Opinion
Volume 3 Issue 2 - 2016
Zika Virus Epidemic: Risk of Collateral Damage from Poorly Defined Risks
Alexander Kofinas*
Cornell Weill College of Medicine, New York Methodist Hospital, USA
*Corresponding Author: Alexander Kofinas, Cornell Weill College of Medicine, New York Methodist Hospital, 506 Sixth St, Brooklyn NY, 11215, USA.
Received: March 7, 2016; Published: May 05, 2016
Citation: Alexander Kofinas. “Zika Virus Epidemic: Risk of Collateral Damage from Poorly Defined Risks”. EC Gynaecology 3.2 (2016): 245-246.
Introduction
In early 2015, an outbreak of Zika virus, a flavivirus transmitted by Aedes mosquitoes, was identified in northeast Brazil, an area where dengue virus was also circulating. By September, reports in the number of infants born with microcephaly in Zika virus affected areas increased and Zika virus RNA was identified in the amniotic fluid of two women whose fetuses were diagnosed with microcephaly by prenatal ultrasound. The natural long term incidence of microcephaly was only 1/20,000 [1]. Several months after the Zika virus outbreak a dramatic increase of new microcephaly cases was noted in women who were pregnant during the outbreak.
A short but comprehensive article was published in late February in the EC Gynaecology [2] journal instead of repeating this knowledge, this current article intends to raise questions regarding the risk of over reacting to the threat of fetal viral infection. There is strong evidence of association between fetal viral infection and microcephaly. However, evidence of causation is sparse and extensive research is urgently needed. The association of Zika virus and certain neurological diseases has been trumpeted in global mass media in a sensational way. It was only natural that social networks, online blogs and mass media have exploded with Zika virus related articles. This large amount of repetitive content has caused the number of searches for Zika virus on Google to increase by 3000% and reach panic levels. The statement by the Director- General of the WHO Margaret Chan who said “Zika virus now spreading explosively” has certainly made many to be concerned [3].
Microcephaly is a brain anomaly that can be caused by genetic causes, secondary to maternal infections with certain viruses, alcohol and drug abuse, environmental toxins and premature fusion of cranial bones (craniosynostosis) as well as certain metabolic disorders.
Microcephaly leads to severe undergrowth of the fetal/neonatal brain with abnormalities ranging from mild mental deficiencies to severe mental retardation and other neurological defects including but not limited to cerebral palsy [4]. The outbreak of Zika virus infections reported in Brazil in 2015 has been associated with a concurrent increase in the cases of microcephaly recorded by various Brazilian health organizations. There are however certain issues that make the information suspect. In Brazil, microcephaly was initially defined as head circumference below 33 cm and later corrected to 32 cm. In Pernambuco, the Brazilian state with the highest number of reported cases in Brazil, among 1373 cases reported, only 248 (18%) have been investigated and of those, only 138 (55%) confirmed as microcephaly associated with some infectious etiology, which may or may not include Zika virus. This became further complicated by the fact that there are at least three different reporting systems in Brazil using varying criteria. On the other hand, because some of the reporting requires microcephaly to be reported when there is some form of association with Zika virus, some researchers suspect that the Zika virus related cases of microcephaly might in reality be underestimated. Such magnitude of discordant information leads to confusion and in turn, confusion can easily lead to panic [3].
A concerted effort is in progress to coordinate the actions of various global and national health agencies in order to obtain valuable and definitive data that could effectively elucidate this global threat.
Until we find the answers to the questions listed in the text box and all questions that will arise during the research, as we gain further knowledge, we must be very cautious on how we interpret the results of recent reports. Microcephaly is defined as a head size that is 3 SD (standard deviations) below the mean. What is a doctor to tell the mother if the fetus head during the early second trimester is small but between 1SD and 2SD which is in the normal range? The fear that a small but normal head might become smaller as the pregnancy advances and become abnormal could prompt many parents to choose abortion as a preemptive action because of an unspecified probability of the fetus developing microcephaly by the time of birth.
Depending on cultural and religious societal influences, some patients might choose to continue the pregnancy regardless of fetal outcome while others might choose to terminate the pregnancy to avoid unwanted complications. This issue must be addressed very seriously by all concerned. Physicians will need to discuss any suspicious findings with the patients and try to educate them about the difficulty of prenatal diagnosis of microcephaly, the potential consequences, available treatments if any, and other alternative management choices, so that patients can make an informed decision free from fear and panic.
1. What is the rate of fetal transmission among all pregnancies infected during the time period under examination?
2. At what gestational age during pregnancy is the virus transmitted more readily through the placenta?
3. Is there any correlation between the gestational age at time of infection and the severity of microcephaly?
4. Are there other congenital defects that can be caused from Zika virus in addition to microcephaly? If yes, at what gestational age are other organs more vulnerable?
5. Does any of the existing antiviral medications decrease the risk of fetal damage in mothers that are actively infected during pregnancy?
6. Are there any environmental factors in the region of the outbreak that might have contributed to the occurrence of microcephaly?
7. Does previous maternal infection with Zika virus protect fetuses in subsequent pregnancies?
8. Identify all modes of transmission.
Bibliography
  1. Schuler- Faccini L., et al. “Possible Association between Zika Virus Infection and Microcephaly- Brazil”. Morbidity and Mortality Weekly Report Journal 65.3 (2015): 4.
  2. Olukayode A Akinlaja. “Zika Virus - The Microcephaly Inducing Flavivirus”. EC Gynaecology 3.1 (2016): 223-224.
  3. Samarasekera U and M Triunfol. “Concern Over Zika Virus Grips the World”. The Lancet Journal 387.10018 (2016): 521-524.
  4. Passemard S., et al. “Microcephaly”. Handbook of Clinical Neurology Journal 111 (2013): 129-141.
Copyright: © 2016 Alexander Kofinas. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


December Issue Release

We Always feel pleasure to share an update with you all. Here, notifying you that we have successfully released December issue for the respective journals and can be viewed in the current issue pages.

Submission Deadline for January Issue

E-Cronicon delightfully welcome all the authors around the globe for an effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before December 26, 2019.

Certificate of Publication

E-Cronicon honours with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

E-Cronicon certify the Editors for their first review done towards assigned article of the respective journals.

Latest Articles

Latest articles will be updated immediately in the articles in press page of the respective journals.

Immediate Assistance

Prime moto of this team is to clarify all the queries without any delay or hesitation in order to avoid the inconvenience. For an immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk