New Orleans, La – The most disturbing thing about having Zika, Dr. Mauro Schechter said, was pruritus, or severe itching. But severe itching isn’t the right way to describe it, he said at IDWeek’s opening plenary. It felt as if “you have pins coming from inside out, plus itching,” he said.
“Maybe it’s a sign of neurologic damage,” he said, “and that’s why it felt different.”
Schechter, Head of the AIDS Research Laboratory at the Hospital Universitario Clementino Fraga Filho and professor of infectious diseases at the Federal University of Rio de Janeiro in Brazil, said his Zika infection did result in some neurological damage – he has minor weakness and pain in his right foot, while his wife, who was also infected, has minor neuropathy in both feet and an arm. Several other members of his family were also infected, he said.
Like the early days of HIV, Schechter said, new information on how the Zika virus manifests itself is coming out every day, and scientists are learning more and more that microcephaly is not the only condition to be concerned about. Current estimates project that one out of every 5000 people who become infected with Zika will develop Guillain–Barré, a neurological disorder in which the immune system attacks the nerves, which can result in paralysis, Schechter said
Forty people have been found to have Guillain–Barré in Puerto Rico, Dr. Lyle Petersen of the Centers for Disease Control and Prevention said in an earlier symposium on this topic on Wednesday. Over 2000 Puerto Ricans are being diagnosed with Zika every week, he said.
Nineteen other Zika-affected countries have reported increases in Guillain–Barré, Petersen said. The cases have several unusual characteristics, he said, including a short period of time between acute illness and manifestation of Guillain–Barré, and rapid progression of disease.
Between 1 and 13 percent of pregnant women infected with Zika during the first trimester will give birth to infants with microcephaly, a condition where the brain does not fully develop, Schechter said. But among children who are not born with microcephaly, other congenital impairments have been seen, including deafness and mental retardation, he said.
While low-level transmission of Zika virus has probably occurred in Africa and Asia since its identification in the 1940s, Petersen said, the current outbreak and its resulting impacts are perhaps different because the strain of virus may be different. As far as is known, Petersen said, congenital and neurological abnormalities have only been seen from the Asian strain.
It’s difficult, however, to assess outbreaks in places with no surveillance systems, Petersen said. There have been no known cases of Zika or congenital abnormalities related to Zika in Africa because no African country does surveillance for birth defects, he said. Brazil began a Zika surveillance system in January of this year, nearly a year after the outbreak began, Petersen said.
The answer to a lack of proper surveillance and other deficiencies in capacity is collaboration, Schechter said, and not just collaboration between countries and multilateral organizations but collaboration between clinicians, basic scientists, and health care providers.
With increasing globalization, urbanization, and the effects of climate change, “we’re in for more of these outbreaks,” Schechter said, and new approaches are necessary to apply the lessons learned from the current outbreak to futures ones.