CDC weighs in with new Zika data, heightened warning about complacency

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The News:

Zika has gradually disappeared from the headlines, buried under the daily avalanche of news coming out of the nation’s capital and terror attacks in Europe. But on Thursday (June 8, 2017), the Centers for Disease Control and Prevention announced that more than 120 children were born with Zika-related birth defects in the US territories during the 15 months since Zika became a public health concern–about 5% of all babies born to women there with confirmed cases of the virus.

@CDCgov found that 120 children were born with #Zika related #birthdefects in the US territories Click To Tweet

Even worse, the data show that birth defects can occur if a woman becomes infected in any stage of pregnancy. That means pregnant women infected with Zika face a substantial risk of delivering a baby with brain abnormalities, vision problems, small heads (known as microcephaly), and other heartbreaking birth defects.

“We are still learning about the full range of defects, brain abnormalities, vision problems and other brain issues,” Acting CDC Director Dr. Anne Schuchat said, according to CNN. “But this data shows that Zika is associated with risk for the fetus when the infection is identified later in pregnancy.”

The CDC data, which represent the “largest number of completed pregnancies with laboratory confirmation of Zika virus infection to date,” were collected from the US territories of Puerto Rico, American Samoa, the Federated States of Micronesia, the Republic of Marshall Islands and the US Virgin Islands. This is the first such CDC report about how the virus has affected pregnant women and their babies in those areas.

“Some [babies] have seizures, while others have little to no control over their limbs and can’t reach out to touch things around them,” Schuchat said. “Some have significant feeding difficulties and have trouble swallowing or even breathing while feeding. Some babies cry constantly and are often inconsolable no matter what their caregivr does to soothe them.”

A total of 3,900 women with possible Zika infections were followed between January 1, 2016, and April 25, 2017. Of those, 2,549 delivered babies in that time. Of the women who carried to term, 1,508 had confirmed infections, and 122 of those had babies obviously affected by the Zika virus.

Although 8% of the birth defects occurred when women were infected during the first trimester, the numbers were not much better for those infected later in their pregnancies. Five percent of women diagnosed in their second trimesters and 4% of those in the third trimester also gave birth to babies suffering the devastating effects of Zika.

“We have also learned that the effects of Zika during pregnancy are not always obvious at birth,” Schuchat said, adding that babies may initially look normal but develop signs of Zika complications such as small heads or vision and hearing problems. “That’s why identification of and follow-up and care of babies with possible Zika-virus infection is so crucial.”

Steve’s Take:

Some things are just plain hard for me to wrap my head around.

For example, as of May 20, the most recent data available, the Puerto Rico Department of Health reported (pdf) 40,330 confirmed cases of the Zika virus since the outbreak began last year. Four hundred twenty-two of those infected have been hospitalized, and five have died. Among those cases, there have been 52 Zika-related cases of Guillain-Barre syndrome, a type of temporary paralysis that is caused by viruses, including Zika.

And yet, Puerto Rico declared its Zika outbreak over this week. Brazil said its emergency was over in May. In the US, with summer right around the corner, there’s little discussion of the virus outside public health circles.

In the US we have this complacency that the battle has been won while researchers are still scrambling frantically to learn how the Zika virus spreads and what we can do to stop it. But they’re increasingly certain about one thing: Zika poses a serious threat to pregnant women and their babies.

The CDC has also been tracking mainland US births and found that one in 10, or 5%, of women with confirmed Zika infections had a fetus or baby with Zika-related complications in 2016. Period.

Despite public confusion over whether Zika remains a public health threat, the Centers for Disease Control and Prevention continues to warn women who are pregnant to avoid traveling to wide swathes of Latin America and the Caribbean, says STAT.

“People are just going to have to accept that as part of the new reality,” said Dr. Martin Cetron, director of the CDC’s global migration and quarantine division (pdf), according to STAT. “Until we have better prevention tools, we’re just facing this as part of the new normal.” He added, “If this were my daughter, I would want her to know and I would caution her not to go there at this time. And that’s tough medicine. I understand that.”

Some of the birth defects like microcephaly are profound and are not problems these children will outgrow. Researchers studying the virus fear other, more subtle problems will only become apparent as children infected in the womb start lagging, developmentally, behind their peers. Brain imaging technology, such as head ultrasounds, can reveal problems before they develop visibly.

Public health officials have been desperate to try to prevent these kinds of birth outcomes since Zika’s link to birth defects was first recognized. And that hasn’t changed as the public’s sense of alarm over the Zika outbreak has faded.

But officials know they’re up against a challenge in trying to keep this issue on the radar of the people who need to pay attention.

“Last year, health experts were concerned that the media’s overstating the threat from Zika would make ongoing messaging to manage the actual level of risk more difficult. That’s where we are now,” said Sandra Mullin, a New York-based risk communications consultant. “Zika, West Nile virus, and other mosquito-borne diseases that once seemed urgent and novel and captured the attention of the news media and policymakers now face the fatigue of other chronic conditions and diseases that present similar challenges for public health communicators.”

CDC officials are encouraging pregnant women in US territories to use insect repellent, wear long sleeves and long pants, and install screen windows and doors to avoid being bitten by mosquitos, according to Mashable. They should also use condoms during sex to avoid Zika infections via sexual transmission.

Steve's Take: Please follow @CDCgov guidelines for #pregnant women to protect against #Zika Click To Tweet

Dr. Cetron said the CDC’s travel advice, found in its regularly updated Yellow Book or in the location-specific advice it lists on its website, sometimes urges pregnant women to take special care. For instance, the agency cautions pregnant women against traveling to places where they can contract malaria, because it can be more dangerous during pregnancy.

That’s the way Zika will likely be handled going forward, Cetron said. It has become another one of the things pregnant women have to guard against.

Just one more thing to guard against. And I get that the public would rather tune in the various investigations emanating from the Capitol and/or the NBA finals. At least that’s the talk in the locker room at the Y where I work out.

Meanwhile, CDC Director Schuchat cuts to the chase, saying, “We must continue preparing for another mosquito season while researchers seek more definitive prevention through vaccine development.”

Okay. Pass the mosquito repellent, please.

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