California bill would require reporting of ‘superbug’ infections, deaths

anitbiotic-resistant bacteria

By Yasmeen Abutaleb

SAN FRANCISCO (Reuters) – A California state senator introduced a bill on Monday that would mandate reporting of antibiotic-resistant infections and deaths and require doctors to record the infections on death certificates when they are a cause of death.

The legislation also aims to establish the nation’s most comprehensive statewide surveillance system to track infections and deaths from drug-resistant pathogens. Data from death certificates would be used to help compile an annual state report on superbug infections and related deaths.

In September, a Reuters investigation revealed that tens of thousands of superbug deaths nationwide go uncounted every year. The infections are often omitted from death certificates, and even when they are recorded, they aren’t counted because of the lack of a unified national surveillance system.

“The (Reuters) story highlighted some of the problems that have come from the lack of information, the lack of reporting, especially deaths,” said state Senator Jerry Hill, who introduced the bill. “I wasn’t aware that on death certificates, antibiotic-resistant infections have never been called out.”

Because there is no federal surveillance system, monitoring of superbug infections and deaths falls to the states. A Reuters survey of all 50 state health departments and the District of Columbia found that reporting requirements vary widely.

California is among the states that do not require reporting of superbug-related deaths. A Reuters analysis of death certificates from 2003 to 2014 identified more than 20,000 deaths linked to the infections in California, the most of any state – and probably an undercount, given the unreliability of death certificate data.

Hill’s bill would require hospitals and clinical labs to submit an annual summary of antibiotic-resistant infections to the California Department of Health beginning July 1, 2018; amend a law governing death certificates by requiring that doctors specify on death certificates when a superbug was the leading or a contributing cause of death; and require the state Health Department to publish an annual report on resistant infections and deaths, including data culled from death certificates.

Hill introduced legislation in 2014 that would require reporting of superbug infections – not deaths. It was ultimately stripped down to mandate that all hospitals in California implement “stewardship” programs to prevent the overprescription of antibiotics that promotes drug resistance. Hill said the state medical association and other physician groups opposed the initial proposal.

The 2014 legislation followed a 2013 threat report from the Centers for Disease Control and Prevention, which estimated that at least 23,000 people in the U.S. die every year from antibiotic-resistant infections. A Reuters analysis of the agency’s math found that the numbers are based on such small sample sizes that they are mostly guesswork.

Hill has written several superbug-related bills that have been signed into law in recent years. Those include laws that regulate antibiotic use in livestock and others that mandate antibiotic stewardship programs in nursing homes and other healthcare facilities.

“We don’t know how (superbugs) affect California,” Hill said. “We could be overreacting in certain areas or underreacting in areas that could create real problems for people.”

(Edited by John Blanton)

Zika striking women at higher rates than men: U.S. study

woman near Zika poster

By Julie Steenhuysen

CHICAGO (Reuters) – Adult women in Puerto Rico were significantly more likely to develop Zika than men, researchers said on Thursday, raising new questions about the potential role of sexual transmission of the virus from males to females.

The study, published in the U.S. Centers for Disease Control and Prevention’s weekly report on death and disease, evaluated more than 29,000 laboratory-confirmed cases of Zika since the outbreak began in Puerto Rico in November 2015.

The data show that of all Zika cases with laboratory evidence of infection, 62 percent were female. The results pattern similar observations from Brazil and El Salvador, the authors said.

One obvious explanation might be that pregnant women are more likely than men to seek treatment for Zika because of the potential risk of birth defects.

To account for that, the researchers excluded all pregnant women who tested positive for the virus. Of the remaining 28,219 non-pregnant women and men testing positive for Zika, 61 percent of these cases occurred in women over the age of 20.

The Zika findings differ from prior outbreaks in Puerto Rico of arboviruses transmitted by the same mosquitoes as Zika. For example, in the 2010 dengue outbreak and the 2014 chikungunya outbreak, infections were equally distributed among men and women.

“It is possible that male-to-female sexual transmission is a contributing factor to this skewing of the burden of disease toward women,” the CDC said in a statement summarizing the findings.

However, the contribution of sexual transmission to overall Zika rates is just beginning to be explored, the CDC said. It could be that women are more likely than men to seek care if they are sick, or that women are more likely to develop Zika symptoms if they become infected.

The CDC is conducting blood tests of individuals living near people with confirmed Zika to try to answer some of these questions.

Zika infections in pregnant women have been shown to cause microcephaly – a severe birth defect in which the head and brain are undersized – as well as other brain abnormalities. The connection between Zika and microcephaly first came to light last year in Brazil, which has since confirmed more than 2,000 cases of microcephaly.

(Reporting by Julie Steenhuysen; Editing by Andrew Hay)

Disease stalks Yemen as hospitals, clinics devastated by war

LONDON (Thomson Reuters Foundation) – More than half of war-battered Yemen’s hospitals and clinics are closed or only partially functioning, the World Health Organization (WHO) said on Monday, warning a lack of adequate health services was increasing the risk of disease outbreaks.

Only 45 percent of 3,507 health facilities surveyed by WHO were fully functional and accessible, while more than 40 percent of districts faced a “critical” shortage of doctors, WHO said.

“These critical shortages in health services mean that more people are deprived of access to life-saving interventions,” WHO said in a statement.

“Absence of adequate communicable diseases management increases the risk of outbreaks such cholera, measles, malaria and other endemic diseases.”

The 18-month-old conflict between a Saudi Arabia-led coalition and the Iran-aligned Houthi group which controls much of northern Yemen has destroyed much of Yemen’s infrastructure, killed more than 10,000 people and displaced millions.

UNICEF says the humanitarian disaster in the country has left 7.4 million children in need of medical help and 370,000 at risk of severe acute malnutrition.

Yemen’s Health Ministry announced a cholera outbreak in early October in the capital Sanaa. By the end of the month, WHO said the number of suspected cholera cases had ballooned to more than 1,400.

In 42 percent of 276 districts surveyed by WHO there were only two doctors or less, while in nearly a fifth of districts there were none.

WHO said new mothers and their babies lacked essential ante-natal care and immunization services, while people suffering from acute or chronic conditions were forced to spend more on treatment or forgo treatment altogether.

(Reporting by Magdalena Mis; Editing by Ros Russell)

U.S. health officials outline Zika spending priorities

County vector sprays neighborhood for mosquitos with Zika

WASHINGTON (Reuters) – U.S. health officials outlined on Tuesday how they planned to divide up $1.1 billion in funds approved by Congress to fight the Zika virus, including repaying $44.25 million they were forced to borrow from a fund allocated for other emergencies.

The funds were borrowed from the Public Health Emergency Preparedness cooperative, which helps state and local public health departments develop response plans to emergencies, while Congress battled over whether to supply the funds.

President Barack Obama in February requested $1.9 billion in emergency Zika funding. Congress approved $1.1 billion in September after months of political bickering.

On a conference call with reporters, health officials said$394 million would go to the U.S. Centers for Disease Control and Prevention, $152 million to the National Institutes of Health and $387 million for the Public Health and Social Services Emergency Fund, which supports the nation’s ability to respond to public health emergencies.

A further $40 million is aimed at expanding primary healthcare services in Puerto Rico and other U.S. territories, and $20 million for projects of national and regional significance in those areas.

Puerto Rico has been particularly hard hit by Zika, a mosquito-borne virus that has been linked with a rare birth defect known as microcephaly. The virus has spread to almost 60 countries and territories since the current outbreak was identified last year in Brazil.

As of Oct. 12, more than 29,000 cases of Zika infection had been reported in the United States and territories. Of those, more than 2,600 cases are in pregnant women. Nearly 26,000 of those cases are in Puerto Rico and other U.S. territories.

The government will be allocating funds, based on a competitive process, to support Zika virus surveillance and other programs. The funds will also be used to expand mosquito control, continue vaccine development and begin studies on the effect of Zika on babies born to infected mothers.

(Reporting by Toni Clarke in Washington; Editing by Peter Cooney)

Florida declares new area of Zika transmission in Miami

avoid Zika ad on an airplane

By Julie Steenhuysen

(Reuters) – Florida officials on Thursday announced a new area of Zika transmission in the Miami region and have called on the federal government for funding to help fight the outbreak.

Florida Governor Rick Scott said state health officials have confirmed that local transmission of the mosquito-borne Zika virus is occurring in a new small area in Miami-Dade County, where the state believes two women and three men have been infected by the virus.

The governor said the state’s health department believes Zika transmission is only occurring in Miami-Beach and in the new area, which covers about 1 square mile (2.6 square km).

Zika, which is spread primarily by mosquitoes but also sexually, is a concern for pregnant women and their partners because the virus has been liked with a series of birth defects including microcephaly, marked by small head size and underdeveloped brains that can lead to severe developmental problems in babies.

Last month, U.S. health officials urged pregnant women to consider putting off all nonessential travel to Miami due to the Zika virus even as the state lifted a travel warning for the Wynwood, the Miami neighborhood which was the first site of local Zika transmission in the continental United States.

Florida has reported a total of 164 cases of Zika caused by local mosquito transmission, including 19 people who were infected in the state but live elsewhere. There are also five cases in which it was not clear whether transmission occurred in Florida or elsewhere.

In a statement released on Thursday, Scott said the announcement of the new area of transmission underscores the “urgent need” for federal funding to fight the virus, adding that the state still has not received any of the funding that was approved by Congress and signed by President Barack Obama two weeks ago.

Scott said he has asked the U.S. Centers for Disease Control and Prevention to work directly with the Miami-Dade Mosquito Control District to identify best practices for defeating Zika in the new area.

Florida officials had already reported four of the five cases of Zika that occurred in the new area of transmission in Miami-Dade County. “With the confirmation of today’s case, this area now meets the CDC’s criteria for a new zone,” officials said in a statement.

The Zika virus was first detected in Brazil last year and has since spread across the Americas. It has been linked to more than 1,800 cases of microcephaly in Brazil.

(Reporting by Julie Steenhuysen in Chicago; Editing by Lisa Shumaker)

Like a nuclear bomb; cholera and destruction after hurricane in Haiti

Relatives and patients treated for cholera after Hurricane Matthew in the Hospital of Port-a-Piment, Haiti,

By Gabriel Stargardter

PORT-A-PIMENT, Haiti (Reuters) – Patients arrived every 10 or 15 minutes, brought on motorcycles by relatives with vomit-covered shoulders and hoisted up the stairs into southwest Haiti’s Port-a-Piment hospital, where they could rest their weak, cholera-sapped limbs.

Less than a week since Hurricane Matthew slammed into Haiti, killing at least 1,000 people according to a tally of numbers from local officials, devastated corners of the country are facing a public health crisis as cholera gallops through rural communities lacking clean water, food and shelter.

Reuters visited the Port-a-Piment hospital early on Sunday morning, the first day southwestern Haiti’s main coastal road had become semi-navigable by car.

At that time, there were 39 cases of cholera, according to Missole Antoine, the hospital’s medical director. By the early afternoon, there were nearly 60, and four people had died of the waterborne illness.

“That number is going to rise,” said Antoine, as she rushed between patients laid out on the hospital floor.

Although there were 13 cases of cholera before Matthew hit, Antoine said the cases had risen drastically since the hurricane cut off the desperately poor region.

The hospital lacks an ambulance, or even a car, and Antoine said many new patients were coming from miles away, carried by family members on camp beds.

Inside the hospital, grim-faced parents cradled young children whose eyes had sunk back and were unable to prop up their own heads.

“I believe in the doctors, and also in God,” said 37-year-old Roosevelt Dume, holding the head of his son, Roodly, as he tried to remain upbeat.

RUBBLE

Out on the streets, the scene was also shocking. For miles on end, almost all the houses were reduced to little more than rubble and twisted metal. Colorful clothes were littered among the chaos.

The region’s banana crop was destroyed with vast fields of plantain flattened into a leafy mush. With neither government or foreign aid arriving quickly, people relied on felled coconuts for food and water.

The stench of death, be it human or animal, was everywhere.

In the village of Labei, near Port-a-Piment, locals said the river had washed down cadavers from villages upstream. With nobody coming to move the corpses, residents used planks of driftwood to push them down the river and into the sea.

Down by the shore, the corpse of one man lay blistering in the sun. A few hundred meters to his left in a roadside gully, three dead goats stewed in the toxic slime.

“It seems to me like a nuclear bomb went off,” said Paul Edouarzin, a United Nations Environmental Program employee based near Port-a-Piment.

“In terms of destruction – environmental and agricultural – I can tell you 2016 is worse than 2010,” he added, referring to the devastating 2010 earthquake from which Haiti has yet to recover.

Damaged houses are seen after Hurricane Matthew passes in Jeremie, Haiti,

Damaged houses are seen after Hurricane Matthew passes in Jeremie, Haiti, October 9, 2016. REUTERS/Carlos Garcia Rawlins

Diarrhea-stricken residents in the village of Chevalier were well aware of the nearby cholera outbreak, but had little option except to drink the brackish water from the local well that they believed was already contaminated by dead livestock.

“We have been abandoned by a government that never thinks of us,” said Marie-Ange Henry, as she surveyed her smashed home.

She said Chevalier had yet to receive any aid and many, like her, were coming down with fever. Cholera, she feared, was on its way.

Pierre Moise Mongerard, a pastor, was banking on divine assistance to rescue his roofless church in the village of Torbeck. In his Sunday best – a sports coat, chinos and brown leather shoes – he joined a small choir in songs that echoed out into the surrounding rice fields.

“We hope that God gives us the possibility to rebuild the Church and help the victims here in this area,” he said, before the music seized him, and he slowly joined in the chant, closing his eyes and turning his palms up toward the sky.

(Editing by Frank Jack Daniel and Kieran Murray)

HELP FOR HAITI

Thailand confirms first Zika-linked microcephaly in Southeast Asia

City worker fumigates area to get rid of mosquitoes carrying Zika

By Aukkarapon Niyomyat

BANGKOK (Reuters) – Thailand reported on Friday the first confirmed cases in Southeast Asia of microcephaly linked to mosquito-borne Zika, as the World Health Organization urged action against the virus across the region.

The confirmation of two case of microcephaly, a birth defect marked by small head size, came a day after U.S. health officials recommended that pregnant women postpone non-essential travel to 11 Southeast Asian countries because of the risk of Zika.

“We have found two cases of small heads linked to Zika, the first cases in Thailand,” Prasert Thongcharoen, an adviser to the Department of Disease Control, told reporters in Bangkok.

He declined to say where in Thailand the cases were found but officials have said they were not in Bangkok.

The World Health Organisation (WHO) said the cases were the first of Zika-linked microcephaly in Southeast Asia and the virus infection represented a serious threat to pregnant women and their unborn children.

“Countries across the region must continue to strengthen measures aimed at preventing, detecting and responding to Zika virus transmission,” Dr Poonam Khetrapal Singh, the WHO’s regional director, said in a statement.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, which can lead to severe developmental problems in babies.

VIRUS SPREADING

The connection between Zika and microcephaly first came to light last year in Brazil, which has confirmed more than 1,800 cases of microcephaly that it considers to be related to Zika infections in the mothers.

Zika has spread extensively in Latin American and the Caribbean over the past year or so, and more recently it has been cropping up in Southeast Asia.

Thailand has confirmed 349 Zika cases since January, including 33 pregnant women, and Singapore has recorded 393 Zika cases, including 16 pregnant women.

Some health experts have accused Thai officials of playing down the risk of Zika to protect its thriving tourist industry, but Prasert dismissed that.

“Thailand is not hiding anything and is ready to disclose everything,” he said, adding that other countries in Southeast Asia might also have cases of Zika-linked microcephaly that they have not disclosed.

The WHO said Thailand’s response was an example for the region.

“Thailand’s diligence underscores the commitment of health authorities to the health and wellbeing of the Thai public, and provides a positive example to be emulated,” Singh said.

The U.S. Centers for Disease Control and Prevention (CDC) said on Thursday people should consider postponing travel to Brunei, Myanmar, Cambodia, Indonesia, Laos, Malaysia, Maldives, Philippines, Thailand, Timor-Leste (East Timor), and Vietnam.

The CDC has already issued a “travel notice” for Singapore, and said such a warning would be considered for the new countries if the number of cases rose to the level of an outbreak.

Thailand’s confirmation of Zika-linked microcephaly comes ahead of China’s week-long “Golden Week” holiday with Thailand expecting 220,000 Chinese visitors, up from 168,000 for the week in 2015, Tourism Authority of Thailand governor Yuthasak Supasorn told Reuters.

NO VACCINE

There is no vaccine or treatment for Zika. An estimated 80 percent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.

There are also no specific tests to determine if a baby will be born with microcephaly, but ultrasound scans in the third trimester of pregnancy can identify the problem, according to the WHO.

Zika is commonly transmitted through mosquitoes but can also be transmitted sexually.

Another Thai health ministry adviser urged everyone to work to stop the spread of mosquitoes but said people should not panic.

“Don’t have sex with a Zika-infected person. If you don’t know if they are infected, then use a condom,” the adviser, Pornthep Siriwanarangsan, told reporters. “We can’t stop women from becoming pregnant … but we mustn’t panic.”

Health authorities in the region said they were stepping up monitoring, but there has been little testing and officials said the real number of cases was bound to be higher than the confirmed figure.

“We do not test everybody, we test only those who are symptomatic,” said Paulyn Jean Rosell-Ubia, health secretary in the Philippines, which has reported 12 Zika cases.

“Yes, we are positive that the number is higher because we are not testing everyone.”

Malaysia, which has reported six cases of Zika, including two in pregnant women, said it would seek information from Thailand on the particular strain of the Zika virus there.

“We are taking serious notice of the reports in Thailand, and we will reach out to the Thai authorities for more information … so that we can be more prepared,” Malaysia’s health minister, Subramaniam Sathasivam, told Reuters.

Authorities in Vietnam, which has reported three cases of Zika, ordered stepped up monitoring of pregnant women.

In Indonesia’s capital, Jakarta, head of disease outbreak and surveillance Dwi Oktavia said there had been no sign of any increase in birth defects there. Indonesia had one Zika case in 2015 but has confirmed none since then.

Microcephaly in babies can lead to respiratory problems related to malformation of the brain, a serious threat to the lives of babies. Children with microcephaly face lifelong difficulties, including intellectual impairment.

Zika was first identified in Uganda in 1947 and first isolated in Asia in the 1960s. It was unknown in the Americas until 2014.

(Additional reporting by Amy Sawitta Lefevre, Juarawee Kittisilpa and Panarat Thepgumpanat, Kanupriya Kapoor in JAKARTA, Roxanna Latiff in KUALA LUMPUR, Karen Lima in MANILA and Pham Thi Huyen My in HANOI; Writing by Robert Birsel; Editing by Alex Richardson)

Doctors say Haiti ripe for large Zika outbreak, virus under: reported

Residents in Haiti

By Makini Brice

PORT-AU-PRINCE (Reuters) – Posters warning of the dangers of Zika only reached Haiti’s health ministry in August, six months after the country reported an outbreak, in one example of delayed prevention efforts that have health experts worried a “large epidemic” is looming.

Gabriel Thimothe, a senior health ministry official, said the public service posters would be distributed to hospitals and airports shortly, but that health funding had been cut this year and foreign aid was sparse to fight the mosquito-borne virus that can cause severe birth defects.

Zika infections in pregnant women have been shown to cause microcephaly – a defect in which babies’ heads and brains are undersized – as well as other brain abnormalities.

Widespread fumigation that has limited the virus’ spread in other Caribbean nations such as Cuba only began in Haiti last month. Publicity campaigns have been all but invisible and hospital workers were on strike for much of the year.

“We’re expecting a large epidemic but we don’t know when it will occur,” said Jean-Luc Poncelet, the World Health Organization’s representative in Haiti. “There is under-reporting.”

Such an epidemic could severely strain Haiti’s fragile healthcare system, battered by an earthquake in 2010 that killed 300,000, and still struggling with a cholera epidemic that has sickened nearly 800,000 people.

WHO data show 5,000 suspected cases have been reported in more prosperous neighbor Dominican Republic, which shares the island of Hispaniola with Haiti and has a similar population and climate. Haiti by contrast, has reported 3,000 suspected cases, according to numbers shared by the U.S. Centers for Disease Control and Prevention.

That makes Haiti’s Zika infection rate about 30 per 100,000 people, compared to 82 per 100,000 in Brazil, where the connection between Zika and microcephaly was first detected, and 50 per 100,000 in Dominican Republic

The connection between Zika and microcephaly first came to light last fall in Brazil, which has since confirmed more than 1,800 cases of microcephaly.

RAINY SEASON

In the Dominican Republic there were spikes in infections in March and May, broadly coinciding with rainy seasons on both sides of the island, a time when mosquitoes and diseases they carry normally flourish. In Haiti, the number of cases reported each week generally dropped from February through the rains.

A long strike by medical residents at most public hospitals coincided with that decline, raising the question of whether there were fewer infections or a lack of health workers available to register cases.

A Zika task force, which includes the government and non-governmental organizations, was formed in May, Thimothe said. Several U.S. health officials in Haiti told Reuters that the United States provided $3 million in August to combat Zika in the country, money that was initially intended to be deployed against Ebola in West Africa.

Thimothe said the impact of an explosion of microcephaly cases would be devastating, but denied the condition was more widespread than thought, even though many Haitian women give birth at home rather than in clinics.

His position is supported by WHO data through June, which did not show an uptick in microcephaly or Guillain-Barre syndrome, a neurological disorder that can cause temporary paralysis and has also been linked to Zika.

But Louise Ivers, the senior health and policy advisor for Partners in Health, which along with Haitian organization Zanmi Lasante runs a hospital in the central town of Mirebalais, said she had seen at least 12 cases this year of Guillain-Barre, normally a rare condition.

The same hospital registered two microcephaly cases, including one confirmed to be linked to Zika, this summer.

“Maybe we are too late for prevention. Maybe we just have to manage the consequences,” Ivers said. “This could just be the tip of the iceberg.”

(Additional reporting by Joseph Guyler Delva; Editing by Frank Jack Daniel and Alistair Bell)

U.S. fights Zika mosquitoes with limited arsenal

Zika virus kit

By Julie Steenhuysen

(Reuters) – Over Wynwood, the Miami neighborhood where Zika gained a foothold in the continental United States, low flying planes have been spraying naled, a tightly controlled pesticide often used as a last resort. It appears to be working, killing at least 90 percent of the target mosquitoes.

Across the Biscayne Bay in Miami Beach, wind and high-rise buildings make aerial spraying challenging. So, the effort in the popular tourist destination has focused on ground-sprayed pyrethroids – pesticides that are safer but don’t always work.

The arrival in Florida of Zika, a virus that can cause a crippling birth defect known as microcephaly, has drawn into focus the limitations of the U.S. mosquito control arsenal.

Larvicides reduce future populations relatively safely. But for use against the mature mosquitoes that spread disease, only two classes of pesticides are approved. Each has drawbacks.

Organophosphates, such as naled, are effective. But there are strict controls to limit risk. Pyrethroids are safer but have been used so much that mosquitoes, in many places, are immune.

“That’s really the weak link in much of the United States,” said Michael Doyle, director of the Florida Keys Mosquito Control District. “We’re kind of caught off guard.”

DENGUE PREVIEW

Doyle led a 2009 effort against a dengue outbreak in South Florida, the first in the United States in nearly a century. Authorities threw everything they had at the Aedes aegypti, the same mosquito that carries Zika: backpack fogging, door-to-door yard inspections looking for watery breeding sites and larvicide spraying.

Still, 88 people were infected before the virus was brought under control more than two years later, and there continue to be sporadic cases in Florida.

The outbreak highlighted gaps in the mosquito control arsenal that remain, according to pesticide makers, abatement officials and entomologists. Few companies make pesticides for use in public health outbreaks, a niche market that is expensive to get into, has a limited upside and varies season to season.

Safety testing a new pesticide can cost up to $250 million and take 10 years, said Karen Larson, vice president of regulatory affairs at privately held Clarke Mosquito.

As long as a product remains on the market, companies must continue testing for unforeseen side effects, an expense that some makers have blamed for decisions to abandon products.

“There’s not a lot of profit,” Larson said.

Sales of the Dibrome brand of naled have been estimated at $12 million a year. By comparison, total crop pesticide sales for some companies can exceed $500 million in a single quarter.

Bayer, Dow Chemical, BASF and other agricultural pesticide makers “are not interested in going after a $20 million or $30 million a year market,” said William A. Kuser, investor relations director at Dibrome maker American Vanguard Corp.

The U.S. Environmental Protection Agency has approved several new pesticides in recent years. But it has received few requests for using them against mosquitoes, said Jim Jones, Assistant Administrator for the agency’s Office of Chemical Safety and Pollution Prevention.

“Although it’s of critical importance, the amount one can sell is small and it’s variable, which makes it difficult for business planning,” Jones said. “You can go many years without having much of a market at all, then suddenly, whether it’s because of a nuisance outbreak of mosquitoes or something like West Nile or Zika, the market grows significantly.”

Abatement authorities have pressed for help with the cost of developing mosquito control pesticides. The 1996 U.S. Food Quality Protection Act includes a provision for subsidies to defray the expense of safety testing, but Congress has never funded it.

RISK AND RESISTANCE

At least 49 cases of locally transmitted Zika infections have been reported in Florida, most in Wynwood and Miami Beach. Most people have no symptoms or mild illness.

Because of the microcephaly link, efforts are focused on preventing infection among pregnant women.

In Wynwood, the campaign began with pyrethroids, synthetic versions of a chemical derived from chrysanthemums. Amid signs of resistance, authorities switched to naled.

Developed as nerve agents, organophosphates, at high doses, can cause nausea, convulsions and death. They can be toxic to wildlife, including bees. The EPA considers naled safe at permitted ultra-low concentrations, and it is sprayed annually over 16 million acres in the United States.

But it is banned in Europe, where the risk is seen as unacceptable. In the U.S. territory of Puerto Rico, where Zika is widespread, the governor prohibited naled amid protests over safety concerns.

Although naled killed more than 90 percent of mosquitoes in traps set in Wynwood, the Aedes aegypti’s resilience remains a concern.

“This is truly the cockroach of mosquitoes,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention.

DROPPING PESTICIDES

CDC entomologist Janet McAllister said pyrethroid resistance typically is limited by the mosquito’s small range. When resistance to one pyrethroid develops, another often works.

Still, she said, “we would love to see additional classes of insecticides available because, even in places that may have an effective tool today, that doesn’t mean it is going to last down the road.”

The EPA can fast-track its evaluation of new pesticides and expand the use of old ones. In response to Zika, it expedited new uses for pesticide-treated bed nets and mosquito traps.

Still, development of pesticides is painstaking. Even if the EPA speeds up its evaluation, required safety data can take years to collect. And the expense of ongoing safety testing has prompted companies to drop products.

Bayer CropScience, for example, told distributors it dropped the pyrethroid resmethrin in 2012, rather than do additional testing. Clarke Mosquito gave up temephos, a larvicide, six years ago, because of costs, Larson said.

That decision led to stockpiling in southwest Florida, said Wayne Gale, director of the Lee County Mosquito Control District.

“We purchased just about every bit,” he said.

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Girion)

Haiti finds case of microcephaly linked to Zika virus

Public Health guy for Haiti

By Makini Brice

PORT-AU-PRINCE (Reuters) – Haiti has identified its first case of the birth defect microcephaly linked to the Zika virus, a senior health ministry official said on Tuesday.

Gabriel Thimothe, director general at the ministry of public health and population, said the case was confirmed on Saturday by the U.S. Centers for Disease Control and Prevention (CDC).

Haiti has confirmed 14 cases of the birth defect since March, up from previous reports of two cases, Raymond Grand Pierre, the director of the Department of Health and Family in the Ministry of Health, said.

In the other 13 cases, authorities have not established a link to microcephaly although the number may indicate Zika is more widespread in Haiti than previously thought.

According to a chart provided by the Centers for Disease Control, Haiti has recorded nearly 3,000 Zika cases.

But the World Health Organization says the overwhelming majority of cases of the virus in the island nation are suspected and not confirmed.

Thimothe said the baby with Zika-linked microcephaly was born in the city of Mirebalais earlier this summer.

Boston-based Partners in Health and its sister organization, Haiti-based Zanmi Lasante, said in a statement on Aug. 9 that two babies had been born with microcephaly in their University Hospital Mirebalais.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly. The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis.

The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed more than 1,600 cases of microcephaly that it considers to be related to Zika infections in the mothers.

Haiti’s healthcare system is still suffering from the fallout of the 2010 earthquake that killed about 300,000 people and a still-ongoing cholera epidemic that began shortly afterward, killing about 8,600 people and infecting 707,000.

Health facilities were also paralyzed this year by a months-long strike by medical residents over pay and working conditions, which Thimothe said had largely ended.

(Reporting by Makini Brice in Port-au-Prince; Editing by Sandra Maler and Cynthia Osterman)