As Senate breaks without writing a “blank check” for Zika responses, CDC and WHO itemize some of the shopping list

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As of last week, 55 countries and territories, including Puerto Rico were reporting ongoing local transmission of Zika virus, a cause of severe neurological birth defects, a virus associated with increased rates of paralyzing illness, and now, according to the U.S. Centers for Disease Control and Prevention, a cause of at least one death. The virus, and what it might do, is new to 42 of the countries. In nine additional countries the virus has been transmitted solely through sexual exposure. The spread of the virus had grown steadily since its detection in the Western Hemisphere in 2015, and is expected to continue to do so as mosquito breeding seasons begin in the United States. Among continuing questions surrounding the spread of the virus are the impacts it will have in each affected country or territory in the months to come.

mmwr42916As U.S. Senators took a break at the end of the last week in April in the midst of their first stirrings of a response to the President’s February request for $1.9 billion in emergency funding for Zika readiness and responses at home and abroad, the U.S. Centers for Disease Prevention and Control released a report on the impact of the disease and responses in just one of them. The numbers listed in the report do not include dollar figures, but it does give an accounting of an effort that, so far there, is struggling to ward off larger impacts. It also does not list the needs for research and development in response to the outbreak — including towards efficient and accurate diagnostic tools, vector control and a vaccine. But even with those unaccounted for, and with the unknowns to be discovered in the months to come, the current needs and endeavors the report documents in the United States territory of Puerto Rico is, like the spread of the virus, wide and growing, encompassing responses across the health spectrum. It includes testing more than 6,000 samples for signs of the virus, care for the 17 patients so far hospitalized as a result of the virus, incorporating diagnoses of the virus into an existing surveillance system, protecting the territory’s blood supply, finding pregnant women through maternal child service programs and attempting to protect them through mosquito control, education, condoms, insect repellent and bed nets.

Since the virus was detected in Puerto Rico six months ago, 683 people across 50 of the island’s 78 municipalities have been infected, more than 400 of them women, and 65 of them pregnant. The report suggests that the much greater proportion of women reported to have been infected with Zika likely reflects outreach targeting women of child-bearing years. This in turn suggests that increased case detection could be necessary to protect women from sexual transmission from infected but undiagnosed male partners. A Zika Active Pregnancy Surveillance System exists now, and affected children who survive will be referred to the Children with Special Health Care Needs program, for specialized services, the report says, until they are three years old.

In the meantime, the World Health Organization’s weekly report on the global impact of Zika lists the current eight countries, territories and areas where children have been born with stunted heads and brains or other central nervous system birth defects associated with Zika infection, topped by Brazil with 1198, and including French Polynesia with 8, Columbia with 7, Panama with 4, the West African island nation of Cabo Verde with three, and the U.S. with two, as well as the 13 places where the virus has been associated with cases of the paralyzing Guillain Barre syndrome.

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