Monday, August 8, 2016

Texas Physicians Fighting Potential Zika Epidemic

With cases of local Zika virus transmission now being reported in Florida, Texas physicians and state officials are preparing to confront inevitable local transmission here, reports Texas Medicine magazine. Local transmission means mosquitoes in the area carry the Zika virus and have bitten someone and infected him or her with the virus. Zika, a primarily mosquito-borne illness, has become a major concern for physicians and other public health experts since outbreaks began spreading in other parts of the world in 2015.

Organized medicine took swift action in Texas to try to prevent the emergence of Zika. For example, Texas Children’s Hospital’s infectious disease pregnancy clinic in Houston opened a Zika-specific clinic where women can discuss their risk factors with physicians and receive Zika testing. The primary Zika concern is pregnant women could spread the disease to their fetus, which can then develop birth defects such as microcephaly, or a smaller, underdeveloped brain.

“We see a lot of pregnant women very concerned,” said Catherine Eppes, MD, an obstetrician-gynecologist at the Texas Children’s clinic. “In the last couple of months, pregnant women possibly exposed to Zika virus have become the largest volume of patients that we’re seeing in that clinic.” Dr. Eppes, a member of the Texas Medical Association’s (TMA’s) Committee on Infectious Diseases, says the clinic has seen a spike in women requesting a Zika screening.

“Not being able to prevent the virus, offer vaccination, or treat it once women have gotten Zika really makes all of the focus needing to be on preventing exposure, and … that means we have to do the majority of the hardest work now,” Dr. Eppes told lawmakers at a state Senate Health and Human Services Committee meeting in May.

As physicians try to prevent the disease from emerging or spreading, TMA offers physicians ways to help. The medical association in June formed a Zika workgroup of physician experts from numerous TMA committees offering the best response to the public health threat. The workgroup discussed challenges with Zika testing, reporting, and referral; emerging shortages at blood banks as a result of bans on donors who had traveled to Zika-infested areas; and potential TMA activities to help physicians and the public prevent and stop Zika. In addition, TMA and the Texas Association of Obstetricians and Gynecologists have prepared guidance for physicians on screening and talking to patients about Zika.

TMA President Don Read, MD, prodded a gridlocked Congress to fund a Zika epidemic response. (Congress recessed without yet funding money for Zika.) Dr. Read knows firsthand the havoc a mosquito-borne illness can wreak on the human body; he contracted West Nile virus in 2005. Its devastating effects sidelined him from work for seven months.

“My arms were paralyzed. My legs were paralyzed. I couldn’t talk. I couldn’t hear. I couldn’t write. I was sleeping 23-and-a-half hours a day, and my legs hurt like hell,” he said. In a letter to the Texas congressional delegation in May, Dr. Read described his personal experience, saying soon local Zika transmission would occur in Texas.

“Local and state public health officers in Texas are working hard to prepare for that day, but we need help,” he wrote. “We have the experience and expertise necessary, but our public health infrastructure is not up to a task of this magnitude.”

Texas Department of State Health Services (DSHS) Commissioner John Hellerstedt, MD, says federal funding would allow state and local officials to bolster every aspect of their Zika response. DSHS drafted its own plan of action to deal with the threat including coordinating with local public health agencies, since the response to an epidemic often begins with local authorities.

“In my opinion, it’s not all about hardware and hiring professionals to go out and spray,” Dr. Hellerstedt told Texas Medicine. “A lot of it is leadership and getting out into communities and faith-based organizations, service organizations in those communities, to get out there and help their neighbors … and make people aware of just how powerful and effective these very simple measures are that they can undertake.”

For example, he urges every Texan to remove standing water from yards where mosquitoes breed, wear mosquito repellent and long clothing, avoid outdoor activity during mosquito-heavy times of the day like dusk and dawn, and put up window and door screens to keep the insects out.

Dr. Hellerstedt is optimistic that with if people take these preemptive measures, Texas has a good chance of preventing a Zika outbreak.

“What I hope will happen is that any kind of evidence of local transmission will only be a further call to action for the rest of the state, for everyone else to keep doing those other things more intensely and more observantly. And that’s going to give us the best chance. Even if we have isolated pockets of Zika transmission, they’ll die out over a period of time,” he said.

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