Zika Found in Hawaii Years Before Caribbean Outbreak

University of Hawaiʻi at Mānoa John A. Burns School of Medicine (JABSOM) scientists have discovered that severe birth defects related to infection with the Zika virus (ZIKV) occurred much earlier than in 2016, when the connection was first made between the virus and an increased likelihood of microcephaly during outbreaks of ZIKV infection in Brazil and Puerto Rico.

UH scientists published their findings in December in the scientific journal PLOS Neglected Tropical Diseases, adding to the potential evidence of a link between ZIKV infection and microcephaly, a congenital condition associated with incomplete brain development and characterized by an abnormal smallness of the head.

Patient information and blood samples were collected voluntarily from mothers in Honolulu who delivered babies between 2007 and 2013 at the Kapiʻolani Medical Center for Women and Children, a Hawaiʻi Pacific Health hospital affiliated with JABSOM. The samples were collected and stored at the UH Biorepository (UHB) after obtaining written informed consent from the mothers.

“As per the information in the UHB, no mothers gave birth to babies with microcephaly in 2007 and 2008,” said Vivek R. Nerurkar, chair of the Department of Tropical Medicine, Medical Microbiology and Pharmacology. “However, from 2009 onwards, we identified six mothers who gave birth to babies with microcephaly. Of the six, ZIKV antibodies were detected in three, fifty percent, of the mothers who delivered babies with microcephaly, suggesting presence of positive Zika virus cases and associated microcephaly in the United States as early as 2009.”

Potential changes to women’s health practices

Nerurkar believes the growing evidence of an association between ZIKV infection and the devastating brain damage in infants justifies a new practice in women’s health.

“We need to be more proactive in tracking pregnant women and testing for the ZIKV ahead of time (before birth),” he said. “It may be time for health care professionals to routinely caution newly pregnant mothers (or those planning to become pregnant) about the ZIKV, and offer pre-natal tests to detect for the presence of the virus.”

Ideally, Nerurkar said, families can plan for safe pregnancies by avoiding travel to areas of known ZIKV outbreaks. In 2016, the U.S. Centers for Disease Control and Prevention and World Health Organization have issued travel alerts about locations with confirmed, locally acquired Zika virus infections.

The UH researchers expressed their gratitude for the women who agreed to voluntarily donate blood and placenta samples to build the UH Biorepository archive. “This has been an indispensable resource in our research,” said Nerurkar.

Nerurkar leads a team of scientists at UH working to develop a vaccine for ZIKV infection as well as robust diagnostic assays to rapidly detect ZIKV and other mosquito-borne viral infections. After the award of a Zika emergency response grant this year from the National Institutes of Health, his team members are also working to understand how ZIKV infection in men makes them susceptible to transmit the virus to their sexual partners, even though the men may appear symptom-free.

Hawaii House and Senate Budget Conferees Agree on Funding to Increase Vector Control Staffing – Concern for Dengue and Zika Drives Need

House and Senate conferees on the state budget today agreed to provide $1,270,120 to bolster the state Department of Health Vector Control Branch to focus on controlling populations of animals and insects that spread disease.

Mosquito Bite

Hawaii Island’s recent outbreak of dengue fever and the Zika virus outbreak in Brazil, which are spread by mosquitoes, have highlighted the continued importance of vector control, and House and Senate conferees want to ensure that the state is prepared to adequately short circuit, monitor and respond to any future outbreaks.

“This funding will help re-establish the vector control branch, which has been reduced over the past few years by furloughs and budget cuts,” said Sylvia Luke, chairperson of the House Finance Committee.  “In making these appropriations, the department will be able to add 20 new positions to monitor populations of vectors such as mosquitoes and rats, and to respond appropriately when a threat arises.”

Before the dengue fever outbreak in October, 2015, the state had 25 vector control positions, but 8 were vacant. With the added 20 new positions, there will be a total of 45 people in vector control when all positions are filled.

“Infectious disease has been and will continue to be one of our key challenges in a world made smaller and more connected with modern day air travel,” said Jill Tokuda, chairperson of the Senate Ways and Means Committee.  “The state’s recent slow response to the dengue fever outbreak on the Big Island was a wake-up call for all us.  We must be more vigilant in anticipating and responding to such outbreaks spread by mosquitoes and other vectors.”

In addition, the budget items agreed upon today included:

  • $6.9 million for public school transportation services;
  • $5.2 million for utilities for public schools;
  • $2.5 million for new fire trucks, firefighter equipment and fire retardant suits to ensure airport safety;
  • $1.5 million to fund a U.S. geographical survey study on Hawaii streams;
  • $1.4 million for port security and safety boats to reduce impact of natural disasters;
  • $1.25 million for maintenance and replacement of equipment at UH community colleges;
  • $400,000 to support beach restoration and protection projects and studies;
  • $180,000 for hydrologist and project development specialist positions for public land management for the disposition of water rights lease management and oversight; and
  • $162,354 for physician salary increases for better access to medical services for the Department of Public Safety.

The agreements were part of House and Senate conferees continued negotiations on a final version of HB1700, the state budget bill.  Earlier in the session, the House Finance Committee and the Senate Ways and Means Committee crafted their respective versions of the budget.

Lawmakers will continue to meet to iron out differences between the two versions through April 29, the deadline for all fiscal bills to pass out of conference committee.  A final conference draft will then be voted upon by the Legislature and if approved, will be sent to the Governor for his signature.

Budget worksheets detailing agreements and disagreements in the state and judiciary budget bills are available on the Capitol website at http://www.capitol.hawaii.gov/budget/2016budget.aspx

The conference committee is scheduled to reconvene on Friday, April 22, at 2:30 p.m. in room 309.

Hawaii Health Department Confirms Second Case of Zika

The Hawaii State Department of Health (DOH) is investigating another imported case of Zika virus in Hawaii. This is the second case of Zika to be confirmed this year by the department’s State Laboratories Division. The Kauai resident has a history of recent travel to Latin America and may still be infectious. The individual has been advised to keep indoors and stay protected from mosquitoes. No additional information will be made available about this case to respect the privacy of the individual.

microcephalyA Vector Control team will visit the individual’s residence to survey the area for mosquitoes and determine if there is a need to treat the area to reduce any mosquito breeding sites. DOH is coordinating closely with its county partners to assure a targeted and efficient response.

“As Zika continues to spread in multiple regions across the world, we anticipate that we will experience an increase in imported cases and must take precautionary measures to reduce our risk for an outbreak in Hawaii,” said Health Director Dr. Virginia Pressler. “There are several simple steps that we can take as a community to accomplish this, such as getting rid of standing water around our homes to reduce mosquito breeding sites and using repellant or protective clothing to prevent mosquito bites. It is crucial that we keep these practices top-of-mind as we prepare for travel in and out of the state, especially to areas that may be affected by Zika and other mosquito-borne illnesses.”

The Centers for Disease Control and Prevention recommends special precautions for women who are pregnant or may become pregnant. Pregnant women should not travel to areas with Zika. If travel cannot be avoided, women should consult with their healthcare providers first and vigilantly follow steps to protect themselves from mosquitoes.

For travel guidance, visit http://wwwnc.cdc.gov/travel/page/zika-travel-information.

For information on symptoms, diagnosis and treatment, visit:

http://www.cdc.gov/zika/symptoms/index.html.

For information on Zika and pregnancy, visit: http://www.cdc.gov/zika/pregnancy/index.html.

Hawaii Department of Health Statement on First Case of Zika This Year

The Hawaii State Department of Health has confirmed the first imported case of Zika in Hawaii this year. The individual had a history of travel in the Pacific and has since recovered and is no longer infectious. The case was confirmed this week by the department’s State Laboratories Division.

Mosquito sucking blood on a human hand

Mosquito sucking blood on a human hand

The department conducted an investigation of the case and has determined there is no health risk to the public.

To protect the privacy of the individual, no other information will be made available about the case.“Because people frequently travel to areas abroad where Zika virus is present, we can expect that we may see more imported cases in the coming months,” said Health Director Dr. Virginia Pressler. “With Zika, and our current dengue outbreak, it’s important for everyone in the state to reduce mosquito breeding areas by getting rid of standing water, and use repellant or protective clothing to prevent mosquito bites.”

The department sent an advisory to healthcare providers statewide on Feb. 17, 2016 updating them on clinical guidance for Zika virus and urging them to be aware of areas abroad where Zika virus is circulating.

In 2015, the Department of Health reported four imported cases of Zika virus in the state.

For travel guidance go to http://wwwnc.cdc.gov/travel/page/zika-travel-information For information on symptoms, diagnosis and treatment go to: http://www.cdc.gov/zika/symptoms/index.html For information on Zika and pregnancy go to: http://www.cdc.gov/zika/pregnancy/index.html

Center for Disease Control Confirms 4 Zika Cases This Year in Hawaii

The Center for Disease Control (CDC) has confirmed that there were 4 cases of the Zika virus reported in Hawaii in the last year.

zika in HawaiiThis is news to many of us, as previously we had only heard of the one case that was brought here from Brazil!

Schatz, Senate Democrats Urge President Obama To Take Robust & Aggressive Actions to Address the Spread of Zika Virus – Comments on Dengue Fever Outbreak

U.S. Senator Brian Schatz (D-Hawai‘i) joined 45 Senate Democrats today and released a new letter to President Obama urging a coordinated interagency response plan to address the spread of the Zika virus both at home and abroad.

Mosquito Bite

“As the dengue outbreak continues to impact communities on Hawai‘i Island, we need more aggressive action to contain it and to stop the threat of Zika, another mosquito-borne virus that is devastating dozens of countries around the world,” said Senator Schatz. “By increasing funding for critical government research and response programs, we can make real progress toward mitigating the impact of the Zika virus abroad and preventing its spread to Hawai‘i and the United States.”

The letter calls for the President to take a number of new actions, including taking the Zika virus into consideration as the Administration coordinates, and allocates resources in the Consolidated Appropriations Act for FY16, and moves forward with the President’s upcoming FY17 budget request, or subsequent amendments. Additionally, Senate Democrats are urging President Obama to:

  • Develop a coordinated interagency response plan to address the Zika virus both at home and abroad;
  • Direct USAID and the Department of Health and Human Services (HHS) to identify key gaps in the international and country-level response in order to best inform our response plan and disseminate, where appropriate, at border crossings and airports;
  • Ensure that federal agencies work with state and local partners to develop a cohesive national strategy for the monitoring, identification, and reporting of domestic Zika infections;
  • Direct HHS and the Department of Homeland Security to develop educational materials to inform travelers regarding the risk of Zika virus exposure;
  • Ramp up research efforts, including at the National Institutes of Health, to better understand the link between the Zika virus, microcephaly, Guillain-Barré Syndrome, and other public health impacts and accelerate rapid diagnostic and vaccine development; and
  • Encourage federal agencies to coordinate, collaborate, or share information with their international counterparts.

The Zika Virus is transmitted by the Aedes aegypti species of mosquitoes, which are also found in the United States. For most, the symptoms of Zika are mild, but when pregnant women become infected, the effects can be devastating. Zika has been linked to microcephaly in developing fetuses, which can lead to below-average head size, developmental difficulties, and brain damage.

The full text of the Senate Democrats’ letter is below:

Dear President Obama:

The ongoing outbreak of the Zika virus requires an urgent and aggressive response from the United States. We are writing to urge you to develop a coordinated interagency response plan to address the spread of the Zika virus both at home and abroad, and protect pregnant women and children. We also recognize that much is still unknown about the Zika virus, and therefore urge you to consider the potential impact the Zika virus will have on the funding needs of the Emerging Pandemic Threats (EPT) Program at the U.S. Agency for International Development (USAID), the Division of Vector-Borne Diseases at the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA) Agricultural Research Services Mosquito and Fly Research Unit, and other key programs in Fiscal Year (FY)17. We believe that a well-coordinated interagency response plan, coupled with strong investments in our research and response programs, is critical to addressing the Zika virus.

The Zika virus is transmitted via bites from the same kind of mosquitoes that carry dengue fever, chikungunya, and yellow fever. For most, the symptoms of Zika are mild, but when pregnant women become infected, there is early evidence its effects can be devastating. Zika has been linked to microcephaly in developing fetuses, which can lead to below-average head size, developmental difficulties, and brain damage. Scientists are also evaluating a possible link between the Zika virus and Guillain-Barré Syndrome, a rare condition that can cause muscle weakness and paralysis. These potential impacts have spurred the World Health Organization to declare the rise in Zika-linked birth defects and neurological conditions a Public Health Emergency of International Concern.

In the Americas, it is anticipated that the outbreak could infect up to 4 million people. Because Zika is carried by low-moisture dwelling mosquitos, local transmission is predicted to spread to all countries and territories where the Aedes aegypti is found, including the United States. There is a critical and urgent need for a robust and coordinated response at all levels of government, and it is necessary to enhance efforts to control outbreaks, counter the spread of the disease, and ultimately reduce the potential for outbreaks in the United States.

Investing in the effort to combat the Zika virus abroad is one of the most important things we can do to prevent widespread transmission of the virus at home. The USAID’s EPT Program helps developing countries prevent, detect, and control the outbreak of infectious diseases. The program has been able to successfully use the technical expertise of the CDC in African, Asian, and Latin American countries to combat infectious diseases like Zika. CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) further works to protect against the spread of diseases like the Zika virus both at home and abroad, while USDA’s Agricultural Research Services Mosquito and Fly Research Unit also plays a critical role in developing better means of mosquito detection, monitoring, and control.

We urge you to take the Zika virus into consideration as you coordinate and allocate resources in the Consolidated Appropriations Act for FY16 and move forward with your upcoming FY17 budget request or subsequent amendments.

At this time, it is also critically important that we take additional steps to respond to the ongoing outbreak and work to prevent additional cases of Zika from occurring in the United States. To meet this challenge we urge you to:

  • Develop a coordinated interagency response plan to address the Zika virus both at home and abroad;
  • Direct USAID and the Department of Health and Human Services (HHS) to identify key gaps in the international and country-level response in order to best inform our response plan and disseminate, where appropriate, at border crossings and airports;
  • Ensure that federal agencies work with state and local partners to develop a cohesive national strategy for the monitoring, identification, and reporting of domestic Zika infections;
  • Direct HHS and the Department of Homeland Security to develop educational materials to inform travelers regarding the risk of Zika virus exposure;
  • Ramp up research efforts, including at the National Institutes of Health, to better understand the link between the Zika virus, microcephaly, Guillain-Barré Syndrome, and other public health impacts and accelerate rapid diagnostic and vaccine development; and
  • Encourage federal agencies to coordinate, collaborate, or share information with their international counterparts.

By taking action now, we can make significant progress toward mitigating the impact of the Zika virus abroad and reduce the potential for Zika virus outbreaks in the United States. Thank you for your consideration of this request.