The World Health Organization declared the Zika Virus to be a Public Health Emergency of International Concern on February 1, 2016.  Though many unknowns still exist and much information remains unclear, the Zika Virus holds significant risk to all those in the Americas, particularly pregnant women and their children, and health authorities at many levels are acting accordingly. Local and regional authorities in the Americas are diligently monitoring the situation, and as of February 8, 2016, the Centers for Disease Control has initiated a Level 1 (highest level) activation of their Emergency Operations Center in response to growing concerns. Collaboration between response organizations and governments during this data gathering period is crucial for swift and effective action. Stay tuned for critical updates and news stories as the Zika Virus story continues to evolve.
Zika: What we know
Here’s what we know so far:
- Local transmission of Zika virus has spread to 48 countries and territories in the Americas, with additional countries reporting travel-related transmissions.  The first confirmed case of this outbreak was reported in Brazil in May 2015. The virus is transmitted by the Aedes mosquito, two species of which are found in the United States, especially in the Gulf Coast region. Those infected may have mild, short-duration symptoms including a mild fever, skin rash, and red eyes, and up to 80% of those infected with the virus do not know they have been infected. Diagnosis by antibody tests is difficult, as the virus has the ability to cross-react with similar viruses such as dengue, West Nile, and yellow fever.  For some time, RT-PCR confirmation during the first week of infection is the only firm diagnostic method currently available and accessing diagnostic capabilities has been a challenge.  However, a new diagnostic tool was recently approved by the FDA, and other tests are showing promise, including a new and highly effective “low-cost paper diagnostic test” developed by the Wyss Institute. 
- Unlike other flaviviruses, there is currently no specific treatment or vaccine for the Zika virus, however researchers are working to create one.  On April 13, 2016, the CDC issued a Special Report through the New England Journal of Medicine in which it stated “we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies”.  The increasing clarity regarding the link between Zika virus and serious congenital complications in infants, including but certainly not limited to, microcephaly, limb spasticity, and chorioretinal scarring has added fresh urgency to the drive for vaccine research and testing. Additionally, Zika virus has also been associated with Guillain-Barré syndrome.  (Guillain-Barré syndrome is an autoimmune disease that can vary from causing minor numbness in the feet to complete whole-body paralysis. ) As there is no treatment for Zika, the only way to prevent Zika-related complications is to avoid contracting the virus. In recent weeks, the scientific understanding of Zika has been catching up with the reality of Zika transmission, and recommendations for pregnant women have evolved to include avoiding engaging in unprotected sexual activity with a male partner who has recently traveled to a region with “active Zika virus transmission” for at least 8 weeks and for up to 6 months if the partner demonstrated Zika symptoms.  This past week, the WHO issued new recommendations regarding Zika virus and pregnancy, stating that “In order to prevent adverse pregnancy and fetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, be correctly informed and oriented to consider delaying pregnancy”.  These recommendations regarding family planning and pregnancy have garnered a great deal of attention from reproductive rights groups and are being received in a variety of ways by government officials and public health personnel in the areas affected with local Zika transmission. 
- One such area considered a hotspot for local Zika transmission, Rio de Janeiro, is also responsible for hosting this summer’s Olympic Games. Many public health experts and medical professionals are advocating for the postponement or relocation of the summer Olympic Games due to concerns that an influx of foreigners will increase the spread of Zika globally.  A press conference hosted by the WHO this week indicated that while the concerns regarding Zika are being acknowledged, the WHO and the International Olympic Committee are not likely to recommend the postponement or relocation of the 2016 Summer Olympic Games.
- Like the global response, the domestic response to Zika has been contentious at best. Based on feedback from local public health departments, public health experts like Peter Hotez, and various government officials, it is clear that additional resources are needed to combat the spread of this virus in the United States.  As of this past week, it has been a full four months since the President requested emergency funding to combat Zika virus. Currently, the bill containing Zika funding appropriations is headed to a conference committee, and whether or not Zika funding will be approved before the July 4th congressional recess is a question yet to be answered.  Local health departments are feeling the pinch of this congressional delay and many have had their preparedness funding reallocated to Zika measures in the absence of a congressional decision, only decreasing their ability to mitigate the spread of Zika virus in the U.S.  The President’s funding request prioritizes expedited vaccine research and trials, and while funding for medical solutions may make up a piece of the ultimate solution, investing in long-term public health infrastructure such as mosquito control and surveillance programs is also critical. CDC Director, Tom Frieden, reminded readers of a recent Time article that combatting Zika will require more than just short-term investments and that interventions such as mosquito surveillance systems are not just “a onetime thing.”  Short-term investments in combatting Zika will likely be insufficient in any region, and will be especially insufficient in those regions where Zika is already having long-term consequences.
- Currently, advice regarding Zika prevention consists mostly of limiting travel to areas with active cases. Other preventative measures include consulting a physician before traveling, wearing long sleeves and pants, “using insecticide-treated mosquito nets and using insect repellents” as indicated by health authorities.  It is also critically important to eliminate mosquito breeding sites.  Recommendations for pregnant women vary by or women trying to become pregnant include additional precautions and more prevention tips can be found on the CDC’s website.
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