Monthly Archives: January 2016

Centers for Disease Control issues travel warning due to birth defects linked to the rapidly spreading mosquito-borne disease

The U.S. Centers for Disease Control and Prevention issued a travel warning for pregnant women and those trying to get pregnant: stay clear of places where Zika virus is present.

The warning about the mosquito-borne illness encompasses 14 countries and areas, which include: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela and the Commonwealth of Puerto Rico. Moreover, the number of areas with active transmission of Zika will increase, says Lyle Petersen, director of CDC’s Division of Vector Borne Infectious Diseases.

“This is a fairly serious problem,” says Petersen. CDC issued the statement today instead of waiting until after the weekend, he says, because “the virus is spreading fairly rapidly throughout the Americas” and there is mounting evidence connecting Zika and microcephaly. The agency was originally slated to issue its announcement Friday afternoon but delayed it until Friday evening.

The agency is issuing this recommendation after CDC scientists tested samples provided by Brazilian health authorities from two infants with diagnosed microcephaly who died shortly after birth and from two pregnancies that ended in miscarriage. All four mothers reported having symptoms consistent with Zika virus disease during their pregnancy. CDC’s analysis found that Zika virus was present in the brains of both full-term infants. Outside of this Zika link, microcephaly is typically caused by genetic factors, exposure to environmental toxins or diseases during pregnancy including rubella or herpes.

CDC is now recommending that women in any trimester of pregnancy “should consider postponing travel to the areas where Zika virus transmission in ongoing.” So far, most evidence suggests the risk to pregnant women is greatest during the first trimester. For women who are trying to get pregnant CDC recommends consulting with a healthcare provider before traveling to these areas. People traveling to any of the 14 areas covered under the warning should make sure windows in their lodgings have screens and strictly follow steps to prevent mosquito bites during the trip, including wearing long sleeves, long pants and applying insect repellents containing substances like DEET. “Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant and nursing women and children older than 2 months when used according to the product label,” the agency said, in a statement.

The mosquito-borne disease caused by the Zika virus was considered minor and rare prior to a large outbreak in Micronesia in 2007. The disease itself is relatively mild – leading to a week of symptoms including rash, fever and joint pain – but its recent links with microcephaly prompted CDC to take this step. “We cannot quantify the risk,” Petersen said.

Last year, Brazil reported about 20 times its average level of microcephaly. Between October 2015 and January 2016 there have been more than 3,500 cases of the incurable condition, CDC says, citing Brazilian health authorities. Babies with the condition are born with abnormally tiny heads, and often, debilitating brain damage. “It is critically important to confirm or dispel a causal link between Zika infection of pregnant women and the occurrence of microcephaly by doing intensive investigative research, including careful case–control and other epidemiologic studies as well as attempts to duplicate this phenomenon in animal models,” Anthony Fauci, director of the National Institute for Allergy and Infectious Disease, and his colleague David Morens wrote in the New England Journal of Medicine earlier this week.

Petersen says it is too early to speculate if the Zika-microcephaly travel warning will still be in effect by the time of Olympics in Rio de Janeiro this summer.

So far, Zika has not yet been locally transmitted in the United States, although 26 U.S. travelers have been infected with the virus elsewhere, Petersen says. The species of mosquitoes biologically capable of transmitting the virus, however, are present in the United States.

Earlier this week Harris County, Texas, confirmed that a middle-aged female who traveled to El Salvador in November had subsequently developed symptoms of Zika and that the disease had been confirmed by laboratory testing. “She is now fully recovered,” says Umair Shah, the executive director of the Harris County Public Health and Environmental Studies. When it comes to the possibility of Zika showing up in their local mosquitoes, however, “for us it’s not a matter of if – it’s a matter of when,” he says.

In the greater Houston area, doctors have been informed to be on the lookout for Zika symptoms and take careful travel histories of people who have traveled to Zika-affected areas, according to Shah. The county’s mosquito control office is also testing local mosquitoes for any signs of dengue – a test that it is using as a proxy for Zika screening because there is no readily available field test for Zika, says Mustapha Debboun, Director of the Mosquito Control Division for the county.


Meliodosis may be killing as many people worldwide as measles, while Zika also raises global alarm

A little-known bacterial disease may be killing as many people worldwide as measles, scientists said on Monday, while a mosquito-borne virus known as Zika is also raising global alarm.

The spread of Ebola in West Africa last year shows how poorly-understood diseases can emerge and grow rapidly while researchers race to design and conduct the scientific studies needed to combat them.

Researchers in the journal Nature Microbiology called for a bacterial infection called meliodosis, which is resistant to a wide range of antibiotics, to be given a higher priority by international health organizations and policy makers.

At the same time, scientists at Britain’s Oxford University warned that a virus known as Zika, which is carried by mosquitoes and has caused a major outbreak in Brazil, has “the potential of rapid spread to new areas.

Zika was first detected in Africa in the 1940s and was unknown in the Americas until last year, but has now been confirmed in Brazil, Panama, Venezuela, El Salvador, Mexico, Suriname, the Dominican Republic, Colombia, Guatemala and Paraguay, according to public health officials.

It is carried by the Aedes aegypti mosquito, which thrives in tropical climates and can also carry other diseases such as yellow fever, dengue fever and chikungunya.

Thousands of people in Brazil have been infected by Zika. While the virus is not thought to kill, health authorities there last year linked it to a surge in babies born with microcephaly, restricted head growth that seriously limits a child’s mental and physical abilities.

Trudie Lang, professor of Global Health Research at Oxford University, said Zika – for which there are currently no known treatments – was a cause for concern.

“It’s definitely becoming an issue, but there is so little research that we just don’t know the size of the potential threat,” she told Reuters.

She urged the international research community to act now to learn more about the virus, about how it is spread, and about how scientists might develop a treatment or vaccine against it.

“We need to learn from what happened with Ebola,” Lang said, referring to the devastating epidemic of that viral fever that swept through three countries in West Africa last year and caused more than 28,600 cases globally.

The vast majority of Ebola cases and deaths were in Guinea, Liberia and Sierra Leone, where more than 11,000 people were killed, according to data from the World Health Organization.

“We need to galvanize the research community now and move as quickly as we can from doing observational work (on Zika) to carrying out proper scientific research,” Lang said.

In the Nature study on melioidosis, scientists said the bacteria that causes it, Burkholderia pseudomallei, is commonly found in soils in Southeast Asia and Northern Australia, but can be spread to non-endemic areas via imports of infected animals.

“Melioidosis is a great mimicker of other diseases and you need a good microbiology laboratory for bacterial culture and identification to make an accurate diagnosis,” said Direk Limmathurotsakul, a microbiologist and assistant professor at Thailand’s Mahidol University, who co-led the study.

“It especially affects the rural poor in the tropics, who often do not have access to microbiology labs, which means that it has been greatly under-estimated as an important public health problem across the world,” he added.

The researchers estimate there are 165,000 melioidosis cases a year in people, of which 89,000 will be fatal. These tolls are similar to those caused by measles – a viral infection that can be prevented with a vaccine – and far greater than dengue fever.

The study found that the highest melioidosis risk zones are in South Asia, East Asia and the Pacific, including all countries in Southeast Asia and tropical Australia, sub-Saharan Africa and South America. There are also risk zones of varying sizes in Central America, southern Africa and the Middle East.


The Puerto Rico Department of Health reported today the first locally acquired case of Zika virus infection in Puerto Rico.  Zika was confirmed in a resident of Puerto Rico with no known travel history.  CDC is working closely with the Puerto Rico Department of Health to investigate how the patient may have contracted the virus. Health officials in Puerto Rico are monitoring for other cases of Zika virus infection.

CDC has issued a travel notice advising people traveling to Puerto Rico to take usual precautions to protect themselves from mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses, such as dengue and chikungunya.  These steps include wearing insect repellent, using air conditioning or window and door screens to keep mosquitoes outside, wearing long pants and long-sleeved shirts when possible, and emptying standing water inside and outside the home.

Zika virus, originally identified in 1947 from Zika forest of Uganda, is transmitted to people primarily through the bite of an infected Aedes species mosquito. These mosquitoes are found throughout tropical regions of the world and are the same mosquitoes that spread dengue and chikungunya viruses. Mosquitoes become infected with the Zika virus when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites. There is no vaccine to prevent or medicine to treat Zika virus infection.

Outbreaks of Zika have occurred in Africa, Southeast Asia, and the Pacific Islands. Because the Aedesspecies mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will spread to new countries. To date, Zika virus has been reported in several countries and territories in the Americas.  Brazil is investigating the possible association between Zika virus infection and cases of microcephaly (smaller than expected head size) in infants.

The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis. The illness is usually mild with symptoms lasting from several days to a week. Infection is thought to provide lifelong immunity. Severe disease requiring hospitalization is uncommon. Deaths are rare. Travelers returning from areas with Zika activity (see map) should seek medical care if they experience a fever and symptoms of infection. Health care providers in areas with reported cases should be on the alert for possible cases.