USA TODAY International Edition

PATHWAY TO PERIL

- Mark Johnson and Devi Shastri

NAIROBI, Kenyan reKENYA searcher James Miser Akoko stood at the edge of Nairobi’s vast Dandora dump in the late afternoon heat, staring down into a recipe for the next pandemic.

Dozens of men and women scoured a 30- acre garbage pit in a grim version of recycling, gathering soiled plastic toys, filthy clothing and blankets, even abandoned airline food. Large marabou storks watched over them. Free- ranging pigs, goats and other livestock grazed on refuse, marking time until the day they become food themselves — human food.

In the neighborin­g Korogocho slum, which shelters 150,000 of Nairobi’s poorest people, Akoko encountere­d a middle- aged woman laboring over a large, uncovered pot of simmering chicken intestines. These she would sell to passersby. Dozens of marabou storks appeared, circling overhead.

Scientists worry the next devastatin­g disease could be born where animals and humans mix in a Third World slum — then cross the globe. Zika may have been a preview.

“One task that is still undone for us,” said Akoko, of the Internatio­nal Livestock Research Institute, “is to go into the dump sites and catch the marabou storks to see what they are carrying ... we don’t know what they are spreading in Nairobi in terms of disease.”

When scientists worry about the next big outbreak, it is places like this they mention: sprawling Third World cities, with large population­s of humans and animals living together amid the squalor of dirty water and poor sanitation. Of Nairobi’s 3.4 million people, about 60% live in densely packed slums, sharing muddy roads with goats, pigs, chickens, cows and rodents.

Imagine a melting pot into which livestock, birds, flies and people all contribute bacteria and other microbes — a Petri dish for the creation of new threats to human health. Pigs, for example, act as mixing vessels for influenza. They can be infected by both bird and human flu, allowing genetic material from each to combine and form new strains.

A few years ago, researcher­s at King’s College London imagined how this biology might play out in a slum.

They devised a hypothetic­al scenario that begins with impoverish­ed residents watching their pigs and poultry fall ill with high fevers and bleeding. Within a day, animals begin to die. Within weeks, the new influenza spreads from animals to the humans who handle them. And because the residents have lives outside the slum, working in hotels and factories, riding on buses, the influenza advances beyond the slum.

Within a month and a half, the authors wrote, “the virus has spread to nearly 80 million people worldwide. Carried abroad by internatio­nal long- distance commercial flights, the illness leapfrogge­d out of Asia and appeared in Hong Kong, London, Paris, Marseilles, North Africa, New York, Beijing, Calcutta and Dubai almost simultaneo­usly.”

All told, the influenza kills 140 million people.

It is only hypothetic­al, of course, though “a plausible situation,” said Kristen Bernard, professor of virology at the University of Wisconsin- Madison’s School of Veterinary Medicine.

The authors set their scenario in the poverty- stricken favelas of São Paulo, Brazil, because these areas have a high density of humans and animals living in close quarters, sharing poor water and sanitation.

Much like Nairobi. Or Mumbai. Or Mexico City. Or dozens of similar cities, all expanding, as the world’s population shifts from rural to urban areas.

—— “A microbe originatin­g in Africa or Southeast Asia can arrive on North American shores within 24 hours,” according to a 2014 report by the U. S. Centers for Disease Control and Prevention. We already see the results. Studies say a majority of U. S. cases of difficult- to- treat, drug- resistant typhoid fever can be traced to six developing countries.

The advance of drug- resistant typhoid in the U. S. has drawn little attention, especially when compared with the disease that arrived by plane in September 2014.

“The first case of Ebola diagnosed in the U. S. had major cascading effects that rippled through several industries,” said Amesh Adalja, a senior associate at Johns Hopkins Center for Health Security. “Every hospital had to augment their preparedne­ss, public health agencies were tasked with monitoring large numbers of those returning from West Africa, airport screening tools had to be developed, and general panic from the public and politician­s ensued.”

Our Ebola scare has since passed, but a longer- term problem arrived last July.

A little more than a year after the Zika virus began storming through Brazil and most of Central and South America, the virus arrived in South Florida. The mosquitoes that carry Zika were waiting. They needed only infected people to bite, and they would find them soon enough.

“There is a huge viral reservoir in the Americas,” said José Szapocznik, a Zika expert at the University of Miami. “And we have people coming from that viral reservoir to Miami on an ongoing basis.” —— Zika arrived last July at the peak of a humid Miami summer. For Yessica Flores, it was a joy- ous time. She was pregnant.

Flores, 38, was nearly three months into her pregnancy. An immigrant from Honduras, she lives in a colorful one- story home in Miami’s Wynwood neighborho­od with her husband, her mother and her 14- year- old daughter, Andrea.

“I heard about Zika from the time it started in Miami,” Flores said through an interprete­r. “But I didn’t bother with it.”

Watching Zika more closely than Flores was Chalmers Vasquez, the operations manager of Miami- Dade County’s mosquito control team. He believed the region was ready to combat the mosquito that carried the virus, Aedes aegypti.

The county had faced the same mosquito during outbreaks of dengue fever in 2010 and 2014, and chikunguny­a, also in 2014.

On July 15, 2016, Vasquez and some co- workers stopped for lunch in Fort Myers when his phone rang. Zika had reached Miami. That night, he and his team set their first round of mosquito traps and began monitoring the population. ——

In the days after Zika arrived in Miami, Vasquez’s team walked through neighborho­ods spraying insecticid­es from their backpacks and searching for anything that could collect water for the mosquitoes to breed in — no bottle cap was too small.

But in some respects the response to Zika was trial and error.

“We found out that the insecticid­e that we were using in the spray trucks was no good,” said Vasquez. The mosquitos had developed a resistance to it.

After testing various compounds, they switched to naled, a potent insecticid­e sprayed from airplanes. Aerial treatments cut the number of mosquitoes they caught to less than half in a week.

On Jan. 27, 2017, Flores went to the school where she worked to request her maternity leave. As she was leaving, she felt an abrupt pain. A co- worker told her to go to the hospital.

That evening, after the baby had been tested, the doctor urged Flores and her husband to relax. At seven pounds, Baby Daniella Elizabeth Yac was healthy and fit.

At University of Miami, Szapocznik said people have the power to stop the spread of Zika by following simple steps: emptying sources of standing water, avoiding excessive skin exposure and using insect repellent.

Still, the CDC and others continue to preach mosquito control.

“So that wasn’t a small outbreak because it just fizzled out,” said Dan Strickman, senior program officer at the Bill & Melinda Gates Foundation. “It was a small outbreak because we did something about it.”

By August, Flores was about five months into her pregnancy. One day, the lab processing her Zika test called. The voice on the other end asked questions until Flores posed one of her own. “Does this mean I have Zika?” The answer she finally got was not the one she wanted.

As of mid- June of this year, Flores was one of 351 pregnant women in Florida to show lab evidence of the Zika infection.

It is still early in our understand­ing of Zika’s link to the birth defect microcepha­ly. Doctors could only monitor the baby’s developmen­t every week.

Flores began to pray.

 ?? PHOTOS BY MARK HOFFMAN, MILWAUKEE JOURNAL SENTINEL ?? Residents working with bare hands and without face masks search for food and items they can resell as trash is being dumped at Dandora, a massive, smoldering pile of garbage in Nairobi’s Korogocho slum.
PHOTOS BY MARK HOFFMAN, MILWAUKEE JOURNAL SENTINEL Residents working with bare hands and without face masks search for food and items they can resell as trash is being dumped at Dandora, a massive, smoldering pile of garbage in Nairobi’s Korogocho slum.
 ??  ?? A marabou stork soars over a dump in Nairobi, Kenya. The birds eat carrion, rotting garbage and small mammals. They can weigh as much as 20 pounds.
A marabou stork soars over a dump in Nairobi, Kenya. The birds eat carrion, rotting garbage and small mammals. They can weigh as much as 20 pounds.
 ?? PHOTOS BY MARK HOFFMAN, MILWAUKEE JOURNAL SENTINEL ?? A woman sells a mixture of chicken intestines and innards and eggs wrapped in sheets of used office paper for about 10 cents outside her home in the Korogocho slum. She has been making and selling the mixture for 30 years and was able to help pay for a...
PHOTOS BY MARK HOFFMAN, MILWAUKEE JOURNAL SENTINEL A woman sells a mixture of chicken intestines and innards and eggs wrapped in sheets of used office paper for about 10 cents outside her home in the Korogocho slum. She has been making and selling the mixture for 30 years and was able to help pay for a...
 ??  ?? James Miser Akoko, Internatio­nal Livestock Research Institute field coordinato­r for the Urban Zoo project, right, talks with Jane Waigwa, assistant chief of the Viwandani slum in Nairobi, Kenya. To make their studies work, Internatio­nal Livestock...
James Miser Akoko, Internatio­nal Livestock Research Institute field coordinato­r for the Urban Zoo project, right, talks with Jane Waigwa, assistant chief of the Viwandani slum in Nairobi, Kenya. To make their studies work, Internatio­nal Livestock...

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