Civil Defense Perspectives March 2016 Vol 32 No 3
The new public health panic, which the World Health Organization (WHO) elevated to the same level as Ebola—a Public Health Emergency of International Concern—(www.who.int/emergencies/zika-virus/en/) is a previously little known disease called Zika virus disease (ZVD). Zika virus (ZIKV) is carried by same mosquito, Aedes aegypti, as other Third World diseases, including dengue and chikungunya.
ZIKV is a flavivirus that was first identified in humans in 1947 in Uganda’s Zika Forest (http://tinyurl.com/hl3u53e). Other flaviviruses are yellow fever, dengue, chikungunya, West Nile, and Japanese encephalitis. Possible cross-reactivity of antibodies complicates diagnosis. There is also concern that previous infection with or vaccination against one flavivirus might mediate antibody-dependent enhancement of a second infection. (Haug et al. NEJM, http://tinyurl.com/hwfuh3b).
ZVD is asymptomatic in about 80 percent of infected individuals. In about 20 percent, it causes a mild, self-limited disease with fever, rash, joint pains, and conjunctivitis (red eyes). It is clinically similar to dengue but generally much milder.
The reason for alarm was a reported 20-fold increase in the incidence of microcephaly in infants born in northeastern Brazil in association with an epidemic of ZVD.
The “island hopping” virus is now causing an “explosive pandemic” throughout South America, Central America, and the Caribbean, in the words of Anthony Fauci and David Morens of the National Institute of Allergy and Infectious Disease (NEJM, http://tinyurl.com/za9jpfl). But since we only just started to look for it, we don’t know that the virus didn’t arrive there long ago, suggests Jon Rappoport (http://tinyurl.com/zddummv).
Cases of sexual transmission have been reported, and the virus is believed to persist longer in semen than in blood.
An aggressive public health response is warranted, even though the microcephaly connection is not established, argues WHO Director-General Margaret Chan, because “people will say, ‘Why didn’t you take action?’” (http://tinyurl.com/z5qvyln).
The Obama White House asked Congress for nearly $2 billion to combat ZIKV, including vaccine research (http://tinyurl.com/jda6xlo). The state of New York is giving 20,000 free “Zika protection kits” to “health care providers” for distribution to patients who might be at risk. These include condoms, mosquito larvicide tablets to put in standing water, and the mosquito repellent DEET (http://tinyurl.com/gm6xkk9).
[Note that DEET is absorbed through the skin, and safety in pregnancy has not been determined. Nerve toxicity has been shown in animal studies (http://tinyurl.com/jtsbmwg).]
ZVD is the rationale for a campaign to legalize abortion in Latin America. A reporter told me that ships are now bringing offshore abortions to Latin American women.
The First Mosquito-Borne Congenital Anomaly?
The reports of microcephaly from Brazil caused great excitement among epidemiologists. Laura Rodrigues of the London School of Hygiene and Tropical Medicine, who dropped everything to fly to Brazil, said: “There had never been a congenital malformation by mosquito before, not ever. It was totally outside our experience” (http://tinyurl.com/hxqw7v4).
But why now, 70 years after identification of ZIKV, and why primarily if not exclusively in northeastern Brazil?
For starters, there are many false alarms. An investigation of 700 of the 4,180 suspected cases confirmed only 270 (38%) actual cases of microcephaly. After at first casting a “wide net,” Brazil changed the definition to require a head circumference of less than 32 cm rather than 33 cm.
Previously, Brazil was reporting a much lower number of microcephaly cases than expected—about 0.5 cases per 10,000 live births, vs. 2–12 cases per 10,000 in the U.S., with the larger number more likely correct (http://tinyurl.com/jxh4yf5).
What is the evidence that ZIKV is responsible for the increase? It is known that viral infections, such as rubella or cytomegalovirus (CMV) can cause microcephaly. But ZIKV was demonstrated in only 41 of 462 (9%) of cases of confirmed microcephaly not attributable to another cause (WSJ 2/16/16).
In animal experiments in the 1950s, ZIKV was shown to be neurotropic and capable of causing nerve cell death. Reports of 93 cases of microcephaly in neonates or fetuses in or linked to Brazil between November 2015 and February 2016 showed that 9 cases (9.7%) had detectable ZIKV infection in brain or amniotic fluid (NEJM, http://tinyurl.com/jcokxnr), and 90% did not.
In a study of 88 pregnant women in Rio de Janeiro, fetal abnormalities were detected in 12 of the 42 (29%) ZIKV-positive women who had an ultrasound and none of the 16 ZIKV-negative women (NEJM, http://tinyurl.com/gp5fda9).
The conclusion that ZIKV is the culprit in current microcephaly cases is based on case reports and epidemiology. Extensive investigations on the aborted fetus of a volunteer worker in Natal recovered ZIKV (NEJM 3/10/16, http://tinyurl.com/jf6a2o9). The CDC reported a case of microcephaly in the infant of a woman who had traveled to Brazil and tested positive for ZIKV on returning to the U.S. (http://tinyurl.com/z8t6mbv).
Applying the Bradford Hill criteria for the likelihood of a causal relationship, an epidemiologist concludes that “the evidence to date strongly implicates the Zika virus in the multifactorial causation of microcephaly” (http://tinyurl.com/zupfjnr).
Still, “the vast majority of women infected with Zika go on to have healthy babies” (Nature 12/11/15). In the 2013-2014 ZIKV outbreak in French Polynesia, which affected 66% of the population, less than 0.5% of pregnancies resulted in a baby with microcephaly (http://tinyurl.com/j8qe4tp).
Suggested cofactors (see p 2) include malnutrition, vaccinations of pregnant women, and exposure to toxic chemicals.
Why Not Control the Vector?
Global warming alarmists call for fighting climate change to retard spread of the [already global] mosquito. Bioethicist Arthur Caplan urges Brazil to cancel the Olympics, which would be economically disastrous. Florida’s emergency declaration will “allow” more spraying for mosquitoes (http://tinyurl.com/j7rl3c4).
Between 1947 and 1962 Aedes was largely eliminated in several Latin American and Caribbean countries, and from Arizona in the 1970s (Az Daily Star 2/7/16). Why is it back (see p 2)?
Zika Pandemic—Courtesy of the EPA?
What happened between the early 1970s, when Aedes (and Anopheles) mosquitoes and the diseases they carry were on their way out, and now? In 1972, the U.S. Environmental Protection Agency banned DDT from agricultural use in the U.S., and the Stockholm Convention on Persistent Organic Pollutants, signed in 2001, restricted most uses worldwide.
A Wikipedia article claims that the DDT ban is “cited by scientists as a major factor in the comeback of the bald eagle and the peregrine falcon from near extinction.” However, bald eagles were reportedly threatened in 1921, 25 years before widespread DDT use, and numbers were increasing after 15 years of heavy use (http://tinyurl.com/hmdq3ln). Falcons were threatened by other factors in the U.S. and were doing just fine in Canada despite DDT (http://tinyurl.com/jbu77e5). In fact, the population of many different birds burgeoned during the “DDT years,” reported J. Gordon Edwards (http://tinyurl.com/2oc6z4).
What unquestionably did make a comeback was the vector of deadly diseases far worse than ZVD. In Africa, mortality from malaria fell from 216 per 100,000 in 1930 to 107 per 100,000 in 1970, then climbed to 165 per 100,000 by 1997. Indoor spraying of homes with DDT led to “spectacular” reductions in malaria, according to WHO (http://tinyurl.com/hder5nq).
Even though “there is evidence that indoor residual spraying (IRS) is particularly effective for controlling Ae. aegypti…primarily due to its indoor resting behavior…no residual insecticides are registered in the US for widespread spraying of indoor areas to control of adult mosquitoes [sic],” according to a 2015 CDC document (http://tinyurl.com/h94lufl).
In the 1990s the Clinton Administration stipulated that the passage of the North American Free Trade Agreement (NAFTA) would be contingent upon Mexico’s willingness to stop its production of DDT. When Mexico ultimately agreed to abandon its DDT programs, its malaria rates increased exponentially (http://tinyurl.com/acc5md3).
And as we fret over ZVD, the fastest growing global health threat is said to be dengue (DDP Newsletter, November 2014).
Will ZVD bring back DDT? Robert Zubrin writes, “The heartless hypocrites will doubtless maintain that while they too are deeply troubled by seeing babies born with missing brain parts, concerns over eggshell thickness must take priority. Like the revelers in Poe’s Masque of the Red Death, they will continue to party in their comfortable quarters, secure in the belief that plague outside the mansion walls will never come for them” (http://tinyurl.com/gtjl69p).
Microcephaly Cofactors
Between 2007 and 2014, the incidence of pertussis had been increasing in Brazil despite high vaccination rates, reaching 2.6 per 100,000, with about 500 deaths in 25,000 confirmed cases. By the end of 2014, the Brazilian Ministry of Health announced a policy of recommending Tdap vaccine for all pregnant women. A sudden increase in microcephaly some months later, from virtually zero in October 2015 to 1,200 in November and 1,200 in December may of course have been purely coincidental.
The package insert states that “there are no adequate and well-controlled studies in pregnant women,” although no problems were found with pregnant rats (http://tinyurl.com/zjz9lpf). Encephalopathy has been reported in post-marketing surveillance of many vaccines, including the pediatric vaccine DTaP. One culprit may be the aluminum adjuvants used to increase immunogenicity.
A case-control study of mothers of affected vs. healthy children, which includes vaccination history, is underway (http://tinyurl.com/j8fsebu), but would not be able to answer the question if all mothers got Tdap. A study of giving Tdap to 50 unvaccinated pregnant women in Vietnam was scheduled for completion in 2015 (http://tinyurl.com/zkjjxkt).
Northeastern Brazil is extremely impoverished, and some areas suffer from chronic malnutrition, which has been blamed for a population of “pygmies” with a 40% reduction in brain size (http://tinyurl.com/z3nkvex). In recent years, Brazil has reportedly experienced “one of the most impressive declines in child malnutrition anywhere in the developing world.”In the Northeast, stunting decreased from 22.2% to 5.9%, totally erasing this region’s disadvantage(http://tinyurl.com/hl33g6r). If reversing the trend requires adequate feeding of two generations of mothers, as pediatrician Meraldo Zisman stated (http://tinyurl.com/z3ou4dy), there has not been enough time.
Also, Brazilian mothers are exposed to high levels of agricultural chemicals, writes Gary Kohls, M.D. These include glyphosate (Roundup), shown to be neurotoxic in rats, and atrazine, for which there was not adequate information to characterize hazards to the human fetus (http://tinyurl.com/zmspaxm). Some pesticides are known to cause microcephaly (http://tinyurl.com/j8gx8y9).
The complex symphony of neurologic development can be disrupted by many factors, even a little alcohol. Focusing effort on politically correct virus hunting may miss the real causes.
The “Cockroach of Mosquitoes”
The Aedes mosquito is said to be one of the hardest types to eliminate. It bites in the daytime and hides at night. It lays eggs in any container holding water, even discarded bottle caps, and the eggs can survive in dessicated form for months. Outdoor spraying doesn’t work because the mosquitoes are indoors. “It’s house-to-house guerrilla warfare.” Brazil is looking at DDT, among other methods (WSJ 2/12/16).
Last year, Brazil had 1.6 million cases of dengue. One town, Água Branca, has reportedly eliminated the vector through an aggressive campaign to eliminate breeding sites, using education, monitoring, and peer pressure (http://tinyurl.com/j44q233).
Live Virus Vaccines in Pregnancy or Post-partum
In the rush to “protect” babies in the womb or newborns from every “vaccine-preventable” disease, we must remember that live virus vaccines are contraindicated in pregnancy. These include measles/mumps/rubella (MMR), Herpes zoster (shingles), varicella, and rotavirus. Note that congenital rubella was the first documented cause of autism. Live vaccine viruses may also be transmitted in breast milk. One case was reported of meningoencephalitis in a nursing infant who was probably infected by yellow fever vaccine virus (http://tinyurl.com/hhwqnhp). Canine distemper, which is related to measles, has occurred in nursing pups, probably from a booster vaccination given to the mother 3 days after they were born (http://tinyurl.com/zdwqhc7). It is likely wise to avoid live vaccines in nursing mothers, until their safety has been investigated, writes F. Edward Yazbak, M.D.
Civil Defense Perspectives 32(3): March 2016