Will Zika Spread Across America?

Infectious Disease Expert Dr. Amesh Adalja Talks Zika In The U.S. & Vaccine Developments

By Fallon Davis

If you have any questions about the current Zika outbreak and how it affects you, Dr. Amesh Adalja is more than prepared to provide you with the scoop. Dr. Adalja is a member of the Infectious Disease Society of America. He’s also in the US Department of Health and Human Services’ National Disaster Medical Assistance Team. In addition, he sits on the board of Pennsylvania’s EMS, Terrorism and Disaster Preparedness Committee.

After finishing insurmountable work in Haiti in 2010, Dr. Adalja became well-known for his work abroad. He’s tasked by the US government with developing guidelines for the treatment of botulism and anthrax in mass casualty settings. Furthermore, Dr. Adalja is in FEMA’s group for nuclear disaster recovery.

Approximately, how many infectious diseases are in the US?

The number of infectious diseases that are in the US are too numerous to count. Infectious diseases range from the mundane, such as the common cold and athlete’s foot, to the more serious such as HIV and Rocky Mountain Spotted Fever.

Are there any rare diseases that are becoming more common? How often do new infections arise per year?

There are infectious diseases that are not well known that occur with regularity in the US. It’s difficult to put a number on how often new infections arise each year. As our diagnostic testing gets better and better, it will be likely that new infections will continue to be identified.

What are some of the best practices to keep yourself free of any bacterial or viral infections?

Vaccination is the single best practice to avoid certain bacterial and viral infections. Good hand hygiene and general health are also important.

In you opinion, what do obstetric health care providers need to know about Zika and pregnancy?

Obstetric providers need to know that Zika is a virus that can cause devastating consequences to a developing fetus. They should be up-to-date on testing algorithms.

What are some of the testing algorithms that pregnant women should expect from Gynecologists?

Pregnant women should expect to be asked regarding travel to an area known to have Zika and/or sexual contact with someone who has been in that area.

Depending on the time frame, a pregnant woman may have her blood and urine tested for presence of the virus, as well as antibody testing of her blood. Ultrasonography of the developing fetus will be performed. Amniocentesis may also be recommended.

What are your views on the current state of the Zika Virus? What can be done as citizens to resolve the spread of the disease?

The Zika virus took this hemisphere by storm and spread very rapidly. We learned a lot that we didn’t previously know about the full scope of this virus. Individuals in an area in which Zika is present or is highly likely should practice meticulous mosquito avoidance, as well as remove sites of mosquito breeding — standing water — from their properties.

Additionally, individuals should support the efforts to devise innovative solutions to this problem, such as genetically modified mosquitoes.

How would genetically modified mosquitoes stop the rapid breeding of other mosquitoes? How do you create these mosquitoes?

The genetically modified mosquitoes that are currently available are sterile males that breed with females. The offspring that results is non-viable. These sterile males are created by inserting a gene into males that will prevent the offspring from surviving into adulthood.

Do you think there can be an epidemic here in the U.S.?

There have been epidemics of Zika-like infectious disease in the US since before its founding and occur with regularity. In the modern era, I don’t think Zika will be able to sustain a major epidemic the way it has in other countries in the Americas.

In the US, people tend to use air conditioning and screens on their windows, making the environment less hospitable to the mosquitoes that spread Zika.

Are there examples of other infections that have spread in the U.S. that can give us a better idea of how Zika will behave in the states?

Dengue and chikungunya — viruses spread by the same mosquito — have, in the modern era, only been able to sustain small outbreaks within the 50 states and not larger epidemics. These two viruses are good models for how Zika will behave within the 50 states.

Are we close to having a vaccine ?

We are in the beginning stages of clinical testing of a few Zika vaccines. There has been a rapid development of these vaccines. I still believe that we are at least a year or more away from widespread availability (if the clinical trials go well).

Based on the current clinical tests, what’s the process to create the Zika vaccine? Is the vaccine going to be through a needle, pill, liquid? What are the results/findings from the latest trials?

There are several methods being employed to develop a Zika vaccine. Some are traditional and some very innovative, such as a DNA vaccine. The vaccine will be injectable. The latest clinical trials show that the vaccines being developed produce antibodies in animal models, such as mice and non-human primates.

What do you predict will be the outcome of the Zika Virus for this year?

I believe the virus will continue to spread in the Americas. In the US, small localized outbreaks in states such as Florida, Texas, and Hawaii will likely occur.

Why do you think Florida, Texas and Hawaii are at risk?

Florida, Texas, and Hawaii are the states that have abundant Aedes mosquitoes. They have battled other similar mosquito borne diseases, such as dengue and chikungunya, in the past. The environment of those states, plus the lifestyle (short sleeves, outdoor exposure, etc), are more conducive to Zika and related viruses than other regions of the US.

Have you seen a virus like Zika before? How did it stop spreading?

There have been outbreaks of dengue and chikungunya in parts of the U.S. that were effectively contained through public awareness, heightened testing, and, most importantly, aggressive mosquito control.

For more information or questions for Dr. Amesh Adalja, visit his website and keep up to date with recent posts on his Twitter account.

This expert interview was originally published in the Dress A Med newsletter on August 3, 2016.