Zika makes it crit­i­cal to mon­i­tor in­fant health, but for how long?

Daily Freeman (Kingston, NY) - - NATION+WORLD - By Lau­ran Neer­gaard

More fed­eral money fi­nally is avail­able to fight Zika even as the news wors­ens. Ba­bies who at first seem to have es­caped the virus’ dev­as­tat­ing hall­mark de­fect — an ab­nor­mally small head at birth — might not be out of the woods af­ter all.

Brazil­ian doc­tors have counted a small num­ber of ba­bies who at birth had a nor­mal-sized head and only later were found to have prob­lems. They have de­layed neu­rode­vel­op­ment. At 5 months, one could use one hand but not the other. Later on, some even de­vel­oped that de­fect, called mi­cro­cephaly. The brain and skull weren’t grow­ing prop­erly af­ter birth, in­stead of be­fore. “Mi­cro­cephaly is only the tip of the ice­berg, only the thing we see when the baby is born,” Dr. Vanessa Van der Lin­den, a pe­di­atric neu­rol­o­gist in Re­cife, Brazil, told a meet­ing at the Na­tional In­sti­tutes of Health where she out­lined a long list of Zika-re­lated ab­nor­mal­i­ties. To chil­dren’s health ex­perts, the mes­sage is clear. In­tense study is needed of ba­bies born to Zika-in­fected moth­ers to learn the range of health prob­lems they may face. “It is just crit­i­cal to eval­u­ate the en­tire child. Even in the child who does not have mi­cro­cephaly, that doesn’t mean no eval­u­a­tion is needed,” said Dr. Cather­ine Spong of the NIH’s Na­tional In­sti­tute of Child Health and Hu­man De­vel­op­ment, which de­spite bud­get con­straints has be­gun re­search to bet­ter un­der­stand the risk to ba­bies. Af­ter months of par­ti­san bick­er­ing, Con­gress last week passed a bud­get bill that in­cludes $1.1 bil­lion to ad­dress the Zika cri­sis. It’s just over half the to­tal emer­gency money that Pres­i­dent Barack Obama re­quested last Fe­bru­ary. While mos­quito sea­son is wind­ing down in parts of this coun­try, Zika’s threat here and abroad is not di­min­ish­ing, and that’s why health of­fi­cials say a sus­tained com­mit­ment is vi­tal.

There are more than 2,200 preg­nant women among the 25,600-plus Zika cases that the Cen­ters for Dis­ease Con­trol and Preven­tion counts in U.S. states and ter­ri­to­ries, mainly Puerto Rico. The vast ma­jor­ity of main­land in­fec­tions are travel-re­lated, but mos­qui­toes have been spread­ing Zika in Florida’s Mi­ami-Dade County.

Out of money over the spring and sum­mer, the gov­ern­ment had raided funds meant for other dis­eases — Ebola, malaria, tu­ber­cu­lo­sis, even cancer and heart dis­ease — to re­search and fight Zika. The new cash in­fu­sion will go to mos­quito con­trol, other pub­lic health mea­sures and re­search. At the top of the list is keep­ing de­vel­op­ment of a Zika vac­cine on track. An ini­tial safety study of an early vac­cine can­di­date is nearly two-thirds en­rolled, and Dr. An­thony Fauci, NIH’s in­fec­tious dis­ease chief, ex­pects a larger study in 2,500 to 5,000 peo­ple to test if it works to be­gin by Jan­uary.

In the con­ti­nen­tal U.S., the CDC says 21 ba­bies have been born with de­fects at­trib­uted to Zika, and doc­tors are look­ing to col­leagues in harder-hit coun­tries to know what to ex­pect. At the re­cent NIH meet­ing, Van der Lin­den cat­a­logued a sober­ing list of ab­nor­mal­i­ties in the most se­verely af­fected ba­bies at her Brazil­ian clinic, the ones born with mi­cro­cephaly — which by it­self can’t in­di­cate the de­gree of un­der­ly­ing brain dam­age.

She showed videos of those ba­bies hav­ing seizures. They tend to cry non­stop. They may not eat enough — only about an ounce of milk at a time — be­cause of painful re­flux and trou­ble swal­low­ing. Their mus­cles are stiff and spas­tic. They have vi­sion and hear­ing prob­lems. If that isn’t wor­ri­some enough, Van der Lin­den then high­lighted less se­vere prob­lems that ap­peared later among about a dozen ba­bies who’d ap­peared healthy at birth, and Dr. Car­men Zor­rilla of the Uni­ver­sity of Puerto Rico added that she’s seen eye prob­lems among a hand­ful of ba­bies born with­out mi­cro­cephaly.

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