WASHINGTON, DC – You pay now, or you pay more later. That was one shared point of two named lectures here Thursday, as speakers told the stories of largely different epidemics with current, lasting and escalating impacts. In responses to both Zika and to sexually transmitted diseases, reductions or gaps in funding for services protecting the health of mothers and children, speakers noted, the costs have been particularly high.
Reductions in U.S. funding for reproductive health services over the last two decades have intersected with rising rates of syphilis, both primary syphilis — the result of sexual transmission, and congenital syphilis, in which the disease is passed from a pregnant mother to the child she is carrying, Dr. Gail Bolan, director of the Centers for Disease Control and Prevention, delivering the Joseph E. Smadel lecture, noted. With disease incidence rising nearly 400% since 2000, having dropped that year to its lowest incidence since public health officials began tracking it in 1941, Dr. Bolan said, “syphilis is back.”
Continued, let alone rising, incidence of transmission from mother to child, she noted was particularly concerning, she said. “A case of congenital syphilis should be considered a sentinel event,” she added, a term used to indicate that a health system is failing, with grave consequences. Such cases — which along with mother-to-child transmission of HIV — no longer occur in countries that include Cuba, Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and St. Kitts and Nevis, Thailand and Belarus, indicate an astonishing gap in a wealthy country, she said. Each case indicates that the mother had no prenatal care at all, had prenatal care but accessed it too late for screening that would prevent the transmission, or had prenatal care that did not include screening for what remains a routine risk. It is an indication that increased and more targeted public health funding supporting maternal care is needed, she said. Funding that supports preventing unintended pregnancies, also “would help,” she added.
Three years after the spread of Zika virus disease in South America and the Caribbean was linked to devastating neurological birth defects in children born to women infected with the virus while pregnant, impacts of those infections continue to emerge, Dr. Karin Nielsen, of the University of California at Los Angeles, presenting the Caroline B. Hall lecture said. Dr. Nielsen, a pediatric infectious diseases physician who was born and raised in Brazil, was preparing to study how dengue fever affected newborns when the scope of Zika’s threat began to emerge.
Discovered in monkeys in Uganda in 1947 and in humans in Nigeria a few decades later, Zika had traveled halfway around the world, causing occasional small outbreaks but without noticed impacts to newborns, Dr. Nielsen noted. A mutation along the way, as the virus made its way from Africa to Asia, may have made the difference. When the virus arrived in Rio de Janeiro along with other travelers to pre-World Cup qualifying games there, it found a hospitable home in the crowded unplanned settlements around the city where standing water and discarded plastic allows the mosquitos spreading the virus to breed in large numbers. As the impacts of a brand new epidemic exploded across the country, researchers tracking the effects of the virus on newborns didn’t know with certainty the full range of what they might find, or how lasting it would be.
The impacts tracked since, that Dr. Nielsen presented during her talk are disabling, comprehensive and continuing, and as children who were exposed to the virus in the womb age, they also go well beyond the initially noted risks of microcephaly — a significantly smaller head than average — which, in at least 90% of children born with the condition, is accompanied by significant neurological issues. Three years later, data indicates that, in some infants exposed to the virus, microcephaly became evident later. Vision, hearing, motion and language deficits are prevalent in exposed children whether they are microcephalic or not. And they are not improving. While a curve showing the developmental range of unexposed children would be bell-shaped, the curve showing the developmental range of exposed children shows a shift to abnormal outcomes, Dr. Nielsen said.
A program of early stimulation during the first year of life for children with neurological defects would have offered an opportunity to improve some of those outcomes, Dr. Nielsen said. Unfortunately, she added, no funding for such a program was made available.