Admins, researchers monitoring spread of Zika virus

With growing concern about the Zika virus, Duke healthcare researchers and administrative leaders say they are well prepared.

Increased levels of the mosquito-transmitted disease—which has been linked to birth defects and deaths in newborns in Brazil—led the World Health Organization to issue an alert last Monday stating that the disease poses a global public health emergency. The U.S. Centers for Disease Control and Prevention issued a travel-alert in January urging American women of childbearing age, whether pregnant or not, to avoid countries where the Zika outbreaks have been reported.

Leaders of Duke’s study abroad programs, including DukeEngage and the Duke Global Education Office for Undergraduates, are following the spread of the disease, Amanda Kelso, executive director of the Global Education Office for undergraduate education wrote in an email.

“Along with Duke’s emergency management team, which includes healthcare professionals, we are constantly monitoring events and outbreaks around the world that could affect our students and study away programs,” Kelso explained. She noted that the University has already issued Zika guidelines—which will be sent to students studying in affected areas.

Dr. Cameron Wolfe, assistant professor of medicine in the infectious diseases department, has been a vocal expert on the Zika virus, explaining its potential risks and implications in the U.S.

Wolfe wrote in an email that the potential for a Zika outbreak in North Carolina is possible in the coming months due to the increase in mosquito prevalence during the summer season.

The level of preparedness in the event of an outbreak is largely contingent on funding availability, he added.

“In recent years there have been funding cuts that have limited our ability to fully understand the extend of the mosquito vectors in North Carolina...That said, the [North Carolina Department of Health and Human Services] has done an excellent job in preparing clinicians and hospitals to look out for symptoms and signs of infections, especially in pregnant women, so I think we’re quite well prepared,” Wolfe wrote.

Generally, only one in five individuals infected with Zika will exhibit symptoms, Wolfe explained. Symptoms include fever, muscle and joint pains and rashes.

Although the virus’s symptoms are relatively mild compared to other mosquito-borne pathogens such as malaria and yellow fever, experts have significant concerns about the Zika virus for its potential impact on fetal development. Children of women who contract the virus during pregnancy are at risk for microcephaly—a condition in which a baby is born with an abnormally small head—but researchers have not yet fully unraveled the link.

These concerns have led experts to suggest pregnant that women who have traveled in the regions of outbreak seek screening if they exhibit two or more symptoms of Zika.

“Most people don’t get symptoms...but we don’t yet understand the full breadth of fetal possibilities, so in theory really anyone who has traveled while being pregnant should be seen,” Wolfe explained. “[Similar symptoms] are common for many travel related problems and many things spread by mosquitoes, but testing should differentiate those for a pregnant woman.”

Although experts primarily caution travelers about the spread of Zika through mosquito bites, the Centers for Disease Control and Prevention confirmed that a case of Zika transmitted sexually in Texas in early February—similar to a case in the 2013 outbreak of Zika in French Polynesia in which the virus was found in an infected individual’s semen.

“I suspect the previous cases of potential STD spread were simply not proven, so I don’t think [the Texas case] is a super surprising development,” Wolfe noted. “It’s a virus that briefly [resides] in your blood... and then sex just becomes the act to exchange such body fluids (and the associated virus) like it does with HIV or Hepatitis C.”

Researchers have also made progress identifying a vaccine for the disease, explained Dr. Sallie Permar, associate professor of pediatrics, immunology, molecular genetics and microbiology.

Permar, a physician and researcher who focuses on vaccines protecting newborns, noted developing a vaccine will take time, as it first requires isolating pieces of the virus to use and then testing in animals.

“If all those things look good, you can go on to human trials, which would first start with safety trials and then move up to efficacy trials,” Permar said.

The National Institutes of Health Vaccine Center has reported that it is beginning tests with the hopes of developing a vaccine that will elicit a safe immune response, Permar added.

The Zika virus is a member of the arbovirus family, which also includes West Nile Virus and Yellow Fever. Arboviruses are primarily carried by mosquitoes or ticks, Wolfe explained. Some people may be concerned the disease could spread through other insects, but he assuaged those fears.

“None of the other [arboviruses] have evolved to change their primary [transmission] vector—that would be extraordinarily unusual,” Wolfe wrote. “Whilst occasionally you see more than one mosquito species carrying the virus, it would never use a different insect or animal.”