With the arrival of the Zika virus in South Florida last summer, the University of Miami Miller School of Medicine immediately launched a new multidisciplinary clinical initiative to provide the best possible care for pregnant women and their babies.

Although relatively little was known about this dangerous tropical virus, UM’s Zika Response Team quickly became known as the “go-to” source for the latest information, appropriate counseling and comprehensive clinical care. Women from throughout South Florida, the U.S. and aboard who tested positive for Zika took advantage of the unique clinical resources of the Miller School and UHealth – The University of Miami Health System.

Led by Ivan Gonzalez, M.D., assistant professor of pediatrics, he is director of the University of Miami’s Zika Response Team. UM’s Zika Response Team continues to take a proactive approach to clinical care and research. A year after the 2016 outbreak, the team’s clinical care and research is focused on follow-up care and screening of infants born to moms who tested positive for Zika.

“UM is in a unique position of having the patient population to conduct research,” said Gonzalez. “The goal is to try to detect signs of abnormalities that might be missed early on. The research will help us contribute to the growing knowledge base of Zika, which will help us develop therapies and fully know the virus’ impact.”

Here are the highlights of a recent interview with Dr. Gonzalez.

Q. What is the mission of the team?

Our goal is to provide the most expert care possible to families that may need assistance, while educating the community about the threat of Zika.

Q. Who is on the team?

We have experienced professionals in high-risk obstetrical care, pediatric infectious diseases, audiology, ophthalmology, endocrinology, neurology and developmental care, and we coordinate with support programs such as Early Steps.

Q. What do you do when a mother tests positive for Zika?

Members of the team, in collaboration with our obstetrics specialists, meet monthly, to discuss each case. We follow both the pregnant women and the infants in utero until birth, and extensively screen the infants after delivery.

Q. What do you do after a baby exposed to Zika is born?

We conduct a comprehensive evaluation, looking at the size of the head, the eyes and ears for evidence of immediate problems. We have eight pediatric subspecialties involved in their care, which may include early intervention with physical therapy, speech or vision. There are definitely eye problems, but we have not found hearing problem yet but continue to screen. We are also screening for other neurodevelopmental problems, as well as the infant’s kidneys for possible renal problems.

Q. Do you continue to follow the mother and infant after birth?

Yes. From the time of birth to one year, we are following the infants every three months, then about every six months until age 3.

Q. What about Zika-positive babies with no obvious problems?

We have a state research grant to follow these infants for three years to be sure that nothing develops later on.  Currently, we are following more than 30 pediatric patients, who are 10 months old or younger.

Q. How do you encourage new mothers to return regularly for follow-up care?

Our team has found an effective way to address that challenge. First of all, we talk with the moms during pregnancy so they get to know us personally.  After the child is born,  we continue to talk with the mothers regularly, asking about their families, and emphasizing the importance of regular follow-up care and examinations. Because they are part of a state-funded research study, the moms receive financial assistance for their participation.

Q. What are the goals of your Zika research?

UM is in a unique position in the U.S. of having a local patient population exposed to the Zika virus. As a result, our team is deeply involved in many different aspects of research  that will contribute to the growing knowledge base of Zika, understand the virus’ impact and help us develop new therapies.

Q. Where are you focusing your pediatric Zika research program?

We are paying particular attention to newborns born to Zika-positive mothers who appear normal at birth. We want to monitor their development and detect possible signs of abnormalities that might be missed early on.

Q. What other research assessments and evaluations are you doing?

We are checking brain wave activity in infants with congenital Zika syndrome, as well as those without evident abnormalities. We are also doing extensive laboratory work to detect blood markers, cardioechograms for possible heart abnormalities, ultrasounds of the eye and hearing tests, along with other general assessments.

Q. What if a mosquito carrying the Zika virus bites a young child?

Because the virus attacks the neurons, it might harm the developing brain of a young child. But we have no evidence of that right now, one way or the other. We also want to be sure a mosquito does not transmit Zika is to older siblings and adults in the family.

Q. How do I get more information about the Zika Response Team?

• Pediatrics: Call 305-243-5437 and ask for Dr. Gonzalez.
• To speak to the Zika Response Team directly call Dr. Gonzalez at 305-243-2700.

UM’s Zika Response Team
Director:
• Ivan Gonzalez, M.D., Assistant Professor of Pediatrics

Other Team Members:
• Charles Bauer, M.D., Professor of Pediatrics, Assoc. Director of Neonatology, and Director, Miami-Dade North Early Steps
• Gary Berkovitz, M.D., Professor of Pediatrics and Director, Pediatric Endocrinology
• Audina Berrocal, M.D., Professor of Clinical Ophthalmology
• Jeffrey Brosco, M.D., Ph.D., Professor of Pediatrics and Associate Director, Mailman Center for Child Development
• Robert C. Fifer, Ph.D., Associate Professor of Pediatrics and Director, Pediatric Audiology & Speech Pathology
• Roberto Lopez-Alberola, M.D., Assistant Professor of Neurology & Pediatrics, and Director, Pediatric Neurology
• Gaurav Saigal, M.D., Professor of Diagnostic Radiology and Director, Pediatric Radiology & Neuroradiology
• Ramzi Younis, M.D.,Professor and Chief of Pediatric Otolaryngology
• Emmalee S. Bandstra, M.D., Professor of Pediatrics, Obstetrics and Gynecology

For additional information, see: http://uhealthsystem.com/zika-virus

The post Zika Response Team first appeared on Zika Global Network.

Zika is a virus transmitted primarily through mosquitoes, which has been linked to congenital Zika syndrome and Guillain-Barré Syndrome. Zika infection can cause a mild flu-like syndrome with fever, joint pain, conjunctivitis and rash. However, most people (80%) infected with Zika will have no symptoms at all. As Zika arrived in the Western Hemisphere only recently, there is much we do not yet understand about the disease—including all there is to know about infectious periods and potential outcomes in children and in those with asymptomatic infections.

Zika’s most concerning effects are its ability to cause congenital Zika syndrome and developmental sequelae in the unborn. Not all pregnant women exposed to Zika will pass the virus to their infants, but some will. Some of these infants may experience consequences including alterations in their brain growth, hearing loss, the development of their vision, hormonal function and other development. Because the virus can impact the developing fetus, a pregnant woman and her infant should be monitored before and after delivery.

The University of Miami has assembled a comprehensive multidisciplinary team, which includes obstetrics and pediatrics to provide the most expert care possible to families who may need assistance. A year after the 2016 outbreak, the team is also heavily engaged in clinical research initiatives currently focused on follow-up care and extensive screening of infants born to moms who tested positive for Zika. UM Zika experts have also stressed prevention for pregnant women, men and children as a way to combat the spread of the virus.

UM’s comprehensive Zika Response Team includes expertise in pediatric infectious diseases, high-risk obstetrical care, developmental pediatrics, pediatric audiology, pediatric ophthalmology, pediatric endocrinology, and pediatric neurology, and coordinates with support programs such as Early Steps. Under the co-direction of pediatrician Dr. Ivan Gonzalez and obstetrician Dr. Christine Curry, UM’s comprehensive Zika Response Team focuses on care first—for each family is welcoming and celebrating a new baby, and we are, too.

For more information, please contact Dr. Ivan Gonzalez: i.gonzalez2@med.miami.edu

UM’s Zika Response Team:

Co-Directors:
• Ivan Gonzalez, M.D., Assistant Professor of Pediatrics
• Christine Curry, M.D., Ph.D., Assistant Professor of Obstetrics and Gynecology

Other Team Members:

• Charles Bauer, M.D., Professor of Pediatrics, Associate Director of Neonatology, and Director, Miami-Dade North Early Steps
• Gary Berkovitz, M.D., Professor of Pediatrics and Director, Pediatric Endocrinology
• Audina Berrocal, M.D., Professor of Clinical Ophthalmology
• Jeffrey Brosco, M.D., Ph.D., Professor of Pediatrics and Associate Director, Mailman Center for Child Development
• Robert C. Fifer, Ph.D., Associate Professor of Pediatrics and Director, Pediatric Audiology & Speech Pathology
• Roberto Lopez-Alberola, M.D., Assistant Professor of Neurology & Pediatrics, and Director, Pediatric Neurology
• Gaurav Saigal, M.D., Professor of Diagnostic Radiology and Director, Pediatric Radiology & Neuroradiology
• Ramzi Younis, M.D.,Professor and Chief of Pediatric Otolaryngology
• Emmalee S. Bandstra, M.D., Professor of Pediatrics, Obstetrics and Gynecology

For additional information, see: http://uhealthsystem.com/zika-virus.

For Appointments and Questions:

• Pediatrics: Call 305-243-5437 and ask for Dr. Ivan Gonzalez or the Zika Clinic
• Obstetrics and Gynecology: Call 305-243-4530 and ask for Dr. Christine Curry

To speak to the Zika Response Team directly, email or call Dr. Ivan Gonzalez: 305-243-2700

Prevention:

Prevention is possible for the vast majority of people. Pregnant women and children over 2 months should take the same precautions as all other people. When going outside, wear clothing with long sleeves and pants, and use approved insect repellent. Children 2 months and younger should be kept away from mosquitoes, either in air conditioning or behind screens and netting. Please be sure that the areas around your home do not have containers which collect water. Cover trash cans or turn them upside down. The Zika virus can also be spread through sexual activity. Prevent sexual transmission by using condoms and other barrier protection. For more information, see: http://www.cdc.gov/zika/prevention/index.html

What is the best insect repellent for children?

https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx

The post Comprehensive Zika Response for Mothers & Children first appeared on Zika Global Network.

As Miami heads into the summer, rainy season and potentially another season of locally-transmitted cases of Zika, preventing mosquito bites and taking other precautions will significantly reduce Zika infection.

Paola Lichtenberger, M.D., associate professor of Clinical Medicine and Director of Tropical Diseases at the University of Miami Health System and Miller School of Medicine advises people to take the following steps to prevent Zika transmission.

• Use an insect a repellant that is approved by the Environmental Protection Agency (DEET 20%, Picardin, Oil of Eucalyptus, IR3535) on any exposed skin.
• Do not use Insect repellent on babies younger than 2 months old.
• Do not use Oil of Eucalyptus on babies younger than 3 years old.
• Protect newborns and babies younger than two months with mosquito nets on the crib and strollers.
• Dress small children with clothing that covers arms and legs.
• Drain all standing water in your yard on a weekly basis, or add a larvacide if that’s not possible.
• Use condoms if you are a man who had Zika virus over the past 6 months or if you had been traveling to endemic areas or if you are a women and had confirmed Zika over the past 2 months or has been traveling to an area that is an endemic area of Zika.
• Wear fresh long sleeves and long pants.
• Take steps to control mosquitos inside of your home by using screens on windows and doors if your house does not have air conditioning system.

“You don’t want mosquitoes to breed near your home,” said Lichtenberger. “And because the Zika virus may also be transmitted through sexual intercourse, couples should have condoms on hand to make sure the virus is not passed to the pregnant partner.”

If infected by Zika during pregnancy, the virus could cause severe brain defects in the fetus/newborn including microcephaly and problems with vision and hearing. In adults, it can also cause Guillian-Barre, a temporary paralysis and uncommonly inflammation of the brain.

Only 20 percent of people who have been infected will experiences symptoms such as rash, fever, joint pain, red eyes and muscle pain.

If someone suspects that they have contracted Zika, they should contact their primary care physician or the emergency room/Urgent care center, or a tropical/travel medicine expert says Lichtenberger, who plays a vital role in diagnosing and treating patients with vector borne illness and other tropical diseases at the University of Miami Health Care System.

With her extensive knowledge of tropical medicine, she also educates the broader South Florida health community on emerging viruses, and provides trainings for area health workers in collaboration with governmental agencies, such as the Florida Department of Health and the Centers for Disease Control and Prevention.

“Most physicians who are trained in the United States don’t have a lot of experience in tropical diseases,” she said. “Zika is here to stay in South Florida’s subtropical climate and we want to make sure that local physicians are aware of these mosquito-borne threats and can contact our team if necessary.”

Lichtenberger is also watching closely for signs of other mosquito-borne tropical diseases, such as dengue, malaria, dengue, Chagas, chikungunya and yellow fever that could surface in South Florida, particularly Miami, if they are on the rise in Latin America and the Caribbean.

For more information on Zika including prevention, visit the Centers for Disease Control and Prevention’s website.

The post Preventing Zika first appeared on Zika Global Network.

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