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September 26, 2016: What Does the Zika Rash Look Like?

This update from Naseem S. Miller.

“I came across one of the most precise descriptions of Zika infection symptoms in a recent New Yorker piece by the award-winning author and physician Dr. Siddhartha Mukherjee.

“In ‘The Race For A Zika Vaccine,’ Mukherjee follows the virus from one side of the globe to the other and into the laboratories of scientists who are racing to find a vaccine.

“The story starts with the case of a woman who walked into an E.R. in Melbourne, Australia, in April 2014 with symptoms that didn’t quite match anything the doctors had seen.

“The case is what we call today a travel-related case of Zika infection.

“The woman had just returned from the Cook Islands in the South Pacific. She first developed a fever, followed by a mild headache that turned into a persistent throb, Mukhrejee writes.

“’Migratory pains appeared in her joints, and an angry, blanching rash—the kind that pales when you press it—was now blooming across her torso,’ he writes.

“He then further describes the rash as ‘vivid raised red dots coalescing into islands—and the color of her eyes (pink, with streaks of vermillion), which was indicative of conjunctivitis, a symptom of certain viral infections.’

If you’re obsessed with learning about the Zika virus as I am, I highly recommend reading this piece.

Source: Orlando Sentinel

September 25, 2016: Sabah People May Have Inborn Zika Virus Antibodies

“People in Sabah may not need to be too worried about the Zika virus because they could have inborn antibodies since it is said to be endemic here.

“A Universiti Malaysia Sabah (UMS) Faculty of Medicine and Health Sciences (FMHS) professor said the virus has been found in apes and probably humans here as early as the 1960s.

“’From what scientists have researched and confirmed, we know that the orang utan are among apes or monkeys that carry the virus,’ molecular epidemiologist Prof Dr Kamruddin Ahmed said.

“However, due to deforestation and other factors forcing more animal-human contact, the Zika virus has been spread to humans, he said during an open forum on the virus at UMS on Tuesday.

“’It means that most of us probably have a natural anti-body against the virus,’ he said.

“’Therefore, it may mean that this Zika virus may not affect us the same way it is affecting other people in other parts of the world, especially Brazil where many babies born of Zika-infected mothers have microcephaly (small head) syndrome,’ Dr Kamruddin said, adding that the Zika virus strains in Malaysia and South America were different.

“He said there was also no concrete proof that microcephaly was caused by Zika virus but researchers are still trying to find answers to its cause and symptoms.

“He also said that international scientists are closer to finding a vaccine against the virus suitable for humans.

“Three experimental vaccines were reportedly developed by researchers at Harvard’s Beth Israel Hospital and the Walter Reed Army Institute of Research.

“The vaccines tested on monkeys were found to be safe and protected the animals against infection, according to the report published in Science magazine.

“Dr. Kamruddin advised people to be cautious but not panic, and to take measures to ensure they do not contract the virus.

“’There are still a lot of questions we cannot answer so it is best that we all take precautionary measures,” he said.

“Kota Kinabalu health office public health medicine consultant Dr. Jiloris @ Julian Dony urged the public to use mosquito nets at home, wear light and long-sleeved shirt and pants, as well as spray repellents when necessary to avoid being bitten by mosquitoes.

“’Everyone has a part in keeping their surroundings clean and to rid their areas of mosquito breeding grounds,’ he said, adding that there is no screening for Zika virus at public hospitals and clinics as of now.

“Also present at the forum were former Sabah Health Department director, who is now the public health medicine consultant for FMHS, Datuk Dr Mohd Yusof Ibrahim; FMHS entomologist Prof Dr Chua Tock Hing; Jesselton Medical Centre infectious disease consultant Dr Timothy William; and FMHS deputy dean of academic and student affairs Prof Dr Ahmad Faris Abdullah.”

Source: The Star

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":, 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

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