FLORIDA - Zika Control?

"In Florida, controlling Zika is no simple matter" PBS NewsHour 10/5/2016

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SUMMARY:  Florida's battle against the outbreak of Zika is intensifying as the number of cases climbs.  The state currently has 940 documented instances of the virus, with 230 in Miami-Dade County alone.  Efforts to contain the spread of the disease focus on mosquito control and avoidance, but many details about Zika remain a mystery.  For more on the outbreak, William Brangham reports from Miami.

WILLIAM BRANGHAM (NewsHour):  Beyond the famous sugar-white sands of South Beach in Miami, there's a clear sense of unease about the growing public health crisis here.

GOV.  RICK SCOTT (R-Fla.):  This means Florida has become the first state in the nation to have local transmission of the Zika virus.

WILLIAM BRANGHAM:  Over the last few months, officials have been waging an all-out war against mosquitoes, spraying pesticides from the air, going door to door in some neighborhoods, checking plants and standing water, and plastering the city with warning signs, telling residents how to protect themselves from Zika.

There are now over 940 documented cases of Zika in the state of Florida and over 230 in Miami-Dade County alone.  But the epicenter is here in Miami, and the largest number of locally-acquired Zika infections have occurred in these two neighborhoods.

How are people in Florida doing with this?

SAMMY MACK, Health Reporter, WLRN:  The pregnant women that I have talked to, and their partners, or people who know pregnant women are taking it very seriously, and there's a lot of anxiety there.  There's a lot of anxiety there.

Pregnant women should avoid nonessential travel to the county.

WILLIAM BRANGHAM:  Sammy Mack is a health reporter for WLRN, the local NPR station in Miami.  While she's eager to cover this big story, Mack has ended up in the middle of in it in a way she'd rather not.  She's also four months pregnant.

SAMMY MACK:  It became an issue of, OK, how — how am I going to cover this thing that is happening in the middle of my beat, in a way that is not putting me at any kind of additional risk?

WILLIAM BRANGHAM:  Mack took one of the free Zika tests offered by the state, but the results took weeks, and those delays can limit the options for pregnant women.

SAMMY MACK:  I waited five weeks to get my results back.

WILLIAM BRANGHAM:  In the middle of a pregnancy?

SAMMY MACK:  In the middle of a pregnancy.

If women don't get their test turned around quickly and are waiting four weeks, six weeks, eight weeks, whatever it is, that may affect their window to decide to terminate the pregnancy.  Florida restricts abortion past 24 weeks.

ZIKA - Miami-Dade County

"What Miami-Dade County is doing about Zika" PBS NewsHour 8/2/2016

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SUMMARY:  With 12 confirmed cases of the Zika virus in Miami-Dade County, officials are asking residents to take part in mosquito-prevention efforts, including draining standing water and wearing insect repellent.  Gwen Ifill speaks with Alina Hudak, Deputy Mayor of Miami-Dade County, for details on the identified cases, what containment measures are being utilized and the “many unknowns” about the disease.  (update, 14 confirmed cases)

GWEN IFILL (NewsHour):  In Florida, workers went door to door today to check for mosquitoes, and to spray in neighborhoods, in the hope of clamping down on the Zika virus.

Officials say 15 people have become infected in Miami's Wynwood neighborhood, and it's believed these are the first mosquito-transmitted cases in the mainland U.S.

The CDC says the mosquitoes are proving harder to eradicate than expected.

For an on-the-ground look, I'm joined by Alina Hudak, the deputy mayor of Miami-Dade County.

Thank you for joining us.

We know now of 15 locally transmitted case of Zika infections.  How many more are likely, and are you prepared to handle an increase?

ALINA HUDAK, Deputy Mayor, Miami-Dade County:  Gwen, thank you for the opportunity to speak tonight to you and to your viewers.

I would like to clarify first and foremost that the confirmed cases in Miami-Dade County are 12.  I want to reiterate and really just be very clear about our mosquito control program here in Miami-Dade County.  We have a very strong and aggressive program that we have had in place since 1935.  We have many years of a proven track record in managing and controlling disease.

We work together with our Department of Health, with the Department of Agriculture.  We have had consultations with the CDC, and they are working very closely with us.  So we feel very confident that this can be contained and it can be contained to a very small area.

I want the viewers to understand that we're talking about one square mile in a community that is over 2,000 square miles, and I think that's important for context and for people to understand exactly the area that we're talking about.

GWEN IFILL:  Why is it confined so far to this one area, Wynwood, which contains an art district and attracts people from outside of the neighborhood?  Why there?

ALINA HUDAK:  You know, I certainly would be speculating relative to that.

We have a high international presence there and a lot of travel in that community.  It is unknown exactly how it is that the transmission takes place, and obviously there is a lot of focus on the mosquito, but there are many unknowns about this disease.  And, you know, quite frankly, we have been able to isolate at this point these particular cases, in consultation with the Department of Health.

Our crews have been there every single day, and have been on the ground since day one.  The moment that a suspected case is identified, our crews are there.  They do inspection.  They do treatment.  And we have, again, a very aggressive program.

In addition to that, we have a very aggressive outreach program to our residents, and we're communicating with our residents regularly about the part and the role that they play in being our partner with this.  We want our…

(CROSSTALK)

GWEN IFILL:  And pardon me.  What are you asking them to do?

ALINA HUDAK:  We're asking our residents to look in their backyards, to drain any standing water.  We're asking our residents and our visitors to wear repellent.

I heard someone today in a meeting describe it as you leave your house in the morning in Miami and you put on sunscreen.  Put on insect repellent and help us and be preventive and do your part in preventing the spread of this disease.

SOUTH FLORIDA - The Zika Scare

"What you need to know about South Florida Zika scare" PBS NewsHour 7/28/2016

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SUMMARY:  The Food and Drug Administration asked two South Florida counties — Miami-Dade and Broward — to immediately halt blood donations as what looks like four cases of locally transmitted, mosquito-borne Zika virus are investigated.  Hari Sreenivasan talks with Dr. Anthony Fauci, National Institutes of Health, about the virus, which can cause birth defects.  Fauci says the FDA is taking “prudent steps.”

HARI SREENIVASAN (NewsHour):  The U.S.  Food and Drug Administration today asked blood centers in two in Florida counties to suspend blood donations until each unit can be screened for the Zika virus.

This comes as state health officials investigate four non-travel-related cases of Zika, which may mean the first cases of local Zika virus transmission by mosquitoes in the United States.

For an update on all this, I spoke earlier this evening with Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

I'm joined now by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH.

Thanks for joining us.

DR. ANTHONY FAUCI, National Institutes of Health:  Good to be with you.

HARI SREENIVASAN:  All right, first of all, this change in status almost, what does this warning in Florida mean?

DR. ANTHONY FAUCI:  Well, the warning from the FDA is saying that in the regions in Miami-Dade and Broward County where you have what looks like local transmission of cases, namely, cases that are not travel-related, don't appear to be sexually transmitted, and very likely mosquito-transmitted locally, mainly because those people never left the continental United States, so they didn't get infected elsewhere, given that, what the FDA is doing is, they're saying there may be more cases out there.

So, in order to protect the blood supply and to be very safe and to keep it safe, they are suspending the collection of blood from those two areas until they can implement either testing of the units as they are donated or decontaminating of any potential units that might be potentially contaminated.

So, they want to be quite safe about it and very prudent, so that we don't get contamination of the blood supply.  That's what their particular order is regarding collection of bloods.

HARI SREENIVASAN:  Now, halting the collection of blood, that is a pretty extreme step.  That has got to affect local hospitals that use it, other places that use blood.

Is there some evidence that you would base a significant move like this on, an idea that there are local mosquitoes there that would be carrying Zika?

DR. ANTHONY FAUCI:  Well, there's no doubt that the mosquitoes that are capable of transmitting Zika are in that area.

This is the Aedes aegypti mosquito that's extensively seen along the Gulf Coast, the Gulf Coast states, and up across in part of the East Coast and a little bit out towards the West, but certainly along the Gulf Coastal states.

We know that we have now more than 1,600 travel-related cases, which is the reason why one would have predicted that, sooner or later, you're going to see some local transmission.  And the local transmission that we're seeing now is the kind of thing that makes one want to make sure we do what we can to prevent that local transmission from becoming sustained and from becoming disseminated.

And the answer to that is by very aggressive mosquito control.

2016 SUMMER OLYMPICS - Securing Rio

"Violence flares in Rio's slums just months before Summer Olympics" PBS NewsHour 5/31/2016

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SUMMARY:  As Brazil prepares for its first Olympic Games, violence is flaring in the notorious favelas surrounding Rio de Janeiro.  While a paramilitary policing initiative known as “pacification” stemmed the tide of drugs and crime for a while, economic downturn and widespread police brutality have once again turned the slum districts into war zones.  Special correspondent Lulu Garcia-Navarro of NPR reports.

HARI SREENIVASAN (NewsHour):  It's just over two months until the opening ceremony of the Olympic Games in Rio de Janeiro.

For the host country, Brazil, it's been a troubled journey.  The Zika virus, corruption scandals, and an economic and political meltdown have all had an impact.  But for many residents, the most worrying development is a spike in crime across Rio and what happens after the athletes go home.

“NewsHour” producer Jon Gerberg teamed up with NPR's Lulu Garcia-Navarro, and they report from the shantytowns, or favelas, of Rio de Janeiro.

And a warning:  Some of the images are disturbing.

LULU GARCIA-NAVARRO (NPR):  The image of glamorous Rio de Janeiro most people know; world-famous beaches like Copacabana, a draw for tourists and residents alike.

But just behind the high-rises and hotels lies another world.  These are two impoverished communities called Babilonia and Chapeu Mangueira.  They are at the heart of a bold policing experiment that started in 2008.  It's called pacification.

It introduced community-based police units to many favelas that are close to tourist areas, its aim, to push out the violent drug gangs that operated here in advance of Brazil's debut on the world stage with the 2014 World Cup and, in two months' time, the Olympics.

Babilonia and Chapeu Mangueira together became the poster children of Rio's transformation.  Crime dropped.  New businesses opened, catering to tourists.  Police would walk around with their weapons holstered.  Dignitaries like U.N. Secretary-General Ban Ki-Moon and media like me were taken here to show off the project's success.

But that success is now under threat.  Pacification is in crisis.  The first time I came to this favela three years ago, it was safe.  It was known as the Disneyland favela.  This time, residents refusing to talk to us because they have been threatened by drug traffickers.  And the only way we can come is with heavily armed police.

These pacification units, known as UPPs, now walk around ready for battle.  Two rival gangs are violently fighting for control in this area, and police are struggling.  At the crest of the favelas, Commander Paulo Berbat tells me the gangs use these jungle paths to ferry weapons and drugs in and out.

He told me that, in March, the battle for control over these routes turned deadly.

So, he's saying that, just up here in this area, members of a rival gang from a different community used the cover of the forest to try and invade this community and take it over.  There was an intense confrontation between the drug gang that controls this community, and three of the drug traffickers were killed.

Businesses that had flourished, attracting foreigners, are now reporting a 50 percent drop in revenue.  Even though no visitors have been harmed in Babilonia and Chapeu Mangueira, tourists are choosing to stay away.  It's a shocking turnaround for the residents here.

Among them is Rodrigo da Silva.  He sells food to make a living on the beaches just near his home in Chapeu Mangueira.  He had hoped that the Olympics and pacification would provide new opportunities, so he opened a hostel, advertised on Airbnb, but clients today are scarce

RODRIGO DA SILVA, Favela Resident (through interpreter):  Our business has decreased.  We had much higher expectations in terms of hosting people throughout the Olympics.  If the situation had improved, maybe I wouldn't still have to work here on the beach.

LULU GARCIA-NAVARRO:  Concerned about gang pressure, da Silva only agreed to meet us outside his favela.

RODRIGO DA SILVA (through interpreter):  If you talk too much, it ends badly.  Here's the deal:  You do not mess with their business.  I don't mess with their stuff and they don't mess with mine.  Everyone wins, in a way.

ZIKA - Republican House Blocks Requested Funding

COMMENT:  It's what you can expect from Big-$Money owned Republican House where money is more important that people.  You see, in the Republican House, women are worth ONLY $622 million.

"What's behind biting political fight in Congress over Zika funding?" PBS NewsHour 5/24/2016

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SUMMARY:  In February, the White House issued a $1.9 billion plan for combating Zika virus in the U.S., including provisions for mosquito control, education and research into a vaccine.  While GOP lawmakers opposed that plan, the Senate passed a bipartisan $1.1 billion compromise bill last week.  Judy Woodruff talks to Rep. Bob Gibbs, R-Ohio, and Rep. Rosa DeLauro, D-Conn., for more on the funding debate.

JUDY WOODRUFF (NewsHour):  Now to Capitol Hill and Washington's efforts to combat the Zika virus.

Back in February, the White House put together a $1.9 billion proposal aimed at mosquito control, education about Zika, plus boosting research into the virus and a possible vaccine.  Last week, the Republican-controlled Senate moved a compromise measure for less than two-thirds that amount over the next year, $1.1 billion.

But the also-GOP-controlled House signed off on a bill for $622 million over six months.

Joining me now from opposite sides of this funding divide are Representative Rosa DeLauro, a Democrat from Connecticut, and Representative Bob Gibbs, Republican from Ohio.

And we welcome both of you to the program.

Congressman Gibbs, let me begin with you.

The administration, as we said, asking for $1.9 billion.  The amount you favor is about a third that much.  Why not give the administration what it's asking for?

REP. BOB GIBBS (R), Ohio:  Well, what the administration did, that's just ongoing through the next — at least the next two mosquito seasons.

Our bill, at $600 million-plus, goes to the end of this fiscal year, September 30, and now we're in the appropriation process, and we will look at that, what we need to do past September 30 of this year going into the next fiscal year and the next mosquito season next summer.

So, we will be appropriating more money, I'm sure, but it's going to go through regular order and the regular appropriation process.  So, we're on board to make sure to appropriate the money as needed to get through to the end of this fiscal year.

JUDY WOODRUFF:  So, Congresswoman DeLauro, it sounds like this is a down payment on this problem.  Is that going to be enough?

REP. ROSA DELAURO (D), Connecticut:  Listen, no, the fact is, is the Zika virus is a public health emergency.  It is a crisis.

It is going to — the mosquitoes that carry the virus will hit the mainland United States within the next few weeks.  We are putting American women at risk, pregnant women who are fearful that their babies will be born with birth defects.

And we have a medical community that is telling women that maybe they shouldn't get pregnant.  That is not message to the American people.  The fact of the matter is, is that the $622 million is a third of what's been asked for.

You know, in this body, when we deal with appropriations for defense or going to war, my Republican colleagues will say, let us get the word from the generals, from those who are in the field, the experts.  They can tell us how much money they need.  And they can tell us how many troops we need.

Well, we do have experts in this war on the mosquitoes.  We have the Centers for Disease Control.  We have the National Institutes of Health.

PANDEMIC - Zika Research Update

"RESEARCHERS CONFIRM ZIKA, BRAIN DEFECT LINK" by Bradley J. Fikes, San Diego Union-Tribune 5/12/2016

NOTE:  This is from the online version of the newspaper, so no link to article.

UC San Diego, Brazilian scientists infect pregnant mice with virus and detect harm to their babies

Scientists from Brazil and UC San Diego said Wednesday that they have produced the world's first direct evidence of how the Zika virus causes brain defects.  Previous research had inferred this mechanism, but never demonstrated it in the lab.

In their new study, the Brazilian and San Diego scientists worked with pregnant mice.  They found that the Brazilian strain of Zika crossed the placenta and into the mice's pups, reducing growth in the brain and the rest of the body.

The brain defects were similar to the microcephaly reported in some human babies whose mothers were infected with Zika during pregnancy.

Additionally, the researchers discovered that the virus caused similar damage in brain “organoids,” which are peasized structures grown from human stem cells.  In essence, the study confirmed earlier findings of Zika's effects on brain organoids, including a report published this month by UC San Diego scientists.

But one strain of mice resisted Zika, the latest study found.  The pups of those mice didn't show any signs of infection and tested negative for the virus.  This suggests that the virus never crossed the placenta in those cases.

This particular strain mounted a “robust” antiviral immune response, the report said.  If the effect can be extended to humans, it would help explain why some Zika-infected mothers give birth to newborns who have no detectable brain damage.

Virus has already achieved pandemic status

The new study was published in the journal Nature.  It can be found at Nature International Weekly.  Zika's stealthy attack on fetal brains makes it especially worrisome.  Unlike Ebola's direct and deadly assault, Zika is rarely fatal.  Most infected people don't feel any symptoms.  So if a pregnant woman is infected, the real damage may not be known until her baby is born.  Another concern: Zika can harm fetal development at all stages of a woman's pregnancy.  The Brazilian strain of Zika is more aggressive than the African strain, said UC San Diego's Alysson Muotri, one of the new study's authors and a Brazilian native.  The two strains share about 90 percent of their genes, meaning that the 10 percent difference is responsible for making the Brazilian version more dangerous.

That fact represents a monumental challenge to Brazil, which is set to host the Summer Olympics in less than three months.  People will travel to Brazil from around the world, possibly become exposed to Zika and carry the virus back to their home countries.  Zika is usually carried by mosquitoes of the genus Aedes, but it also can be transmitted sexually.  The virus has already achieved pandemic status, and it has been reported throughout the United States.  San Diego County's first case this year was announced in February.  The patient was a woman who had become infected while in Colombia.  She was not pregnant at the time and has recovered fully, public health officials said.

From Jan. 1 through May 4, a total of 472 Zika cases were reported in the U.S., including 40 in California, according to the U.S. Centers for Disease Control and Prevention.  Pregnant women were involved in 44 of those cases, and 10 of the infections were sexually transmitted.

There has been no “homegrown” Zika infection by mosquitoes in the United States, health officials said.

However, the potential for transmission is present in the form of the Aedes Aegypti mosquito.  The species, a relatively recent arrival in San Diego County, is black with white stripes.  Scientists not involved in the new study said it meshes with results from previous research and shows a way forward for potential counter- measures.

“This report has revealed a new approach to investigate the pathological outcomes of Zika infection in innovative experimental models and is the first of its kind,” said medical virologist Grant Hill-Cawthorne at the University of Sydney in Australia.  His comments were provided by the Australian Science Media Center.  “It has shown the experimental models used can reflect the clinical presentation of Zika infection and thus serve as an excellent basis to understand the disease process and evaluate strategies for prevention,” Hill-Cawthorne said.  Dr. Nathalie MacDermott, a clinical research fellow at Imperial College London, said: “The study lends further support to the likelihood that the damage to the infant resulting in microcephaly, microencephaly and brain malformations occurs during the first and second trimesters of pregnancy, a time when the infant's brain is rapidly developing and nerve cells are migrating to the correct regions.”  Her comments were provided by the United Kingdom-based Science Media Center.

GULF COAST - 'Zika is Coming'

"Is a perfect storm of Zika virus conditions coming to the Gulf Coast?" PBS NewsHour 4/18/2016

(click for better view)

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SUMMARY:  In the wake of the CDC's revelation that Zika virus causes microcephaly in infants, doctors are grappling with the thorny issue of whether they should recommend that women in high-risk areas avoid getting pregnant this summer.  Hari Sreenivasan talks to Dr. Peter Hotez of Baylor College for more on how medical experts are confronting the prospect of Zika in the U.S.

HARI SREENIVASAN (NewsHour):  Worries over a potential Zika outbreak in the U.S., and who may suffer a bigger impact.

Public health officials have been increasingly concerned about the virus spreading via mosquitoes this summer.  One report even suggested government officials were split over whether to advise women to avoid pregnancy in areas where Zika is circulating.

In an op-ed titled “Zika Is Coming,” Dr. Peter Hotez focused on some of these questions and what it might mean in some cities in the southern parts of the country.  He’s the dean of the National School of Tropical Medicine at Baylor College of Medicine and a pediatrician and microbiologist at Texas Children’s Hospital.  I interviewed him from our New York studios.

I want to read you the first sentence of the op-ed you wrote in (link to op-ed) The New York Times recently.  It said: “If I were a pregnant woman living on the Gulf Coast or in Florida in an impoverished neighborhood and city like Houston, New Orleans, Miami, Biloxi, Mississippi, or Mobile, Alabama, I would be nervous right now.”

Explain.

DR. PETER HOTEZ, Texas Children’s Hospital:  Well, the reason I made that statement, Hari, was because what we know, where this terrible birth defect, microcephaly, is happening.

It happens when pregnant women are bitten by the Aedes mosquitoes.  So, the first requirement is, it has to be a part of the world where we have the Aedes mosquito.  And, also, the other component that not many people appropriate is both crowding and poverty.

And the reason why poverty is so important is because women who live in poverty have increased exposure to mosquitoes because of absent — or broken window screens, collected garbage, environmental degradation near the home that breeds mosquitoes.

And so what you have on the Gulf Coast of the U.S. is the perfect storm of all three factors, the Aedes aegypti mosquito, the extreme poverty and crowding, that you would find in Northeastern Brazil, which is the epicenter of this epidemic or what we have seen moving into Colombia.

So, for all the reasons we’re seeing microcephaly cases appear in Brazil and Colombia, I believe we’re going to see on the Gulf Coast, especially as we move into the warmer months, when our mosquito numbers start to rise.

So we’re already finding Aedes aegypti mosquitoes on the Gulf Coast, including here in Houston.  But I’m very worried that as we go into the warmer months, those mosquito numbers are going to incline, with it, the poorer neighborhoods on Gulf Coast cities, such as Houston, New Orleans, others, are really going to be affected by Zika.

HARI SREENIVASAN:  So, what’s that timeline of progression that you see?  Not all mosquitoes have Zika.  It will take some time for some of them to get Zika, and then some of them to bite people, some of those people to have symptoms, some of those symptoms to be severe.

DR. PETER HOTEZ:  Well, arboviruses, viruses transmitted by mosquitoes are not new to the Gulf Coast.  We have experienced a number of epidemics of arboviral infections.

For instance, in 2003, Houston experienced an epidemic dengue fever caused by the same Aedes aegypti mosquito.  And what we found was, those numbers started to rise in May and into June, and with it, we then started seeing a dengue outbreak back in 2003.