What We Know and Don’t Know About Zika

The first time I heard about Zika was last year, when I was in Colombia over the summer doing my DrPH practicum. We went to a small town in the jungle to investigate an outbreak of Chikungunya. It was a very interesting experience for me because the outbreak investigations I had participated in at DHMH didn’t usually include fieldwork. My contact with people affected by outbreaks was mostly over the phone, asking them questions about their condition. This time, I was in the jungle, surrounded by soldiers with big guns (to protect us from the rebels), seeing how people were being affected by a pretty bad arboviral infection.

After we collected some blood samples and interviewed some cases, we all went to a private residence to have lunch. As we ate some delicious chicken, rice, and lettuce salad, the entomologists in the group started talking about Zika. One of them told us about a woman who traveled to Colombia from Brazil to take care of her grandchildren. She was pretty sick when she arrived in Colombia, and he was asked to consult on whether or not she had Chikungunya. “There are a good number of Zika cases in Brazil,” he said. I found it interesting, but there wasn’t really much in the news about it then.

That was June of 2015. By December, countries all over South America, Central America, the Caribbean and Mexico had reported cases. By then, we also knew that babies born to Zika-infected mothers were more likely to have microcephaly, an underdeveloped (or even undeveloped) brain. (It wouldn’t be until the middle of 2016 that the epidemiologic evidence of Zika causing microcephaly was irrefutable.) Over the summer, Zika found “its goldilocks zone” in Puerto Rico, a United States territory. Since then, thousands of cases have been reported, and it is expected that hundreds of thousands of Puerto Rico’s residents will contract the disease. Tens thousand (at least) will be pregnant women.

In essence, it’s going to get worse before it gets better.

Even with the enormous number of people working on figuring out Zika, there is still a lot that we don’t know. We have some good ideas/theories of how Zika works, but there are still a number of unknowns that are unsettling. For example:

  • Of all the pregnant women who get infected, how many are going to have a fetus with microcephaly? How many of those fetuses will develop some other neurological condition?
  • How many otherwise healthy people will develop complications? How many people with comorbid conditions will do so as well?
  • Will Aedes albopictus become as good a transmitter of Zika as Aedes aegypti already is? What about other vectors? And how will Zika travel since it is also sexually transmitted?
  • On the political side of things, will the US Congress ever approve funding to fight Zika at home and abroad? And will the people of the United States do what is needed in order to not allow Zika to invade now that it has a foothold in Florida?

Those are just a few of the questions yet to be answered completely.

On the other hand, we know that Zika is transmitted by Aedes species mosquitoes, and we know what to do to prevent those mosquitoes from having suitable environments in which to reproduce. We also know how to test for it now, and a rapid test is probably coming online in a widespread manner soon. And, of course, we all know about safe sex, right?

Over the next few weeks, while I’m in Puerto Rico aiding in the Zika outbreak response, I’ll be updating this blog with news and information about Zika and what is happening on the island. I will also be posting pictures and thoughts from my time there. It goes without saying that there will be some restrictions to this… No private/confidential information, no pictures of cases without their consent. That kind of stuff.

I’m glad you’re coming along with me on this.

Featured image is a photograph of an Aedes aegypti mosquito via the Public Health Image Library fromCDC/ Paul I. Howell, MPH; Prof. Frank Hadley Collins (2007), ID#9534.

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