Zika Update at Hopkins 17FEB16
Live streamed: http://www.hopkinsglobalhealth.org/news-events/events/zika-the-current-epidemiology-research-agenda-public-health-response/
2:00 PM: Dr. Durbin continues. The conversation needs to start now on how to use the vaccine, where, when, and in what populations.
Moving onto Q&A. (No more notes after this.)
1:55 PM: Dr. Whitehead continues. Next? Usutu virus? It’s like West Nile, and it is moving through Europe. It’s a government’s role to take a chance on what is coming next, because pharma won’t take the risk.
Dr. Anna Durbin will talk about vaccination strategies and then move into Q&A. Pathway can be accelerated. We can have the vaccine in trials by 2016. The problem is getting it to market and to those who need it ASAP. There are a lot of questions yet to be answered. What populations do you target first? Pregnant women and women of childbearing age?
1:50 PM: Dr. Whitehead continues. More results of Dengue vaccine trials. Good antibody response. Live attenuated vaccine looks good. Sanofi-Pasteur vaccine against Dengue, live attenuated, already licensed in Mexico and the Philippines. Hoping to do the same with NIAID vaccine. Dengue vaccine very efficacious (~100%). More on other phases of testing in other locations. So, basically, it’s not like the movies. You don’t get a vaccine in weeks, or months… It takes years. All of this work has laid the groundwork to get a Zika vaccine going and deliver it quickly after it is developed. Still, it’s going to take time. Second generation vaccine will add the Zika component to a multivalent vaccine.
What is next?
1:45 PM: Dr. Whitehead continues. Lots of questions to answer and consider with vaccines, even if it is done in 46 months. When we have the vaccine, people might not care any more. Multivalent vaccine would be great, to tie Zika vaccine with Dengue vaccine. Dengue is a much bigger problem. There are 2.5 billion people at risk for Dengue. (Only African countries have experience with Zika vaccine plans.) Going over NIAID Dengue Vaccine. It is in Phase III. It took 15 years to get there.
Live vaccines require infection, and proof of infection. Data on Dengue vaccine shows this.
1:40 PM: Dr. Stephen Whitehead on vaccine. Vaccine is only one of many, many strategies that can be used against Zika. Different approaches on vaccine development are needed. Different candidates are out there. Dr. Whitehead is talking about the development of vaccines. All of this takes a while. Vaccine candidate in 4 months… Then full development and launch in about 46 months. All of this is ideally. Lots of groups working on it, which is good.
Who do you vaccinate? When? How? Safety? Sustainability? Cost?
1:35 PM: Dr. Ko continues. The brain stem is there, so a lot of the primitive reflexes are there, but there is no higher brain functions. A lot of stillbirths were also noticed. No good surveillance system for them, either. One case of fetal demise presented. Zika beyond the CNS? Lots of questions. What is the association between Zika and congenital defects? Risk factors? What are the critical times of infection, transmission? More lab support is needed. What is the spectrum of disease manifestation? Is microcephaly only the tip of the iceberg?
No effective vector control. It is spreading to countries that are very poor. Serologic testing. CDC protocol is 99% unfeasible in those poor countries. What do we do in those poor countries? Will it come back? Serological testing may start stratifying risk among pregnant women. What is the level of herd immunity, and will it hold?
1:30 PM: Dr. Ko continues. The team went back and identified cases retrospectively and screening them. Over 650 mother-newborn pairs were followed-up. Lots of issues around the study, like social support and clinical management. A lot of professionals had to come together. In first 3 weeks, over 80 microcephaly cases identified. Many patients hypertonic. Many calcifications and simplified gyral patterns. Scarring in newborn eyes.
1:25 PM: Dr. Ko continues. Obstetricians started identifying cases of neurological abnormalities in fetuses, shared it via WhatsApp but not with health department. It took a while for that information to make it to official sources. Syndromic surveillance for microcephaly started in December. There were about 150 cases per year (with 3 million births), under-reporting? “Microcephaly” was not written into database. Once cases started to be detected and associated with Zika, increased surveillance led to increased cases. It’s all in the case definition. By December, three hospitals were set up as sentinel sites for active suveillance. PCR testing was brought in.
1:20 PM: Dr. Albert Ko from Yale. He has been working in Brazil. He will talk on outbreak study design in Brazil and what is being done to understand all this better. Description of program: https://publichealth.yale.edu/research/training/ghes/brazil.aspx
Outbreak of microcephaly detected late last year in NE Brazil, which is also the poorest region of the country. Warning signs started in March-May of 2015. It took a few months to figure out that the rashes and symptoms were infectious in nature. Dengue surveillance didn’t pick it up. (Not the same symptoms as Zika.) Cluster of Guillain-Barre and other neurological conditions started showing up between April and July of 2015.
