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[Thorpe] Thank you for joining us I'm Dr. Phoebe Thorpe
and here with me today is Dr. Sonja Rasmussen,
Editor in Chief of the MMWR.
Thank you so much for joining us, Sonja.
Today's session was on the Aedes mosquito, it transmits Dengue
and Chikungunya but also Zika.
Zika has just recently been associated with birth defects.
What can you tell me about this?
The Zika and birth defects.
[Rasmussen] Yeah
as Dr. Rosenberg mentioned earlier Zika has been
around for a long time.
We've known about Zika for nearly 70 years.
But the link with birth defects wasn't known
until relatively recently, within the past year.
The first suspicion that Zika was linked
to birth defects was seen in Brazil
when doctors started seeing that there was a large number
of babies being born with severe microcephaly.
Which is an abnormally small head.
And those babies had also other serious brain defects as well.
And I think initially most scientists were skeptical
because never before there had been a vector borne disease,
a mosquito borne disease that had caused birth defects
in babies, in human babies.
And so it really took a few months for a lot
of data to be collected.
Data to be collected in Brazil, in French Polynesia
in which there had been an outbreak before Brazil.
And some of the other countries including the United States
where some travelers had returned from countries
where there had been Zika transmission.
And women were having babies with microcephaly here too.
And in April of this year, 2016, CDC confirmed,
was able to confirm that Zika is a cause of microcephaly
and other birth defects.
[Thorpe] It sounds like that was a lot of fact checking
and going back and looking at things
and putting the whole picture together to get to that.
Where CDC was comfortable making that case.
They've also done a lot of other guidelines
and information for people.
You're the MMWR Editor-in-Chief so you know a lot of those.
Tell me about some of the things that we,
that CDC has put out about Zika.
[Rasmussen] Yeah, CDC has a number of ways
that they get information out.
We sometimes use other journals, other than the CDC MMWR.
Sometimes we use the morbidity
and mortality weekly report or MMWR.
MMWR is considered to be the voice of CDC
and that has been one of the main ways that scientists here,
have worked to get information out about Zika quickly.
And that's one of the advantages.
MMWR publishes weekly.
That's the weekly report.
If there's really important news we do early releases
and then the data comes out whenever it's ready to get
out we put it out the door.
And so we want to get that information to other scientists,
to healthcare providers across the United States
and to the general public as quickly as we possibly can.
And some of the kinds of things that we've been able to get out,
early on, there was a report from Brazil
that was really truly the first report
of what those babies were looking like.
What kinds of problems they had other than a small sized head.
Also an early report that we published was
from investigators here at CDC, where they were able to show
that babies who had severe microcephaly who had died,
actually had Zika virus in their brain.
And that was one of the things that really helped us to,
be able to confirm that Zika virus was a cause
of microcephaly and other serious brain defects.
We've also published a lot of guidelines,
a lot of interim guidelines, for healthcare providers
who are taking care of pregnant women, who are taking care
of infants, children, who are either potentially infected
or definitely infected with Zika virus.
[Thorpe] So let's talk about the healthcare,
guidelines for healthcare providers
who are taking care of pregnant women.
What if you, what do they need to know?
[Rasmussen] Well they need to know, first off, that they need
to talk to their pregnant patients about how
to avoid getting Zika.
And I know Dr. Rosenberg talked a little bit about that already.
But I think it's really important that doctors talk
to their patients about not traveling to places
where they could be infected with Zika virus.
It's of course more complicated for women who live in a place
where Zika virus is already actively transmitting.
And for those women they need to be counseled
about the importance
of protecting themselves from mosquito bites.
So as much as possible, being in places
where there's air-conditioning or screen,
screens on the windows.
Wearing insect repellent.
Wearing long sleeves, long pants.
Another thing, is if a woman doesn't want to get pregnant
at that time, to use an effective contraceptive.
[Thorpe] No unplanned pregnancies as possible.
Exactly. Yeah and then the other thing that's very unusual
about the Zika because it's a Arbor virus.
Is that that it can be sexually-transmitted and it's,
we heard that the male partners who travel
to where it's being transmitted, if they come back,
they need to either abstain or use condoms for eight weeks
after they've returned.
But the rules are little bit different
if the partners pregnant.
Why? What's going on there?
[Rasmussen] Yeah, we know that male partners have been able
to transmit Zika virus through the semen to their sex partners,
both male and female sex partners.
And so there's really a concern when a woman is pregnant
and what we don't really know right now is how long a man can
do that.
We've looked at some cases where we see
that it can be several weeks we don't know what
that long tail is.
And because of the severe effects on a baby
of Zika virus we think the safest thing is for the couple
to either use condoms every time they have sex
for the remainder of the pregnancy.
Or to choose not to have sex during the pregnancy.
[Thorpe] So it's a combination
of not knowing how long he may be infectious and the severity
or the unknown severity of the Zika virus during pregnancy
and its effect that that's why this these recommendations are
that way.
[Rasmussen] Right and we still have,
there's still a lot we don't know
about Zika virus and birth defects.
We don't know the level of risk.
We have looked in different studies
and the risk really seems to be ranging right now from 1%
to maybe as high as 10, even a little bit higher than that,
percent of babies whose moms get sick in the first trimester
of pregnancy and then their babies can have, first
or early second trimester of pregnancy,
and their baby can have microcephaly.
[Thorpe] I know your birth defects expert
and I've heard some about the concern
about we are recognizing the microcephaly,
but there might be something else going on,
What? What, can you speak a little bit about that?
[Rasmussen] Yeah, I think that's a really good question
and I think that's one of the key things
that we really don't know right now, is what's the full spectrum
of the effects of Zika virus
when a woman gets it during pregnancy.
We've seen some women that have had Zika virus infection during
pregnancy and they've had miscarriages
or later pregnancy losses.
We don't know at this point if the Zika virus caused that
or was it coincidental.
Was it just by chance?
The other kinds of things we have seen, microcephaly,
we've seen other serious brain defects.
We've seen sometimes eye problems
that could cause serious vision problems, hearing problems.
Problems with contractures of the joints and club foot.
But we don't know the full spectrum at this point.
Are there other kinds of birth defects that could be seen?
I think one of the other concerns is,
we know from other infections, other infections
like CMV, or Rubella, exactly,
that you can have problems with learning later on.
So the CDC is doing a number of studies,
including the US Zika pregnancy registry.
Pregnancy registry is one of the ways
to better understand information about that.
[Thorpe] And there's a there's a website with that?
The one with the pregnancy registry?
[Rasmussen] Yes and so you can get to all the information
about Zika from CDC at www dot CDC dot gov slash Zika.
[Thorpe] OK, thank you.
The other thing that I think a lot of people are worried
about is the risk of acquiring it through a blood transfusion
and I know there's been an update with that.
What's going on there?
[Rasmussen] Right.
We know that Zika virus is in the blood
and there's some evidence that it may be transmitted
through blood transfusions.
And so actually in the MMWR recently we published a report
on the rate in Puerto Rico of positive,
people having positive blood specimens for Zika virus.
And that testing is being done
because of course we don't want someone to get a transfusion,
for perhaps a pregnant woman getting a transfusion
and then having Zika virus infection
and then passing it onto her baby.
I think that report was important for a couple reasons.
One is the test is a new kind of test, and it is a new kind
of test that can be used as other areas.
It's being used in Puerto Rico, but it can be used
in other areas where there's active Zika virus transmission
so that we can protect people from getting Zika virus.
I think the other thing,
the other reason why it was important,
is that we are seeing increasing rates of positivity
in blood donations in Puerto Rico
and that makes us increasingly concerned
about the outbreak that's occurring in Puerto Rico.
[Thorpe] And that and the reason the article is
about Puerto Rico is because that's
where local transmission is actively occurring,
but as we heard from Ron today there's none here
in the continental United States.
[Rasmussen] Exactly.
In the continental United States there isn't any evidence
of active transmission from a mosquito
to a person of Zika virus.
There is in the 3 of the territories in US Virgin Islands
and American Samoa and in Puerto Rico.
And of course we're all concerned about, as mosquito
season starts that there could be transmission here
in the Continental United States.
So there's a lot of work preparing,
working with our state and local partners to prepare.
[Thorpe] Prepare them for it.
Of course.
And if people wanted to know,
can you tell me again the website
where can people go for more information?
[Rasmussen] CDC has a lot of information on their website
and that website address is www dot CDC dot gov slash Zika,
Z I K A. And that includes information
for the general public as well as information for scientists
and for healthcare providers.
Information about our guideline.
[Thorpe] And if they want to check something out on MMWR,
where do they go for that?
[Rasmussen] Yeah I think scientists may be interested
in looking and healthcare providers might be particularly
interested in looking at some of the information from the MMWR
because that's where the more scientific
and interim guidelines are posted
and that is www dot CDC dot gov slash MMWR.
[Thorpe] Thank you very much for joining us.
[Rasmussen] Thank you.
[Thorpe] And thank you very much
for joining us see you next time on Beyond the Data.
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