It was an honor to testify June 15 in Washington, D.C., before 12 members of the Florida delegation of the U.S. House of Representatives, regarding the worldwide Zika virus crisis. I told the congressmen that while there have been no reported positive cases in Sarasota or Manatee County, no county in Florida is impervious to the Zika threat. The number of cases we have seen thus far is only the beginning. This virus could spread exponentially across the state in the months ahead. We must prepare and plan for the worst.
In preparation for the meeting I spoke with a number of state health department officials, and also specialists in neonatology, obstetrics, and infectious disease, and an expert in mosquito control. Their quantitative and anecdotal findings support my concerns. Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January. There have been more cases in Florida than in any other state. As of the week of June 13, 2016, some 1,451 patients were tested in Florida. Of those, 183 (12.6 percent) tested positive. Among those who tested positive, 38 (20.7 percent or 1 in 5) were pregnant.
I told the congressmen I have five primary concerns:
First is the importance of easy availability to accurate and efficient lab testing, both from the county and state health department levels, as well as from the commercial labs. There has been concern about that reduced availability of testing due to the fact that we had to go through the state lab and local health departments and only specific criteria was accepted. However, commercial lab testing is now available for real-time PCR (polymerase chain reaction) testing for the acute Zika virus disease in the first seven days, through Quest and LabCorp. This facilitates the general ability to more widely test patients, as needed.
Another concern is the increased possibility of spread in the United States by sexual transmission, in addition to mosquito vector-borne disease. If we look at the U.S. history of other flavivirus infections – of which the mosquito-borne Dengue virus is a good example – we note that despite a worldwide spread, we have only had small outbreaks such as Key West in 2009 and recently Hawaii in 2015. The concern of several physicians is our impact and outreach to the child-bearing population and continued efforts to educate on the risk of transmission of Zika to their sexual partners, especially as related to conception. More cases may be noted that result from sexual transmission. Sexual transmission is always a concern, no matter what age you are. We have to continue education to make sure people understand how to prevent this disease sexually.
Also of concern are the complications of Zika and its economic burden, which could add pressure to the U.S. health care system. These include issues such as prolonged NICU hospitalizations and long-term care for infants born with microcephaly or other neurological conditions. This also can stand the same for the concern regarding Guillain Barre syndrome. Some experts who have studied the long-term consequences of rubella— another virus that attacks fetuses — say they believe children who survive a Zika infection without microcephaly nonetheless may suffer serious consequences, including blindness and deafness at birth, learning and behavior difficulties in childhood, and perhaps even mental disabilities later in life.
I also stressed the importance of reporting all cases of suspected Zika early on — regardless of whether the lab test has or has not come back. This is important so that mosquito-control specialists can begin immediate testing and surveillance.
Finally, I expressed my concern about the ability to educate sufficient obstetricians who are willing to follow pregnant women who have laboratory evidence of Zika virus exposure. Infectious disease physicians in areas of higher incidence such as Dade County say they have had an increasingly more difficult time finding OBs to take care of these Zika-exposed women due to medical legal concerns, and perhaps due to the relative newness of this disease and the disease’s uncertainty. The health department has reached out to them directly.
I shared the speakers’ table with national and local experts, including Dr. Tom Frieden, director of the Centers for Disease Control and Prevention in Atlanta, Dr. Mario Stevenson, chief of the division of infectious diseases at the University of Miami and T. Wayne Gayle, executive director of Lee County Mosquito and Hyacinth Control Districts. Dr. Frieden said the CDC lacks adequate funding to manage the Zika virus. He added that a vaccine “will take years to develop.” President Obama has requested $1.9 billion from Congress to fight the Zika virus. The emergency funds would expand education, prevention, and mosquito control programs, improve diagnostics and testing, speed the development of a vaccine and boost research into the complications of contracting the virus.
The Congressmen asked me how I thought the crisis could affect the elderly population in Sarasota. I told them there had not been any direct proof that the virus is worse in immune-suppressed individuals. However, research needs to be done to determine if the elderly population is more susceptible to Guillain-Barre Syndrome syndrome as a result of the Zika virus.
I want to thank delegation co-chairs U.S. Rep. Vern Buchanan (R-Longboat Key) and Rep. Alcee Hastings (D-Fort Lauderdale), whose staffs made the meeting possible. The majority (maybe 90 percent) of the congressmen had a very positive response to what they heard. They felt that the money was required and that they should fund it. We will continue to be very cautious and be aware of symptomatology of any patient that we have admitted, so we can have them tested early. We’re constantly vigilant and we will continue to be so with patients that could be at risk.