research, overseas response and state public health efforts. , the CDC warned state officials those federal dollars were running out. They to last through the end of this fiscal year, in September.

Meanwhile, the White House budget released Tuesday proposes establishing an emergency fund to finance responses to outbreaks like Zika. But it also calls for a $1.3 billion cut to the CDC and slashes $838 million from the National Institute of Allergy and Infectious Diseases, the agency behind vaccine development. So far, there has been little talk from Congress of approving extra funding.

“Funding from Congress has been critical for our response to Zika. However, additional support will be needed,” said Rick Bright, director of the federal Biomedical Advanced Research and Development Authority, a subsidiary of the U.S. Department of Health and Human Services, at the hearing.

Some advocates also warn at HHS could limit the agency’s capacity to support a Zika response.

“Obviously we live in tough times when it comes to budget constraints,” said Tom Skinner, a CDC spokesman. “And we have to find creative ways to do the best we can with what we’re given.”

If those constraints thwart surveillance efforts this year, experts warned, it will make it harder to know precisely when Zika hits. That blind spot puts women of childbearing age — for whom the virus’ consequences are most dramatic — at greater risk. Reports highlight microcephaly as a significant consequence, but a burgeoning field of research suggests its impact on children may be broader, and may manifest years after a child is born.

“Without active surveillance — I’m worried we missed [many cases of] Zika last year and we’ll miss Zika this year,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, in Houston. “If you’re a woman of reproductive age, living on the Gulf Coast of the United States, or Arizona or Southern California, and you’re pregnant or might be pregnant — you don’t really know if Zika’s in your area or not.”

Texas, which experienced six cases of local Zika transmission last year, has identified counties it deems most vulnerable. All pregnant women in those areas are advised to get Zika screenings as part of their routine prenatal care. The state works with the CDC to monitor how many pregnant women test positive and intends to monitor babies born to mothers who experienced infection.

But long-term follow-up will probably require more funding, noted Chris Van Deusen, a spokesman for Texas’ Department of State Health Services. And leveraging prenatal care to push Zika testing has its own shortcomings. Many women most at risk are low-income, Van Deusen noted, and therefore less likely to interact with the health care system, or get prenatal care. Those people won’t be tested or accounted for in the state’s Zika tracking efforts.

That, Hotez said, compromises authorities’ ability to discover Zika when it hits and then get the word out. “The only way we identify Zika outbreaks like [last year’s] in South Florida is through serendipity,” he said.

Testing is another concern. Current tests are unreliable in identifying Zika among patients previously infected with related viruses, such as dengue.

(Courtesy of National Institute of Allergy and Infectious Diseases, National Institutes of Health)

Limited resources could also strain the states’ ability to process tests efficiently. Last year, the volume of patient samples sent for Zika testing overwhelmed laboratories in some affected areas, noted Kelly Wroblewski, director of infectious disease at the Association of Public Health Laboratories.

The surge translated to delays in determining if women had Zika. That could continue this year, since universal testing in affected areas is a burden that many of these labs don’t have the resources to meet.

If the virus spreads, Wroblewski said, “we may find a capacity gap.”

Many states also lack the infrastructure to adequately address an outbreak. Surveillance of mosquito-borne diseases is virtually nonexistent in many states, from the Council of State and Territorial Epidemiologists. Mosquito surveillance among states dropped from 96 percent in 2004 to 80 percent in 2012. In many areas, mosquito eradication has shrunk along with dwindling public health budgets.

“We need better mosquito control methods, we need better surveillance,” Petersen said at last week’s hearing. “We need to develop more of a nationally standard approach to vector control and laboratory testing. … This will require a sustained effort to rebuild infrastructure.”

The scarcity of resources is compounded by scientists’ limited knowledge of the virus.

Experts are “discovering new things every day,” particularly regarding how the virus plays out after birth, Engel said. Beyond an obvious condition like microcephaly — which results in an abnormally small head and brain impairment — it’s tough to say just how consequential the disease can be. Preliminary work suggests children without microcephaly whose mothers carried the virus may have developmental issues later in life. But the extent of those issues — and the odds they do in fact manifest — is unclear. And limited knowledge about how Zika interacts with similar viruses means available tests aren’t always accurate.

“Unfortunately, it’s the problem with these rapidly emerging diseases; you can’t get the research up quickly enough to get the best answers,” said Scott Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch in Galveston.

Because Zika’s long-term consequences remain murky, states are trying to keep tabs on children whose mothers tested positive. Beyond Texas, Louisiana is also tracking children for at least three years after birth, even if they don’t show obvious symptoms. But that assumes a surveillance system is robust enough to track all mothers who carried the virus. It also assumes sufficient resources to keep monitoring children. Those, experts said, are hardly guaranteed. And they still might not be enough.

“It’s going to take a generation of pediatric neurologists to study and sort this out,” Hotez said. “This is just the beginning.”

This article/public-health/a-new-zika-threat-hovers-as-summers-mosquitoes-get-bzzzzy/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=734034&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Federal Money For State-Level Zika Tracking, Prevention May End This Summer

Ana B. Ibarra — Tue, 02 May 2017 09:00:48 +0000

Money that has helped states with Zika tracking and education may come to an end by this summer, putting at risk efforts to better understand the mostly mosquito-borne virus and the devastating birth defects associated with it.

The Centers for Disease Control and Prevention told state health officials in a meeting last month that Zika funding is running out and that additional support should not be expected, according to a . An agency spokeswoman declined to confirm the report, saying in an email that the CDC did not yet have a budget for the next fiscal year and could not speculate on how funding for Zika might be affected.

Last year, Congress provided to the CDC for Zika response and preparedness that was mostly passed on to local and state public health departments.

In California, the federal money helped to expand mosquito surveillance, tracking of birth defects related to Zika and programs to educate residents about the disease, among other efforts. The money has been distributed to states through different grants for different purposes. Between fiscal years 2016 and 2017, for example, the state of California received for the surveillance of Zika-related birth defects. Los Angeles County received another also to be used for the tracking of birth defects.

California Healthline requested comment from the state’s department of public health, but the agency did not provide information in time for publication.

Compared to other states, the Zika risk in California tends to be low. A federal published last year showed that the West’s drier climate keeps in check the population of Aedes aegypti mosquitoes known to transmit the virus. Southern states are more humid and at higher risk.

As of April 21, 534 Zika virus infections have been reported in California since October 2015, according to state data. All of the infections were related to travel. Five babies have been born in California with Zika-related birth defects, state data also show.

According to the CDC, 58 babies in the U.S. were born with birth defects related to Zika as of April 11. Those defects include microcephaly, a condition in which a baby’s head and brain are smaller than normal, causing developmental delays and other problems.

The potential end of federal funds may affect states’ ability to track Zika-related birth defects, said Cindy Pellegrini, the senior vice president of public policy and government affairs at the March of Dimes.

Before Zika emerged, microcephaly was so rare that most states did not track it. If states can no longer afford to do so, it will be difficult for health officials to know for certain which cases of birth defects were triggered by Zika, Pellegrini said.

The CDC and the March of Dimes recently launched , a website in which the public can search for providers who are qualified and willing to treat women and children with Zika. The site currently covers only 10 states, including California.

Mosquitoes that can transmit Zika to people have been detected in in California: Fresno, Madera, Riverside, San Mateo, Tulare, Kern, Los Angeles, Orange, San Bernardino, Imperial and San Diego.

San Diego County, which has reported 87 infections contracted abroad, last month born with Zika-related microcephaly. San Diego County health officials said they are aware that Zika funding from the CDC was a one-time investment and used their share of funds to purchase lab equipment and hire temporary staff.

Since 2015, when the first case of Zika was confirmed in Brazil, the state of California established guidelines to handle the growing caseload of infections. Some of these include consulting with doctors on testing and interpreting results, educating the public on the risks of sexual transmission of Zika and monitoring pregnant women with suspected infections.

This story was produced by , which publishes , an editorially independent service of the .

This article/health-care-costs/federal-money-for-state-level-zika-tracking-prevention-may-end-this-summer/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=725531&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Sprint To Find Zika Vaccine Could Hinge On Summer Outbreaks

Carmen Heredia Rodriguez — Thu, 23 Feb 2017 10:00:25 +0000

As warmer temperatures herald the arrival of pesky mosquitoes, researchers are feverishly working on several promising vaccines against Zika, a virus notorious for infecting humans through this insect’s bite.

The speed and debilitating effects of Zika outbreak in the Western Hemisphere prompted a sprint to develop a vaccine. Just a little more than a year after the pandemic was declared a global health emergency, a handful of candidates are undergoing preliminary testing in humans.

But researchers say the uncertainty over whether the Zika epidemic will continue affects their ability to finish testing. They need locations with an active viral outbreak to conduct large-scale human trials and make sure the vaccine actually protects against disease.

“On one hand, you don’t want to see outbreaks of infection,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “But on the other hand, [without that testing] you might have to wait a long time to make sure that the vaccine works.”

All the vaccines currently being tested are in Phase I clinical trials, which means they are being tested for safety in a small number of people. According to in the journal Immunity, the vaccines represent a variety of scientific techniques to thwart the disease, ranging from inactivating the virus to manipulating its DNA.

The NIAID announced Tuesday it is launching yet another Phase I trial for a vaccine made out of proteins found in mosquito saliva. The product is intended to trigger a human immune system response to the mosquito’s saliva and any viruses mixed with it. If successful, the product could protect humans against a spectrum of mosquito-transmitted diseases, including Zika.

Col. Nelson Michael, director of the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research and co-author of the paper, said he expects preliminary reports on the safety of some of the older vaccines in April. As of now, he said, it is impossible to guess which vaccine will prove most effective in providing immunity.

“Sometimes it’s difficult to predict which horse will win the race,” Michael said.

The NIAID announced Tuesday it is launching yet another phase I trial for a vaccine made out of proteins found in mosquito saliva. (Courtesy of NIAID)

Zika ― which is or sexual contact, often infects people without showing symptoms. In some cases, it causes flu-like symptoms, such as fever, muscle aches and joint pain in adults ― and, in rare cases, Guillain-Barré syndrome, which can cause temporary paralysis. But it is most notorious for causing some children to be born with microcephaly ― a birth defect in which a child’s head is smaller than the average size ― if their mothers were exposed to Zika.

The virus garnered international attention after hundreds of cases of disabled babies surfaced in Brazil. It quickly swept through South America and the Caribbean before stopping on the southern coast of the U.S.

The World Health Organization a “public health emergency of international concern” on Feb. 1, 2016, then .

Vaccines that meet the safety standard in Phase I clinical trials undergo subsequent rounds of testing to gauge effectiveness. To measure this, researchers rely on the gold standard of administering the vaccine to large number of people at risk to see if the medicine is effective. However, Zika’s recent arrival to the Western Hemisphere means researchers don’t know whether the virus will become a perennial threat, or a one-time explosion.

The uncertainty poses several implications for the surge in Zika vaccine development. A lull in the outbreak could cause significant delays in testing, pushing back the timetable for a commercially available product, Fauci said.

While researchers can use alternative methods to measure efficacy without large-scale testing, a decline in the circulation of the Zika virus could set progress back by years because the vaccine testing would be ineffective.

“If we don’t get a lot of infections this season in South America and Puerto Rico, it may take years to make sure the vaccine works,” he said.

Fauci expects to launch the next round of human trials for a DNA vaccine developed by the NIAID next month.

Michael also worries that a lag in the number of Zika cases could lead the private sector to pull funds from vaccine development. It takes millions of dollars to develop a drug or vaccine, and pharmaceutical companies play a critical role in making and manufacturing them, he said. But those companies have many competing interests, he noted, and if it is hard to test a vaccine this year, the public and private Zika prevention efforts may turn their attention elsewhere.

“This is a constant issue where you put your resources,” he said.

A transmission electron micrograph of Zika virus, which is a member of the family Flaviviridae, is shown. (Cynthia Goldsmith/CDC)

So far, signs suggest that the climate could be ripe for Zika again this year. Warmer-than-usual temperatures are affecting areas across the Western Hemisphere, CBS reported, including hotbeds of the Zika outbreaks in Brazil. The higher temperatures increase the voracity of Zika’s main transmitter, the Aedes aegypti mosquito.

In the United States, areas with populations of the Aedes aegypti are closely monitoring their numbers. Last year, Texas and Florida dealt with locally acquired cases of Zika infection.

In Texas, public health officials have monitored mosquito populations throughout the winter to track their numbers and any presence of the virus. Despite unseasonably warm weather, said Chris Van Deusen, spokesman for the Texas Department of State Health Services, they have seen lower numbers of the Aedes aegypti and no cases of Zika.

Van Deusen said the state is also monitoring the outbreak in Mexico, since heavy traffic across the border increases the possibility of transmission. Officials are expecting another outbreak of locally transmitted cases of disease, Van Deusen said.

“There’s so many factors that go into it, it’s really impossible to make an ironclad prediction,” he said.

This article was updated to add information about the vaccine testing process.

This article/public-health/sprint-to-find-zika-vaccine-could-hinge-on-summer-outbreaks/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=702847&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

In Puerto Rico, The Joy Of Pregnancy Is Tempered By Fear Of Zika

Carmen Heredia Rodriguez — Mon, 09 Jan 2017 10:00:10 +0000

CAGUAS, Puerto Rico — Before the virus overwhelmed Puerto Rico, Zika already lurked in Keishla Mojica’s home.

First her partner, John Rodríguez, 23, became infected. His face swelled and a red, itchy rash covered his body. Doctors at the time diagnosed it as an allergy.

Two months later, Mojica, 23, had the same symptoms. Medics administered shots of Benadryl to soothe the rash and inflammation. She didn’t give it much more thought.

A month later she also found out she was pregnant, and that eventually led to a surprising revelation. The rashes hadn’t been caused by allergies, but instead by Zika, a virus known to cause serious birth defects.

Since 2015, the virus, which is spread by mosquitoes and sexual contact, has risen from relative obscurity to a worldwide menace. Puerto Rico marks the epicenter of the outbreak in the United States. As of Dec. 16, the commonwealth’s 35,648 confirmed cases, including 2,864 pregnant women. Federal health officials have declared a here and anticipate 25 percent of the population will have contracted the virus by the end of 2016.

The epidemic raises difficult personal questions for women like Mojica, who live on an island with strong religious undercurrents and a health care infrastructure bowing under the weight of fiscal debt. Is abortion acceptable or can faith overcome the fear? If a baby is born with disabilities like microcephaly, characterized by an abnormally small head, or cognitive impairments, how will families provide the care a child will need?

A sonogram taken in August 2016 at HIMA San Pablo Hospital in Caguas, Puerto Rico, reveals a healthy baby boy inside Keishla Mojica, 23. Doctors initially feared his small size indicated a Zika infection, but they later learned Mojica became pregnant later than previously thought. (Carmen Heredia Rodriguez/KHN)

In response to the association between congenital defects and the virus, virtually all pregnant women on the island undergo testing for Zika as part of their prenatal care. Dr. Alfonso Serrano, 57, chairman of the obstetrics and gynecology department at HIMA San Pablo Hospital in Caguas and Mojica’s doctor, said the testing has shown that 5 to 8 percent of his patients contracted Zika.

Even though the threat of Zika frightens women, he said, most of his patients don’t consider abortion.

“It’s not something that is talked about every day,” he added.

Serrano attributes the aversion to terminating a pregnancy as more of a cultural idiosyncrasy than particularly devout faith. Abortion is easy to obtain here and relatively inexpensive, but surveys show that an overwhelming majority of residents said they oppose the practice.

For Mojica, abortion was the first thought that crossed her mind when she heard she had been infected. She told no one but her mother and Rodríguez about the diagnosis. She cried and prayed often. Public service announcements on television about the outbreak angered her. But Mojica never actually discussed the possibility of an abortion with anyone, and she realized quickly that she couldn’t choose that option.

“I waited until they gave me the results and that they verified everything,” she said. But Mojica added that she quickly put aside any thoughts about abortion. “I said, ‘No, forget it. Everything’s fine. Forget about it.’ That was in the moment.”

Religious Objections To Abortion

The echoes of Roman Catholicism introduced by Spanish colonial rule still reverberate through contemporary Puerto Rican society. of its residents believe in God. Children greet their elders by asking for a benediction, to which they reply, “Dios te bendiga” — “May God bless you.”

Planificacion Familiar, an abortion clinic operating out of the corner unit of a strip mall in Bayamon, Puerto Rico, is run by Dr. Hector Diaz, 86. Diaz says he administers surgical and medical abortions, charging between $250 to $300 for the full procedure and follow-up appointment. (Carmen Heredia Rodriguez/KHN)

But the church’s influence is declining. Just over half of the population self-identifies as Catholic, according to a survey. In contrast, the number of Protestants has surged, now comprising a third of residents.

Puerto Ricans and religious leaders generally don’t support abortion. More than 70 percent of Catholics and eight out of 10 Protestants on the island the procedure, according to Pew.

In February, the Catholic Archbishop of San Juan released a responding to the health department’s advisory to use condoms as part of preventing Zika transmission. The church’s stance against birth control are “well-known,” he said, encouraging couples to practice “personal discipline,” or abstinence from sex.

The Pentecostal Fraternity of Puerto Rico (FRAPE) — a network of Pentecostal churches across the island — also view their opposition to abortion as a non-negotiable tenet.

“God is the giver of life,” said FRAPE president Alberto Rodríguez. “And he has absolute control to take it or give it.”

Although rates have declined in recent years, thousands of women in Puerto Rico continue accessing abortion services. Seven of the island’s eight clinics performed 5,363 abortions in the fiscal year starting July 2013, based on the most recent data available from the commonwealth’s health department. More than 2,000 had undergone one other abortion. And roughly 1,350 women had sought two or more procedures.

Mojica was a faithful member of a Seventh-day Adventist congregation — which does allow for abortion in cases of certain congenital abnormalities — but says she now converses with God on her own.

Resources Available For Kids with Disabilities

Recent research suggests that Zika causes a wider range of congenital problems that previously suspected. And with a quarter of Puerto Rico’s residents thought to be infected, it is unclear how many babies will have special needs. But finding adequate care for children born with disabilities is difficult in Puerto Rico, where services are fragmented, poorly funded and already oversubscribed. Nearly half the population lives in poverty.

A nurse holds a vial with a camouflaged stopper that is used to collect blood specimens from newborns whose mothers were infected with Zika during their pregnancy at HIMA San Pablo Hospital in Caguas, Puerto Rico in November 2016. (Carmen Heredia Rodriguez/KHN)

The Division of Children with Special Medical Needs, part of the commonwealth’s health department, runs some programs to assist families with children with disabilities, such as Advancing Together, a service that trains caregivers and helps families set up a development plan for the child. But the program expires when the child turns three, and responsibility for services is transferred to the Puerto Rican Department of Education, which has consolidated or closed dozens of schools in recent years due to declining enrollment rates and strapped budgets. of students attending public schools on the island in 2013 were enrolled in individualized education programs.

Nonprofit groups also play a role in helping children with special needs, such as and the . Yet, therapy services available are extremely limited, said Miguel Valencia, director of the Division of Children with Special Medical Needs. Although half the island’s residents rely on Medicaid for health insurance, Valencia said, many specialized clinicians no longer accept the plan due to low reimbursement rates.

Puerto Rican residents for Social Security Administration’s Supplemental Security Income program, which provides assistance if a medical condition results in severe disability, chronic illness or death. The service is limited to individuals living in the 50 states, the District of Columbia and the Mariana Islands.

A small figurine of a boat sits on a shelf in the nursery of Keishla Mojica and John Rodriguez in Mojica’s mother’s home in November 2016 in Caguas, Puerto Rico. The couple settled on the room’s decoration after a compromise between the couple; Rodriguez chose the theme for the baby shower, Mojica the theme for the nursery. (Carmen Heredia Rodriguez/KHN)

Waiting For Jayden

Among the pixels of black and shades of orange, the ultrasound image shows the outline of a human face with his eyes closed directly facing the camera. It appears modulated, akin to a half finished piece of pottery. The five stubby fingers of his right hand are pressed against his forehead as if he is lost in contemplation.

It is a sonogram, one of the first portraits of Mojica’s son, who she plans to name Jayden Aramick.

The nursery overflows with outfits in anticipation of his arrival early this year. Black Converse booties and Batman onesies hang in the armoire. Wooden letters spell his name on the wall above the crib.

Although the baby continues to grow without complications or signs of microcephaly, Mojica’s son still faces possible developmental delays from the virus that could develop after he arrives. But at this point, the risk no longer weighs on her conscience. She has given her worries to God.

“What He says is what will come to be,” she said.

This article/public-health/in-puerto-rico-the-joy-of-pregnancy-is-tempered-by-fear-of-zika/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=685824&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

In Light Of Zika Findings, Stepped-Up Monitoring Of Children’s Symptoms Urged

Shefali Luthra — Wed, 14 Dec 2016 21:44:35 +0000

A series of studies released Wednesday shed a preliminary light on the Zika virus’ consequences for children infected in the womb. But, experts said, the findings also highlight additional challenges: identifying affected babies and making sure they receive needed follow-up care as they grow.

That task could prove complicated, especially as new data emphasizes the virus may cause more damage than previously thought.

Two studies track how many women infected with the mosquito-borne virus have had babies with identifiable evidence of birth defects, with one providing the first lens into how the virus has so far affected American children. A third paper suggests the disease stays active in those infants’ brains days beyond birth.

One paper, published in by researchers from the Centers for Disease Control and Prevention, tracked the 442 American pregnant women exposed to the virus who completed pregnancies between Jan. 15 and Sept. 22. The researchers found that about 6 percent of those children were born with Zika-related birth abnormalities — including but not limited to the brain disorder known as . Another study, published in the , tracked outcomes for pregnant women in Brazil and suggested a higher rate of birth defects — 42 percent. Some experts say that higher figure may result from many of the Brazilian women having more severe infections, or from the prior exposure many had to dengue fever. The , also conducted by the CDC, found that the Zika virus was still active and replicating in children’s brains days after they were born. That builds on suggesting Zika remained a threat post-utero.

This study underscores the need for pediatricians to test babies who may have been exposed in utero to Zika, even if they don’t show obvious signs of infection at birth. The CDC has been urging aggressive screening. A released in August supports the approach, too.

The findings also underscore the need for thorough monitoring of how the disease develops and the importance of ensuring affected children access helpful treatments and therapies.

Zika has no cure or vaccine, but identifying children early on who have been affected can help. Doctors can undermine some of the infection’s consequences, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and an expert on the virus.

“Early intervention, Head Start — all those things could make a difference” for children with neurological conditions, he said. “Occupational and physical therapy. All that needs to be done.”

But making sure those infants do get tested and treated remains difficult.

“We’re certainly hearing, from some of our state and local health department partners, that it’s challenging — making sure the mom’s testing information, and the fact that mom was documented to have Zika infection, is passed on to the pediatric health provider,” said Dr. Margaret Honein, an epidemiologist who co-chairs the CDC’s birth defects branch and was the lead author on the JAMA paper.

The JAMA paper, for instance, notes that 41 percent of infants who may have been exposed to Zika in the womb didn’t get tested for the virus. “What it suggests to me is that OB/GYNS are incorporating the [CDC’s recommendations] into their practice, but potentially, the pediatricians are not as aware,” said Julie Fischer, who co-directs the Center for Global Health Science and Security at Georgetown University. “The focus has been so much on pregnancy and treating pregnant women and identifying pregnant women. … Pediatricians are not as sensitized to these issues.”

That speaks to a need for greater communication about who may be at risk, and for how long, said Martha Rac, a maternal-fetal medicine specialist at Texas Children’s Pavilion for Women and Baylor College.

“That is a big area where there can be a push for broader screenings,” Rac said, referring to infants born to women who were exposed to the virus, regardless of what symptoms they have at their first physical examinations.

That said, coordinating this kind of testing and long-term follow-up won’t be easy.

Some argue low-income people are at greater risk of Zika exposure. They are more likely to live in conditions in which the mosquitoes carrying the disease thrive.

And those families are generally less likely to consistently access health care. low-income children are less likely to receive regular preventive screenings and check-ups. by the U.S. Department of Health and Human Services found that, in the previous year, about 40 percent of children covered by Medicaid received fewer than six wellness visits in their first 15 months of life. Doctors advise they receive nine in that timeframe.

“Children who are born in families where exposure risk is higher may also be at risk of not having the kind of close monitoring of development through early childhood” that’s needed, Fischer said.

That could have consequences, since public health experts said tracking babies over time is crucial to understanding how the virus affects brain development and how widespread its consequences may be. The percentages found so far could be “the tip of the iceberg,” Hotez.

And, to be sure, more research is needed to determine what kind of subtle consequences the virus could have on a child’s long-term brain development, Fischer noted.

“If the findings do end up supporting the idea that children exposed to Zika virus in utero — particularly early in pregnancy — are at a higher risk of developmental disabilities, then clearly there’s the possibility there will be missed chances to intervene early, with therapies that might help.”

This article/public-health/in-light-of-zika-findings-stepped-up-monitoring-of-childrens-symptoms-urged/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=683711&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Genetically Engineered Mosquitoes Split A Straw-Poll Vote In The Florida Keys

Rachel Bluth — Thu, 10 Nov 2016 13:02:15 +0000

Voters in one Florida county on a ballot referendum Tuesday about whether to allow the first trial of “Frankenflies” — mosquitoes genetically engineered to reduce populations of the species that spreads Zika.

That species, the Aedes aegypti, lives in homes and is difficult to root out with insecticides. In addition to Zika, they spread yellow fever, dengue and chikungunya.

In Key Haven, the town where the trial could be staged, more than 65 percent of voters rejected the plan. In Monroe County, which encompasses Key Haven, more than 57 percent of voters said yes to it.

The ballot measure, sometimes referred to as a “straw poll,” is non-binding. A final decision on the question will be made by the Florida Keys Mosquito Control District Board, which is scheduled to meet Nov. 19 to discuss the poll results as well as the results of five other surveys the county has conducted.

The outcome of these deliberations could encourage further exploration of the technology, which its manufacturer and charity benefactors describe as a silver bullet to curbing mosquito-borne illnesses, but detractors say is an expensive and risky business opportunity.

“While we did not win over every community in the Keys, Oxitec appreciates the support received from the community and is prepared to take the next steps with the Florida Keys Mosquito Control Board,” said CEO Hadyn Parry in a . Oxitec, the company that developed the “Frankenflies,” is owned by Intrexon Corporation, a biotechnology firm with a portfolio focused on synthetic biology.

If the trial moves forward, the British-based company’s mosquitoes would be released three times a week over the small peninsula. Key Haven is home to just 1,000 residences and a single gas station. The native mosquito population is insulated by seawater and the island’s main highway, making for a perfect trial location, the company said.

If the trial goes as planned, those mosquitoes will breed with native females, the ones that bite. Both the genetically engineered insects and their offspring carry a fatal gene, and die quickly. Over time, the population will thin out.

“We’re very happy with the results,” Mosquito Control Board Chairman Phil Goodman said of the Monroe County vote. He thought Key Haven voters got bad information about the safety of the trial and anticipates the board will choose to go forward, but find another site in the county.

But the referendum has implications beyond this tiny section of the Florida Keys. Miami-Dade County, Florida’s most populous county, has been watching closely and is considering using the genetically modified mosquitoes as well. But the small enclave of Key Haven is a vastly different place than the bustling tourist destination of Miami-Dade, home to 2.7 million people.

A company representative said he could not discuss pricing until the product is sold commercially — as opposed to in a trial period. But in the past, Oxitec has charged based on number of people benefiting from the technology’s use. In Brazil, the tab ran $7.50 per resident. Company officials, however, have told Monroe County that its costs will not be more than it already budgets to control Aedes in the lower keys — about $1.2 million annually, Goodman said.

Trial skeptics raise additional red flags. For instance, since the genetically engineered mosquitoes do not by design produce offspring, the company would have to continually pump them into the environment.

“If you want to implement a male sterilization program, there are other ways to do that,” said Durland Fish, a Yale University professor of microbial diseases as well as forestry and environmental studies, who questions the plan. “This is a business opportunity. This is expensive. And you can’t stop doing it.”

Some vocal Monroe residents have raised environmental concerns and even circulated an online petition.

The Food and Drug Administration determined in that the trial would have “no significant impact” on the environment, paving the way for the mosquitoes’ release. And the World Health Organization and Pan American Health Organization have tentatively recommended expanding trials, with the caveat that more clinical data is needed.

But it may not be so straightforward, said Fish. Eliminating Aedes from one ecosystem could lead to a reinvasion, or an invasion of another disease-carrying species, like Aedes albopictus, he added.

Luke Alphey, who engineered the mosquitoes and cofounded Oxitec, has a very different view. “Part of the motivation for this research was using modern genetics to provide the striking benefits of this kind of approach [sterilizing mosquitoes],” including the avoidance of insecticides and being able to target a specific species without harming others.

This article/elections/genetically-engineered-mosquitoes-split-a-straw-poll-vote-in-the-florida-keys/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=674322&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">