Warnings From the Zika Virus

By John Fanning

As the Zika virus continues to grow to pandemic proportions, it’s time for us to learn what we need to know about this contagion, and devise a plan for what to do about it.

The word Pandemic comes from the Greek words, “pan” which means all, and “demos,” which means people. It is the word we use to describe an illness or disease that suddenly spreads over a vast region affecting many people and/or animals. In modern times there have been several pandemics that reached America’s shores; two are recognized as especially devastating: the Spanish flu of 1918, which was brought to America by returning World War I soldiers, and HIV/AIDS, which originated in Cameroon and was, according to a study published in The American Journal of Medicine, brought to America by a Canadian flight attendant.

The Spanish flu caused the death of nearly five percent of the world’s population. Worldwide, about half a billion people contracted the virus. In the U.S., over a quarter of the population became infected and more than half a million died from the illness. Keeping in mind that the U.S. was at war during this pandemic, from a national security standpoint, it is significant to note that 40 percent of personnel in the U.S. Navy and 36 percent in the Army were among those infected by the virus.

Graphics by De'Anna Clark
Graphics by De’Anna Clark

HIV/AIDS, which is still active in the U.S., has thus far claimed more than 650,000 lives. More than one million Americans are currently infected with the illness, and approximately 50,000 new HIV infections are reported each year.

Considering how quickly and deadly such pandemics can be, it is little wonder that health officials in every country are quick to sound the alarm when a disease cluster manifests itself somewhere in the world. In modern societies filled with information technologies, such alarms can spread faster than any virus and can create as much fear and panic in a populace as would the actual presence of most pandemics. While unduly alarming people in order to sell newspapers has always been a business part of the press — in a society where information is everywhere and common experience with high-impact infectious disease is rare — panic can rapidly spread, fueled by statistically unsupported expectations espoused by misinformation widely disseminated through social media. When such expectations are unmet due to the pandemic being isolated abroad or simply dying off, some people become frustrated, angry and, eventually, wary of such alarms that may come in the future.

Such wariness of pandemic alarms may be the reason why an emerging new pandemic that has already affected millions and is now knocking at America’s doorstep seems largely ignored by its citizens. The Zika virus is a mosquito-borne illness (termed arbovirus, an acronym for arthropod-borne virus) generally having little or no effect on human beings. But it can have a devastating neurological effect on the unborn and others such as Pacific Island and Pan-American populations with naïve immune exposure to Zika virus. In such case, adults may develop a form of partial or whole body paralysis known as Guillain-Barré syndrome.

First identified in 1947, the virus was isolated in a Rhesus monkey in Uganda’s Zika Forest — hence the name. The disease was not identified in humans until 1952, when it was discovered in patients in Uganda and Tanzania. The means of transmission was thought only to occur through mosquito bites from infected Aedes species of mosquitos to primates (or humans) and back to Aedes species mosquitoes, and so forth. By 1968 it had spread to Nigeria, and in 2007, it had migrated to the island of Yap in Micronesia.

With few to no symptoms shown in about 80 percent of those infected — some patients exhibit a temporary fever, rash, some pain in body joints, and red eyes (these symptoms typically pass in a few days). Because of its mildness, Zika didn’t actually raise much initial concern either in the media or within health officials. But that began to change dramatically last year after Brazil hosted the FIFA World Cup, with the most probable introduction of the virus occurring during the 2014 World Championship Canoe and Rafting Events in the fall.

With visitors traveling to Brazil from French Polynesia, where more than 10 percent of the population has become infected with Zika since it came to the area in 2013, thousands in Brazil quickly became infected with the virus. Millions in Brazil now have the virus, which has quickly advanced throughout South and Latin America and is now spreading throughout Caribbean nations as it advances toward the Florida Keys and U.S. mainland.

In the unborn, the Zika virus is blamed for skyrocketing cases of microcephaly. Thousands of pregnant women throughout Brazil, infected with the virus, have given birth to babies with microcephaly. Not only have those babies tested positive for Zika, but the antibody produced by the fetus against the virus has been confirmed in the spinal fluid, amniotic fluid and other tissues of conception.

Microcephaly is characterized by abnormal growth of the brain. Generally, life expectancy is reduced and normal brain functioning is poor in victims. While a solid relational correlation has been established between Zika infection in pregnant women and an increase in microcephaly in the children they carry, the various methods by which the virus is delivered are still being researched.

We do know that the virus can be delivered through the bite of a mosquito. We also know that the mosquito that carries the virus is the female Aedes, which generally feeds during the day. For this reason, protection from the mosquito is more difficult. Of concern now is whether Zika infections in pregnancy, which can lead to microcephaly, are the results of pregnant mothers being bitten by infected female Aedes mosquitos, the results of infected male partners spreading the virus during intercourse, or both. As of this writing, there are only two cases of sexually transmitted Zika virus infections — one previously reported in Hawaii and currently one in Dallas, Texas.

While the advance of the Zika virus makes it clear that the disease will reach the U.S. mainland, from a national health perspective, the question is what should state and U.S. officials actually do about it. With Latin American and Brazilian Carnival celebrations currently underway, and spring break, the Brazilian 2016 Summer Olympics and 2016 Brazilian Summer Para-Olympics just around the corner, millions of traveling and vacationing men and women of prime childbearing age will be venturing to areas where the disease already is prevalent. While spring breakers may generally not be interested in starting families, underestimates of the risk for alternative means of transmission are suggested. Studies reveal that the virus remains in human body tissues and secretions like blood (serum), saliva and urine for about 10 days, whereas it has been found to exist in semen for two additional weeks and therefore may be worthy of greater concern for human-to-human transfer during sex. These early findings have profound implications for surveillance and protection of human organ transplantations, blood and blood product supplies, human sperm bank and other human-tissue product lines.

In the near-term, we must certainly undertake measures to inform the public and mitigate the consequences inherent in a Zika epidemic. The long-term outcome of the Zika virus’ arrival to the Americas is unknown, but it is near certain that it shall make an endemic presence in the country. Like the other prevailing mosquito-borne viruses dengue fever, West Nile, chikungunya and yellow fever, the Americas are ecologically favorable to the propagation and unexpected evolution of the Zika virus, having:

favorable climate and seasonal habitat conditions for propagation and overwintering.

two known mosquito species through which Zika may propagate. Notably, one mosquito species, the Asian tiger mosquito, Aedes albopicus, is an invasive species newly introduced to the Americas in the mid-1980s.

There are five susceptible species of primates in Central and South America that can become carriers.

Susceptible mobile populations throughout the lower temperate, subtropical and tropical inland river, coastal and island zones of the Americas will hasten spread.

The potential for new intermediary mosquito species (e.g., Culex) or other non-primate animal hosts.

The unexpected and unpredictable.

As of this writing, official warnings and guidelines call for caution in the winter and future 2016 travel plans being made by Americans have been ironically slow to emerge with the mainstream media seemingly apprehensive in issuing warnings of their own. Whether this is a symptom of wariness from too many past alarms or fear for the economic fallout from warm vacation areas that may result, remains to be seen.

The first travel, health and clinical care warnings and guidelines were only posted by the CDC on January 29, 2016, with the World Health Organization (WHO) finally announcing a Global Public Health Emergency of International Concern on February 1, 2016, after summarizing the pandemic as “spreading explosively” just three days before. One thing, however, seems clear when it comes to pandemics: We have no real communications plan in place in the United States. Past threatened pandemics have seen a weakness on the part of communication from government and public health officials give way to misinformation and public media hysteria. The current pandemic knocking on America’s door has resulted in tepid warnings issued by the CDC and an apparent stony silence from most other government agencies and officials. InfraGard members have for some time recognized a need for communications plans to be put in place to inform the public of pending or ongoing hazards. Perhaps in the wake of the pending tragedy the Zika virus pandemic is certain to inflict, the time for effective communications plans finally will have come.

http://www.healthmap.org/zika/

This important website geospatially depicts (5 km2 resolution) the past and ongoing timeline of Zika virus human-driven transmission from its Africa-Asia endemic historical ecology across the Pacific Islands from 2007 to its new ecological foray in the Americas as of 2014. Please note that check boxes provide the capability to underlay the global geospatial predicted distribution of Aedes species (the invasive Asian tiger mosquito Aedes albopictus and the native Aedes aegypti mosquitos — both of which have been demonstrated to propagate Zika virus among other currently existential North American arboviral threats such as Dengue, Chikungunya, Yellow Fever and West Nile viruses).

Dr. Terry Donat contributed to this report.endicon