Zika: Forgotten, but not gone; Trump budget would slash funds aimed at safeguarding the public

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The News:

As the weather gradually gets warmer, and in some areas more humid, public health officials in the United States are quietly gearing up to combat the threat still posed by the Zika virus.

As warm weather approaches, the threat of the #ZikaVirus will increase Click To Tweet

In the coming months, the threat of Zika “will get worse, and the consequences of inaction are very real for pregnant women and their babies,” Claude Jacob, president of the National Association of County and City Health Officials (NACCHO), warned Wednesday (May 31, 2017) during a media briefing, according to Medscape.

NACCHO, along with the Big Cities Health Coalition (BCHC) and the March of Dimes, held the briefing to discuss the threat posed by the Zika virus this summer.

Zika infections continue to be “widespread in Puerto Rico and the US Virgin Islands, and of course we had outbreaks in Miami and Brownsville, Texas, last year, and we expect more local outbreaks of Zika in this country, the mainland as well as other territories,” said Paul Jarris, MD, chief medical officer of the March of Dimes.

The Southern and Gulf Coast regions in the United States are particularly vulnerable to Zika outbreaks.

When it comes to Zika, “we absolutely need to maintain vigilance and funding for Zika as it spreads and we learn more about the effects on pregnancy and newborns,” said Dr. Jarris.

It is now known that Zika is responsible not only for microcephaly but also a spectrum of physical and neurologic effects on the fetus and newborn, Jarris explained.

“It’s not just spread through mosquitoes but also through sexual activity, and it can remain in body fluids for weeks or even months. We know that it causes brain damage, and we are learning that even newborns who appear normal at birth later suffer deterioration in the weeks or months,” said Jarris.

More alarmingly, Dr. Jarris said: “We also recently had a case report about of an adolescent who underwent neurologic changes after a Zika infection. This is a single case, but it’s concerning that this virus may affect developing adolescents.”

According to the Centers for Disease Control and Prevention (CDC), thus far in 2017, 121 cases of Zika have been reported on the US mainland, and an additional 498 have been reported in US territories. In 2016, 10% of the 250 women with confirmed Zika infection delivered a fetus or baby with a Zika-related birth defect.

Steve’s Take:

Alright. Zika isn’t going away any time soon.

All members of the US briefing panel agreed yesterday that combating the Zika virus will be severely undermined as federal funding wanes.

Steve's Take: @realDonaldTrump cuts to @CDCgov will damage ability to fight #ZikaVirus Click To Tweet

Predictably, nowadays, President Trump’s budget proposal eliminates $2.1 billion from the CDC’s budget, cuts in half funding for the Epidemiology and Laboratory Capacity for Infectious Diseases program, and cuts the Public Health Emergency Preparedness program by $109 million. These cuts will have “lasting damage” to efforts to fight Zika, Jacob said.

Oscar Alleyne, senior advisor for public health programs at NACCHO, said, “Zika funds are not where they should be if we are serious about protecting the lives of people we serve in the community. Failing to fund Zika efforts can and will be catastrophic.”

No one can afford to be complacent when it comes to Zika, said Zachary Thompson, director, Dallas County Health and Human Services and BCHC member. His advice: “Use mosquito repellent all day every day” when outdoors.

The bummer about complacency is that given all the daily (often hourly) tumult emanating from the Trump administration, Zika has become invisible, languishing under the media’s coverage scanners.

Problem is, Zika is here to stay and exact its inconceivably cruel toll on our collective global lives. Political regimes on the other hand–both here and mostly elsewhere in the world–are transient.

So what do we know that we didn’t when “Zika” was just a funky-sounding curiosity? Stat News enumerates the list of sobering new data:

  • Sequencing the genome of Zika virus has indicated that in almost every affected country, Zika was circulating for months–or even years–before the first cases were reported (The Atlantic).
  • Though good news for the broader population, a drop in Zika cases in Latin America has made it hard for research studies on the virus to recruit enough participants to have meaningful results (Nature).
  • By removing protections for preexisting conditions, the GOP health bill may make insurance prohibitively expensive both for pregnant women who have had Zika and for infants born with microcephaly (Mother Jones).

So how are we doing so far here in the US?

The supposedly independent Government Accountability Office (GAO) last week released a report on the US government’s response to the Zika epidemic, concluding that the CDC and many states were underprepared to battle the outbreak. The report finds that the federal government could do better specifically on distributing and regulating diagnostic tests and on communicating geographic risk of the virus.

That’s a patently skimpy, almost dismissive, characterization of the problem and all that needs to be done, seems to me.

Then there’s a worrisome case study.

A recently published case study describes an American adolescent who contracted Zika on a trip to the Caribbean. Symptoms of sore throat, headache, rash, and joint pain resolved soon after the individual returned to the US, but a range of worrying psychiatric symptoms–including “excessive energy, decreased sleep, rapid and tangential speech, grandiose thinking, impulsivity, and decreased inhibition”–stuck around for weeks afterward and even necessitated a period of hospitalization.

Fifteen weeks after symptom onset, doctors reported, the patient’s symptoms were better but not gone. All told, they write, the case “raise[s] the possibility that Zika virus infection may trigger neuropsychiatric and cognitive symptoms.”

And then there’s the thorny issue of the logical solution to much of the Zika pandemic’s longer-term threat.

NPR reported earlier in the week that the US Army is planning to grant an exclusive license to the French pharmaceutical company Sanofi Pasteur to manufacture and sell a Zika vaccine the Army developed last year.

And that has US health officials worried about how to pay for it.

“God forbid we have a Zika outbreak. We’re in the middle of a fiscal crisis, we’re already cutting services to people and we’re already potentially cutting our funding to fight the Zika virus,” says Rebekah Gee, Louisiana’s secretary of health.

If the Army goes through with its plan, she says, Sanofi could set a price for the vaccine at a level that Louisianans just won’t be able to afford.

It’s still not certain the vaccine developed by the Army will work, or that there will be a market for it in the end, says says Dr. Jon Heinrichs, an associate vice president at Sanofi Pasteur in Pennsylvania, where he leads vaccine development.

There are many other efforts to develop Zika vaccines, some of which have government funding, and it’s not clear which will be most effective. Plus viruses can mutate, so a vaccine that is effective this year may not be in the future.

Bottom Line:

Largely forgotten right now, but gone forever? No; Zika is here, biding its time waiting for the warmer weather its mosquito partners/enablers relish. And if the images of the newborns with microcephaly aren’t enough to spur our Congressional reps to fend off the GOP’s proposed budget cuts in order to protect us, it’s time to pick up the phone and give her or him an earful.

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