Congress has finally passed legislation allocating $1.1 billion to fund the fight against Zika. This will cover primarily vaccine development, but also mosquito control efforts. This is very good news; however many would argue that this is too little too late. The director of the Centers for Disease Control (CDC), Dr. Anthony Fauci, has indicated that more fundamental research on Zika "will need to be cut back.
There are over 2000 confirmed cases of Zika among American pregnant women. The majority of these are from Puerto Rico. However, the true number is probably under appreciated, due to lack to testing or delays in getting testing results back. Zika Virus may be transmitted through the bite of the Aedes Mosquito, but also via body fluids. By body fluids they mean tears or sweat, not only blood and sex related secretions. Zika virus causes numerous serious abnormalities in the developing fetal and neonatal brain, and can cause post viral paralysis ( Guillane Barre Syndrome) in non pregnant adults.
A scandal is developing in Florida. Officials in Miami Dade County are accusing the Florida Department of Health of keeping the mosquito capture sites secret, a charge which the Health Department denies. This all started when the Miami Herald sued to find out the location of the traps.
Texas, which has not yet experienced a confirmed case of Zika, is still expected to be at risk. This is because such epidemics travel in a delayed fashion. Dr. Peter Hotez, Dean of the National school of Tropical Medicine at Baylor College of Medicine, Has stated that we will not know if we've had local transmission of the Zika virus in Texas until seven or eight months from now, when babies are born with microcephaly. He noted that detecting the virus is difficult because most people who are infected are asymptomatic.
ACOG’s Journal of Obstetrics and Gynecology has published a report indicating that from 2000 to 2014 maternal mortality in the Continental 48 states has increased 27%. A 2015 report from the World Health Organization indicated that the US has a higher maternal mortality rates than Iran, Libya, and Turkey. This is been reported in previous weeks, although these new numbers put it in better global perspective.
In the good news department, the use of antenatal steroids in women at high risk for preterm labor has been expanded. Until recently we used such steroids to accelerate lung maturation in unborn babies through 34 weeks of gestation. For reference, 40 weeks is the due date and 37 to 41 weeks is considered full-term. The period of 34 to 37 weeks was considered preterm, but until recently there was no proof that the use of antenatal corticosteroids helped this group of babies. Now there is. Accordingly the American College of Obstetricians and Gynecologists has published an updated committee opinion on the use of these medications. With this expanded therapy, it would be reasonable to expect fewer breathing complications in this group of premature babies.
In the "proud of my college" category, The American College of Obstetricians and Gynecologists (ACOG) has been solicited by the Federal government to "review and recommend updates to" several preventive health services for women under the Affordable Care Act. ACOG’s draft recommendations states that “ women should be able to get free mammograms as early as age 40 and if any follow-up is required, like a biopsy, it should be considered an integral part of the screening and also covered at no cost.” ACOG has also recommended that male birth control be covered as well.
Also in the good news department, the death rate from ovarian cancer decreased 16% between the years 2002 and 2012.
In the vaccination success department, the World Health Organization (WHO) has declared America free of measles. The WHO Director General Dr. Margaret Chan has indicated that the Americas is the first region in the world to eliminate measles. It has achieved this after a 22 year vaccination campaign. As the measles may be imported from elsewhere, vaccinations for measles should continue as per usual.
Also in the vaccine success department is this: A recent study indicates that the recent introduction of a prenatal TDAP booster vaccination has been effective. This booster can prevent both the development of pertussis ( whooping cough) and decrease the severity of neonatal pertussis infections that do occur.
Our last bit of news this week is also in the good news category. Teen pregnancies have declined over the last 10 years and the most recent data is even better. Data from 2015 indicate indicate that the teenage birth rate in the United States has hit a new record low, according to a report from the Centers for Disease Control and Prevention. The rate had a one year decline of 8% falling to 22.3 births for every 1000 women between the ages of 15 and 19. Experts attribute this to teenagers having less sex, using more reliable contraception, and being more aware of the difficulty of having a child while still a teenager.
Stay tuned for more news from the world of OB/GYN next week on Medical Monday.