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What do we still need to know about Zika?

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map of Aedes mosquito habitat in the United States

CDC map of Aedes mosquito habitat in the United States

As the sixth week of 2016 draws to a close, the medical community is still uncertain about the effects of Zika viral illnesses, and any relationship to microcephaly in unborn children and Guillain-Barré syndrome in people of all ages. It is unclear at this time just how many people have had the mosquito borne illness.

In no particular order, here are a few questions that really, really should be answered.

  • How many people who contract a Zika illness will be asymptomatic?
  • The currently accepted belief is that about 80 percent of those infected will be asymptomatic. That figure is based on one study, done on the island of Yap and published in 2009. “The estimated ratio of symptomatic to asymptomatic patients with Zika virus infection in this outbreak is similar to that described for West Nile virus infection.” It would be prudent to confirm these findings in a continental setting and not just on an isolated island.

  • At this time, it is believed that the virus is being transmitted by the Yellow Fever mosquito, Aedes aegypti. The Asian Tiger mosquito, Aedes albopictus, is always mentioned as a competent vector. Is it, in fact, transmitting Zika in the current outbreak in the Western Hemisphere?
  • Aedes albopictus has a much larger habitat in North America and in Europe. It is important to know if it is acting as a vector at this time, in order to gauge the future threat to populations in its habitat.

  • With respect to microcephaly, what is the normal baseline for this birth defect in each nation reporting cases? And, what other causes for the condition preexisted in those nations prior to the arrival of Zika?
  • For example, fetal alcohol syndrome can produce microcephaly.

  • With respect to Guillain-Barré syndrome, what is the normal baseline for this birth defect in each nation reporting cases? And, what other causes for the condition preexisted in those nations prior to the arrival of Zika?
  • The most common factor in the appearance of Guillain-Barré syndrome is an infection with a food borne bacteria, campylobacter. In other words, food poisoning. Influenza, other infections, recent surgery and, on rare occasions, vaccines may also preceed the appearance of GBS.

  • What are the latest numbers for the “outbreak” of microcephaly in Brazil?
  • The last data released was from Jan. 30. At that time, about 1,100 of the 4,700 plus reports of microcephaly had been investigated. Some 63 percent of those reports were discarded as incorrect diagnoses. If you are going to create a world-wide panic by reporting a vast surge in birth defects, you ought to keep us posted on a regular basis.

There are very credible reports that state that the Zika virus has been found in autopsied fetuses and newborns with microcephaly. While some of those reports detail testing for other viral causes of the condition, they all leave unanswered the question of other possible causes. What about a history from the mother, including her alcohol and drug use? What about testing the mother for the same infections that the fetus / newborn was tested for? For toxins?

And, the biggest question of all:
How can Brazilian physicians interviewed by the media claim that microcephaly is rare when more than one study has demonstrated that it was present in large numbers before the arrival of Zika?

Microcephaly in northeastern Brazil: a review of 16,208 births between 2012 and 2015

Microcephaly: normality parameters and its determinants in northeastern Brazil: a multicentre prospective cohort study

Establishing base levels of microcephaly in Brazil prior to the arrival of Zika viral illnesses

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