Those who proclaimed the end of infectious diseases spoke too soon.
The words of Stony Brook University President Samuel L. Stanley Jr., MD, resonated with a group of 250 primary care providers who gathered online and in person at the Stony Brook Medicine Campus on Sept. 29 to hear an update for medical professionals on the Zika virus.
Titled “From A to Zika: An Update on Zika Virus for Primary Care Providers,” the event was hosted by New York State Department of Health Commissioner Howard A. Zucker, MD, JD, as part of the Commissioner’s Medical Grand Rounds series.
A panel of experts including Dr. Stanley, a medical doctor and researcher whose expertise is focused on emerging infectious diseases and their role in epidemics, addressed providers who learned the latest evidence about transmission, best practices for laboratory testing and evaluation, potential health effects and prevention of Zika virus infection.
Others on the panel included Louis Manganas, MD, PhD, Assistant Professor in the Department of Neurology at Stony Brook University School of Medicine; Burton Rochelson, MD, Chief of Maternal Fetal Medicine at Northwell Health; and Philip Kurpiel, PhD, MPH, Program Supervisor for the MARO Regional Epidemiology Program with the New York State Department of Health.
“There was a time in the ’70s when people felt that we had conquered infectious diseases,” Dr. Stanley said. “We had the vaccines and we had the antibiotics necessary to conquer this scourge.” But the emergence of HIV changed all that.
“We’ve all heard the wide range of opinions on what should be done,” said Kenneth Kaushansky, MD, Senior Vice President, Health Sciences, and Dean, Stony Brook University School of Medicine, who moderated the panel. One positive piece of news came when Congress passed a bill on Sept. 28 allocating $1.1 billion to fund Zika virus research and prevention.
Dr. Stanley provided a brief overview of what is currently known about the Zika virus:
- It is primarily transmitted by mosquito bites; it can also be sexually transmitted.
- The virus crosses the placental barrier and can infect the fetus of a pregnant woman who is infected.
- The virus can also be transmitted through blood and bodily fluids.
- The Aedes aegypti mosquito is most likely to transmit the disease since it prefers to feed on people, and its cousin the Aedes albopictus can also transmit the disease, although not as likely, since it feeds on both animals as well as people. Both are found in the United States.
Only one in four to five people will develop symptoms, and most are asymptomatic, he said. Possible symptoms include headache, fever, muscle or joint pain, skin rash, vomiting or conjunctivitis.
Dr. Stanley noted that physicians and researchers have identified two complications from Zika:
- Guillain-Barré syndrome, a disorder in which the body’s immune system attacks the nerves. Research from the Centers for Disease Control and Prevention (CDC) suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS.
- Microcephaly, a congenital condition in which an infant’s head is significantly smaller than normal. The CDC has identified maternal infection with Zika virus during pregnancy as a cause of microcephaly.
Commissioner Zucker told the group that researchers are aware that symptomatic pregnant women are more likely to transmit the virus to a fetus than asymptomatic women, but they don’t know if any symptoms in particular are involved.
For clinicians wondering how to treat Zika infection, Dr. Stanley noted that currently there is no vaccine or antiviral drug.
“I think there’s very strong evidence that after infection people do develop protective immunity and that, in turn, provides reason to be optimistic that a vaccine would be effective,” he said. “But we don’t know yet how long the immunity may last.”
For more information on Zika prevalence and prevention, visit the NYSDOH website.
(As of Sept. 29, 2016)
Though most people get the Zika virus from a mosquito bite, there are other methods of transmission:
- During pregnancy: A pregnant woman can pass Zika virus to her fetus during pregnancy. Zika causes microcephaly, a severe birth defect that is a sign of incomplete brain development.
- Through sex: Zika virus can be passed through sex from a person who has Zika to his or her sex partners.
- Through blood transfusion: There is a strong possibility that Zika virus can be spread through blood transfusions.
In the United States, there have been 3,358 cases of the Zika virus:
- Locally acquired mosquito-borne cases: 43
- Travel-associated cases reported: 3,314
- Laboratory acquired cases reported: 1
Of these, 28 were sexually transmitted and eight were diagnosed with Guillain-Barré syndrome.
In U.S. Territories, a total of 19,777 cases have been reported:
- Locally acquired cases reported: 19,706
- Travel-associated cases reported: 71
Of these, 37 were diagnosed with Guillain-Barré syndrome.
In the United States and the District of Columbia, there are 749 pregnant women with any laboratory evidence of Zika infection. In the U.S. territories, there are 1,348.
Preventing mosquito bites is imperative. Preventive measures include:
- Long sleeves and pants
- Window screens
- Air conditioning
- Insect repellent