Science AMA Series: I’m Dr. Isaac Bogoch, Infectious Disease physician at University Health Network in Toronto. I focus on Tropical Infectious Diseases and have been seeing patients with suspected and confirmed Zika. I’m also part of a team looking at the spread of Zika around the world. AMA!

Abstract

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What are your expectations regarding the spread of Zika due to Olympics related travel?

multiple_iterations

Hi multiple_iterations,

This is an issue that has received a ton of attention in the build-up to the Olympics. While there is certainly Zika virus transmission throughout much of Latin America and the Caribbean (and now 16 cases in a small geographic area in Florida), it appears that the risk of spread due to the Olympics is very small. Here are a couple of scientific sources that model this low risk, and I would agree with this approach:

Lewnard et al., 2016: http://annals.org/article.aspx?articleid=2538663 Grills et al., 2016: http://www.cdc.gov/mmwr/volumes/65/wr/mm6528e1.htm

Of course some people feel otherwise. To balance this discussion, have a look at this paper recently published as well: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30230-4/fulltext

The editors reply to this article is also worth reading: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30266-3/fulltext


Does contracting Zika pose long term increased risk of pregnancy complications, or do risks return to normal after the infection subsides? If risks return to normal, how long does it take for this to happen?

CapinWinky

Hi CapinWinky,

Excellent question and certainly on the minds of many people. I am cutting and pasting this paragraph from the CDC (USA) webpage as they say it best:

“Based on the available evidence, we think that Zika virus infection in a woman who is not pregnant would not pose a risk for birth defects in future pregnancies after the virus has cleared from her blood. From what we know about similar infections, once a person has been infected with Zika virus, he or she is likely to be protected from a future Zika infection.”

(from http://www.cdc.gov/zika/pregnancy/question-answers.html)

Just to add to this, the virus is cleared from a person’s blood in a few days (typically less than 7).

We should consider both the female and male partners when discussing risks of Zika virus infection and pregnancy. I have discussed the prevention of sexual transmission in another response, but here is a good link to the CDC’s sexual transmission recommendations: http://www.cdc.gov/zika/prevention/protect-yourself-during-sex.html

Please note that there are some subtle differences in guidelines between countries.


Thanks for doing this AMA. I have 3 questions.

1. With recent reports of Zika virus persisting in semen, as well as association with uveitis, what are your thoughts about long-term persistence of Zika virus in immune privileged sites? What impact do you think this will have on controlling the spread and potential re-emergence of Zika over the next several months/years?

2. What are your thoughts on the potential for Zika virus persistence in the female reproductive tract, in what sites it might persist in the female, and what is the likelihood of the virus being passed to a sexual partner and/or fetus weeks/months post viral clearance from serum?

3. I find the clustering of microcephaly to a relatively small area in northeastern Brazil interesting. What other factors do you think are contributing to microcephaly? What would you estimate the risks of microcephaly are outside of this area?

 

edit: 3.

RedQueenConflicts

Hi RedQueenConflicts,

Let’s go through these one by one. Great questions and great points.

  1. Zika virus may certainly be present in the semen long after a person has recovered. There is a well publicized case of Zika virus present in semen >2 months after someone left an endemic region. Hopefully cases like these are the minority. I think in the months to come, we will have a much better understanding of which body sites have the potential for Zika virus persistence, and for how long, and we will certainly know more about what is the norm versus what is an outlier. In addition, we will hopefully soon have an understanding of what risk factors are for Zika virus persistence in these sites. We have seen all of the public health guidelines for preventing Zika virus transmission evolve with emerging clinical data and they will continue to do so. So for example, there are guidelines to prevent sexual transmission of Zika virus - namely avoid sex or wear a condom for specified periods of time after returning from a Zika virus affected region. These guidelines have changed a few times and may continue to change as we learn more about the virus. I think that viral persistence may play into future infections but hopefully this is mitigated by vaccination, which will be available in the near future (2018?).

  2. This is a tough one. I really have to think a lot more about this. I have not seen any quality data to date, but it is an excellent question and would be important to know.

  3. Please see my other comments on this topic.


Other than bug dope, and staying clear of marshy areas, what else can be done to lessen risk? And what are tell tale signs you may have it?

DigitalMafia

Hi DigitalMafia,

At an individual level, applying bug spray, wearing pants and long-sleeved shirts, and if possible, using permethrin on clothing will be very effective. Remember that the mosquitoes that transmit Zika virus tend to bite during the day and are particularly active at dawn and dusk. The Canadian Public Health Agency has good guidelines on how to prevent mosquito bites here. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-3/index-eng.php

It is also important to remember that there are many infections that can be transmitted by mosquitoes in tropical and subtropical zones. For example, malaria, Dengue fever, West Nile Virus, and chikungunya may be present in certain regions. It is always a good idea to avoid mosquito bites, day and night. I have discussed this a bit further detail in a few other posts here.

Thank you for the question.


How long does the Zika virus last in the body? This area of concern is for individuals interested in conceiving at some point in the future but say not within the next 12-24 months.

science_rules12

Hi science_rules12,

It is likely that the virus does not last very long in most people. There certainly are cases where the virus has been detected months after leaving a Zika virus-affected region (e.g. in semen greater than 2 months). It is still unclear which body compartments can harbor the infection and for how long, but we continue to learn more about this infection rapidly and will certainly have a better understanding in the months to come. Based on the information we have now, it would seem very unusual to harbor the virus 12 months after being infected.

Thanks for your question.


Can you explain how a virus we've known about since the 1950's suddenly developed a predilection for the brains of Brazilian neonates? There is no evidence of an uptick of Microcephaly anywhere else in Central or South America despite the virus being ubiquitous throughout the region.

https://www.sciencedaily.com/releases/2016/06/160624150813.htm

Justmetalking

Hi Justmetalking,

Thank you for this question. I will have the answer to a similar question on this AMA but will add a bit more here. While the virus was first discovered in the 1940’s in non-human primates and in humans in 1954, we did not know too much about this virus until the current epidemic. We are still learning quickly about issues around transmission, pathogenesis, and complications. We now know that this is a neurotropic virus - that means that this virus has predilection for affecting the nervous system, and seems to have an affinity for the developing central nervous system. There is a rapidly growing body of evidence on this - here is an example of one recent study (http://www.ncbi.nlm.nih.gov/pubmed/27364784).

Microcephaly related to Zika virus infection has been seen in several countries to date, including Brazil, Columbia, Panama, Spain and the USA to name a few. In addition, there are other deficits seen in developing brains beyond microcephaly (e.g. visual issues, hearing loss). Of course the medical and scientific fields do not have all the answers yet. There may be certain factors that predispose some pregnant women to develop fetal complications. Are these genetic factors? Environmental factors? Some combination of the two? Unclear. Other factors such as timing of infection and different quality of surveillance across regions may be at play. It is safe to say that pregnant women and women considering becoming pregnant in the near future, regardless of where they live, should avoid getting Zika virus infection to prevent these complications.


Does Zika pose any particular risk to infants and is there any evidence or indication the virus can be transferred through breast milk? In other words, does the threat of the virus persist after birth (separate from the general risk that Zika poses to adults)?

allnadream

Hi allnadream,

We know that Zika virus has a predilection for developing brains, but there is little known about what the effects are in newborns and infants. I am not a pediatrician and cannot comment on the specifics related to the medical care of kids. I hope a few resources may be helpful to you here. The first is one by the World Health Authority, outlining the recommendation that breastfeeding should continue in Zika-virus affected areas as the benefits outweigh the potential risks:

http://www.who.int/elena/titles/zika_breastfeeding/en/. The other is a dedicated CDC page related to the care of infants with Zika virus.

http://www.cdc.gov/zika/hc-providers/infants-children.html

Thanks for your question!


With the current state of the outbreak what kind of timeline can we expect on an antiviral for Zika? Also what are the predictions of rate infections during the coming winter months? Can we expect a sharp decline and possible eradication, or do you think there will be a resurgence post winter? And thank you for doing this AMA

0AntiGone0

Hi 0AntiGone0,

Thank you for the question - this is certainly on a lot of people’s minds. Rather than antiviral therapy, the big focus is on vaccine development. Vaccines have the capability to prevent the spread of this infection, and protect at the individual and population level.

There are several vaccines under investigation, and one just recently entered Phase I human trials. (https://www.niaid.nih.gov/news/QA/Pages/Zika-DNA-Vaccine-QA.aspx)

Another promising vaccine is still in non-human animal studies: (http://science.sciencemag.org/content/353/6299/529).

Of course there are more, but these are two that recently caught my attention. Developing vaccines (and drugs) takes time. Many candidates that are under development will never see the light of day. I would guess that the first vaccines we see for Zika virus are ready by 2018...but this is just a guess.

For the other questions about Zika virus spread and seasonality - it really depends on what part of the world you are in. Warmer average daily temperatures, elevations below 2000 meters (6500 feet), the presence of Aedes species of mosquitoes, and a population with low immunity to this infection will all form a suitable environment for transmission. Colder seasonal temperatures can certainly dampen transmission. As you point out, a big question will be how much of this will we see in upcoming years? I suspect this may take the path of viruses such as West Nile Virus or Chikungunya - namely, it will still be present, but circulating in much lower numbers compared to when it was first introduced.


My family had a few questions about the Zika virus since we are going to Miami for family vacation. I have 2 kid. There is a high alert in the area we are staying in. Our few questions are:

  • I was worried about the kids catching the Zika virus from mosquitos bites.

  • How long will the virus stay in one's system. I don't want the kids having problems down the road.

  • Is there any immunization we can take right now?

  • Right now, there seems to be problems only if you are pregnant, are there other issues we should be worried about?

  • What symptoms will you have, if you have caught the Zika virus?

  • I also read the these mosquitos carrying the Zika virus bite during the daytime while most others bite during dawn/dusk time when temperature is cooler. Should we be avoiding the beach during the day as well?

  • Are there any recommendation of mosquito spray is better to use?

Science_Questions2

Hi Science_Questions2,

Great questions. As you may have heard, there have now been 16 cases of Zika virus likely acquired by mosquito bites in a Miami neighbourhood. The CDC has outlined a very narrow geography of where this area is. While I cannot give specific health advice, the general risk of acquiring Zika virus in the USA is incredibly small. There is impressive surveillance and mosquito control efforts in place. Also remember that the vast majority of individuals infected with Zika virus will not even know they have the infection - they will have no symptoms at all, and of the minority of patients who do get infected, most will have very very mild symptoms. The key is that we want to avoid infection in pregnant women, or women who may become pregnant in the near future. Should someone get infected, the virus typically runs its course in a few days. There are rare case reports where the virus may stick around longer in someone’s system (e.g. it has been detected in semen ~2 months after infection).

While Zika virus will be a mild-to-non-issue in many individuals, nobody would really want this and the best course of action is to avoid mosquito bites. The mosquitoes that transmit this are active at dawn, dusk and during the day. Cover up, and use a spray that contains deet or icardin (sometimes called picardin).

Here is a great link to mosquito control strategies by the Public Health Agency of Canada: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-3/index-eng.php


How can individuals get tested for Zika right now in Canada? Can primary care providers perform the test and obtain the results or does it have to be sent to the International Centre for Infectious Disease in Winnipeg?

Can an individual request a test if they have visited an area with known cases or do they have to show symptoms?

Thank you for doing this AMA.

citymouse

Hi citymouse,

Canadians can certainly be tested for Zika virus. The process will differ from province to province. Family Physicians can order the test and have results sent back to their office. For example, here in Ontario, the turn around time is about a couple of weeks.. Please speak with your primary care provider about this if it is of interest to you or your family member. In Ontario, for example, they will be looking at this website (below) for guidance on which test to send, what information is required to accompany the test (e.g. travel history, symptoms, pregnancy history), and where to send the sample. All samples here are processed by the Ontario Public Health Labs.

https://www.publichealthontario.ca/en/ServicesAndTools/LaboratoryServices/Pages/Zika-Virus.aspx


How do we have the Zika virus, without the birth defects in some countries?

English_Teeth

How do we have the Zika virus, without the birth defects in some countries?

Great question. We are still learning more about this infection day by day, but it appears that the fetal complications are appearing in multiple countries. They have been seen in Brazil, Columbia, Panama, Spain and the USA, to name a few. There is very strong evidence that continues to grow, demonstrating the risk of fetal complication should a pregnant woman be infected.


Thanks for taking the time: what specific vector controls do you believe will be most effective in containing/reducing cases of Zika?

afghanistanimator

Hi afghanistanimator,

I think a multi-modal approach will be best and this includes environmental modification (e.g. removing as much free-standing water in urban areas as possible), larvicides for pools of water that cannot be drained, spraying for adult mosquitoes.

There are some creative innovations for mosquito control efforts coming through the pipeline as well.

For example check this out: http://www.greenlidenvirosciences.com/ (I should point out that I do not endorse individual products and have no financial gain here).

Also, genetically modified mosquitoes have been used in the past for Dengue control efforts and may work here. This is pretty interesting: http://www.fda.gov/animalveterinary/newsevents/cvmupdates/ucm490246.htm

Also important to mention, while not vector-related, is vaccine development. This will be extremely useful at an individual and population level in the near future.

Thanks for asking.


Apologies if this information is easily available elsewhere...

My wife and I have recently decided to begin trying to conceive our second child. We live in a rural suburb Cleveland, Ohio near Lake Erie. What is your recommendation concerning couples trying to conceive while there is a risk of contracting Zika? Are our chances of contracting the virus too great to responsibly seek to conceive a child?

Secondly, do you believe there will be an uptick in the spread of Zika after the Olympic Games?

Edit: PS. Thank you for your work and for doing this AMA. I look forward to reading it.

thesuper88

Hi thesuper88,

Congratulations on thinking about having a second child! That is certainly a big decision. While I do not give specific medical advice over the phone or internet, please have a look at where Zika virus is being transmitted, and please have a chat with your primary care provider to discuss your individual risks. There are only 16 cases of mosquito-transmitted Zika virus infection in the continental USA (all in Florida) to date. Here is a link to the CDC on regions that have mosquito-transmitted zika virus infection: http://www.cdc.gov/zika/geo/active-countries.html

I will discuss the Olympics and Zika transmission in another question on this AMA and will peek back at that to see if there are additional comments/questions.

Thanks for asking and all the best.


Welcome to Reddit, and Thank-you for doing this AMA.

If Zika gets into the animal world what are the implications for food production?

What was learned during the SARs outbreak that can be used against Zika?

4Li3n

Hi 4Li3n,

Wonderful questions and I only have partial answers for these - really need to think a bit more. Zika is in the animal world in the sense that we know it can infect humans and non-human primates, but I have to really think more about food production. I love your question about lessons learned from SARS. This is a big issue. We live in a very interconnected world. Individuals can travel to just about anywhere within 48 hours through commercial means. Infections that we thought existed in some far off corner of the planet can quickly land on our doorstep. We have seen this multiple times over the past few years: SARS in the Americas, MERS-CoV in Korea and other places, Chikungunya in the Americas, Ebola virus in West Africa, and of course the current Zika virus epidemic to name a few. I think to better prepare for for future infections of Global Health significance, we need to take several simultaneous approaches. This includes improving international coordination and communication between countries and public health agencies, enabling and boosting the public health infrastructure of many resource-constrained countries, improved surveillance, and focusing on predictive tools to model future outbreaks.

Thanks for asking!


Thanks for taking the time to do an AMA. As a resident of Puerto Rico, I'm concerned about how we are dealing with the Zika crisis.

Many people here deny knowing anyone who has been affected by Zika and thus believe it is just another virus that has been blown out of proportion (the symptoms are similar to dengue and thus we don't have to worry because we know how to deal with it, that kind of thinking) and that it can be handled by simply using bug spray a little more liberally and preventing water from pooling. So my question is: How worrisome are our relaxed attitudes towards Zika?

amrs25

Hi amrs25,

That is very interesting to hear what people’s perception is of Zika virus is in Puerto Rico, thank you for sharing that. On one hand, the virus can be considered rather mild - Zika virus infection causes no symptoms in most people, and those who are unlucky to have symptoms associated with their infection will generally have a very mild and short course of illness. I would agree, there is no need to be alarmed about that part. On the other hand, we know that there is the risk for birth defects (e.g. microcephaly) in some pregnant women that are infected with Zika virus. We should be doing everything possible to ensure pregnant women do not get infected. For now that means preventing mosquito bites (prevention at the individual and population levels are discussed in this thread). In the near future that may mean the wide scale implementation of vaccines.


Without interference, can you predict how long it would take for Zika to spread globally? As mosquitoes favour warmer climates, are countries with colder climates without risk? or can the virus spread in a number of ways? Thank you.

Fantasyfare

Hi Fantasyfare,

It would be very challenging to predict how long it will take the virus to spread globally. We know the factors that play into the spread of this virus (warmer temperatures, elevations below 2,000 meters, presence of appropriate mosquitoes, non-immune population, degree of international travel), to name a few. You are entirely correct about the countries with different temperatures. Colder places will either have no mosquito-related transmission or the potential for only seasonal transmission during warmer months, depending on the presence or absence mosquitoes that transmit Zika virus.

Thanks for your questions.


I live about a mile from the Miami hotzone. Is the Zika virus here in Miami the same as Uganda 1947 or similar?

WHO says gbs and microencephaly are linked to zika, and they are investigating links other neurological diseases. Which ones?

Prior to the outbreak in Brasil, increases in microencelphaly in any of the historical outbreak areas were not noticed. Is this because of changes in the Zika virus? Do we have actual samples of the virus from historical outbreaks for comparison?

Is there any merit to the accusation that the first appearance of the microencephaly effect coincided with the release of oxitec's modified mosquitos? There was extensive reporting on the poor handling of records and success tracking of the oxitec experiment in Brasil. Oxitec released several times as many mosquios as they planned because the gm mosquito-lethality absence of tetracyline was being filled by antibiotic fed cattle in commercial farming operations.

suteny0r

Hi suteny0r,

The Zika virus that is currently circulating in the Americas is an Asian strain, similar, but not identical to the one fist isolated in Uganda. While microcephaly seems to be a well-cited neurological complication of Zika virus infection in pregnancy, there may be others such as retinal issues or hearing impairment for example. Also, it is unclear if there may be more subtle cognitive issues in children born to women who were infected during pregnancy, but time will tell as there are cohorts of children now being followed longitudinally. Regarding your questions about microcephaly and complications in Brazil - this may be related to many factors. I have answered this once or twice already in this post, but basically this may be related to a surveillance bias, that the virus is somehow slightly different, or perhaps genetic/environmental factors that could predispose some individuals to complications.

Thanks for your questions.


Can Zika exist in animals? In other words, in areas of Florida where there are small clusters of cases in humans, would we be able to eradicate the the disease there if we simply quarantined all the people who were infected? Or would the mosquitoes be able to obtain the virus from other sources like pets?

Shnazercise

Hi Schnazercise,

Zika is known to infect non-human primates such as several monkey species in Africa, where the virus was first detected. While other non-human vertebrates can be infected, it is unclear what threat this poses to further disease transmission and possible eradication strategies if they are a competent reservoir. I wonder how much of an issue this will be given that multiple vaccines are in development, some entering Phase 1 human trials.

The US CDC answers some of these points rather well. This is a direct quote from their website:

http://www.cdc.gov/zika/transmission/qa-animals.html

“Zika virus was first discovered in a monkey with a mild fever in the Zika Forest of Uganda in the 1940s. Nonhuman primates (apes and monkeys) have shown the ability to become infected with Zika virus; but, only a few naturally and experimentally infected monkeys and apes have had any signs of illness at all, and then it was only a mild, transient fever without any other symptoms. A small number of monkeys were reported to have Zika virus in one study done in 2016 in an area of Brazil with high numbers of human illness. More research is needed to better understand the potential for monkeys and apes to be reservoirs for Zika virus. The prevalence of Zika virus in monkeys and other nonhuman primates is currently unknown. There is also limited evidence from one study done in Indonesia in the late 1970s that horses, cows, carabaos (water buffaloes), goats, ducks, and bats could become infected with Zika, but there is no evidence that they develop disease or pose a risk for Zika virus transmission to humans. There have not been any reports of pets or other types of animals becoming sick with Zika virus.”

Thanks for asking!


Hi Dr. Bogoch. As a Canadian, what is your best hockey story?

learningblearning

I love the sport (huge Flames and Bruins fan since childhood), and have not missed a season since age 5. I was never that good, so probably breaking my nose on the outdoor ice from an errant high stick in the late-eighties is the first thing that comes to mind.


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Is there Zika in Toronto? In other words, has anyone caught Zika in Toronto?

photonicsguy

Hi Photonicsguy,

For Toronto (and the rest of Canada), there certainly have been individuals who have travelled to Zika virus-affected countries and returned home with the infection. In addition, we have had sexually transmitted cases in Canada. Canada certainly has mosquitoes...just go on a canoe trip in Northern Ontario or Manitoba to find out - but the mosquitoes in Canada are not the right species that would transmit Zika virus.


Has Zika been found in Sweden, and if it comes to Sweden, how long after the first discovered virus must pregnant women protect themselves specifically with the virus in mind?

TattoosNgirlyHearts

Hi TattoosNgirlyHearts,

It appears that a Swedish tourist was infected with Zika virus while travelling a few months ago (http://www.thelocal.se/20160127/swedish-tourist-got-zika-virus-on-visit-to-brazil) and there may be other travel-related cases of Zika virus infection in individuals who have returned to Sweden from travel to affected regions.

I doubt there will be infections acquired in Sweden from mosquito bites. Here is a neat paper modelling the potential/suitability for Zika virus introduction and transmission in Europe. http://www.sciencedirect.com/science/article/pii/S2352396416302535

Even if the virus cannot be acquired from mosquito bites in Sweden, it is important to take precautions to prevent sexual transmission of this virus should one return from an area where there is the potential for transmission.

Thanks for asking!


Here are a few questions:

1) Should Canada worry? 2) Should Canadian travelers worry when heading only as far as Florida (Orlando/Miami) 3) What is the incubation period of the Zika virus if at all? 4) Does the zika virus present immediate symptoms? 5) If a female is bitten this year, how long does she have to wait until she can start reproducing?

anagajic8

Hi anagajic8,

Canada should not have any cases of mosquito-transmitted Zika virus infection - we just don’t have the right type of mosquitoes here that can transmit the infection to humans. Having said that, Canadians should not be complacent. There is certainly the potential to acquire the infection via travel to Zika virus-affected countries and return home with the infection. The virus can be sexually transmitted as well, and there have been reported cases of sexually-transmitted Zika virus here in Canada this year. While there are now 16 cases of Zika virus infections that were acquired by mosquito bites in Florida, this has been in a very small area, and the risk to travelers is extremely small.

The incubation period for Zika virus is quite short….less than two weeks, but typically in the 3-6 day range so symptoms, although mostly mild, can occur after that period. In the vast majority of individuals who get symptoms from their infection, this should be quite mild and resolve in 2-4 days.

Zika virus infection during pregnancy should be avoided at all cost. I will answer this question in detail below, but there are guidelines from public health agencies around the world (e.g. CDC in the USA, Public Health Agency of Canada, World Health Organization) that have similar (but not identical) recommendations.

Thanks for your questions!


Has the spread so far meshed with your predictions early in the outbreak, or has it surprised you in some way?

recentfish

Hi recentfish,

So far things have plotted along as predicted. Areas that are suitable for Zika virus in Latin America and the Caribbean started reporting cases and now we are seeing cases in Florida. Having a suitable region by no means guarantees an epidemic. Other factors are at play, namely socioeconomic factors. For example, while Florida certainly has a suitable environment for Zika virus transmission, there is incredible public health capacity for mosquito control efforts there, and many people have a different lifestyle (e.g. air conditioners at home and work, less exposure to free-standing water) compared to other regions affected with this virus. For me the big surprise several months ago was the role of sexual transmission. We are now gaining an appreciation on how to better prevent sexual transmission of this virus by understanding where (and for how long) the virus may stay in certain body compartments.

Thank you for your question!


Has the spread of Zika over the course of the virus spread in a rural suburb Cleveland, Ohio near Lake Erie.

Rangeeee2222

Hi Rangeeee2222,

No, it has not. However travellers can certainly return to this area with the infection if they acquired it in a Zika virus-affected region.

Thanks for your question.


How does the Zika virus affect a liver transplant recipient? What would have to be done for the recipient if they do get the Zika virus? Is a medication being developed and will it react with immunosuppressants?

This question could probably pertain to all organ transplants

Thank you for your answers in advance.

Science_Questions2

Hi Science_Questions2,

Tough question. To date I have not come across data related to Zika virus infection in transplant recipients and have not seen any patients in this situation. Below are two articles that discuss the potential issues with diagnosis and treatment. Given that we currently do not have a targeted antiviral treatment, we would likely just provide supportive care for affected individuals. It is unclear if the manifestations would be more severe in this population due to immune suppression. Other less common complications of Zika virus, such as Guillain-Barre Syndrome (GBS), may be less frequent in transplant recipients (pure speculation). GBS is an immune response to infection, and transplant recipients may not have the capacity to mount such a response. http://www.ncbi.nlm.nih.gov/pubmed/27197772 http://www.ncbi.nlm.nih.gov/pubmed/27023395

Thanks for your questions.


Is there a purposeful effort by health organizations to use the media to "shape" people's perception about Zika? Or is it just coincidence that there has been a surge in reporting on the subject.

madmaxges

Hi madmasges,

I cannot really comment on what or how the media chooses to report. I know that there is enormous interest in this area given the potential for birth defects should pregnant woman be infected. Earlier on in the epidemic we were very busy answering emails, phone calls, and seeing patients with real or potential Zika virus exposures. As you can imagine this is a very sensitive issue, and we still do not have all the answers but are miles ahead of where we were compared to late 2015. People were looking for answers when there was a potential threat and incomplete information - it was (and still is) quite challenging.

Thank you for your question.


Hi Dr. Bogotch, Thanks for your time!

I am wondering where all of the data comes from for your analyses.

Also, is there an app or web site out there where lay people can find out current info like this about Zika and other diseases?

Thanks in advance!

shockema

Hi schockema,

Great to hear from you. As stated above, I work with a large interdisciplinary team on research projects and my clinical work is focused at the Toronto General Hospital. The research collaborations are with wonderful friends and colleagues based at St. Michael’s Hospital in Toronto, Oxford University, and Harvard University.

Thanks for your question.


I've been bitten by mosquitoes many times over the course of the summer. Should I be concerned?

pigletsquidink

Hi pigletsquidink,

It really does depend where you are, and what infections are carried by the mosquitoes in your region. Remember, there is a lot more than Zika that can be transmitted by mosquitoes in many parts of the world.

Thanks for your question.


What in particular is done to prevent a disease like Zika from infecting humans when simply going outside in an area with infected mosquitoes poses a great risk? Additionally, how are you able to predict where Zika will spread to next and what steps can you take to stop it?

Thank you for taking the time to do this AMA!

edit: finished my coffee and made this question make sense

arkosic

Hi arkosic,

I like to think of this in terms of how you can protect yourself, and how we can protect communities.

You can protect yourself with mosquito repellents, wearing pants and a long-sleeved shirt (which is kind of tricky when it is 40 degrees Celsius outside - I think that’s about 300 Fahrenheit or something). Also, you can treat your clothes with a type of mosquito repellent (permethrin) which is helpful. Some mosquitoes bite at night, and measures such as sleeping under a mosquito net, using air conditioning, or ensuring there are screens on the windows are very helpful. At the community/population health level, mosquito control efforts are key. This means targeting mosquitoes at various stages of their lifecycle...and this is pretty specific to the types of mosquitoes that are being controlled. For example, Aedes aegypti mosquitoes are known to transmit Zika virus. This mosquito likes urban environments and can reproduce in very small pools/puddles of water. Ensuring there is no free standing water around houses (e.g. in gardens, garbage, etc) is key. Sometimes larvicides are used as well if the water cannot be drained. In addition, adult mosquito populations can be controlled with spraying or ‘fogging’.

A fascinating new-ish approach is to modify adult mosquitoes in some way and release them in the wild. This has been done in the past, and is being considered now in Florida. See this link below for details: http://www.fda.gov/animalveterinary/newsevents/cvmupdates/ucm490246.htm

Also, a very comprehensive review of preventing mosquito bites can be found at the link, from the Public Health Agency of Canada: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-3/index-eng.php

Hope you enjoyed your coffee and thanks for asking!


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