Guest Host: Tom Gjelten

A Cambodian health official shows a bottle containing mosquitoes caught for testing in efforts to stem any outbreak of the Zika virus in Phnom Penh on Thursday.

A Cambodian health official shows a bottle containing mosquitoes caught for testing in efforts to stem any outbreak of the Zika virus in Phnom Penh on Thursday.

Florida declares a health emergency in counties with the Zika virus; a case is sexually-transmitted in Texas. We get an update on the spread and risks of the Zika virus.

Guests

  • Dr. Michael Osterholm Director of the Center for Infectious Disease Research and Policy and director of the NIH-sponsored Minnesota Center of Excellence for Influenza Research and Surveillance; board member, National Science Advisory Board on Biosecurity.

Transcript

  • 10:06:54

    MR. TOM GJELTENThanks for joining us. I'm Tom Gjelten of NPR sitting in for Diane Rehm. She's on a book tour now. She'll be back next week. There were calls this week for women to register for the draft. We'll talk later about the changing role of women in the American military, but first, we have an update on the zika virus. We've got reports about new US cases and Florida has declared a state of emergency in counties with the virus.

  • 10:07:20

    MR. TOM GJELTENIt's linked to serious birth defect and a rare disorder that can lead to paralysis. Joining me now by phone from Minneapolis to give us the latest is Dr. Michael Osterholm of the Center for Infectious Disease Research and Policy. He's also director of the NIH-sponsored Minnesota Center of Excellence For Influenza Research and Surveillance. We will save a couple of minutes for your questions.

  • 10:07:49

    MR. TOM GJELTENOur number, remember, is 1-800-433-8850. Dr. Osterholm, thanks for coming on.

  • 10:07:56

    DR. MICHAEL OSTERHOLMGood morning. Thank you.

  • 10:07:58

    GJELTENI bet you're getting a lot of questions about zika and what risks it presents to people here in this country.

  • 10:08:07

    OSTERHOLMRight. The risk, really, to individuals in this country is actually going to a country in Central or South America or the Caribbean where this virus is now being transmitted. That's the primary risk. We heard a lot over the last couple of days about a sexual transmitted disease case in Dallas, Texas, which was acquired from someone bringing it back and having sex with someone else. That is going to be the rare exception to that kind of situation. But generally speaking, this country really is at not major increased risk at this time from this virus infection.

  • 10:08:43

    GJELTENBut we're getting some mixed signals, Dr. Osterholm. First, we had the WHO saying that pregnant women could travel to countries with the zika virus, as long as they took basic precautions and then we had the CDC came out and contradicting that with the director of the CDC saying if you are a woman who's pregnant living in the U.S., there's one really important thing you need to know. You shouldn't go to a place that has zika spreading. So we're a little bit confused here.

  • 10:09:13

    OSTERHOLMYeah, yeah, thanks, Tom. I think that's an important to try to clarify. First of all, it was the CDC that first came out with the recommendation for individuals who are pregnant or potentially could become pregnant in the near term not to travel to one of these areas. I, for one, very much support that recommendation. I think it was a very prudent recommendation based on the data we have. Zika virus is surely transmitting in certain areas of Brazil and potentially in Columbia and Venezuela where we would be concerned about this.

  • 10:09:46

    OSTERHOLMWe don't know exactly what the real risk is, meaning how often if someone is pregnant and becomes infected that you end up having this serious side effect occur. The WHO subsequently did not come out and say the same thing, but called for more information before they called for it. That's not completely surprising in that they're looking at it from a global perspective of putting travel restrictions on going to countries. I think the CDC took the prudent step. Surely, it doesn't keep someone from going, but it gives them that good clear public health warning.

  • 10:10:17

    OSTERHOLMI think as this outbreak unfolds and we see, over the upcoming months, millions of cases of zika virus occurring throughout the Americas, this is really a virus that is just emerging right now, you're going to see more and more recommendations coming out from bodies around the world that support the CDC position.

  • 10:10:34

    GJELTENWell, you say the virus is just emerging. We're still learning about it. What are the gaps in our understanding of the virus right now and specifically of the link between it and microcephaly and Guillain Barre Syndrome, for example?

  • 10:10:47

    OSTERHOLMWell, you know, at this point, there are those who are saying that we don't have enough information to say that there is a link. Anyone who's ever worked on an outbreak of infectious disease knows that that's not true. You know, if 30 people go to a restaurant one night and 24 hours later, they're all sick with vomiting and diarrhea and the only contact they had in common was that restaurant, I can pretty well tell you that restaurant was the source of their illness, even though I don't know necessarily what caused it yet or which food was responsible.

  • 10:11:12

    OSTERHOLMI think we're at that very same place right now with the zika virus in South and Central America where we have enough evidence, clearly, to say that this is occurring, where women are becoming infected with the virus during their pregnancy and resulting in these cases of microcephaly or these smaller than normal head sizes with potentially diminished brain capacity. The questions remains is just how frequently that occurs and under what conditions it occurs. Is it certain parts of the pregnancy, like first, second or third trimester issues? But the data are there and it'll be forthcoming.

  • 10:11:45

    OSTERHOLMWe and public health have access to more data than has been published or put it. It will be coming soon. The second point you raised, though, is another one that is more concerning, I think, not just for the occurrence of cases now, but for the potential for a vaccine. And that is Guillain Barre Syndrome, a type of paralysis that usually is associated with an autoimmune disease, meaning once you've been infected with an agent like campylobacter, a bacterial infection does this, your body creates an immune response which actually attacks the coating of the nerve and in doing that, it basically shuts down the nerve's ability to send and electric potential, meaning you can't then move your arms and legs.

  • 10:12:23

    OSTERHOLMIn some severe cases, you can't even breathe. We need a lot more information about that. And one of the things we're, first and foremost, is if we have a vaccine, could it, itself, do that, create that same immune response. And so safety data are going to become important and there are enough listeners on your program today here to remember Swine Flu back in 1976 and the Guillain Barre Syndrome cases associated with that vaccine. So we want to be very certain that any vaccine forthcoming is going to be safe and that it is also going to be effective.

  • 10:12:50

    OSTERHOLMAnd the Guillain Barre Syndrome cases surely complicate that and there is no question in my mind that the increased occurrence of Guillain Barre is happening. There are some very good data now coming out of selected cities that zika is really hitting hard in Northern Brazil where this is actually the case.

  • 10:13:06

    GJELTENNow, just to clarify, with regard to microcephaly, you're only talking about the risk to pregnant women, but with this link to Guillain-Barre, it can be anyone who's infected with the zika virus.

  • 10:13:19

    OSTERHOLMAnd that, in fact, is the case. It surely could affect all ages and, again, most people will fully recover usually without needing extensive care. But when you get the more severe cases where, in fact, you can't even breathe because of the inability of the respiratory muscles, those in your chest, diaphragm, to allow you to breathe, then you actually have to breathe for someone. That requires a very sophisticated medical care delivery and so one of the things we're going to be looking at carefully is that this is occurring, what kind of medical care do we need to get at.

  • 10:13:51

    OSTERHOLMBut all along, the bottom line message is we've got to get rid of the mosquitoes and that, I think, is the key message in all of this and that, really, is all about local vector control or practices to get rid of these mosquitoes and that's what we need to concentrate on.

  • 10:14:04

    GJELTENBecause you said that the sexual -- the transmission of the virus through sexual contact is so far a rare exception, and are you expecting that that will continue to be the exception, rather than the rule, that mosquitoes are the vector that you have to worry about?

  • 10:14:20

    OSTERHOLMRight. I think there are really going to be two modes of transmission beyond the mosquito itself that are going to be potentially important, but not a big risk. That is sexual transmission from an infected partner to another as well as blood transfusion. Surely, we do know that as we've seen for other similar infectious diseases, that if someone just happens to be infected with the virus, they may not even be ill, give blood at about the same time that they're at the height of their infection, they may be able to transmit that on.

  • 10:14:49

    OSTERHOLMAnd so you'll see recommendations coming out now for travelers to these countries that they not donate blood after a period of time upon return. Hopefully, we'll have a blood test soon that will allows us to quickly determine if transfusion participants are, in fact, potentially infected in those countries because, of course, we still need blood donations in South and Central America and we don't want people transmitting zika that way. So that's clearly going to be a challenge, but those two mechanisms are going to really pale in comparison to trying to stop the transmission from the mosquitoes to people.

  • 10:15:24

    GJELTENAnd we've heard many times with regard to malaria and other mosquito-borne diseases how important it is to look for places where mosquitoes breed. They can breed in very small amounts of water. That's the kind of thing I hear you saying we need to be emphasizing now.

  • 10:15:40

    OSTERHOLMYeah, you know, Tom, this has been one of the areas that's been confusing. I'll be quite honest and I surely don't mean to challenge any of my colleagues out there. But we have a lot of clinicians right now who are, for a lack of a better term, spokespersons in the media who have never done any vector control. They don't understand that mosquitoes are all a very different lot of predators, meaning that the aedes mosquito that’s involved with this outbreak basically is equivalent to the Norway rat.

  • 10:16:09

    OSTERHOLMIt has learned to live with humans in very close contact, and I'll mention in a minute, whereas the mosquitoes have often caused West Nile virus infection or even malaria in many cases are more like buffalo or deer. They live in a very different world. Anopheles mosquitoes that cause malaria largely live in rice fields, large bodies of water, swamps and in tree forest canopies, et cetera. These mosquitoes that cause this are living in your closet. These are the mosquitoes that are breeding in the discarded non degradable plastics and rubber tires that are littering the world right now.

  • 10:16:42

    OSTERHOLMAnd so that we have to clean up our communities. One bottle cap that might be on a beer bottle or a soda bottle is enough to -- with water in that to actually be an ideal breeding site for aedes aegypti. Discarded plastic, tires, old water pots. And so one of the problems we have today is all the spraying in the world is not going to stop that breeding if we don't clean up those areas. And so, in a sense, this is a call for solid waste management in a way we've never done before. And communities can do that on their own. We don't need to have a global response to make that happen.

  • 10:17:13

    GJELTENSo Dr. Osterholm, we just have a couple seconds left, but what do you make of the reaction? You know, people easily get scared here. Is the reaction appropriate so far, very quickly?

  • 10:17:23

    OSTERHOLMWell, you know, our job is to scare people into their wits, not out of their wits. It's to basically -- what action can they take? And, you know, we'll always see sensationalization occurring, you know, this case of one sexual transmitted disease case has gotten a lot of publicity. What we need to do stick with the facts. The facts are we can do a lot about this and we need to do it at the local level.

  • 10:17:40

    GJELTENOkay. Dr. Michael Osterholm is director of the Center For Infectious Disease Research and Policies at the University of Minnesota. After the break, we're going to be shifting gears and we're going to talk about women in the military. You'll want to stay tuned for that. Thank you, Dr. Osterholm, for joining us. I'm Tom Gjelten. We'll be right back.

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