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

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According to the World Health Organization, there are currently 85 countries and territories with past or present active Zika transmission across the Americas, Asia, Africa, and Oceania and the Pacific Islands. This map includes areas with varying levels of risk of Zika, including no known risk.

Credit: Map courtesty of the Centers for Disease Control and Prevention (CDC)

The post Global Risk of Zika Virus first appeared on Zika Global Network.

The total Zika case counts for 2017 (as of July 12, 2017) are 163 cases in U.S. states and 522 in U.S. territories. For 2016, the total case counts are 5,102 cases in U.S. states and 36,079 in U.S. territories. For 2015, the total case counts are 61 cases in U.S. states and 9 cases in U.S. territories.

Explore the maps below to learn more.

Zika in the United States: 2017

Zika in the United States: 2016

Zika in the United States: 2015

Credit: Maps courtesy of the Centers for Disease Control and Prevention (CDC)

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What you should know about the Zika virus and its effects.

CORAL GABLES, Fla.– With Zika spreading rapidly across the Americas for over a year, there is still much to be learned about this insect-borne disease and its effects on humans. But scientists and researchers do have some knowledge about the virus and its public health implications.

Zika symptoms include fever, rash, joint pain, conjunctivitis (red eyes) and can include muscle pain and headaches. The symptoms usually last for several days and typically are not enough to prompt an emergency room visit. People very rarely die of Zika. Most people (4 out of 5) who have been infected with Zika will show mild to no symptoms of the virus. There is currently no medicine or vaccine for Zika but you can take steps to alleviate the symptoms, such as getting plenty of rest, staying hydrated, and taking medicine such as acetaminophen or paracetamol to reduce fever and pain. If you think you have been infected with Zika, talk to your doctor or healthcare provider.

Though spread mostly by the bite of Aedes aegypti and Aedes albopictus mosquitoes, which are aggressive daytime biters but can bite around the clock, Zika can also be transmitted from a pregnant woman to her fetus, through sex, or, very rarely but still likely, through blood transfusions.

The Aedes aegypti and Aedes albopictus mosquitoes are the same mosquitoes that spread dengue and chikungunya. They typically lay eggs in and near standing water, such as in buckets, bowls, flower pots and vases. These mosquitoes prefer to bite people and they become infected when they feed on the blood of a person already infected with the virus. Infected mosquitoes then go on to spread the virus by biting other people.

A pregnant woman infected with Zika can pass the virus to her fetus during the pregnancy or at the time of birth. To date, there are no reports of infants getting Zika through breastfeeding. Zika is a cause of microcephaly—babies born with smaller heads and incomplete brain development—and can cause other severe fetal brain defects.

Zika can also be transmitted via sex, even if the infected person does not have any symptoms at the time. Studies are currently underway to find out how long Zika stays in semen and vaginal fluids of people with the virus.

To date there have been no confirmed cases of transmission of Zika through blood transfusions in the United States, but there have been several reports of such cases in Brazil.

Though no vaccine for Zika currently exists, the virus can be prevented by avoiding mosquito bites and using protection while having sex.

Key points:

1. Zika primarily spreads through infected mosquitoes. You can also get Zika through sex.
2. The best way to prevent Zika is to prevent mosquito bites, by using insect repellent, wearing long-sleeved shirts and long pants, and removing standing water around your home.
3. Zika is linked to birth defects.
4. Pregnant women should not travel to areas with Zika.
5. Travelers that become infected with Zika overseas or domestically can spread the virus at home through mosquito bites. During the first week of infection, Zika virus can be found in a person’s blood and can pass from an infected person to a mosquito through mosquito bites. An infected mosquito can then spread the virus to other people.

For more information, visit http://www.cdc.gov/zika/index.html.

Photo credit: Felipe Dana/Associated Press

The post About Zika first appeared on Zika Global Network.

In July 2016, the first locally acquired case of Zika in the United States was confirmed in Miami, Florida. To date, every U.S. state and territory has at least one confirmed travel-associated case of Zika. As of late September 2016, Florida is the only state to have confirmed locally acquired cases of the Zika virus. In light of this, the Centers for Disease Control and Prevention (CDC) issued travel warnings for three areas in Miami-Dade County—Wynwood, a local arts district, Little River and Miami Beach, popular tourist destinations.

The CDC previously issued guidance related to Zika for people living in or traveling to Miami-Dade County, advising that pregnant women not travel to this area because of local transmission of the virus. The CDC designates areas for Zika virus transmission prevention in the continental United States and Hawaii as red or yellow. Miami-Dade County was previously designated as a Zika cautionary (yellow) area, but that designation was removed on June 2, 2017. This means that there are no longer any travel recommendations related to Zika virus for Miami-Dade County, Florida. Although the level of risk of Zika virus transmission after a yellow area is removed is unknown, it is likely to be low. However, sporadic cases may still occur. For this reason, the CDC recommends that people living in or traveling to Miami-Dade County continue to protect themselves from mosquito-borne illnesses, including Zika virus.

KEY: Miami-Dade County, FL. Red shows previously designated areas of active transmission where the CDC recommends adherence to travel and testing guidance for pregnant women, women of reproductive age and their partners. Yellow shows previously designated areas where CDC advised cautionary travel recommendations and strict adherence to precautions to prevent mosquito bites.

Credit: Map courtesty of the Centers for Disease Control and Prevention (CDC)

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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

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Photo credit: iStock.com/Pixtum

The post Tracking the Impact first appeared on Zika Global Network.

Overview of where the Zika virus started and where it’s moved across the globe.

CORAL GABLES, Fla.—Zika often goes undiagnosed because its symptoms are so similar to many other diseases, including dengue and chikungunya. Zika was first discovered in 1947 in a rhesus monkey in the Zika forest of Uganda, which gave the virus its name. The virus was recovered from the Aedes africanus mosquito in the Zika forest in 1948. In 1952, the first human cases of Zika were detected in Uganda and Tanzania. From the 1960s through the 1980s, the disease was mapped as it moved from Uganda to western Africa and Asia. Between 1969 and 1983, Zika was detected in mosquitoes found in equatorial Asia, including India, Indonesia, Malaysia, and Pakistan.

Before 2007, only 14 cases of the virus had been documented, though it is likely that other cases had occurred but were just not reported. In 2007, the first large Zika virus epidemic took place in Micronesia on the Island of Yap. The following year, an American scientist working in Senegal was infected with Zika while abroad and, upon his return to Colorado, infected his wife in what is believed to be the first case of sexual transmission of an insect-borne disease.

Five years later, Zika outbreaks occurred in four other Pacific Island groups—French Polynesia, Easter Island, the Cook Islands, and New Caledonia.

In May 2015, Brazil confirmed the Zika virus was circulating in the country and this was the first report about locally acquired Zika in the Americas. Two months later, Brazil reported neurological disorders associated with a history of infection, primarily from the northeastern state of Bahia. Among these reports, 49 cases were confirmed as Guillain-Barré syndrome, a rare condition in which a person’s immune system attacks their peripheral nerves, which can result in muscle weakness, loss of sensation in the limbs, or even paralysis.

In October 2015, Colombia confirmed over 150 cases of Zika. The same month, Brazil reported an unusual increase in the number of cases of microcephaly among newborns. In November, Brazil reported two adult deaths and one newborn death associated with Zika virus infection. Over the next two months, the virus continued to spread across Latin America and the Caribbean with reported cases in Suriname, El Salvador, Guatemala, Mexico, Paraguay, Venezuela, Panama, Honduras, French Guyana, and Puerto Rico.

In December 2015, the World Health Organization and the Pan-American Health Organization issued an epidemiological alert on the association of Zika with neurological syndromes and congenital malformations in the Americas. The cases of microcephaly, Guillain-Barré syndrome, and other neurological and development abnormalities associated with the Zika virus infection continued to rise in newborns in early 2016. At the same time, the list of countries with confirmed Zika cases in the Americas and the Caribbean continued to grow.

In February 2016, the United States reported three cases of sexual transmission of Zika. In July 2016, the first case of locally acquired Zika in the United States was confirmed in Miami.

Currently, cheaper and more accurate preventative, diagnostic, and therapeutic treatments for the Zika virus are being developed. Browse this site to learn more about what the University of Miami is doing to combat the Zika epidemic.

For more information, visit http://www.who.int/emergencies/zika-virus/history/en/ and http://www.cdc.gov/zika/about/overview.html.

Photo credits: Isaac Kasamani/AFP/Getty Images

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Researchers at the University of Miami Miller School of Medicine collaborate with other U.S. and Brazilian scientists to discover a monoclonal antibody “cocktail” that prevents Zika infection in primates.

A collaborative study led by a University of Miami Miller School of Medicine researcher has found that a “cocktail” of monoclonal antibodies prevented Zika virus (ZIKV) infection in primates. “This is a promising intervention to prevent and treat ZIKV infection during pregnancy,” said David Watkins, professor and vice chair for research, Department of Pathology. “We would like to develop this antibody combination and get it into clinical trials as soon as possible.”

Watkins and Dennis Burton, chairman and professor of the Department of Immunology & Microbiology at the Scripps Research Institute, led the collaborative international study, “Neutralizing Human Monoclonal Antibodies Prevents Zika Virus Infection in Macaques,” published recently in Science Translational Medicine. Miller School co-authors included Diogo M. Magnani, associate scientist and co-first author of the study; Ronald C. Desrosiers, professor of pathology and director of research faculty development; Michael J. Ricciardi, Varian K. Bailey, Lucas Gonzalez-Nieto, Martin J. Gutman, Núria Pedreño-Lopez, Helen S. Maxwell, Aline Domingues, and Mauricio A. Martins, all in the Department of Pathology.

“ZIKV infection is a serious, ongoing public health threat to South Florida, the Caribbean, Latin America and other regions around the world,” Watkins said. “If a Zika outbreak occurs in a metropolitan area like Miami, the only way to prevent infection is to avoid the Aedes aegypti mosquitoes that carry the virus. Therapies to prevent maternal Zika virus infection and its subsequent fetal developmental complications are urgently required.”

Working closely with Burton and Tom Rogers, from the Scripps Research Institute in La Jolla, California, Watkins’ laboratory team used a cocktail of three monoclonal antibodies to treat four monkeys. These three potent ZIKV-neutralizing monoclonal antibodies – called SMZAb1, SMZAb2, and SMZAb5 – were isolated by the Burton group from a South American patient.

“We administered a cocktail of these three antibodies to nonhuman primates one day before challenging them with Zika virus that had been isolated from a pregnant woman during the 2016 epidemic in Rio de Janeiro,” he said. “To our surprise, this prophylactic treatment completely prevented the virus from taking hold in the animals.”

In four control animals, the virus caused a fulminant infection that lasted for seven days, Watkins added. But there were no measurable virus levels in the blood of the four animals treated with the monoclonal combination, nor was there any immune system response, indicating the virus had been blocked completely.

“Since these antibodies have exceptional safety profiles in humans and cross the placenta, this combination could be rapidly developed to protect uninfected pregnant women and their fetuses,” he said.

The collaborative study involved research teams led by Burton; Esper G. Kallas, an infectious disease specialist at the University of São Paulo; Myrna C. Bonaldo, Laboratório de Biologia Molecular de Flavivírus, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil; Guido Silvestri, professor of pathology, and Thomas Vanderford, Yerkes National Primate Research in Atlanta where the macaques used in this study were housed; and Stephen S. Whitehead, senior associate scientist, Laboratory of Infectious Diseases at the National Institutes of Health, Bethesda, Maryland.

The post Antibody ‘Cocktail’ Halts Zika Infection first appeared on Zika Global Network.

UM infectious disease specialist Mario Stevenson, Ph.D., discusses ways that UM Miller School of Medicine scientists are working to tackle the Zika virus.

Mario Stevenson, Ph.D., is chief of the division of infectious diseases and co-director of CFAR, and professor of medicine at the Miller School of Medicine. Stevenson’s research is aimed at uncovering the functions of viral accessory genes, mechanisms of viral persistence and immunopathogenicity as well as cellular factors influencing virus-host cell interplay. He worked with colleagues to develop a diagnostic blood test for Zika that costs a fraction of current tests, delivers results quickly, and can be performed on the spot in any hospital or outpatient clinic. Here, Stevenson describes the various Zika detection tests that UM scientists are developing, as well as the projects underway at the UM Miller School to understand the spread of the virus.

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