HHS Responds to Zika Outbreak Amidst Zika Surge in Puerto Rico

As the Puerto Rico Department of Health (DOH) reports tens of thousands of Zika cases, the US Department of Health and Human Services (HHS) declares a public health emergency in the island. More than 1000 of these cases are pregnant women, who already face the threat of their fetuses developing microcephaly as a result of the Zika infection, and will now have to face a new threat: joint deformities in infected fetuses.

HHS Zika Response

On Thursday, August 11, 2016, HHS Secretary Sylvia M. Burwell relocated $81 million in government funds to support Zika vaccine efforts, since lawmakers have failed to provide funding in response to the growing Zika outbreak. Of the total, $34 million will be provided to the National Institute of Health (NIH), while the remainder will be going to the Biomedical Advanced Research and Development Authority (BARDA). This amount will be granted in addition to previous Zika funds, which the NIH and BARDA predict will be “exhausted by the end of the month.”

The funding for the NIH will be relocated from existing NIH funds. Nonetheless, the NIH estimates that it will need an additional $162 million until fiscal year 2018 in order to continue its research into Zika virus diagnostics and DNA vaccine development. Conversely, the funding for BARDA will be relocated from several existing funds: The Administration for Children and Families, the Centers for Medicare and Medicaid Services, as well as the Substance Abuse and Mental Health Services Administration. Secretary Burwell noted that these funding shifts will warrant rapid response once Congressional committee meetings resume in September.

One day after the reallocation of funds, the HHS announced that Secretary Burwell declared a public health emergency in Puerto Rico under the Public Health Service Act. There are currently 10,690 individuals who tested positive for the Zika virus in Puerto Rico, of which 1,035 are pregnant women, according to the island’s DOH. Since only 20% of Zika-infected individuals present with symptoms, the HHS estimates that the actual number of those infected is much higher than those who tested positive for the virus. According to the HHS, this public health emergency will provide the island with the ability to apply for funding which would allow Puerto Rico to utilize the US Department of Labor’s National Dislocated Worker Grant program to hire unemployed individuals to aid in educating the general public about Zika and prevention measures, as well as help with vector control efforts. In addition, through the Public Health Service Act programs, officials in Puerto Rico will also have the ability to request that local public health workers be temporarily reassigned to aid in Zika response.

In a press release, Secretary Burwell stated, “As [Zika is] the first virus that can be transmitted by mosquitoes known to cause severe birth defects, we are working closely with Puerto Rican officials to pursue solutions to fight the virus in Puerto Rico with a focus on protecting pregnant women and continuing our efforts with jurisdictions throughout the United States to address this public health threat. This emergency declaration allows us to provide additional support to the Puerto Rican government and reminds us of the importance of pregnant women, women of childbearing age, and their partners taking additional steps to protect themselves and their families from Zika.”

Zika Complications

Combating Zika infection in pregnant women is as important now as it has ever been, since new research is proving that fetal complications range far beyond microcephaly. According to a study published in BMJ, congenital Zika virus syndrome is associated with arthrogryposis, a severe joint condition. Previous studies linking congenital Zika infection and arthrogryposis did not present substantial evidence to confirm an association; however, scientists from Recife, Brazil analyzed brain and joint images taken from seven children who presented with the following: arthrogryposis; a history of a congenital infection; brain calcifications associated with microcephaly; and negative tests for toxoplasmosis, cytomegalovirus, rubella, syphilis, and HIV—other major cause of microcephaly. According to a press release about the article, “All the children underwent high definition scanning of the joints and surrounding tissues, but there was no evidence of joint abnormalities,” leading the researchers to believe that joint abnormalities were “likely to be of neurogenic origin.”

The researchers were not able to form any conclusions regarding the effects of Zika on joint conditions in infected fetuses, since this was an observational study. The scientists believe, however, that arthrogryposis may be associated with either the manner by which motor neurons transmit signals to a fetus’s muscles, or to vascular disorders.

According to the scientists, further studies with a larger pool of participants are needed before an association between neurological abnormalities and the development of arthrogryposis can be made. The researchers believe that there is a possibility that these children will develop secondary musculoskeletal deformities due to their neurological complications, and therefore recommend orthopedic follow-up. According to the research team, “congenital Zika syndrome should be added to the differential diagnosis of congenital infections and arthrogryposis.”

Zika in the United States

The number of Zika-infected individuals in Puerto Rico has been on the rise since the beginning of the outbreak and two deaths have already been reported. To combat active transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention issued a warning on travel to Puerto Rico, as well as other regions with active transmission.

Local transmission of the virus was recently confirmed in Miami, Florida in early July 2016. The number of Zika infections in Florida has steadily increased since then, with a total of 30 cases, as of August 15, 2016, according to the Florida Department of Health.