Critical to monitor babies’ health after Zika

But for how long

WASHINGTON — More federal money finally is available to fight Zika, even as the news worsens. Babies who at first seem to have escaped the virus’ devastating hallmark defect — an abnormally small head at birth — might not be out of the woods after all.

Brazilian doctors have counted a small number of babies who at birth had a normal-sized head and only later were found to have problems. They have delayed neurodevelopment. At 5 months, one could use one hand but not the other. Later on, some even developed that defect, called microcephaly. The brain and skull weren’t growing properly after birth, instead of before.

“Microcephaly is only the tip of the iceberg, only the thing we see when the baby is born,” Dr. Vanessa Van der Linden, a pediatric neurologist in Recife, Brazil, told a meeting at the National Institutes of Health where she outlined a long list of Zika-related abnormalities.

To children’s health experts, the message is clear. Intense study is needed of babies born to Zika-infected mothers to learn the range of health problems they may face.

“It is just critical to evaluate the entire child. Even in the child who does not have microcephaly, that doesn’t mean no evaluation is needed,” said Dr. Catherine Spong of the NIH’s National Institute of Child Health and Human Development, which despite budget constraints has begun research to better understand the full range of abnormalities they may face.

“Some will be apparent at birth, but likely some will not be,” Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, told reporters Monday. He called “the biggest unknown” what will happen to those babies who don’t have an obvious abnormality at birth.

After months of partisan bickering, Congress last week passed a budget bill that includes $1.1 billion to address the Zika crisis. It’s just over half the total emergency money that President Barack Obama requested last February. That was well before cases in U.S. states and territories rose to more than 25,000, and well before mosquitoes started spreading the virus in Florida’s Miami-Dade County.

Federal health officials said Monday they’d race the money to the researchers and state health departments that need it as soon as possible.

Topping the list: A Zika vaccine. An initial safety study of one vaccine candidate enrolled its final participant over the weekend, said Dr. Anthony Fauci, the National Institutes of Health’s infectious disease chief. If follow-up of those participants shows the vaccine was safe and triggered an appropriate immune response, a larger study to test if it really protects is set to begin in January, maybe late December.

Other priorities include mosquito control, development of faster Zika tests, and hunting possible treatments.

Out of money to fight Zika over the spring and summer, the government had raided funds meant for other diseases — Ebola, malaria, tuberculosis, even cancer and heart disease — to get started.

But it wasn’t enough, said CDC’s Frieden: “We haven’t been able to get a running start.”

Nor has Congress refunded the plundered money, meaning work against those other diseases also was delayed.

At the recent NIH meeting, Brazil’s Van der Linden catalogued a sobering list of abnormalities in the most severely affected babies at her clinic, the ones born with microcephaly — which by itself can’t indicate the degree of underlying brain damage.

She showed videos of those babies having seizures. They tend to cry nonstop. They may not eat enough — only about an ounce of milk at a time — because of painful reflux and trouble swallowing. Their muscles are stiff and spastic. They have vision and hearing problems.

If that isn’t worrisome enough, Van der Linden then highlighted less severe problems that appeared later among about a dozen babies who’d appeared healthy at birth. Dr. Carmen Zorrilla of the University of Puerto Rico added that she’s seen eye problems among a handful of babies born without microcephaly.

How many babies might be at risk from Zika? How long will they need to be monitored for health problems?

NIH’s child health agency has begun a study to try to tell. In areas where Zika is spreading, researchers plan to enrol 10,000 women in the first trimester of pregnancy and then track all the babies through the first year of life. Some will have been infected with Zika and some won’t, allowing a comparison of resulting health problems.

“I can’t say at this moment in time how long do we need to follow these children, because this is new for us,” said Spong, who expects eventually to see a wide variety of health effects more subtle than microcephaly. “It’s just essential to be able to come up with what these answers are, to be able to help women and families know.”

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