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September 24, 2016: Quest Diagnostics Debuts New Test Service for Zika Virus

Quest Diagnostics on Wednesday unveiled a new antibody test service that helps medical professionals diagnose infection by the Zika virus.

“Quest is using a test developed by the Centers for Disease Control and Prevention (CDC).

“The test is authorized for emergency use by the U.S. Food and Drug Administration. The CDC has licensed the test to Quest Diagnostics and other select laboratories to aid the response to the Zika emergency in the United States.

“Quest operates about 2,300 patient service centers across the U.S., with approximately 260 of these centers located in Florida, the first state to document cases of local transmission.

“In addition, many health care providers can also collect patient specimens in their offices for testing by Quest Diagnostics, the company said in a statement. Quest Diagnostics serves half the physicians and hospitals in the United States each year.”

Source: CNBC

September 23, 2016: More Insurers Now Offering Coverage for Zika

At least five big players involved; protection provided in personal accident or travel plans

Janice Tai reports that "There is now “Zika insurance” for those afflicted with the mosquito-borne virus.

At least five major insurance firms here have started offering coverage for Zika in their personal accident or travel plans. This comes within a month of confirmation that it had spread within Singapore.

Great Eastern, for instance, extended coverage for Zika to all its existing and new personal accident policyholders last Friday. They can claim up to $300 for medical costs and $30,000 if death is due to the virus.

A pregnant woman diagnosed with Zika is entitled to twice the amount of medical reimbursement, and if her baby is born with Zika-related microcephaly, or abnormally small head, Great Eastern will pay a lump sum of $3,000.

Sompo Insurance Singapore has included Zika coverage for its home and selected personal accident insurance products from Sept 7.

“With an increasing number of Zika cases reported locally and worldwide, and feedback from our intermediaries and policyholders, we see a need to cover our existing and new policyholders against this virus,” said Ms Koh Yen Yen, its chief distribution officer.

NTUC Income was among the first to introduce such coverage back in April through the optional infectious disease cover under its Personal Accident Assurance policy.

“This could be extended to other products with infectious disease cover, said Ms Annie Chua, vice-president for personal lines at NTUC Income.

“Such coverage is similar to that for other infectious diseases such as dengue fever and hand, foot and mouth disease.

“Zika is also covered under some travel insurance plans, offered by Sompo and NTUC Income.

“The other insurers that provide Zika coverage are Prudential Singapore and AIA Singapore. So far, NTUC Income, Sompo and Prudential said they have not received any claims related to Zika.”

Source: The Straits Times

September 22, 2016: Predict Zika’s Spread? It’s Hard Enough to Count the Cases

How far will the Zika outbreak spread, and for how long?

“Predicting Zika’s course in the continental United States is difficult. Health experts have never confronted a virus quite like this one: a mild infection that can nonetheless devastate unborn infants, and that is transmitted by both mosquitoes and sex.

“Even tracking cases is hard because so few cause symptoms. ‘This is such a new thing entomologically that we’re all speaking above our pay grade,’ said Joseph M. Conlon, a technical adviser to the American Mosquito Control Association.

“Still, there is growing agreement among some experts that the virus may be, at best, slowed by aggressive mosquito control. Nothing short of winter will stop it, they said, and how many cases are mounting up is still hotly debated.

“Virtually no entomologists believe that the transmission of Zika is limited to a few square miles of downtown Miami and Miami Beach, no matter how vigorously state officials insist it is.

“’That’s just dreaming — it’s totally unrealistic,’ said Duane J. Gubler, a former director of the vector-borne diseases division of the Centers for Disease Control and Prevention. ‘Mosquitoes move around, people move around. Mosquitoes even move by car sometimes.’

“Nonetheless, the C.D.C. on Monday lifted its travel advisory for the Wynwood neighborhood of Miami, saying that no new locally transmitted cases had been detected there since early August and traps there had few mosquitoes since the spraying of two pesticides, naled and Bti, began.

“Elsewhere, Florida has been reporting new locally transmitted cases almost every day. There were 79 as of Sept. 16. As of Friday, it was investigating 17 infections to ascertain whether each was a lone case or part of a wider cluster.

“The state has refused to reveal the five places where it has trapped mosquitoes that tested positive for the virus, saying the information was “not necessary to public health.” Last week, arguing that it was, The Miami Herald sued Miami-Dade County to force it to name the sites. And it’s likely that some local transmission is not even known about yet. According to local doctors, hundreds of women are waiting weeks to get test results from overwhelmed state laboratories.”

“Experts have long predicted that other Gulf Coast cities might have outbreaks like Miami’s. Indeed, they may be having them now without realizing it because of the testing lags and asymptomatic cases.

“’Every week there’s another ‘Little Shop of Horrors,’ and everyone seems surprised,” said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. ‘But finding virus in both people and mosquitoes suggests intense transmission.’

“But a wildfirelike spread on the Gulf Coast, such as Puerto Rico is experiencing, is not expected, largely because air-conditioning and screens are more common.

“Also, Zika usually smolders for months before exploding. For example, Puerto Rico reported its first locally transmitted case in December, but did not have thousands each week until the summer. Florida’s first local case was in late July, so cold weather may break the cycle.

“Since January, the CDC has predicted that Zika would not spread faster on the American mainland than dengue and chikungunya, both of which are also carried by the Aedes aegypti mosquito.

“But some scientists argue that dengue and chikungunya are poor models for Zika. Lab animals with Zika develop more virus in their blood than they do when infected with the other viruses, said Rebecca C. Christofferson, a disease transmission specialist at Louisiana State University’s veterinary school. And, she said, Zika appears to be unusually quick to move from a mosquito’s gut to its salivary glands, where it is injected into the next victim.

“Dengue takes seven to 10 days to make that trip; chikungunya takes as few as five days, depending on temperature, mosquito size and other factors. ‘Zika is looking like chikungunya,’ Dr. Christofferson said.

“Also, Zika flies below the public health surveillance radar. Dengue’s nickname is “breakbone fever,” and chikungunya’s is “bending-up disease.” Both can be excruciatingly painful, so victims often see doctors quickly and their test results are reported to the state.”

“By contrast, 80 percent of Zika victims lack symptoms and may never see a doctor. ‘The symptoms are so diffuse that many, including many physicians, fail to recognize that a person has it,’ said Manuel F. Lluberas, a former Navy entomologist now in the private sector.

“As a result, a Zika cluster can grow without being noticed until someone infected, usually a pregnant woman, is tested.

“Also, the state’s biggest dengue outbreak began in 2009 in Key West, a tiny vacation island with a relatively rich and educated population of 25,000. It still took two years to contain, with 90 confirmed cases.

“The state’s first Zika outbreak is in Miami, an area of 5.5 million. Cities are more likely to have residents, some with guns or dogs, who refuse to open their doors to mosquito inspectors, said Mr. Conlon of the mosquito control association. One property’s pools and gutters can produce enough mosquitoes to blanket a neighborhood.

“’What’s getting to me is how complacent people in Miami are about this,”’he said. ‘That does not bode well for containment.’

“For example, he said, mosquitoes breed in flowering bromeliads. Yet despite threats of $1,000 fines, some Miami Beach residents resist ripping up their gardens.

“Half measures will not slow the virus. Aedes aegypti lay eggs that can cling to a dry surface until the rain they need arrives. It is not enough merely to empty the rows of conch shells, for instance, that decorate outdoor restaurants in Miami. ’”You have to scrub each one out":https://youtu.be/EacJsCirabE, Mr. Conlon said.

“Predictions of Zika’s course are also made difficult by a monumental wild card. Unlike other tropical viruses, it can be sexually transmitted.

“’That makes Zika a different breed of dog,’ Dr. Gubler said.

“If an infected person passes it to a household sexual partner, the virus will be in human blood for up to 20 days at that location for local mosquitoes to pick up and pass on.

“The long-term picture is even fuzzier. Experts are divided on whether the virus could become endemic, recurring summer after summer.

“The virus itself has two ways to survive winter. A recent laboratory experiment showed that about one mosquito in 300 passes it on to the next generation in her eggs. And Zika can last for six months in men’s semen.

“Either route could seed a new domestic outbreak next year — or the virus could be reimported from Latin America or the Caribbean.”

Source: The New York Times

September 21, 2016: Is Another Zika Brewing in the Caribbean?

Florida researchers have discovered a mosquito-borne virus called Mayaro in Haiti, where it had never been observed before.

“They found the virus in a blood sample taken in January 2015 from an 8-year-old boy who had tested negative for other mosquito-borne illnesses, including chikungunya and dengue. Researchers don’t know yet how widespread the infection could be or whether they will find it in other parts of the Caribbean, but the specific strain they identified is different from those previously seen in the Amazon, where most cases of Mayaro have historically been reported.

“Dr. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute, which identified the virus, says the findings underscore how additional viruses are ‘waiting in the wings’ and may pose future threats.

“Researchers who discovered Mayaro in Haiti had been studying the country’s chikungynya outbreak. When blood samples tested negative they aimed to discover whether other ailments were present. Their findings were published in the journal Emerging Infectious Diseases, which is run by the Centers for Disease Control and Prevention.

“Mayaro’s symptoms, which include fever and joint pain, are similar to chikunguya, but Dr. John Lednicky, a University of Florida associate professor in the environmental and global health department of the College of Public Health Professions, says joint pain from Mayaro can last for as long as year, and that people who are infected tend to have stomach problems.

“’The joint pain can be debilitating in day-to-day activities, even making walking around difficult,’ Lednicky says.

“The finding occurred as most attention has been centered on on Zika, a virus primarily spread through mosquitoes that is particularly dangerous to pregnant women, who risk giving birth to babies with the birth defect microcephaly, characterized by abnormally small heads.

As with Zika, little is known about Mayaro. It was first isolated in Trinidad and Tobago in 1954, and since then roughly 40 cases have been studied in South America by U.S. researchers. A couple of people have returned to the U.S. after traveling to parts of the world where the virus was circulating, including in eastern Peru. In 2011, a Swiss tourist who visited Peru was diagnosed with the virus after he returned home.

“Lednicky’s team was the first to identify the spread of Zika in Brazil, and later to discover its presence in spit and urine.

“It isn’t known yet whether – like Zika – Mayaro can be transmitted sexually. Researchers also don’t yet know whether the boy got Mayaro through the same type of mosquito, called Aedes aegypti, that has been linked to the Zika virus. Lednicky says studying Mayaro in Haiti will be difficult because it has only been discovered there once so far, but that lessons learned from Zika will help inform his team’s approach.

“He says that when he announced the discovery of Zika in Brazil, few were paying attention and he had difficulty getting funding for additional research.

“’Everyone was telling us we found an obscure virus that was of no interest to anybody,’ he says. ‘With Mayaro it’ll probably be the same thing.’

“Since then, Zika has spread rapidly, infecting more than 20,000 people in the U.S. and its territories. Congress has not allocated emergency funding to prevent and treat the Zika virus, though it is now working on doing so through a spending bill.

“‘We could have been so far ahead if we’d had access to research funds,’ Lednicky says.”

Source: US News

September 20, 2016: Thailand to Crack Down on Zika Breeding Spots

Authorities in Thailand seeking to curb the growing number of Zika cases say they will criminally charge homeowners who fail to remove mosquito breeding grounds on their property.

“The Public Health Ministry announced it will revive a 1992 law allowing officials to order the removal of decorative ponds or any areas with still water found to foster mosquitoes, which can transmit the Zika virus. Anyone failing to clean up or remove the mosquito breeding grounds can face a jail term of one month and a fine of 2,000-5,000 baht ($57-143).

Source: FOX News

September 19, 2016: Researchers Strengthen Link Between Zika and Microcephaly

This from Karen Kaplan from The Los Angeles Times.

“A first-of-its-kind study is strengthening the case that Zika is the culprit behind Brazil’s mysterious surge in babies born with microcephaly.

“Preliminary results from a study commissioned by the Brazilian Ministry of Health found that 13 out of 32 newborns with microcephaly tested positive for the Zika virus. Meanwhile, none of the 62 newborns in a comparison group who had normal-sized heads showed any sign of infection.

“The findings, reported Thursday in the journal Lancet Infectious Diseases, are the first to emerge from a longer-term effort to study 200 infants with microcephaly and compare each of them with two unaffected controls from the same region who were conceived at about the same time. Given the magnitude of the health crisis posed by Zika, the team decided to report interim results of babies who joined the study between mid-January and early May.

“The babies in the study were recruited from eight hospitals in and around Recife, a ‘hotspot of the microcephaly epidemic in Brazil,’ according to an editorial that accompanies the study. Each infant with microcephaly had a head circumference at least two standard deviations smaller than the average for his or her gestational age and gender. In fact, all but two of them had a head circumference that was three standard deviations smaller than average.

“In addition to measuring head size, the researchers took samples of umbilical cord blood, cerebrospinal fluid and sometimes peripheral blood from the microcephalic babies and ordered CT scans of their heads. Infants in the control group went through a similar procedure, except their heads were examined via ultrasound instead of CT and they were not subjected to a spinal tap.

“Mothers of babies in both groups provided blood samples and answered a questionnaire.

“Mothers in the microcephaly group had a higher rate of Zika infection than their counterparts in the control group — 80% versus 64% — but that difference was small enough that it could have been due to chance, according to the study. Likewise, more of the mothers in the microcephaly group reported having a rash during pregnancy — 41% versus 26% — but that difference was also too small to be statistically significant.

“The researchers noted that they had no way of determining when in their pregnancies the mothers had been infected.

“The babies in the microcephaly group had a range of health problems. For instance, 84% of them had a low birthweight for their gestational age (compared with only 6% of babies in the control group). Among the 27 who had a head CT, 11 had at least one abnormality, such as large ventricles, brain tissue that was smooth instead of folded, or calcifications that can be a sign of a past viral infection.

“One of the babies in the microcephaly group was stillborn and three others died in a hospital intensive care unit.

The most dramatic finding was that 41% of the microcephaly infants tested positive for Zika infection in their blood or cerebrospinal fluid, compared with 0% of the matched controls.

“In the editorial, infectious disease researchers Patricia Brasil of the Oswaldo Cruz Foundation in Rio de Janeiro and Dr. Karin Nielsen-Saines of UCLA called the association between Zika and microcephaly ‘striking.’

“The study authors saw the results as a wake-up call to the world.”

Source: Los Angeles Times

September 18, 2016: The American Zika Outbreak

The virus’s prevalence in Puerto Rico threatens disaster if Congress cannot pursue long-term action

“America is already experiencing a Zika outbreak. The disease has already infected almost 20,000 American citizens and more than 1,500 pregnant women — with some estimates reaching as high as over 10,000 infected pregnant women. There have been dozens of hospitalizations and dozens of cases of the immune disorder Guillain-Barré, including at least one fatal case. Thirteen Zika-infected mothers have either aborted or miscarried fetuses, many of which exhibited the brain damage often associated with the disease. This year’s cases are just the beginning, and it looks like the virus could become endemic on American soil in the near future.

“As Congress dithers over funding for Zika prevention on the mainland, the island commonwealth of Puerto Rico is at a stage well beyond the reach of a preemptive strike. As the virus still struggles to establish a beachhead among Aedes aegypti mosquitoes in southern Florida, it has found a home in the Caribbean heat and moisture of Puerto Rico. And that’s awful for an island still deep in the throes of an economic and humanitarian disaster, and for one that’s always struggled with an underfunded and undermanned health infrastructure. Though Puerto Rico’s unique tropical climate is an outlier compared with that of much of the continental United States, the underlying issues with its infrastructure provide examples of just how Zika could spread elsewhere in the country, too.

“It’s been less than a year since the first reported case of Zika in Puerto Rico, but doctors in the territory are already at their breaking points. Zika infections themselves are not terribly taxing to health-care systems—symptoms usually resemble those of a cold or flu, if patients exhibit them at all—but the potential complications can stagger even well-funded health systems. Treatment for microcephalic infants and adults that develop neurological complications can cost millions per patient. Evidence from Brazil presented in an upcoming Centers for Disease Control and Prevention study indicates that the true burden of neurological disorders from Zika is underreported, and that in addition to a well-reported link to Guillain-Barré, the disease is associated with a rise in expensive hospitalizations from other neurological conditions, including encephalitis, myelitis, and encephalomyelitis. Additional services for child and maternal health—including screening and access to abortions—and contraceptive services simply add to the price tag. And with so little information available about Zika’s long-term effects, it’s impossible to know if hidden symptoms and costs don’t lurk down the road.”

Source: The Atlantic

September 17, 2016: Unique Utah Zika Case Remains Medical Mystery

“A case of the Zika virus in Utah is now the only one in the continental U.S. that’s still puzzling researchers on exactly how it spread, health officials said Tuesday.

“The man caught the illness after caring for his infected father, who had an extremely high level of the virus in his blood when he died in June, according to a report released by the U.S. Centers for Disease Control and Prevention. One possibility is that he transmitted the virus to his son through a bodily fluid in a way that hasn’t been recognized with Zika yet, officials said. The son kissed and hugged his dying father and helped care for him in a hospital, according to the report.

“Investigators couldn’t test the unidentified Salt Lake County man because he had already been cremated by the time he was diagnosed, said Angela Dunn with the Utah Department of Health. Signs of Zika have been found in blood, urine, semen and saliva, and the case could direct new research into whether it can also be carried in things like tears or stools, she said.

“No other cases have yet been found among the family or health workers. It’s unclear whether the case points to a potentially common mode of transmission, said Alex Kallen with the CDC. ‘I don’t think we know the answer to that right now,’ he said.

“The father caught the mosquito-borne virus abroad, but the son didn’t travel to an affected area or have sex with anyone who did, the report said.

“The son has since recovered. The virus causes only a mild illness in most people. But during recent outbreaks in Latin America, scientists discovered that infection during pregnancy has led to severe brain-related birth defects.

“Health officials also haven’t found any of the tropical mosquitoes that mainly spread the virus in the area or evidence that local mosquitoes are carrying the virus, according to the report released by the CDC.

“The son didn’t report touching any bodily fluids, and other family members had similar interactions with the father without getting sick, Dunn said. ‘We weren’t able to identify anything he did that was different,’ she said.

“It’s not uncommon to be unable to identify a key thing a patient did or didn’t do before catching an illness like Zika, Kallen said. Small, even unremembered, factors can often make a big difference, he said.

“The investigation is ongoing, and more information is expected later this year.

“More than 2,900 Zika illnesses have been reported in continental U.S. and Hawaii, including 13 in Utah, according to health officials.”

Source: CBS News

September 16, 2016: Florida Zika Count Hits 70 Local Cases

Florida health officials said Tuesday they found six new locally transmitted cases of Zika virus, bringing the state’s count to 70 cases.

“Florida Governor Rick Scott traveled to Washington D.C. Tuesday to lobby Congress for federal funding to fight the virus, and doctors repeated warnings that money’s running out, even as more and more pregnant women seek testing to see if they have Zika infections.

“’These are pregnant women who really want to know if their baby is at risk,’ said Dr. Beth Bell of the Centers for Disease Control and Prevention. ‘Tests take time.’ Bell said the CDC doesn’t have any more cash to work on faster and better tests so that women don’t have to wait for weeks to find out if they’ve been infected.

“The Zika virus causes catastrophic birth defects, as well as neurological conditions in adults.

“The Population Institute released a report Tuesday showing that the biggest threat of Zika is in states that provide the lowest levels of medical care to women who may become pregnant. ’It’s a cruel irony that the women most at risk of Zika are often the ones with the least access to reproductive health services,’ said Population Institute president Bob Walker.

“Congress has spent months dithering over Zika funding. President Barack Obama asked for $1.9 billion in emergency cash to fight the virus in February. Republicans who control both houses of Congress want to offer less, and Democrats have rejected bills that they say have unacceptable political extras written in.

“Senate Majority Leader Mitch McConnell now says Zika funding is likely to be included as part of a last-minute spending measure called a continuing resolution. The federal budget year runs out at the end of September.

“There’s no agreement on a final budget, but a CR, as the measure is called, would provide three months of funding so the federal government does not have to close — something that last happened in 2013.

“Federal health officials say three months worth of money is far from ideal.

“Bell said programs to develop better Zika tests, to monitor people for the virus and to study the damage that it can do to babies are all at risk.”

Source: NBC News

September 15, 2016: Miami's Beloved Bromeliad is a Zika Breeding Ground

“The battle of the bromeliads is underway in South Florida.

“As the region tries to contain the Zika virus, government officials have taken particular aim at the plants that are popular for their vibrant colors but can become breeding grounds for mosquitoes. Their hard leaves grow in tight, cylindrical formations, which allows water to pool inside and provide a perfect mosquito incubator.

“Miami-Dade County and Miami Beach have ordered bromeliads removed from all government property and are encouraging residents to do the same in their homes and businesses. The city of Miami has removed hundreds of plants along the central US-1 corridor. Those who fight mosquitoes every day have applauded those decisions to eliminate the plants that serve as incubators for mosquitoes that spread Zika.

“But some in South Florida feel the bromeliad is being unfairly targeted.

“Leo Castro, a nursery owner in the Redlands agricultural area south of Miami, said he has 100,000 bromeliads in his nursery but doesn’t have mosquito problems because he regularly flushes the water from the plants to make sure mosquito larvae don’t have time to grow. He said he’s lost big contracts recently – from government buildings to commercial complexes to hospitals – that have heeded government warnings and decided to rip out their bromeliads.

“Castro, who owns Country Garden Bromeliads, said that’s unfair to the plants – and his business – considering that South Florida was built on a swamp and has dozens of other trees and plants that pool water.

“’The bromeliads are getting a bad rap,’ he said. “Even if you got rid of every single bromeliad in South Florida, the mosquitoes wouldn’t go away.”

“Sandy Shapiro is so concerned about the plight of the bromeliad that she’s hosting a community forum next week to talk about the impact Zika is having on the region’s horticultural industry. Shapiro is the executive director of the Miami Beach Botanical Garden, which was closed down for a week after Florida health officials captured mosquitoes with the Zika virus in the garden.

“Shapiro said her staff has been closely monitoring the garden’s 2,000 bromeliads since Zika was first detected in South Florida. She said they followed the standard protocol for the plants – flushing the water regularly to remove mosquito larvae, spraying the plants with non-chemical larvicides and trimming dying leaves.

“Despite those efforts, she said Miami Beach officials came in and removed all the plants, filling three dump trucks.

“’Public health is the most important thing,’ she said. ‘But…that was a regrettably extreme measure. It has ripple effects, and we don’t realize how it spills over into the broader community.’

“To date, more than 600 people, including more than 80 pregnant women, have tested positive for the Zika virus in Florida – all contracting the virus while traveling abroad. The state Department of Health says 56 people contracted the virus locally. Miami-Dade County began aerial mosquito spraying last week and will continue through the month to lower the mosquito population on Miami Beach.”

Source: USA Today

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