De­spite few cases, Zika re­search con­tin­ues in Md.

Maryland Independent - - Front Page - By ROB­BIE GREENSPAN Cap­i­tal News Ser­vice

AN­NAPO­LIS — Mos­quito sea­son may be wan­ing in Mary­land, but Zika re­search here is in full force.

Al­though Mary­land ac­counts for fewer than 3 per­cent of the Zika cases na­tion­wide, there are at least five sites in Mary­land re­search­ing the virus: The Johns Hopkins Hos­pi­tal, U.S. Army Med­i­cal Re­search In­sti­tute of In­fec­tious Dis­eases, the Univer­sity of Mary­land School of Medicine, Wal­ter Reed Army In­sti­tute of Re­search in Sil­ver Spring, and the Na­tional In­sti- tutes of Health Clin­i­cal Cen­ter in Bethesda.

“There is a lot of re­search go­ing on in biomedical sci­ences lo­cated in the Bal­ti­more-Wash­ing­ton cor­ri­dor,” said Dr. Matt Lau­rens, a pe­di­a­tri­cian and the direc­tor of in­ter­na­tional clin­i­cal tri­als for the Univer­sity of Mary­land School of Medicine. “It is a mag­net for biomedical re­search.”

Be­ing a leader in medi- cal re­search is a nat­u­ral fit for Mary­land, said Chris Gar­rett, a spokesman for the Mary­land Depart­ment of Health and Men­tal Hy­giene.

“[It] is char­ac­ter­is­tic of Mary­land, given our prox­im­ity to the na­tion’s cap­i­tal, as well our stature in public health, pre­pared­ness and re­sponse,” Gar- rett said. “Mary­land was one of the prin­ci­pal states lead­ing the re­sponse to the Ebola virus in 2014 and 2015, as well.”

The hos­pi­tal-based Johns Hopkins Zika Cen­ter opened in Bal­ti­more this sum­mer to help pa- tients and in­fants with Zika. Ac­cord­ing to Johns Hopkins’ web­site, the cen- ter has spe­cial­ists from epi­demi­ol­ogy, in­fec­tious dis­eases, ma­ter­nal-fe­tal medicine, or­tho­pe­dics, pe­di­atrics, phys­io­thera- py, psy­chi­a­try and so­cial work to treat pa­tients with Zika.

Pa­tients from around the world are wel­come at the cen­ter, which is in­te­grated into the hospi- tal. Pa­tients with sim­i­lar symp­toms are treated in rooms near each other for con­ve­nience, al­though there is not a sep­a­rate wing of the hos­pi­tal for the Zika Cen­ter.

Dr. Wil­liam May, as­so­ciate pro­fes­sor of oph­thal­mol­ogy at the Wilmer Eye In­sti­tute and co-di­rec- tor of the Johns Hopkins Zika Cen­ter, said he has seen two pa­tients from Mary­land, in­clud­ing one baby.

The most com­mon symp­toms of Zika in adults are fevers, rashes, joint pain and con­junc­tivi­tis, as well as mus­cle pain and headaches.

Ac­cord­ing to the Cen- ters for Dis­ease Con­trol, Zika can also cause Guil- lain-Barre Syn­drome, an au­toim­mune re­ac­tion where the im­mune sys­tem at­tacks the nerves and can cause se­vere pa- ral­y­sis. Pa­tients usu­ally re­cover, but it is fa­tal in 1 per­cent of vic­tims.

How­ever, the virus can have much more se­ri­ous ef­fects on ba­bies.

Typ­i­cally con­tracted in the womb when their moth­ers are bit­ten by a mos­quito car­ry­ing the vi- rus, ba­bies with Zika can have se­vere fe­tal birth de­fects, in­clud­ing eye prob­lems, hear­ing loss and im­paired growth. Ac­cord­ing to the CDC, it can also cause mi­cro­cephaly, a birth de­fect that causes a baby’s head to to be smaller and the brain to not fully de­velop or grow.

Mi­cro­cephaly can lead to seizures, de­vel­op­men­tal and in­tel­lec­tual de­lays, hear­ing loss, and vi­sion and feed­ing prob­lems. In se­vere sit­u­a­tions, it can also lead to death, ac­cord­ing to the CDC.

There have been more than 100 cases of lo­cally ac­quired Zika cases in the United States, all in Florida. Of the more than 4,000 cases of Zika con­firmed in the states, about 3,900 have been travel-re­lated, or con­tracted when peo­ple were trav­el­ling out­side the countr y.

Mary­land has had 105 con­firmed cases of Zika as of Oct. 27, none lo­cally con­tracted.

Yet with the mos­quito pop­u­la­tion dwin­dling in the fall and win­ter months, the Zika fo­cus shifts, said Gar­rett.

“There is a dan­ger with peo­ple as­so­ci­at­ing Zika solely with mos­quito trans­mis­sion,” Gar­rett said.

Be­sides be­ing trans- mit­ted through the bite of an in­fected mos­quito, Zika can be con­tracted through sex, blood trans- fu­sions, or lab­o­ra­tory ex- po­sure, ac­cord­ing to the CDC.

There has been one doc­u­mented case in Mary­land of Zika be­ing con­tracted through sex- ual ac­tiv­ity. A woman con­tracted the virus af­ter hav­ing sex with an asymp­to­matic man less than two weeks af­ter he re­turned from the Do­mini­can Repub­lic.

About 80 per­cent of peo­ple who get Zika are asymp­to­matic, said Lau­rens, mak­ing it dif­fi­cult to track and con­tain the virus.

May said he be­lieves the virus will spread through­out the United States in a mat­ter of years.

“It has taken about a year and a half for it to go through Cen­tral and South Amer­ica into the United States,” he told the Univer­sity of Mary­land’s Cap­i­tal News Ser­vice. “If it keeps up that rate it will take over the U.S.”

The Wal­ter Reed Army In­sti­tute of Re­search has been work­ing with Beth Is­rael Dea­coness Med­i­cal Cen­ter in Bos­ton on a vac- cine for Zika. Ac­cord­ing to De­bra Yourick, a rep­re­sen­ta­tive for Wal­ter Reed, re­searchers com­pleted the sec­ond round of pre­clin­i­cal stud­ies in Au­gust.

The re­searchers found a vac­cine that com­pletely pro­tected rhe­sus mon­keys from ex­per­i­men­tal in­fec­tion with the Zika virus, ac­cord­ing to an Aug. 4 news re­lease.

Yourick also said clini- cal tri­als are sched­uled to be­gin next week at Wal- ter Reed’s Clin­i­cal Tri­als Cen­ter, as well as at other, unan­nounced lo­ca­tions.

The Na­tional In­sti­tute of Al­lergy and In­fec­tious Dis­eases, a part of the Na- tional In­sti­tutes of Health Clin­i­cal Cen­ter in Bethes- da, is work­ing with the Univer­sity of Mary­land School of Medicine and Emory Univer­sity to de­velop a vac­cine as well.

At least 80 vol­un­teers, ages 18-35, are en­rolled in the study among the three sites. Ac­cord­ing to a re­port from the NIH, the study be­gan in July and will con­tinue un­til De­cem­ber 2018.

Un­like the flu shot or other vac­cines, the im­mu­niza­tion the NIH is de­vel­op­ing for Zika does not con­tain the virus. In­stead, Lau­rens said, it is DNAbased.

The vac­cine in­structs the body to make a small amount of Zika virus pro­tein, which may build an im­mune re­sponse, ac­cord­ing to the NIH.

“That is what we are eval­u­at­ing in this phase 1 study,” Lau­rens said. “We hope that the vac­cine will pro­duce a ro­bust im­mune re­sponse, ca­pa­ble of pre­vent­ing Zika in­fec­tion in per­sons vac­ci­nated.”

The CDC is still re­search­ing how long Zika can stay in gen­i­tal flu­ids, how com­mon it is for Zika to be passed dur­ing sex and whether Zika passed to a preg­nant women dur­ing sex has dif­fer­ent risks for birth de­fects than Zika trans­mit­ted by a mos­quito bite, ac­cord­ing to the CDC web­site.

To com­bat Zika, the Mary­land Depart­ment of Agri­cul­ture has been using pre­ven­tion tech­niques.

“The best way to pre­vent [mos­qui­toes] from car­ry­ing any­thing is to not al­low them to breed,” said Brian Pren­der­gast,

the pro­gram man­ager of mos­quito con­trol for the Mary­land Depart­ment of Agri­cul­ture.

The Mary­land De­part- ment of Agri­cul­ture has 15 state in­spec­tors who go to Mary­land homes, check­ing for still wa­ter. The in­spec­tors gen­eral- ly work dur­ing mos­quito sea­son, which is May to Au­gust, said Pren­der- gast.

But due to the un­sea- son­ably warm weather this year, the in­spec­tors were still work­ing into late Oc­to­ber, he said.

Af­ter the in­spec­tors re­ceive per­mis­sion from the home­owner, they search the front and back yards for any wa­ter ves­sels. The Aedes species of mos­qui­toes that can carry Zika breeds in ob­jects that hold rain­wa­ter, Pren­der­gast said.

“They do not breed in swamps or ditches or pud­dles,” he added.

These mos­qui­toes can- not travel far, of­ten less than 50 yards. Be­cause they are not fly­ing long dis­tances, find­ing their rafts (mos­qui­toes’ nests) is es­sen­tial.

“If we elim­i­nate their breed­ing, we elim­i­nate the skeeters,” Pren­der- gast said.

When ex­am­in­ing the yard, the in­spec­tor dumps out any item that holds wa­ter. They then place it in a way that will hold no wa­ter in the fu­ture, be­fore no­ti­fy­ing the home­owner about what they found.

“We ex­pend a lot of en­ergy be­cause peo­ple do not take the sim­ple step of dump­ing any­thing that can hold rainwa- ter,” Pren­der­gast said.

The in­spec­tors from the Mary­land Depart­ment of Agri­cul­ture use three pes­ti­cides to kill mos­quito lar­vae and a dif­fer­ent pes­ti­cide on adult mos­qui­toes, Pren­der­gast said. The in­spec­tors can treat “any type of stand­ing wa­ter that can’t be dumped with pes­ti­cides,” he said.

The three pes­ti­cides the in­spec­tors use against the lar­vae in­clude two chem­i­cals and a bac­terium. The tools “have no tox­i­c­ity to any­thing other than mos­quito lar­vae and midge lar­vae,” Pren­der­gast said. “It all is en­vi­ron­men­tally friendly.”

To con­trol adult mos­qui­toes, the in­spec­tors use a pes­ti­cide called Bifen­thrin, and the Depart­ment of Agri­cul­ture also uses trucks spray­ing Per­manone 30-30 pes­ti­cide.

Pren­der­gast stressed all the pes­ti­cides used are “bio­ra­tional,” or non-toxic.

Pre­vent­ing mos­qui­toes from re­pro­duc­ing is a big step for pre­vent­ing Zika trans­mis­sion, but, Gar­rett said, his fo­cus is still on peo­ple.

“Mary­lan­ders need to make sure they fol­low the CDC guid­ance on pre­ven­tion,” he said. “Par­tic­u­larly if they or their part­ners have oc­ca­sion to travel to ar­eas with on­go­ing Zika trans­mis­sion.”

Zika is not com­mon in Mary­land, and Gar­rett sees the col­lab­o­ra­tion of dif­fer­ent groups as a good way to main­tain that, and po­ten­tially de­feat the virus.

“We all want to see an end to the scourge of Zika and to the birth de­fects it has been proven to cause.”

PHOTO COUR­TESY OF CEN­TERS FOR DIS­EASE CON­TROL AND PRE­VEN­TION VIA AP/JAMES GATHANY

In this photo taken by James Gathany and pro­vided by Cen­ters for Dis­ease Con­trol and Pre­ven­tion, the Aedes al­bopic­tus mos­quito, bet­ter known as the Asian tiger mos­quito, bites a hu­man host. The Asian tiger mos­quito is found in Mary­land and can carry the Zika virus.

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