Tag Archives: Microcephaly

Asia outbreaks prompt question: Is all Zika dangerous?

A worker sprays insecticide for mosquitos at a village in Bangkok, Thailand,

By Julie Steenhuysen and Amy Sawitta Lefevre

CHICAGO/BANGKOK(Reuters) – Zika’s rampage last year in Brazil caused an explosion of infections and inflicted a crippling neurological defect on thousands of babies – an effect never seen in a mosquito-borne virus.

It also presented a mystery: why had a virus that had been little more than a footnote in the annals of infectious diseases taken such a devastating turn in the Americas? How had Africa and Asia, where Zika had quietly circulated for decades, escaped with no reports of major outbreaks or serious complications?

Scientists initially theorized that Zika’s long tenure in Africa and Asia may have conferred widespread immunity. Or, perhaps older strains were less virulent than the one linked in Brazil to more than 2,100 cases of microcephaly, a birth defect characterized by arrested brain development.

Now, amid outbreaks in Singapore, Thailand, Vietnam and other parts of Southeast Asia, a much graver explanation is taking shape: perhaps the menace has been there all along but neurological complications simply escaped official notice.

The question is driving several research teams, according to leading infectious disease experts and public health officials.

The answer is immediately important for Asia, the region most affected by Zika after the Americas. Thailand has been hardest hit with more than 680 reported Zika infections this year, followed by Singapore with more than 450 and Vietnam with as many as 60.

Much of the population lives in the so-called “dengue belt,” where mosquito-borne diseases are prevalent. And vulnerable countries – including Vietnam, the Philippines, Pakistan and Bangladesh – are ill-prepared to handle an outbreak with any serious consequences, experts said.

Lacking evidence of varying degrees of virulence, public health officials have warned Asia leaders to prepare for the worst. The scientific community is following similar assumptions.

“Zika is Zika until proven otherwise. We assume that all Zikas are equally dangerous,” said Dr. Derek Gatherer, a biomedical expert at Lancaster University in Britain.

WHICH ZIKA?

The World Health Organization recognizes two major lineages of Zika. The first originated in Africa, where it was discovered in 1947 and has not been identified outside that continent. The Asian lineage includes strains that have been reported in Asia, the Western Pacific, Cabo Verde and, notably, the Americas, including Brazil.

The Asian lineage was first isolated in the 1960s in mosquitoes in Malaysia. But some studies suggest the virus has been infecting people there since the 1950s. In the late 1970s, seven cases of human infection in Indonesia were reported.

The first record of a widespread outbreak was in 2007 on Micronesia’s Island of Yap.

Experts began to suspect a link to birth defects during a 2013 outbreak in French Polynesia when doctors reported eight cases of microcephaly and 11 other cases of fetal malformation.

In 2015, it hit Brazil, causing spikes in an array of neurological birth defects now called congenital Zika virus syndrome, as well as Guillain-Barre syndrome, a neurological disorder that can lead to temporary paralysis.

Viruses mutate rapidly, which can lead to strains that are more contagious and more virulent. Many researchers theorized early on that the devastation in Brazil was caused by an Asian strain that had mutated dramatically.

That theory relies, among other things, on the absence of Zika-related microcephaly in Asia. So when Zika broke out in parts of Asia earlier this year, researchers were on the lookout.

If researchers were to connect a case of microcephaly to an older Asian strain – and not one that boomeranged back from Brazil — it would debunk the early theory. It would mean Zika “did not mutate into a microcephaly-causing variant as it crossed the Pacific,” Gatherer said.

At least three microcephaly cases have been identified in Asia, but the verdict is still out.

For two microcephaly cases in Thailand, public health officials could not determine whether the mothers had an older Asian strain of Zika or a newer one that returned from the Americas, said Dr Boris Pavlin, WHO’s acting Zika incident manager at a recent briefing.

In Vietnam, where there have been no reports of imported Zika infection, officials are investigating a third case of microcephaly. If it is linked to Zika, Pavlin said it would suggest the older strains there could cause microcephaly and, perhaps, Guillain-Barre.

In Malaysia, where at least six cases of Zika infection have been reported, authorities have identified both an older Southeast Asian strain and one similar to the strain in the Americas, suggesting the possibility that strains from both regions could be circulating in some countries.

The hunt is on in Africa as well. In Guinea-Bissau, five microcephaly cases are under investigation to determine whether the African lineage of Zika can cause microcephaly.

It is a top research priority at WHO, said Dr Peter Salama, executive director of the agency’s health emergencies program, in a press briefing Tuesday.

“That is a critical question because it has real public health implication for African or Asian countries that already have Zika virus transmission,” Salama said. “We are all following this extremely closely.”

 

HERD IMMUNITY

Scientists also are trying to learn whether people in places where Zika is endemic are protected by “herd immunity.” The phenomenon limits the spread of virus when enough of a population is inoculated against infection through vaccination, prior exposure or both.

Experts believe Zika moved explosively in the Americas because there was no prior exposure. It’s not clear how widely Zika has circulated in Africa and Asia, whether there could be pockets of natural immunity – and, importantly, whether immunity to one strain would confer immunity to another.

One recent review of studies suggests 15 to 40 percent of the population in some African and Asian countries may have been previously infected with Zika, said Alessandro Vespignani, a professor of health sciences at Northeastern University in Boston.

That’s far below the 80 percent population immunity one mosquito borne virus expert estimated in the journal Science would be necessary to block Zika.

Researchers also believe it’s possible that microcephaly went undetected in parts of Asia and Africa where birth defects weren’t well tracked.

That too, is under investigation, said Dr David Heymann, Chair of the WHO Emergency Committee, at a press briefing last week.

“Now,” he said, “countries are beginning to look back into their records to see on their registries what the levels of microcephaly have been.”

(Reporting by Julie Steenhuysen in Chicago and Amy Sawitta Lefevre in Bangkok; Additional reporting by Mai Nguyen and My Pham in Hanoi and Susan Heavey in Washington; Editing by Michele Gershberg and Lisa Girion)

Babies exposed to Zika developed microcephaly after birth

A 4-month-old baby born with microcephaly is held by his mother in front of their house in Olinda, near Recife, Brazil,

By Julie Steenhuysen

CHICAGO (Reuters) – Thirteen babies in Brazil born with normal head circumference have been diagnosed with congenital Zika syndrome, with brain scans showing extensive malformations, inflammation and reduced brain volume, researchers reported on Tuesday.

Of the 13 infants, 11 gradually developed the birth defect microcephaly, or abnormally small head size, in the months following birth.

The findings raise new concerns about the hidden effects of pre-natal exposure to the mosquito-borne Zika virus, which has been shown to cause birth defects when women become infected during pregnancy.

On Friday, the World Health Organization declared the global Zika emergency over because the link between Zika and microcephaly has been confirmed. WHO intends to continue studying Zika as a serious infectious disease that will require years of research.

Although others have observed neurological problems in infants exposed to Zika during gestation, the study is the first to carefully document birth defects in a group of babies with confirmed Zika exposure whose head circumference fell into the normal range at birth.

The study, published on Tuesday in the U.S. Centers for Disease Control and Prevention’s weekly report on death and disease, was done by teams in Recife and Fortaleza in northeastern Brazil.

Eleven of the infants were born with heads that were on the small side and were referred for evaluation shortly after birth. The remaining two, born with normal head circumferences, were referred for evaluation at 5 to 7 months because of developmental concerns.

Among the observed symptoms, 10 of the 13 babies had trouble swallowing, seven had epilepsy, five showed some degree of irritability, nine could not voluntarily move their hands and all had hypertonia, or excessively stiff muscle tone.

In a conference call with reporters on Tuesday, WHO officials said the fact that children can be born with normal head size but later develop microcephaly demonstrates that the definition of congenital Zika virus syndrome – the term WHO has associated with Zika-related birth defects – continues to expand.

Dr. Anthony Costello, WHO’s expert on maternal, newborn, child and adolescent health, said some 2,100 babies in Brazil have had confirmed cases of microcephaly related to Zika. He expects another 1,000 cases to be confirmed as doctors continue to investigate a backlog of suspected cases.

“We know the problem has not gone away in Brazil,” he said.

(Reporting by Julie Steenhuysen; Editing by Dan Grebler)

Amid government silence, Venezuela’s microcephaly babies struggle

Ericka Torres holds her 3-months old son Jesus, who was born with microcephaly, at their home in Guarenas, Venezuela

By Alexandra Ulmer

GUARENAS, Venezuela (Reuters) – Deep inside a hilly Venezuelan slum, Ericka Torres rocks her three-month-old son Jesus to soothe his near-constant crying.

Jesus was diagnosed with microcephaly, a birth defect marked by a small head and serious developmental problems, after his mother contracted what was probably the mosquito-borne Zika virus during pregnancy in the poor city of Guarenas.

Torres said her boyfriend left after scans showed their child had birth defects, and she now struggles to afford medicine, clothes and even diapers for Jesus in the midst of Venezuela’s brutal economic crisis.

“It’s intense. But I can’t get stressed, because this struggle is only just beginning,” said Torres, 28, a supermarket security guard who smiles easily despite barely sleeping because of Jesus’ screams and convulsions, common traits of babies born with microcephaly.

The Venezuelan government, however, has not acknowledged a single case of Zika-related microcephaly in the country.

Beyond some health warnings and a handful of televised comments about Zika at the start of the year, the leftist government of President Nicolas Maduro has largely kept quiet about the virus even as neighboring Brazil and Colombia publish weekly bulletins.

Venezuela does provide data to the World Health Organization, which shows it has had some 58,212 suspected Zika cases and 1,964 confirmed ones since the virus emerged in Brazil last year and then spread rapidly through the Americas.

But it has not, however, declared any cases of confirmed congenital syndrome associated with Zika, such as microcephaly, and has not mentioned any suspected cases either.

To be sure, inadequate Zika testing has thwarted efforts to precisely diagnose Zika-caused microcephaly. But countries like Brazil have turned to clinical diagnoses and report “confirmed and probable cases” of Zika-associated congenital syndromes to the WHO, for instance.

Some doctors accuse Venezuela’s unpopular government of hiding the Zika problem amid a deep recession that has everything from flour and rice to antibiotics and chemotherapy medicines running short and spurred fierce criticism of Maduro.

They also say government inaction means kids are missing out on targeted state-sponsored therapy programs that would help to stimulate them.

“This delays the patient’s development, because no matter how much knowledge or drive you have, if you don’t have the physical tools like materials, resources, medicines, well that delays everything,” said Maria Pereira, a doctor in Caracas.

Local media have put the number of babies born with suspected Zika-linked microcephaly so far this year at around 60. Physicians in Caracas, the western city of Maracaibo, and the coastal state of Sucre, confirmed at least 50 cases in interviews with Reuters.

Venezuela’s Institute of Tropical Medicine estimates the real number could be much higher by the end of the year – between 563 and 1,400. That estimate is based on the numbers in Brazil, which has more than 1,800 confirmed cases, and pregnancy rates in Venezuela.

Product shortages have likely aggravated the effects of Zika in Venezuela: lack of contraceptives lead to unwanted pregnancies; lack of bug spray and fumigations lead to bites; and lack of anticonvulsant drugs or state support add to the hardships of children with the birth defect.

Venezuela’s health and information ministries did not respond to multiple requests for comment.

The government says it has one of the best health care systems in the world, pointing to free Cuban-staffed clinics in slums and social programs for maternal and child wellbeing. But it has stopped releasing data as the health sector has crumbled in the last two years.

‘NO RESOURCES’

Dozens of women and babies line up in the hot, dimly lit corridors of the J.M. de los Rios children’s hospital in Caracas, often waiting hours before an overstretched doctor can finally see them.

In the last three months, doctors say some 25 babies with microcephaly have been examined at what was once one of the leading hospitals in Latin America, with the majority of their mothers reporting symptoms including rashes or fevers during pregnancy.

Physicians order exams and prescribe therapies, but the overwhelmingly poor families struggle to scrape together enough money in the face of triple-digit inflation.

That delays early intervention and the discovery of other potential syndromes that have been linked to Zika, like vision problems or joint deformities.

“You feel impotent that you can’t provide anything more because there are no resources,” said Pereira, who works at the J.M. de los Rios hospital. Her family has to send her food and money from the provinces because she only earns around $70 a month between her salary and food tickets.

Other poor Latin American countries have also been criticized for their response to Zika. Brazil was called slow to investigate the initial surge of microcephaly cases and doctors say Zika prevention was spotty in Honduras, which estimates it will have some 340 cases of microcephaly by the end of the year.

Doctors and opposition lawmakers say Venezuela is faring the worst and have called for foreign aid and a stronger stance from the WHO.

Venezuela has rebuffed requests for aid, with officials saying it is an attempt to justify a foreign intervention in the oil-rich country.

When asked about criticism it was not doing enough in Venezuela, the WHO’s regional office for the Americas told Reuters its role was to provide technical cooperation to member countries and that it was working to strengthen that cooperation with Venezuela’s Health Ministry.

In the meantime, families are feeling the squeeze.

Home-based hairdresser Isabel Jimenez, her unemployed husband, and their four kids had already stopped having breakfast before the birth of Joshua, who has microcephaly, two weeks ago.

Now the family in the isolated Caribbean peninsula of Paraguana is under further pressure and has to rely on relatives for help with diapers, milk and medical appointments.

“I cried a lot,” said Jimenez, 28, of learning about Joshua’s condition. “At first I had a lot of anger and sadness, but I have to keep going with my baby because I can’t do anything else.”

(Additional reporting by Mircely Guanipa in Punto Fijo, Liamar Ramos and Daniel Kai in Caracas, Gustavo Palencia in Tegucigalpa, Ivan Castro in Managua, Paulo Prada in Rio de Janeiro, and Julia Symmes Cobb in Bogota; Writing by Alexandra Ulmer; Editing by Kieran Murray)

Thailand confirms first Zika-linked microcephaly in Southeast Asia

City worker fumigates area to get rid of mosquitoes carrying Zika

By Aukkarapon Niyomyat

BANGKOK (Reuters) – Thailand reported on Friday the first confirmed cases in Southeast Asia of microcephaly linked to mosquito-borne Zika, as the World Health Organization urged action against the virus across the region.

The confirmation of two case of microcephaly, a birth defect marked by small head size, came a day after U.S. health officials recommended that pregnant women postpone non-essential travel to 11 Southeast Asian countries because of the risk of Zika.

“We have found two cases of small heads linked to Zika, the first cases in Thailand,” Prasert Thongcharoen, an adviser to the Department of Disease Control, told reporters in Bangkok.

He declined to say where in Thailand the cases were found but officials have said they were not in Bangkok.

The World Health Organisation (WHO) said the cases were the first of Zika-linked microcephaly in Southeast Asia and the virus infection represented a serious threat to pregnant women and their unborn children.

“Countries across the region must continue to strengthen measures aimed at preventing, detecting and responding to Zika virus transmission,” Dr Poonam Khetrapal Singh, the WHO’s regional director, said in a statement.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, which can lead to severe developmental problems in babies.

VIRUS SPREADING

The connection between Zika and microcephaly first came to light last year in Brazil, which has confirmed more than 1,800 cases of microcephaly that it considers to be related to Zika infections in the mothers.

Zika has spread extensively in Latin American and the Caribbean over the past year or so, and more recently it has been cropping up in Southeast Asia.

Thailand has confirmed 349 Zika cases since January, including 33 pregnant women, and Singapore has recorded 393 Zika cases, including 16 pregnant women.

Some health experts have accused Thai officials of playing down the risk of Zika to protect its thriving tourist industry, but Prasert dismissed that.

“Thailand is not hiding anything and is ready to disclose everything,” he said, adding that other countries in Southeast Asia might also have cases of Zika-linked microcephaly that they have not disclosed.

The WHO said Thailand’s response was an example for the region.

“Thailand’s diligence underscores the commitment of health authorities to the health and wellbeing of the Thai public, and provides a positive example to be emulated,” Singh said.

The U.S. Centers for Disease Control and Prevention (CDC) said on Thursday people should consider postponing travel to Brunei, Myanmar, Cambodia, Indonesia, Laos, Malaysia, Maldives, Philippines, Thailand, Timor-Leste (East Timor), and Vietnam.

The CDC has already issued a “travel notice” for Singapore, and said such a warning would be considered for the new countries if the number of cases rose to the level of an outbreak.

Thailand’s confirmation of Zika-linked microcephaly comes ahead of China’s week-long “Golden Week” holiday with Thailand expecting 220,000 Chinese visitors, up from 168,000 for the week in 2015, Tourism Authority of Thailand governor Yuthasak Supasorn told Reuters.

NO VACCINE

There is no vaccine or treatment for Zika. An estimated 80 percent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.

There are also no specific tests to determine if a baby will be born with microcephaly, but ultrasound scans in the third trimester of pregnancy can identify the problem, according to the WHO.

Zika is commonly transmitted through mosquitoes but can also be transmitted sexually.

Another Thai health ministry adviser urged everyone to work to stop the spread of mosquitoes but said people should not panic.

“Don’t have sex with a Zika-infected person. If you don’t know if they are infected, then use a condom,” the adviser, Pornthep Siriwanarangsan, told reporters. “We can’t stop women from becoming pregnant … but we mustn’t panic.”

Health authorities in the region said they were stepping up monitoring, but there has been little testing and officials said the real number of cases was bound to be higher than the confirmed figure.

“We do not test everybody, we test only those who are symptomatic,” said Paulyn Jean Rosell-Ubia, health secretary in the Philippines, which has reported 12 Zika cases.

“Yes, we are positive that the number is higher because we are not testing everyone.”

Malaysia, which has reported six cases of Zika, including two in pregnant women, said it would seek information from Thailand on the particular strain of the Zika virus there.

“We are taking serious notice of the reports in Thailand, and we will reach out to the Thai authorities for more information … so that we can be more prepared,” Malaysia’s health minister, Subramaniam Sathasivam, told Reuters.

Authorities in Vietnam, which has reported three cases of Zika, ordered stepped up monitoring of pregnant women.

In Indonesia’s capital, Jakarta, head of disease outbreak and surveillance Dwi Oktavia said there had been no sign of any increase in birth defects there. Indonesia had one Zika case in 2015 but has confirmed none since then.

Microcephaly in babies can lead to respiratory problems related to malformation of the brain, a serious threat to the lives of babies. Children with microcephaly face lifelong difficulties, including intellectual impairment.

Zika was first identified in Uganda in 1947 and first isolated in Asia in the 1960s. It was unknown in the Americas until 2014.

(Additional reporting by Amy Sawitta Lefevre, Juarawee Kittisilpa and Panarat Thepgumpanat, Kanupriya Kapoor in JAKARTA, Roxanna Latiff in KUALA LUMPUR, Karen Lima in MANILA and Pham Thi Huyen My in HANOI; Writing by Robert Birsel; Editing by Alex Richardson)

Thailand investigates four cases of suspected Zika-linked microcephaly

A city worker fumigates the area to control the spread of mosquitoes at a university in Bangkok, Thailand,

By Amy Sawitta Lefevre and Pracha Hariraksapitak

BANGKOK, Sept 27 (Reuters) – Thailand is investigating four suspected cases of Zika-related microcephaly in three babies and a 36-week old unborn baby, the public health minister said on
Tuesday, in what could be the first cases of Zika-linked microcephaly in Southeast Asia.

Several countries in Southeast Asia have reported increasing cases of infection from the mosquito-borne Zika virus but Thailand has one of the highest numbers in the region, with 349 confirmed since January, including 25 pregnant women.

Public Health Minister Piyasakon Sakolsatayadorn said authorities needed to be thorough in their investigation of the cases as confirmation would be “sensitive.”

“The lab results will take at least two days because we have to be thorough with this as it is a big deal and a link hasn’t been detected before,” Piyasakon told Reuters.

“This is a sensitive matter for Thailand,” he said.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies.

Piyasakon said the three babies were born with small heads and an ultrasound appeared to indicate the unborn baby had a small head.

Of the four mothers, two were diagnosed with Zika when they were pregnant but two were not confirmed to have had Zika, said Apichai Mongkol, director-general of the ministry’s Department of Medical Sciences.

If a Thai case were confirmed, it would be the first in Southeast Asia, the World Health Organization (WHO) said in a statement emailed to Reuters.

The connection between Zika and microcephaly first came to light last year in Brazil, which has confirmed more than 1,600 cases of microcephaly that it considers to be related to Zika infections in the mothers.

MONITORING

Some health experts have accused Thailand, which has a thriving tourist industry, of playing down the risk from Zika.

But officials dismiss that saying the response has been adequate and another mosquito-born disease, dengue, which can be deadly, is a bigger threat.

The director-general of Thailand’s Disease Control Department, Amnuay Gajeena, said the four cases were being
monitored but he declined to say exactly where they were suspected of contracting the virus.

“It is not in Bangkok,” Amnuay told Reuters. “Both the mothers and babies are being tested and we have sent the tests to several labs.”

There are no specific tests to determine if a baby will be born with microcephaly, but ultrasound scans in the third trimester of pregnancy can identify the problem, according to the WHO.

The World Health Organization lists Singapore, the Philippines, Malaysia, Thailand and Vietnam as countries
reporting new cases of Zika.

Singapore has recorded 393 cases since diagnosing its first in August. It has confirmed 16 pregnant women with the virus.

The WHO has also said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

According to the WHO, there are two major lineages of Zika – an African lineage, which has only been reported in Africa, where the virus was first discovered in 1947, and an Asian lineage of strains.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes. An estimated 80 percent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.

(Additional reporting by Cod Satrusayang and Panarat
Thepgumpanat in BANGKOK, Marius Zaharia in SINGAPORE; Writing by
Amy Sawitta Lefevre; Editing by Robert Birsel)

Florida declares neighborhood Zika free; CDC remains cautious

Florida Gov. Rick Scott speaks at a press conference about the Zika virus in Doral, Florida,

By Julie Steenhuysen and Ransdell Pierson

(Reuters) – U.S. health officials on Monday continued to advise pregnant women and their partners to consider postponing non-essential travel to Miami to avoid the risk of exposure to Zika, even as Florida Governor Rick Scott declared the city’s Wynwood neighborhood Zika-free and invited visitors to return.

The U.S. Centers for Disease Control and Prevention said in a statement that the Wynwood neighborhood of Miami had been considered an area of active Zika virus transmission from June 15 to Sept. 18, 2016. It urged pregnant women who lived in or traveled to the neighborhood to consider getting tested for Zika.

“We want to continue to emphasize to pregnant women that they still should consider postponing non-essential travel for all of Miami-Dade (County). That is still in effect,” said CDC spokesman Tom Skinner.

Wynwood is the first neighborhood in the continental United States to have a local outbreak of Zika, a mosquito-borne virus that has been shown to cause birth defects.

Florida’s governor, at a news conference earlier on Monday, said there have not been any cases of Zika in the Wynwood neighborhood in the past 45 days, and declared that “everybody should be coming back here and enjoying themselves.”

“We had an issue, everybody took it seriously and we solved it,” he said.

Scott’s pronouncement followed news on Friday that the state had expanded the zone with active Zika transmission to nearby Miami Beach after five new cases of the virus were detected.

The Zika zone in Miami Beach, a popular tourist destination, tripled in size, growing from 1.5 square miles to 4.5 square miles. As of Friday, Florida has a total of 93 cases of Zika caused by local mosquitoes.

Zika is a particular threat to pregnant women because the virus can cause serious birth defects in babies whose mothers were infected during pregnancy, including microcephaly, a condition in which the brain is undersized, reflecting arrested development.

Scott also called on the U.S. government to approve spending to arrest any future spread of the virus in Florida and elsewhere, including funds for mosquito abatement, education and testing for Zika. A spending bill has been delayed in Congress.

(Reporting by Colleen Jenkins, Julie Steenhuysen and Ransdell Pierson; Editing by Dan Grebler)

Study confirms ZIKA causes brain birth defects, questions remain

Physiotherapist Leal does exercises with Lucas, 4-months old, who is Miriam Araujo's second child and born with microcephaly in Pedro I hospital in Campina

By Kate Kelland

LONDON, Sept 15 (Reuters) – Early results from a crucial case-control study in Brazil have confirmed a direct causal link between Zika virus infection in pregnant women and the brain damaging birth defect microcephaly in their babies, scientists said on Thursday.

But while preliminary findings from the first 32 cases involved in the study confirm causality, the researchers said, the true size of the effect will become clear only after full analysis of all 200 cases and 400 controls.

The study, published in The Lancet Infectious Diseases journal, was requested by the Brazilian health ministry to investigate the causes of the microcephaly epidemic that the World Health Organization (WHO) declared an international public health emergency earlier this year.

The outbreak of Zika, a mosquito-borne disease, was detected last year in Brazil, where it has been linked to more than 1,700 cases of microcephaly, a birth defect marked by small head size that can lead to severe developmental problems. The virus has since spread rapidly through the Americas and Caribbean.

While the WHO and other disease experts had said there was strong scientific consensus that Zika and microcephaly were linked, evidence until now has been largely circumstantial.

MISSING PIECE OF JIGSAW

Laura Rodrigues, a professor at the London School of Hygiene and Tropical Medicine who worked on this study, said its results were “the missing pieces in the jigsaw” proving the link.

The research followed and compared pregnancies that resulted in healthy babies with those that resulted in cases of microcephaly – looking for signs that the Zika virus is passed onto fetuses who develop the defect.

It covered all babies born with microcephaly delivered in eight public hospitals in Brazil’s north-eastern Pernambuco State between January 15 and May 2 this year. For each case, two controls were added. These were the first two babies born the following morning without microcephaly in one of the hospitals.

After taking samples and conducting brain scans, the researchers found that 41 percent of mothers of babies with microcephaly tested positive for Zika infection in blood or cerebrospinal fluid samples, compared with none of those whose babies did not have microcephaly.

A high proportion of mothers of both microcephaly and non-microcephaly babies also tested positive for another mosquito-borne virus, dengue fever, as well as other infections such as herpes, rubella and toxoplasma.

“Our findings suggest Zika virus should be officially added to the list of congenital infections,” said Thália Velho Barreto de Araújo of Brazil’s Pernambuco University, who also worked on the research team. “However, many questions still remain to be answered – including the role of previous dengue infection.”

Rodrigues warned that preliminary analyzes should be viewed with some caution, since they can overestimate the strength of a link. “When complete, the study, along with other ongoing research, will provide vital information on any role co-factors might have in the epidemic,” she said.

(Editing by Ralph Boulton)

 

Doctors say Haiti ripe for large Zika outbreak, virus under: reported

Residents in Haiti

By Makini Brice

PORT-AU-PRINCE (Reuters) – Posters warning of the dangers of Zika only reached Haiti’s health ministry in August, six months after the country reported an outbreak, in one example of delayed prevention efforts that have health experts worried a “large epidemic” is looming.

Gabriel Thimothe, a senior health ministry official, said the public service posters would be distributed to hospitals and airports shortly, but that health funding had been cut this year and foreign aid was sparse to fight the mosquito-borne virus that can cause severe birth defects.

Zika infections in pregnant women have been shown to cause microcephaly – a defect in which babies’ heads and brains are undersized – as well as other brain abnormalities.

Widespread fumigation that has limited the virus’ spread in other Caribbean nations such as Cuba only began in Haiti last month. Publicity campaigns have been all but invisible and hospital workers were on strike for much of the year.

“We’re expecting a large epidemic but we don’t know when it will occur,” said Jean-Luc Poncelet, the World Health Organization’s representative in Haiti. “There is under-reporting.”

Such an epidemic could severely strain Haiti’s fragile healthcare system, battered by an earthquake in 2010 that killed 300,000, and still struggling with a cholera epidemic that has sickened nearly 800,000 people.

WHO data show 5,000 suspected cases have been reported in more prosperous neighbor Dominican Republic, which shares the island of Hispaniola with Haiti and has a similar population and climate. Haiti by contrast, has reported 3,000 suspected cases, according to numbers shared by the U.S. Centers for Disease Control and Prevention.

That makes Haiti’s Zika infection rate about 30 per 100,000 people, compared to 82 per 100,000 in Brazil, where the connection between Zika and microcephaly was first detected, and 50 per 100,000 in Dominican Republic

The connection between Zika and microcephaly first came to light last fall in Brazil, which has since confirmed more than 1,800 cases of microcephaly.

RAINY SEASON

In the Dominican Republic there were spikes in infections in March and May, broadly coinciding with rainy seasons on both sides of the island, a time when mosquitoes and diseases they carry normally flourish. In Haiti, the number of cases reported each week generally dropped from February through the rains.

A long strike by medical residents at most public hospitals coincided with that decline, raising the question of whether there were fewer infections or a lack of health workers available to register cases.

A Zika task force, which includes the government and non-governmental organizations, was formed in May, Thimothe said. Several U.S. health officials in Haiti told Reuters that the United States provided $3 million in August to combat Zika in the country, money that was initially intended to be deployed against Ebola in West Africa.

Thimothe said the impact of an explosion of microcephaly cases would be devastating, but denied the condition was more widespread than thought, even though many Haitian women give birth at home rather than in clinics.

His position is supported by WHO data through June, which did not show an uptick in microcephaly or Guillain-Barre syndrome, a neurological disorder that can cause temporary paralysis and has also been linked to Zika.

But Louise Ivers, the senior health and policy advisor for Partners in Health, which along with Haitian organization Zanmi Lasante runs a hospital in the central town of Mirebalais, said she had seen at least 12 cases this year of Guillain-Barre, normally a rare condition.

The same hospital registered two microcephaly cases, including one confirmed to be linked to Zika, this summer.

“Maybe we are too late for prevention. Maybe we just have to manage the consequences,” Ivers said. “This could just be the tip of the iceberg.”

(Additional reporting by Joseph Guyler Delva; Editing by Frank Jack Daniel and Alistair Bell)

U.S. fights Zika mosquitoes with limited arsenal

Zika virus kit

By Julie Steenhuysen

(Reuters) – Over Wynwood, the Miami neighborhood where Zika gained a foothold in the continental United States, low flying planes have been spraying naled, a tightly controlled pesticide often used as a last resort. It appears to be working, killing at least 90 percent of the target mosquitoes.

Across the Biscayne Bay in Miami Beach, wind and high-rise buildings make aerial spraying challenging. So, the effort in the popular tourist destination has focused on ground-sprayed pyrethroids – pesticides that are safer but don’t always work.

The arrival in Florida of Zika, a virus that can cause a crippling birth defect known as microcephaly, has drawn into focus the limitations of the U.S. mosquito control arsenal.

Larvicides reduce future populations relatively safely. But for use against the mature mosquitoes that spread disease, only two classes of pesticides are approved. Each has drawbacks.

Organophosphates, such as naled, are effective. But there are strict controls to limit risk. Pyrethroids are safer but have been used so much that mosquitoes, in many places, are immune.

“That’s really the weak link in much of the United States,” said Michael Doyle, director of the Florida Keys Mosquito Control District. “We’re kind of caught off guard.”

DENGUE PREVIEW

Doyle led a 2009 effort against a dengue outbreak in South Florida, the first in the United States in nearly a century. Authorities threw everything they had at the Aedes aegypti, the same mosquito that carries Zika: backpack fogging, door-to-door yard inspections looking for watery breeding sites and larvicide spraying.

Still, 88 people were infected before the virus was brought under control more than two years later, and there continue to be sporadic cases in Florida.

The outbreak highlighted gaps in the mosquito control arsenal that remain, according to pesticide makers, abatement officials and entomologists. Few companies make pesticides for use in public health outbreaks, a niche market that is expensive to get into, has a limited upside and varies season to season.

Safety testing a new pesticide can cost up to $250 million and take 10 years, said Karen Larson, vice president of regulatory affairs at privately held Clarke Mosquito.

As long as a product remains on the market, companies must continue testing for unforeseen side effects, an expense that some makers have blamed for decisions to abandon products.

“There’s not a lot of profit,” Larson said.

Sales of the Dibrome brand of naled have been estimated at $12 million a year. By comparison, total crop pesticide sales for some companies can exceed $500 million in a single quarter.

Bayer, Dow Chemical, BASF and other agricultural pesticide makers “are not interested in going after a $20 million or $30 million a year market,” said William A. Kuser, investor relations director at Dibrome maker American Vanguard Corp.

The U.S. Environmental Protection Agency has approved several new pesticides in recent years. But it has received few requests for using them against mosquitoes, said Jim Jones, Assistant Administrator for the agency’s Office of Chemical Safety and Pollution Prevention.

“Although it’s of critical importance, the amount one can sell is small and it’s variable, which makes it difficult for business planning,” Jones said. “You can go many years without having much of a market at all, then suddenly, whether it’s because of a nuisance outbreak of mosquitoes or something like West Nile or Zika, the market grows significantly.”

Abatement authorities have pressed for help with the cost of developing mosquito control pesticides. The 1996 U.S. Food Quality Protection Act includes a provision for subsidies to defray the expense of safety testing, but Congress has never funded it.

RISK AND RESISTANCE

At least 49 cases of locally transmitted Zika infections have been reported in Florida, most in Wynwood and Miami Beach. Most people have no symptoms or mild illness.

Because of the microcephaly link, efforts are focused on preventing infection among pregnant women.

In Wynwood, the campaign began with pyrethroids, synthetic versions of a chemical derived from chrysanthemums. Amid signs of resistance, authorities switched to naled.

Developed as nerve agents, organophosphates, at high doses, can cause nausea, convulsions and death. They can be toxic to wildlife, including bees. The EPA considers naled safe at permitted ultra-low concentrations, and it is sprayed annually over 16 million acres in the United States.

But it is banned in Europe, where the risk is seen as unacceptable. In the U.S. territory of Puerto Rico, where Zika is widespread, the governor prohibited naled amid protests over safety concerns.

Although naled killed more than 90 percent of mosquitoes in traps set in Wynwood, the Aedes aegypti’s resilience remains a concern.

“This is truly the cockroach of mosquitoes,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention.

DROPPING PESTICIDES

CDC entomologist Janet McAllister said pyrethroid resistance typically is limited by the mosquito’s small range. When resistance to one pyrethroid develops, another often works.

Still, she said, “we would love to see additional classes of insecticides available because, even in places that may have an effective tool today, that doesn’t mean it is going to last down the road.”

The EPA can fast-track its evaluation of new pesticides and expand the use of old ones. In response to Zika, it expedited new uses for pesticide-treated bed nets and mosquito traps.

Still, development of pesticides is painstaking. Even if the EPA speeds up its evaluation, required safety data can take years to collect. And the expense of ongoing safety testing has prompted companies to drop products.

Bayer CropScience, for example, told distributors it dropped the pyrethroid resmethrin in 2012, rather than do additional testing. Clarke Mosquito gave up temephos, a larvicide, six years ago, because of costs, Larson said.

That decision led to stockpiling in southwest Florida, said Wayne Gale, director of the Lee County Mosquito Control District.

“We purchased just about every bit,” he said.

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Girion)

Haiti finds case of microcephaly linked to Zika virus

Public Health guy for Haiti

By Makini Brice

PORT-AU-PRINCE (Reuters) – Haiti has identified its first case of the birth defect microcephaly linked to the Zika virus, a senior health ministry official said on Tuesday.

Gabriel Thimothe, director general at the ministry of public health and population, said the case was confirmed on Saturday by the U.S. Centers for Disease Control and Prevention (CDC).

Haiti has confirmed 14 cases of the birth defect since March, up from previous reports of two cases, Raymond Grand Pierre, the director of the Department of Health and Family in the Ministry of Health, said.

In the other 13 cases, authorities have not established a link to microcephaly although the number may indicate Zika is more widespread in Haiti than previously thought.

According to a chart provided by the Centers for Disease Control, Haiti has recorded nearly 3,000 Zika cases.

But the World Health Organization says the overwhelming majority of cases of the virus in the island nation are suspected and not confirmed.

Thimothe said the baby with Zika-linked microcephaly was born in the city of Mirebalais earlier this summer.

Boston-based Partners in Health and its sister organization, Haiti-based Zanmi Lasante, said in a statement on Aug. 9 that two babies had been born with microcephaly in their University Hospital Mirebalais.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly. The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis.

The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed more than 1,600 cases of microcephaly that it considers to be related to Zika infections in the mothers.

Haiti’s healthcare system is still suffering from the fallout of the 2010 earthquake that killed about 300,000 people and a still-ongoing cholera epidemic that began shortly afterward, killing about 8,600 people and infecting 707,000.

Health facilities were also paralyzed this year by a months-long strike by medical residents over pay and working conditions, which Thimothe said had largely ended.

(Reporting by Makini Brice in Port-au-Prince; Editing by Sandra Maler and Cynthia Osterman)