Tuesday December 12 2017

Posted by Tomas on December 12, 2017
  • Risks vary greatly across Central and South America and withing countries. Check local health statistics to assess the risk to the areas to which you are traveling. Zika is only a potential threat to women who are or may become pregnant.
    Risks vary greatly across Central and South America and withing countries. Check local health statistics to assess the risk to the areas to which you are traveling. Zika is only a potential threat to women who are or may become pregnant.
  • The tiger strips on the abdomen of the Aedes aegypti identifies them as the threat
    The tiger strips on the abdomen of the Aedes aegypti identifies them as the threat
  • Spraying for mosquitoes in La Pa
    Spraying for mosquitoes in La Pa
  • Use mosquito repellents containing DEET or the less effective pyrethrin, derived from a type of Chrysanthemum
    Use mosquito repellents containing DEET or the less effective pyrethrin, derived from a type of Chrysanthemum

Updated  December 12 2017,  This week's numbers represent the two week from November 27, 2017 to December 11, 2017, apparently someone was on  vacation at theSecretary of Health office last week. The cooler weather across Mexico has reduced the number of new cases reported, despite the fact that test results are several weeks behind in testing and reporting. There were no new cases reported in Baja California and three new cases reported in Baja California Sur. 

Posted 12-11 2015-16 Last Week This Week Change Total
In All Mexico 8,573 2,742 2,952 210.0 11,525
Aguascalientes  1 0.0 0.0 0.0 1
Baja California 4.0 4.0 0.0 4
Baja California Sur 26 11.0 14.0 3.0 40
Campeche 92 2.0 2.0 0.0 94
Coahuila 62 245.0 266.0 21.0 328
Colima 294 2.0 2.0 0.0 296
Chiapas 817 4.0 4.0 0.0 821
Durango 1.0 1.0 0.0 1
Guerrero 861 21.0 24.0 3.0 885
Hildalgo 191 77.0 83.0 6.0 274
Jalisco 87 190.0 269.0 79.0 356
Mexico 20.0 20.0 0.0 20
Michoacán 61 6.0 6.0 0.0 67
Morelos 302 179.0 186.0 7.0 488
Nayarit 50 488.0 491.0 3.0 541
Nuevo León 848 91.0 95.0 4.0 943
Oaxxaca 508 5.0 5.0 0.0 513
Puebla 119 104.0 105.0 1.0 224
Querétaro 17.0 17.0 0.0 17
Quintana Roo 380 7.0 8.0 1.0 388
San Luis Potosi 31 429.0 448.0 19.0 479
Sinaloa  65 80.0 91.0 11.0 156
Sonora 24 40.0 51.0 11.0 75
Tabasco  354 12.0 13.0 1.0 367
Tamaulipas 148 578.0 610.0 32.0 758
Veracruz 1,967 114.0 122.0 8.0 2,089
Yucatán  1,284 15.0 15.0 0.0 1,299
Zacatecas 1 0.0 0.0 0.0 1
Pregnant Women 5,065 1,628.0 1,695.0 67.0 6,760

The weather across Mexico has turned cooler, colder in the interior of Mexico and the number of new cases will begin got fall. It is important to remember that the weekly statistics show significant lag between time of testing and the posting of test results. The lag in certain states is as much as 8 weeks. it is also important to note that the statistics do not indicate whether the cases were contracted locally or on travel to other regions of Mexico or the world. 

The epidemic that authorities projected in 2015 has yet to materialize with the notable exception of some Caribbean locations. Every US state currently has cases of Zika under treatment, but only Florida has 273 locally acquired cases, a total of more than 5000 cases were contracted during travel to infected regions. Unfortunately, the Mexican Secretary of Health statistics we quote here in this article do not differentiate between locally acquired and travel contracted cases of the disease. Puerto Rico is the hemispheric hotspot with more than 37,000 cases of Zika reported. 

The disease has not proved as disastrous to the unborn as previously anticipated. With more than 4804 pregnant women testing positive for the virus in Mexico since January 1, 2016, only 5 babies have been born with symptoms of microcephaly. This number should rise as we move into the next 9 month period as more babies are born that were concieved since the beginning of the outbreak. The first week of February 2017 saw the first death from microcephaly as the baby was born with unsustainable brain deficiencies. 

As we enter the cooler season here in Baja California Sur the mosquitos have all but disappeared. But because most of the peninsula never gets a killing frost it is a good idea to remain protected from mosquito bites to avoid Dengue Fever, Zika virus and Chikungunya which are present in Baja California Sur and most tropical climates. 

Also remember that there are a number of small biting insects that leave a welt, while only the Aedes aegypti mosquito is a carrier of Zika. Keep you panic to a minimum. 

Do the Statistics Tell the Whole Story?

Absolutely not.

First, it is evident in the Mexican statistics that they are almost exclusively testing women, and possibly only those of childbearing years. Many people may have or have had Zika and not know it or even sought medical treatment for it. So the number of total cases is likely much higher. Since Zika can appear with limited symptoms, this is likely true everywhere.

Second, the Mexican statistics don't indicate if the cases of Zika were contracted locally or in travel. As of August 2016 the US had more than 5200 cases and less than 200 were contracted locally (Florida). 

Third and perhaps of most concern is are the doctors actually reporting cases? In a recent personal interaction with doctors there seemed to be a "hear no evil, speak no evil" policy on the three mosquito-borne diseases. Several other diagnoses were presented for what seem to be clearly one of the three (as they present similar symptoms) before tests we insisted on proved it to be Chikungunya.

There has also been NO mention of the confirmed Zika cases in any of the local press. The only mention of increased mosquito control efforts has been in the very rural communities of the Comondu region, Loreto and in Cabo San Lucas "for control of Dengue'.

Background on the Zika Epidemic

The World Health Organization declared the Zika Virus a Global Health Emergency on February 1, 2016. The Zika Virus, when contracted by pregnant women or women trying to become pregnant appears to have a direct correlation to an increase in the birth defect microcephaly, or underdeveloped brains. By this declaration, it allows for the immediate release of special funding for research and containment. Since Late February 2016 a number of additional health problems have been linked to a Zika infection, including paralysis in adults. However, these problems are extremely rare, the major threat remains to pregnant women and their unborn child.

On April 10 the Center for Disease Control (CDC) announced that they believe the Zika virus poses a greater threat than originally thought and that contracting the virus during any phase of pregnancy can be harmful to the fetus. Direct links have been made to the virus and birth defects and it is believed that mutation in the virus from its origins in Africa have made it not only more virulent but is what has resulted in the connection to birth defects and temporary paralysis syndrome in a rare number of patients. Birth defects remain the main concern in the contraction of the virus while the general risk of other side effects remains relatively low.

We had our first two reported cases of Zika Virus in Baja California Sur as of 10-24-16. There are now 22 reported cases in BCS. There are no reported cases in Baja California15

The number of infected persons is likely much higher and tested numbers really just represent a relative assessment of risk, as the vast majority of people (particularly males) contracting Zika are unaware they have had it, writing it off to a bad cold, case of the flu or travel sickness.

Zika poses a potential threat to the unborn of mothers who are pregnant or who may become pregnant in the near future. In researching the Health Ministries of several countries the definition of 'near future' appears to be about 6 months. There have also been some links to a neuro-paralysis disorder affecting both men and women. 

Should I cancel my trip to Baja?

The last week of October 2016 has produced the first two reported cases of Zika Virus in Baja California Sur and the first case of Zika was reported in the northern state of Baja California the first week of February 2017. I checked all the local news outlets and finding any information on the Zika virus locally was virtually impossible. The major newspaper Sudcaliforniano had no mention. This year's extended dry period of the normally rainy late summer has kept the spread of the mosquitos to a minimum. The number of Dengue cases in the southern peninsula has been near record lows this year as well in Baja California Sur.

An interesting side note here is the Aedes aegypti mosquito is not found in locations higher than one mile in altitude. (Mexico City and Nairobi Kenya for example) 

The Zika virus is transmitted by the same Aedes aegypti mosquito that carries Dengue. The mosquito contagion season in Baja California Sur usually runs from late July until early November. Zika may pose a greater threat to the peninsula at that time. As of this date, the city of La Paz has authorized an early start to the 2016 mosquito eradication programs in a city that were plagued by a heavier than usual outbreak of Dengue in 2014. 

Prevention of Contraction

The Center for Disease recommends the use of a DEET-containing mosquito repellent applied over your sunscreen when traveling to areas where the Aedes aegypti, the carrier of this virus, are located. DEET (N,N-Diethyl-meta-toluamide) however is also a toxin and previously not recommended for children under 9 years of age. Some organic and less toxic mosquito repellents are available, but these are generally considered to be less effective. The effectiveness of DEET is also limited to about 4hrs between applications. The mosquito is most prevalent in tropical areas in the morning and evening hours, during rainy periods. However, I have also found the Aedes aegypti active during full moon periods in the nighttime hours and 24hrs per day in moist bathrooms. All it takes is one bite from an infected mosquito to be at risk of infection. (see other means of contraction below. 

Please recall that two decades ago it was recommended that mosquito repellent products containing DEET should not be used on children under the age of 9. 

What is the Zika Virus?

The Zika virus is caused by the bite of a mosquito and is classified as an arbovirus belonging to the genus flavivirus, which are those invertebrate animals such as mosquitoes and ticks that transmit the disease to humans. The Zika is similar to dengue, yellow fever, West Nile virus and Japanese encephalitis. It is transmitted by the bite of a mosquito of the genus Aedes, as the Aedes aegypti mosquito that causes dengue, Current evidence indicates human to human transmission is unlikely. 

Where is Zika From?

The virus was identified in 1947 for the first time in Uganda, specifically in the forests of Zika. It was discovered in a Rhesus monkey when a study of the transmission of yellow fever in the jungle was performed. The serological analysis confirmed infection in humans in Uganda and Tanzania in 1952, but it was in 1968 that the virus was isolated in samples from people in Nigeria. Genetic analyses have shown that there are two major lineages of the virus: the African and the Asian. The disease mutated somewhere in its travels to South America where this outbreak was discovered in Brazil and has become not only more virulent but caused the side effect of causing the birth defect of microcephaly.

How do you get the Zika Virus?

The #1 answer to that is almost always from the bite of the Aedes aegypti mosquito that has been infected with the virus.
On rare occasion from mother to child during the birth process
Through the transmission of blood and on rare occasion may be transmitted through sexual contact and bodily fluids.
The Zika Virus is not available in stores. 

What are the Symptoms of Zika?

Zika usually last four to seven days and may be confused with dengue.

In most cases the apparent symptoms are mild, the person may have a fever of less than 39 °C/102.2°F a headache, weakness, muscle and joint pain, inflammation usually concentrated in the hands and feet, conjunctivitis nonpurulent, lower limb edema and rash, which tends to begin in the face and then spreads throughout the body. Less often vomiting, diarrhea, abdominal pain and loss of appetite occur.

Although further study is required to determine the links to birth defects and some of these birth defects can result in premature mortality, there are no deaths directly attributed to the disease. The detrimental results appear to be limited to the unborn of mothers infected during pregnancy.

What is the Treatment for Zika?

There is no vaccine or specific treatment for Zika, only symptomatic management consisting of rest and take acetaminophen or paracetamol to control fever. 

The use of aspirin is not recommended because of the risk of bleeding that entails for many patients. It is also advised drinking plenty of fluids to alleviate the fluid loss and dehydration. To deal with the itch caused by the eruption can be used antihistamines.

Pregnant women or women trying to become pregnant should stay away from the patient at least during the first week of the disease to avoid contagion, although there have been no known incidents at this time of human to human transmission. There is the question as to whether the Zika virus can be transmitted through seminal fluids during sexual intercourse

Why the Concern?

The Aedes aegypti mosquito ranges of much of the western hemisphere from the temperate lower altitude regions of Central and South America to much of the United States. (Editor's Note: High-altitude locations near 1 mile like Denver, Nairobi, and Mexico City are not threatened by mosquitoes, although it recent years some species seem to be adapting) It is likely to eventually spread to most of these areas, particularly those that confront the tropical mosquito-borne illnesses like Dengue. The affected regions cover the homes of more than half a billion people, even a fractional statistical rise in birth defects could result in tens of thousands of children that will need lifetime care.

Center for Disease Control Recommendations

The CDC notice follows reports in Brazil of microcephaly and birth defect outcomes in babies of mothers who were infected with Zika virus while pregnant. Additional studies since the first posting of this article in January indicate a very strong correlation between the Zika virus and birth defects. 

Reference:

The Center for Disease Control Website
The Mexican Secretary of Health
Secretaría de Salud Mexico, Dept de Epidemiologia
The World Health Organization Website
BBC News

 

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