H5N1

Zika virus: GM mosquitoes, vision problems in infants, map of US Zika imports

Just before a very news-rich week begins, an item from NEJM Journal Watch: Zika Virus: GM Mosquitoes, Vision Problems in Infants, Map of U.S. Zika Imports. Click or tap through for links to the original reports:

Here is the latest news on the Zika virus from the weekend: 

• Scientists in Brazil are working on a genetically-modified Aedes aegypti mosquito to combat the spread of Zika and other mosquito-borne viruses. Male mosquitoes would pass a deadly gene to their offspring that would kill them prior to adulthood, the New York Times reports. In addition, another group of scientists is infecting mosquitoes with bacteria that make the mosquitoes less likely to acquire and transmit viruses. 

• Infants born with microcephaly in Brazil seem to be at risk for vision problems, Reuters reports. Half of infants evaluated in a rehab center in one city had impaired vision because of deformed optic nerves and retinas. 

• Scientific American has constructed a map showing where all of the imported cases of Zika in the U.S. were likely infected, using data from state health departments.

Zika in Brazil: Health system fails in diagnosis and rehabilitation of microcephaly cases

Via O Globo: Drama amplificado.[Drama intensified] Edited excerpt from the Google translation, and then a comment:

Rosa Angela took two days to accept the daughter who had just been born.

"She went to nursery, I was in a room. They asked then if I wanted her to go up to the room. They spent two days climbing, because I did not want to. Stay there with her, you know? I wasn't prepared. I cried, the psychologist came, he spoke. Then I settled down."

Still wearing braces on her teeth, the 17-year-old saw the face of microcephaly in her first daughter. Lara Safira was born three months ago with a skull diameter of 28 cm and took the family by surprise: Zika had not been diagnosed previously, although the mother had prenatal care and three ultrasounds during pregnancy. 

Rosa Angela lives with her husband and their daughter in Itapissuma, municipality of the Metropolitan Region of Recife, about 45 km from the state capital which has the most registered cases of microcephaly in Brazil.

Rehabilitation needs more places

The tragedy that emerged with the revelation that pregnant women who contracted Zika virus had, because of the virus, babies with microcephaly - by the end of 2015, hundreds of babies in the country - is a sum of family tragedies. 

This will be the real disaster: The coming years and decades when microcephaly has been forgotten in the rush of new health threats, but parents and communities will still have to do what they can for some people unlucky enough to have been born in 2015 and 2016. 

WHO: Zika in the US Virgin Islands

WHO has published Zika virus infection – United States of America - United States Virgin Islands. Excerpt:

On 25 January 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of the first laboratory-confirmed cases of Zika virus infection in St. Croix, one of the three main islands in the United States Virgin Islands (USVI). 

The USVI Department of Health received laboratory confirmation of the case on 22 January. The patient is a non-pregnant woman from USVI who reported the onset of fever, rash, conjunctivitis and arthralgia on 1 January. She had not travelled in the three weeks that preceded the onset of symptoms. A serum sample obtained from the patient on 8 January tested IgM positive at the U.S. Centers for Disease Control and Prevention. The sample was negative for dengue and chikungunya virus infections. 

Public health response 

The territorial health department currently is investigating several suspect cases of Zika virus disease. The public is being urged to take preventive measures to avoid mosquito bites.

Colombia has more than 2,100 pregnant women with Zika virus: Government

Via Colombia Reports, a Reuters report: Colombia has more than 2100 pregnant women with Zika virus: Govt. Excerpt:

More than 2,100 pregnant Colombian women are infected with the mosquito-borne Zika virus, the country’s national health institute said on Saturday, as the disease continued its spread across the Americas. 

The virus has been linked to the devastating birth defect microcephaly, which prevents the brain of a fetus from developing properly. There is no vaccine. 

There are 20,297 confirmed cases of the virus in Colombia, the national health institute said in a epidemiology bulletin, and among them are 2,116 pregnant women. 

There are so far no reported cases of microcephaly or deaths from the virus in Colombia. 

The institute said 37.2 percent of pregnant women with Zika live in Norte de Santander Province, along the eastern border with Venezuela.

Meanwhile, Vanguardia.com reports four pregnancies in Santander department, just next door, and then says, somewhat confusingly, 

If these cases are considered as high-risk pregnancies, the Ministry of National Health has made it known that only one in every 1,000 pregnant women with Zika may have a child with neurological changes, according to official projections.

 

... The Departmental Secretariat of Health says all Zika cases in pregnant women are under special surveillance, with tracking and gyneco-obstetric follow-up. Any suspected Zika case must continue to be tracked until giving birth to see whether the baby has neurological change. (My translation.)

I wish I knew where the ministry got that one-in-a-thousand statistic.

China: New H7N9 case in Hangzhou

Via the Shanghai Daily: Avian flu diagnosis.

Another human H7N9 avian flu case has been confirmed in east China’s Zhejiang Province. The patient is a 59-year-old woman from Gaoxin District in Shaoxing City, the Hangzhou Health and Family Planning Commission announced on Thursday. 

Disease control and prevention authorities in the province say avian flu cases have been on the rise this winter, with H3N2 and H1N1 being the most commonly seen strains. 

Sporadic human H7N9 cases have also been reported in Shanghai, Hunan, Guangdong and Fujian. There have been two fatalities this winter, one in Zhejiang and another in Guangdong. Medical experts have warned of an upsurge in flu cases as millions of people travel across the country for the Chinese New Year.

Nigeria: Lassa fever kills doctor in Nasarawa

Via Vanguard: Lassa Fever kills doctor in Nasarawa. Excerpt:

A Medical personnel in Dalhatu Specialist Hospital (DASH) Lafia, has been confirmed dead after treating a patient with Lassa Fever in the only specialist hospital owned by the state. 

The death of the medical doctor, Ibrahim Oshafu bring the toll to two while scores are hospitalized, mostly in Lafia. 

Oshafu was among the members of the rescue team in DASH. He has since been buried according to Islamic injunction. 

Consequently medical personnel from DASH Lafia have decided to join the ongoing strike action leaving the state grounded.

Zika virus found in Indonesia

Via the South China Morning Post: Zika virus found in Indonesia: Authorities stumble across positive case during tests for dengue fever. Excerpt:

An Indonesian research institute said on Sunday it had found one positive Zika case on Sumatra island, adding that the virus has been circulating in the country “for a while”. 

Indonesia’s health ministry could not immediately comment on the report by the Eijkman Institute for Molecular Biology. 

The mosquito-borne virus has sparked widespread alarm in parts of the Americas. It is suspected of causing grave brain damage in newborns and has similar symptoms to dengue fever. 

The institute said a 27-year-old man living in Jambi province on Sumatra island who had never travelled overseas had been found to be infected. It said it stumbled on the case while studying a dengue outbreak in the province. 

Researchers set aside specimens which produced dengue symptoms such as rashes and fever but which tested negative for dengue, and researched them further. 

“Out of the 103 [dengue-negative] specimens that we checked, we found one positive for Zika,” the institute’s deputy director, Herawati Sudoyo, said. 

Zika is transmitted by the Aedes aegypti mosquito, which also spreads dengue fever and the chikungunya virus. It produces flu-like symptoms including a low-grade fever, headaches, joint pain and rashes. 

Sudoyo said the specimens were taken during a dengue outbreak in Jambi between December 2014 and April 2015. It was not known how and when the man, who never travelled overseas, contracted the virus. 

“We concluded that the virus has been circulating in Indonesia for a while,” Sudoyo said.

MSF: Starvation continues in Madaya

Via MSF.org: Syria: Starvation continues in Madaya - MSF denounces continued blockage of essential aid and medical evacuations. Excerpt:

Residents of the besieged Syrian town of Madaya continue to die of starvation, despite the provision of aid in convoys, as the Syrian government-led coalition blocks life-saving medical supplies from the town, Médecins Sans Frontières (MSF) said Friday. 

“It is totally unacceptable that people continue to die from starvation, and that critical medical cases remain in the town when they should have been evacuated weeks ago,” said Brice de le Vingne, MSF’s director of operations. 

After the heavy shelling of Madaya last summer and the tightening of the siege during the winter, massive restrictions placed on humanitarian assistance mean that essential medical supplies – including enough therapeutic food to treat the most severe cases of malnutrition – are not available. 

MSF estimates that between 1.5 and two million people are trapped in sieges imposed by the Syrian government-led coalition, as well as by opposition groups. In many of these places, medical evacuations are prevented and medical material, drugs and therapeutic food is repeatedly blocked at checkpoints. As a result, medical teams in these areas simply cannot cope with the demands they face. The situation in Madaya is even worse as there are no doctors present in the town. 

According to health workers supported by MSF inside Madaya, 16 people have died since the delivery of aid in three convoys earlier this month. 

There are an estimated 320 cases of malnutrition in the town of 20,000 people, of which 33 are severe, meaning that they are in danger of death if they do not receive prompt and effective treatment.  

“There needs to be a permanent and independent medical presence in Madaya immediately, as we expect the medical situation to worsen as access to healthcare for people inside remains extremely limited,” said de le Vingne, the operations director.

Oxfam: Ebola funds impossible to track

Via Oxfam International: Ebola funds impossible to track. Excerpt:

Global leaders are failing to honor their promises to communities devastated by Ebola in West Africa as $5.8 billion of pledged recovery funds proving almost impossible to track, Oxfam warned today.  

Six months after the International Conference on Ebola Recovery in New York, at least $1.9 billion worth of promised funds have not been delivered and scant information is available about the remaining $3.9 billion.   

Aboubacry Tall, Oxfam's Regional Director for West Africa, said: "We know that $1.9 billion of the promised funds have not even been committed to a specific country but we can't say for sure how much of the remaining committed money has been effectively delivered.  

"A lack of transparency throughout the whole process, from donors to implementing organizations to programs on the ground means we're finding it hard to understand which donors have given what money, to whom and for what purpose." 

The Ebola outbreak has set the affected countries back years; shattered already inadequate health systems and ruined people's livelihoods. Donors and the governments of Sierra Leone, Liberia and Guinea must act now to meet their commitments to communities by publishing accurate, timely and detailed information on aid delivery and Ebola recovery efforts. 

It has taken almost two years, more than 11,300 deaths, massive provision of resources, technical assistance and billions of US dollars from around the world to tackle the Ebola epidemic in West Africa. Yet despite this, last week, another 150 people were exposed to the risk of Ebola in Sierra Leone according to the World Health Organisation. This is not the end of Ebola in West Africa or globally.  

Tall said: "In order for the countries to quickly build the health systems they require, governments and communities need to know what aid they are getting, when it is coming, where it is going and they need to have a say in how it is used. We urge donors to ‘put their money where their mouths are' and demonstrate what transparency really means by, at a minimum, publishing information in accordance with International Aid Transparency Initiative standards."  

As African Heads of State meet in Addis Ababa this week to discuss making 2016 the year of Human Rights in Africa, Oxfam is calling on them to focus attention on the Right to Health. 15 years ago, African leaders made a commitment to provide 15% of their budgets to the health sector - urgent action is required to achieve this. Adequate investment in health systems, water, sanitation and hygiene is vital to protect lives.

Zika virus could be bigger global health threat than Ebola, say health experts (oh yeah?)

Via The Guardian: Zika virus could be bigger global health threat than Ebola, say health experts. Excerpt and then a comment:

The Zika virus outbreak in Latin America could be a bigger threat to global health than the Ebola epidemic that killed more than 11,000 people in Africa. 

That is the stark claim of several senior health experts ahead of an emergency meeting of the World Health Organisation on Monday which will decide whether the Zika threat – which is linked to an alarming rise in cases of foetal deformation called microcephaly – should be rated a global health crisis. 

“In many ways the Zika outbreak is worse than the Ebola epidemic of 2014-15,” said Jeremy Farrar, head of the Wellcome Trust. “Most virus carriers are symptomless. It is a silent infection in a group of highly vulnerable individuals – pregnant women – that is associated with a horrible outcome for their babies.” 

There is no prospect of a vaccine for Zika at present, in contrast to Ebola, for which several are now under trial. “The real problem is that trying to develop a vaccine that would have to be tested on pregnant women is a practical and ethical nightmare,” added Mike Turner, head of infection and immuno-biology at the Wellcome Trust. 

With at least 80% of those infected showing no symptoms, tracking the disease is extremely difficult. The mosquito species that spreads Zika, Aedes aegypti, has been expanding its range over the past few decades. “It loves urban life and has spread across the entire tropical belt of the planet, and of course that belt is expanding as global warming takes effect,” added Farrar. 

Only extreme measures are likely to contain the Zika threat, said Turner. These could include the use of DDT to eradicate Aedes aegypti as quickly as possible. “We have to balance the risk posed to the environment by DDT with the terrible impact this virus is having on the unborn.”

I'm certainly willing to consider bringing back DDT if that's what it takes (but why couldn't we have found something since then that's both mosquito-hostile and bird-friendly?). 

But saying "worse than Ebola" trivializes the state of global health. 

 

When I feel in need of a reality check, I go to Worldometers, which offers real-time counts of many kinds of statistics, with the numbers rising before my eyes. For example, it tells me on this peaceful Saturday night in Vancouver that over 25,000 people around the world have died of hunger today. So far in this year of grace 2016, over 147,000 have died of water-related diseases.

 

Worldometers tells me that over one million people have died this month of communicable diseases. Malaria in 30 days has killed over 80,000 of us. Over 600,000 children under five have died so far this year, and over 28,000 mothers have died giving birth—well over twice the total toll of Ebola, and 11 months to go. Go check the HIV/AIDS deaths for yourself (spoiler alert: they're well over ten times the deaths from Ebola).

 

So spare me, health experts, from idle comparisons between new diseases that are still mere distractions from the old standbys that have killed us by the million for centuries.