Why the Zika virus is causing alarm


Global health officials have said that the Zika virus, which has been linked to severe birth defects in thousands of babies in Brazil, is rapidly spreading in the Americas and could infect 3 million to 4 million people. The race is on to develop a Zika vaccine. 

Here are some questions and answers about the virus and the current outbreak.

How do people become infected?

The virus is transmitted to people through the bite of infected female Aedes mosquitoes, the same type of mosquito that spreads dengue, chikungunya and yellow fever. The Pan American Health Organization (PAHO) said Aedes mosquitoes are found in all countries in the Americas except Canada and continental Chile, and the virus will likely reach all countries and territories of the region where Aedes mosquitoes are found.

How do you treat Zika infection?

There is no treatment or vaccine available for Zika infection. Companies and scientists are racing to develop a safe and effective vaccine for Zika, but one is not expected to be ready for months or years. 

How dangerous is it?

The PAHO said there is no evidence that Zika can cause death, but some cases have been reported with more serious complications in patients with pre-existing medical conditions.

The virus has been linked to microcephaly, a condition in newborns marked by abnormally small heads and brains that have not developed properly. It also has been associated with Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks part of the nervous system. Scientists are studying whether there is a causal link between Zika and these two disorders.

How is Zika related to microcephaly?

Health officials have yet to establish a direct causal relationship between Zika virus infection and birth defects, but it is strongly suspected. Brazil has reported 3,700 cases of suspected microcephaly that may be linked to Zika. It is unclear whether in pregnant women the virus crosses the placenta and causes microcephaly. Research in Brazil indicates the greatest microcephaly risk appears to be associated with infection during the first trimester of pregnancy.

What are the symptoms of Zika infection? 

People who get Zika virus disease typically have a mild fever, skin rash, conjunctivitis, muscle and joint pain and fatigue that can last for two to seven days. But as many as 80 percent of people infected never develop symptoms. The symptoms are similar to those of dengue or chikungunya, which are transmitted by the same type of mosquito.

How can Zika be contained?

Efforts to control the spread of the virus focus on eliminating mosquito breeding sites and taking precautions against mosquito bites such as using insect repellent and mosquito nets. U.S. health officials have advised pregnant women to avoid travel to Latin American and Caribbean countries where they may be exposed to Zika.

How widespread is the outbreak in the Americas?

Health officials said Zika cases have been reported in more than 30 countries ranging from the Americas to Ireland to Australia in the current outbreak. Brazil has been the nation most affected. Other nations and territories include Barbados, Bolivia, Colombia, Costa Rica, Curacao, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, Venezuela and the U.S. Virgin Islands, according to the PAHO. (http://tinyurl.com/hoq6qqo)

What is the history of the Zika virus?

The Zika virus is found in tropical locales with large mosquito populations. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Southern Asia and the Western Pacific. The virus was first identified in Uganda in 1947 in rhesus monkeys and was first identified in people in 1952 in Uganda and Tanzania, according to the World Health Organization.

Can Zika be transmitted through sexual contact?

Two cases of possible person-to-person sexual transmission has been described, but the PAHO said more evidence is needed to confirm whether sexual contact is a means of Zika transmission. 

The PAHO also said Zika can be transmitted through blood, but this is an infrequent transmission mechanism. There is no evidence the virus can be transmitted to babies through breast milk.

What other complications are associated with Zika?

The WHO says because no big Zika outbreaks were recorded before 2007, little is known about complications caused by infection. During an outbreak of Zika from 2013-2014 in French Polynesia, national health authorities reported an unusual increase in Guillain-Barre syndrome. Health authorities in Brazil have also reported an increase in Guillain-Barre syndrome.

Long-term health consequences of Zika infection remain unclear. Other uncertainties surround the incubation period of the virus and how Zika interacts with other viruses that are transmitted by mosquitoes such as dengue.

Why I have vaccinated my daughters


I have two girls, ages three and eleven. My daughters have gotten every last vaccine I can possibly get for them. I have done the same for myself. 

Why? Because quite simply, vaccines are one of the most amazing medical discoveries we humans have ever pulled off. Because I don't want my daughters to lose their hearing from measles. Because hepatitis b kills 780,000 people each year and I don't want my daughters to be part of those awful numbers.  Because polio isn't quite gone from the planet. Because the flu made two of my dear friends so sick I literally begged them over the phone to run to an ER. Because there is no cure or treatment for tetanus. Because whooping cough can choke a child to death and break an adult's ribs. Because a friend got chicken pox when babysitting and spent two weeks miserably in bed when she was twenty-four. She still has the scars on her face, by the way. 

[READ MARK PAREDES' COLUMN ON WHY HE DOESN'T VACCINATE HIS DAUGHTHER]

Sometimes these actual facts about vaccines get lost. Open nearly any modern American publication and seek out information on the subject of parenting. You will inevitably come across an article implying that vaccines are death on a platter. Vaccines, we are told, cause autism. They have toxins. They are used for diseases that are not only not life threatening but actually fun. 

Nonsense. 

None of these allegations are true. Vaccines have been repeatedly studied. And studied. And studied. And studied. Scroll down for a list of over a hundred studies showing no link between vaccines and autism. We have autism because of many reasons including the fact that kids who used to be diagnosed as mentally retarded are now called autistic. Friends who are special education teachers (including my late mom) now tell me that no one is labeled mentally retarded. Autism is where we put the social services so that's where we put our kids. 

Vaccines do not contain toxins any more than your own body does because formaldehyde is a byproduct of your basic metabolic processes.

I'm in my forties. When I was attending the Hebrew Academy of the Five Towns and Rockaway in the 1970's we didn't have as many vaccines. We had hib instead. We had about a thousand needless deaths a year. I had the chicken pox when I was seven. I was in agony and so was my little brother. To this day, the smell of calomine lotion evokes a peculiarly ugly memory in my brain and an urge to itch. We didn't really have flu shots. We had the flu. I had it in my teens. I lost five pounds in a week and remember the odd happiness when I could finally sit up. 

My daughters get the shots. They will grow up in a world where girls will get the Gardasil shots instead of cervical cancer or genital warts. In 2007, the Aussies wisely decided to provide the shots for all their girls free of charge. Over seventy percent of Aussie girls get the shots. A recent study found the results: a sixty-one percent decrease in the rate of genital warts. This evil little disease causes all kinds of head and neck cancers so they should see a corresponding reduction there as well in the near future. Only thirty-eight percent of all American girls get the vaccine.

Please explain to me again why it is better to get cancer than to get three shots. Because it is one question I am grateful I will never have to answer when talking to my girls.

Nearly all doctors, all peds and all scientists are not engaged in a massive conspiracy to poison our kids with vaccines. Neither I am. I don't have a multi-million dollar house like a certain anti-vax doctor in Chicago who runs one of the most profitable websites on the net. I don't have a mansion like Andrew Wakefield who helped start a needless epidemic of measles in the UK. 

I am lucky. My daughters will not be one of the children growing up in India, who does not have access to the MMR shot so they get one of the most contagious diseases in the world. According to the UN sponsored organization Shot@Life, an organization dedicated to providing access to four life saving vaccines (and an organization I proudly volunteer with), hundreds of thousands of children die each year just from lack of access to vaccines that we take for granted here in the United States.

So I vaccinate. I vaccinate because I really am lucky. I vaccinate so that my girls will get a flu shot instead of two weeks in bed from the flu. I vaccinate so that the neighbor with the compromised immune system doesn't get hepatitis b. I vaccinate so that the neighbor with the newborn doesn't have to worry that her baby will get brain damaged from a bout of pertussis or that SSPE from the measles.

I vaccinate because this is the world we all need and deserve: one where all of us benefit from one of modern medicine’s best achievements.

— Stacy Mintzer Herlihy is a freelance writer based in New Jersey. Her work has appeared in publications such as USA Today and the Newark Star Ledger. She is the co-author of Your Baby's Best Shot: Why Vaccines are Safe and Save Lives (Roman & Littlefield 2012 paperback edition 2015).

Cervical cancer vaccine stirs hope and debate


The first human papillomavirus (HPV) vaccine approved last year is inspiring passionate debate as state legislatures take up the issue of compulsory inoculation for preteen girls as a way to prevent cervical cancer. HPV infection is the major cause of cervical cancer in women. A bill, written by California Assemblywoman Sally Lieber (D-Mountain View), would make the FDA-approved vaccine mandatory for girls entering the sixth grade.

The Merck-produced HPV vaccine, Gardasil, is approved for girls and women between the ages of 9 and 26, and is recommended to be given to girls between 11 and 12. It was found to be more than 95 percent effective against the four types of HPV that account for approximately 70 percent of all cervical cancers and 90 percent of genital warts. There are currently 100 strains of HPV, 30 of which are sexually transmitted.

According to the Centers for Disease Control, at least 50 percent of sexually active people contract a genital HPV infection. About 6.2 million new cases are diagnosed each year, the agency reports, and by age 50 at least 80 percent of women will be infected.

Dr. Ilana Cass, a gynecologic oncologist at Cedars-Sinai Medical Center and assistant professor of obstetrics and gynecology at UCLA, will discuss the vaccine and its implications for women’s health at Cedars-Sinai’s sixth annual Women’s Health Conference on March 16.

Jewish Journal: How does the vaccine work?

Dr. Ilana Cass: Pretty much every single person who has cervical cancer has been infected with the human papillomavirus…. The idea of this vaccine is to prevent cervical cancer by preventing infection with the human papillomavirus.

With this vaccine, it is estimated that we can completely prevent 70 percent of cervical cancers. That’s huge. That’s why this is so incredibly important.

JJ: Why does the HPV vaccine target such a young population?

IC: The vaccine has specifically been designed to target young girls before they start to have sexual intercourse. These women have the highest antibody levels and enjoy the most protection from HPV if they are vaccinated before their sexual debut, before any exposure to HPV.

Based on what we clearly know about sexual practices in the U.S., we have to target preteens and teens. Data suggests that fully one-third of 15-year-old girls in the United States have had vaginal sexual intercourse. So the target age chosen … is essentially ages 9 to 26, with a big effort by the Advisory Committee on Immunization Practices recommending vaccination for all girls between the ages of 11 and 12.

JJ: Is it a single-dose vaccine?

IC: The vaccine is given as three shots: baseline, two months later and then six months later. At this point in time, we don’t know if patients will need to have a booster.

JJ: Are there any risks?

IC: There are risks with everything. But it is incredibly safe. The most common side effect is, like with many other vaccines, some soreness on the arm. It should not be given to women who are pregnant. We don’t have a lot of data yet about women who are breast-feeding.

JJ: But it’s not a substitute for regular screening?

IC: The vaccine does not eliminate the need for routine screening. [Regular Pap screening should begin at age 21 or within three years of beginning sexual activity.] It will reduce cervical cancer incidence over time by 70 percent, but there are still HPV types not included in the vaccine that can cause cancer.

JJ: If a woman already has been infected with one strain of HPV, can the vaccine still help?

IC: Women exposed to one type absolutely still derive benefit from the vaccination from the other three, but less overall protection from cervical precancer…. Girls and women ages 9 to 26 should still be vaccinated, even if they have had sex and have been infected with HPV, because the studies show that even these women derive benefit from the vaccine.

JJ: Does cervical cancer impact Jewish women differently than the general population? And are Jewish women less susceptible to cervical cancer because men who are circumcised are less likely to transmit the disease?

IC: Jewish women are not differentially affected by this disease, as there is no familial syndrome or inherited predisposition that we are aware of at this point in time. HPV transmission is higher from non-circumcised men to women than from circumcised men, yes, but so many boys are circumcised these days, and with the frequency of interfaith marriage, this is less of a component in cervical cancer incidence.

JJ: What are your thoughts on the proposed legislation introduced by California Assemblywoman Lieber?

IC: I know that in Texas, there have been protests [against similar efforts]. I don’t understand the protests. As a mother, I’m vaccinating my kids on a regular basis to prevent much less significant diseases…. I’m vaccinating them to prevent whooping cough and chicken pox…. If I can vaccinate them against cervical cancer and it’s a shot, where do I sign up?

We have to be very clear: this is a vaccine to prevent cancer. Wouldn’t everyone want to protect their child and loved one from getting cancer?

The 2007 Cedars-Sinai Women’s Health Conference will be held March 16 at the Hyatt Regency Century Plaza Hotel. For more information or to register, visit www.womenshealthconference.org or call (800) 233-2771.

Dr. Ilana Cass:
http://www.cedars-sinai.edu/5574.html

Assemblywoman Sally Lieber:
http://democrats.assembly.ca.gov/members/a22/

California Assembly Bill 16:
http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=ab_16&sess=CUR&house
=B&author=lieber

Centers for Disease Control HPV facts:
http://www.cdc.gov/std/HPV/STDFact-HPV.htm

Make the Commitment:
http://makethecommitment.org/

Gardasil:
http://www.gardasil.com/

Gardasil commercial:
http://www.youtube.com/watch?v=hJ8x3KR75fA

Dr. Donnica Moore, women’s health expert, and Stacy London, host of TLC’s
“What Not To Wear” talk about the Make The Commitment campaign and ways to
prevent cervical cancer:
http://www.youtube.com/watch?v=UDooMSb6Hn4

Community Braces for Flu Shot Scarcity


 

Michael Gabai is on a quest.

The owner and administrator of Ayres Residential Care Home has spent the last two weeks calling physicians, senior centers, grocery stores and pharmacies in search of flu shots for about half of the 18 residents in his facilities who have been unable to get one. Gabai was finally able to secure a reservation for his oldest resident, a 96-year-old, to get vaccinated at a grocery store about 10 miles away.

“We’re scrambling to get it done, Gabai said. “We know how easily [flu] can turn into pneumonia for our elderly clients.”

With the flu vaccine shortage becoming a national — and political — crisis, people working with seniors, like Gabai, are the most troubled.

“Flu is always a concern,” said Molly Forrest, director of the Los Angeles Jewish Home for the Aging (JHA). Vaccinations are normally given to all of JHA’s residents and frontline caregivers willing to be inoculated, she said. However, JHA has not yet received its supply of vaccines from the Los Angeles County Department of Health Services, which has promised to deliver them late this month or early in November. Flu season generally spans from November to March, and affects between 10 percent to 20 percent of Americans.

During the 2003-2004 flu season, there were 1,600 deaths from influenza and pneumonia in Los Angeles County, according to the Center for Disease Control. Also, over the last five years, nearly 90 percent of all deaths from flu andpneumonia were among those 65 or older.

Forrest believes they will get adequate amounts of vaccine to cover the residents, but thinks they might need to seek additional doses for frontline staff.

During her nine-year tenure, Forrest said that JHA had not experienced any serious flu outbreaks. When cases have arisen, they have isolated individual buildings or patients in order to contain the spread of the disease.

Jewish Family Service’s (JFS) Valley Storefront and West Hollywood Senior Center had to cancel scheduled flu shot clinics when the Red Cross failed to deliver vaccines as promised, said Lisa Brooks, one of the agency’s directors.

“We’re waiting to see if more supplies become available,” she said. Directors of JFS’s senior centers are in close contact with sources of the vaccine to find out when that might be.

Additional flu shots might soon be forthcoming from drug manufacturer Aventis Pasteur. The majority of its 22.4 million doses, which were promised but not yet shipped to customers, will be routed to entities designated by the Centers for Disease Control and Prevention (CDC) as priorities. In addition to seniors, those considered most at-risk of developing potentially life-threatening complications from the flu include children under 2 years old (the vaccine is not recommended for babies younger than 6 months old), individuals with chronic medical conditions and pregnant women. According to United Press International, CDC Director Dr. Julie Gerberding said the agency is mapping areas where the vaccine has been sent and those where it is needed and also tracking flu cases by county to quickly identify flu hot spots.

The flu shot shortage does not seem to trouble early childhood educators.

“I don’t think at this time anyone is particularly panicking,” said Betty Zeisl, director of public relations and communications for the Bureau of Jewish Education (BJE), who noted that at a meeting of early childhood center directors last week “the subject didn’t come up.” (While BJE facilities must conform to federal, state and local guidelines, protocols for dealing with illness are determined by each individual center.)

“I don’t think [the shortage] is going to affect us,” said Angie Bass, director of the early childhood center at Temple Beth Am, who believes that sensationalized media reports are needlessly scaring parents. Bass said that the school maintains routine health precautions such as undergoing regular cleaning, a hand-washing policy for staff and students and a practice of sending children home if they need to wipe their noses more than three times in a 15-minute period.

Bass said that “if it really looked like a real epidemic and not just media hype,” she would send home a letter informing parents and include advice from pediatricians. Thus far, however, none of the pediatricians she has consulted have expressed concern.

“As soon as the pediatricians are worried, then I’ll worry,” she said.

“I think it is a potential problem,” said Dr. Carol Berkowitz, professor of clinical pediatrics at Harbor-UCLA Medical Center in Torrance and president of the American Academy of Pediatrics. “We never know how serious a flu season we will have.”

At the same time, she said that last year was the first year that vaccination was suggested for healthy children between 6 and 24 months.

“Flu vaccine has never been recommended for healthy children over the age of 2 years,” she added.

Berkowitz and others emphasize the importance of following CDC recommendations to help prevent flu. These include avoiding close contact with people who are sick, staying home from work or school if you are sick, covering your mouth and nose with a tissue when coughing or sneezing, avoiding touching your eyes, nose or mouth and washing your hands frequently. Certain prescription antiviral medications (oseltamivir, rimantadine and amantadine) can either prevent the flu or lessen its symptoms if taken promptly after exposure to the virus — or soon after symptoms begin. Symptoms may include fever, headache, chills, body aches, dry cough, stuffy nose and sore throat.

Unfortunately, even if individuals take precautions, they cannot control the habits of others. As the JHA’s Forrest notes, this is especially true for the most vulnerable populations.

“The very young and very old, who get help from other people, are incredibly at risk because they depend on someone else’s hygiene,” she said.