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Former Health Secretary: Worse Yet to Come Regarding Zika in Puerto Rico

By on October 21, 2016

SAN JUAN—Former Puerto Rico Health Secretary Johnny Rullán painted a sobering picture of the Zika virus epidemic in Puerto Rico during a speech before the San Juan Rotary Club earlier this week in the capital’s Condado district.

In particular, the health expert raised the alarm regarding the high number of pregnant women getting infected on the island and the eventual birth of babies with complications stemming from a Zika infection. “The real drama will start next month all the way to next summer,” Rullán said in reference to the health and social costs that the looming influx of babies with congenital conditions is slated to bring on the island.

During the last few months, Puerto Rico has become of particular focus in the ongoing Zika crisis in the Western hemisphere, with a total of 24,127 official cases documented by the local Health Department as of late September; unofficial estimates are much higher.

Direct symptoms concerning Zika are relatively benign compared to similar mosquito-borne viruses such as chikungunya and dengue. However, links between infection in pregnant women and congenital disorders in newborns, and possible complications such as the Guillain-Barré nervous system syndrome—which tends to occur in one out of every 20,000 cases—have prompted widespread concern to the point that it has affected the island’s tourism sector in recent months.

Rullán, a notable epidemiologist, said that in Puerto Rico nowadays, about 50 pregnant women are getting infected with Zika a day, mostly through sexual transmission. “Here, many more pregnant women are infected in this manner than through mosquito bites,” said the health expert, noting that less than 1% of males on the island use condoms.

“The virus lives in the blood for 12 days, and in vaginal fluids for only a couple of days, but it can stay in semen for up to six months,” Rullán explained. “That’s why we tell women not to get pregnant for at least six months if the male partner is infected with Zika. They must either use protection or abstain altogether. When it comes to most sexually transmitted diseases, one of the partners usually shows symptoms. In the case of Zika, it’s a double whammy, in the sense that both partners usually don’t show outward signs of infection.”

Microcephaly—with its visible effects on babies and infants, namely an abnormally small head—has captured most of the media attention regarding Zika-related complications in newborns, but Rullán stressed that such instances only make up about 7% of cases in babies affected by Zika.

By the same token, only a fraction of babies born from pregnant women infected with Zika develop related conditions. “[In] only 5% of those [pregnant women] who get infected [the virus] gets transmitted through the placenta to the baby,” Rullán noted. Babies may get infected with Zika at different stages of the pregnancy, including right at the moment of childbirth, which increases the odds. “Out of 522 babies that have been born from Zika-infected mothers [so far on the island], an estimated 15% to 20% will develop problems,” he added.

Despite this, the sheer number of pregnant women getting infected on a daily basis, according to Rullán, practically guarantees a heavy influx of babies being born with complications later this year. “The Health Department Secretary [Ana Ríus] estimates that about 2,000 babies with complications will be born [this year], while some pediatricians say 7,000 babies. My own estimate is that it will be closer to the 3,000 mark,” he said.

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Former Puerto Rico Health Secretary Johnny Rullán

Once the virus infects the baby, it goes after the neuron cells, severing connections between key regions in the brain. The degree of damage wrought by such developments may not be readily apparent once the baby is born,” Rullán went on to say. “It’s a gradient; babies may be born normal or we think they are, until we check their eyes and realize their optic nerve may be severed, for instance.”

In Brazil, where many Zika cases have been reported, there have been instances of babies who cannot swallow, and thus must be fed via a gastrointestinal tube. “A lot of them become highly irritable and cry constantly, to the point that many fathers leave the family as a result,” said the former Health secretary, who estimated that each affected baby is going to cost $10 million to society. “We are going to need a lot of support systems, and the financial strain for these families will be considerable,” he added.

Zika is frequently compared to chikungunya and dengue in that they are mosquito-borne and cause similar symptoms, but Rullán noted that Zika actually resembles another condition that caused havoc among Puerto Rican babies decades ago, namely rubella, also known as German measles. “In the 1960s, before a vaccine was developed, all the congenital rubella babies ended up in Modesto Gotay [a nonprofit based in Trujillo Alto],” he said. “Now with the Zika virus, we’re going to have another Modesto Gotay moment.”

Rullán urged all pregnant women on the island get tested for Zika, specifically the immunoglobulin M (IgM) antibody test, preferably during the first trimester or early second trimester of pregnancy. “IgM is good for 10 weeks, because the antibodies last about 85 days,” he explained. Another oft-used test, dubbed PCR (for polymerase chain reaction) is performed on males and non-pregnant women, but only detects the virus within the first 12 days of infection.

Regarding the local tourism sector, Rullán noted that, at least as mosquito vectors go, tourists don’t need to worry over getting infected. “You would get infected at home, not in hotels; certainly not in places with air conditioning or that are windy,” he said.

Nevertheless, he criticized the decision by some hotels and high-end condos for not following some landscaping guidelines, particularly in the use of bromeliads, a plant that is popular for its vibrant colors but whose shape, which easily allows water to pool, makes it likely to become a breeding spot for mosquitoes. By contrast, the city of Miami, which earlier this year registered its first Zika cases, went on the aggressive in removing bromeliads from government property and called upon citizens to do the same. “It’s just another indication that the situation is not being treated seriously enough on the island,” Rullán said.

 

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