Tag Archives: Zika Virus

Health agency reports U.S. babies with Zika-related birth defects

Mosquito under microscope, studying Zika

By Bill Berkrot

(Reuters) – Three babies have been born in the United States with birth defects linked to likely Zika virus infections in the mothers during pregnancy, along with three cases of lost pregnancies linked to Zika, federal health officials said on Thursday.

The six cases reported as of June 9 were included in a new U.S. Zika pregnancy registry created by the Centers for Disease Control and Prevention. The agency said it will begin regular reporting of poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection in the 50 states and the District of Columbia.

Zika has caused alarm throughout the Americas since numerous cases of the birth defect microcephaly linked to the mosquito-borne virus were reported in Brazil, the country hardest hit by the current outbreak. The rare birth defect is marked by unusually small head size and potentially severe developmental problems.

The U.S. cases so far involve women who contracted the virus outside the United States in areas with active Zika outbreaks, or were infected through unprotected sex with an infected partner. There have not yet been any cases reported of local transmission of the virus in the United States. Health experts expect local transmission to occur as mosquito season gets underway with warmer weather, especially in Gulf Coast states, such as Florida and Texas.

The CDC declined to provide details of the three cases it reported on Thursday, but said all had brain abnormalities consistent with congenital Zika virus infection. Two U.S. cases of babies with microcephaly previously were reported in Hawaii and New Jersey.

The poor birth outcomes reported include those known to be caused by Zika, such as microcephaly and other severe fetal defects, including calcium deposits in the brain indicating possible brain damage, excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures and abnormal eye development, the CDC said.

“The pattern that we’re seeing here in the U.S. among travelers is very similar to what we’re seeing in other places like Colombia and Brazil,” Dr. Denise Jamieson, co-leader of the CDC Zika pregnancy task force, said in a telephone interview.

Authorities in Brazil have confirmed more than 1,400 cases of microcephaly in babies whose mothers were exposed to Zika during pregnancy.

Lost pregnancies include miscarriage, stillbirths and terminations with evidence of the birth defects. The CDC did not specify the nature of the three reported lost pregnancies, citing privacy concerns about pregnancy outcomes.

The CDC established its registry to monitor pregnancies for a broad range of poor outcomes linked to Zika. It said it plans to issue updated reports every Thursday intended to ensure that information about pregnancy outcomes linked with the Zika virus is publicly available.

The CDC said the information is essential for planning for clinical, public health and other services needed to support pregnant women and families affected by Zika.

“We’re hoping this underscores the importance of pregnant women not traveling to areas of ongoing Zika virus transmission if possible, and if they do need to travel to ensure that they avoid mosquito bites and the risk of sexual transmission,” Jamieson said.

(Reporting by Bill Berkrot; Editing by Will Dunham)

House Speaker Ryan: All options open on Zika funding

Aedes aegypti mosquitoes

WASHINGTON (Reuters) – House Speaker Paul Ryan on Wednesday said a range of options to provide funds to fight Zika, adding that lawmakers take the threat seriously but have not yet decided the best way to allocate resources to prevent and combat the deadly virus.

“We’re looking at all different options,” adding that the White House has begun providing congressional staff with answers to questions over President Barack Obama’s funding request. “The administration has a bit of a track record of over-requesting what they need.”

(Reporting by Susan Heavey)

Zika mystery deepens with evidence of nerve cell infections

Aedes aegypti mosquitoe

By Julie Steenhuysen

CHICAGO (Reuters) – Top Zika investigators now believe that the birth defect microcephaly and the paralyzing Guillain-Barre syndrome may be just the most obvious maladies caused by the mosquito-borne virus.

Fueling that suspicion are recent discoveries of serious brain and spinal cord infections – including encephalitis, meningitis and myelitis – in people exposed to Zika.

Evidence that Zika’s damage may be more varied and widespread than initially believed adds pressure on affected countries to control mosquitoes and prepare to provide intensive – and, in some cases, lifelong – care to more patients. The newly suspected disorders can cause paralysis and permanent disability – a clinical outlook that adds urgency to vaccine development efforts.

Scientists are of two minds about why these new maladies have come into view. The first is that, as the virus is spreading through such large populations, it is revealing aspects of Zika that went unnoticed in earlier outbreaks in remote and sparsely populated areas. The second is that the newly detected disorders are more evidence that the virus has evolved.

“What we’re seeing are the consequences of this virus turning from the African strain to a pandemic strain,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

The Zika outbreak was first detected in Brazil last year and is spreading through the Americas. It has been linked to thousands of suspected cases of microcephaly, a typically rare birth defect marked by unusually small head size, signaling a problem with brain development. Evidence linking Zika to microcephaly prompted the World Health Organization to declare a global health emergency in February.

The suspicion that Zika acts directly on nerve cells began with autopsies on aborted and stillborn fetuses showing the virus replicating in brain tissues. In addition to microcephaly, researchers reported finding other abnormalities linked with Zika including fetal deaths, placental insufficiency, fetal growth retardation and injury to the central nervous system.

Doctors also are worried that Zika exposure in utero may have hidden effects, such as behavioral problems or learning disabilities, that are not apparent at birth.

“If you have a virus that is toxic enough to produce microcephaly in someone, you could be sure that it will produce a whole series of conditions that we haven’t even begun to understand,” said Dr. Alberto de la Vega, an obstetrician at San Juan’s University Hospital in Puerto Rico.

First discovered in the Zika forest of Uganda in 1947, the virus circulated quietly in Africa and Asia, causing rare infections and producing mild symptoms. A 2013 outbreak in French Polynesia, the largest at that time, led researchers to make the Guillain-Barre link. Other neurological effects were noted but scientists made little of them at the time.

A rare and poorly understood condition, Guillain-Barre can weaken muscles and cause temporary paralysis, often requiring patients to need respirators to breathe.

An estimated 32,000 people in the French Polynesia Zika outbreak were infected, and 42 patients were confirmed to have Guillain-Barre, a 20-fold increase in incidence over the previous four years, the WHO reported. Another 32 patients had other neurological disorders, including encephalitis, meningoencephalitis, myelitis and facial paralysis.

Guillain-Barre is an autoimmune disorder, in which the body attacks itself in the aftermath of an infection. But the newly discovered brain and spinal cord infections are known to be caused by a different mechanism – a direct attack on nerve cells. That has prompted scientists to consider whether the Zika virus also may infect nerves directly in adults, as they already have suspected in fetuses.

In medical journals published last month, doctors described neurological syndromes in two patients that they attributed to Zika. Doctors in Paris diagnosed meningoencephalitis, an infection of both the brain and spinal cord, in an 81-year-old man who was hospitalized after being exposed to Zika on a cruise.

Another French team reported acute myelitis, a paralyzing infection of the spinal cord, in a 15-year-old girl who had been infected with Zika on the French Caribbean island of Guadeloupe.

In its latest surveillance report, the WHO said the two cases “highlight the need to better understand the range of neurological disorders associated with Zika-virus infection.”

Other mosquito-borne viruses – including dengue, Japanese encephalitis and West Nile – are known to directly infect nerve cells in the brain and spinal cord. But such viruses are seldom associated with Guillain-Barre, and never with microcephaly, said Baylor’s Hotez.

POSSIBLE EVOLUTION

In a recent paper, WHO researcher Mary Kay Kindhauser wrote that Zika “appears to have changed in character,” noting its transition from a mild infection to one causing “large outbreaks linked with neurological disorders.”

Scientists studying Zika in Brazil now are reporting the same neurological disorders seen in French Polynesia. From April through July 2015, doctors in Brazil identified a spike in Guillain-Barre cases.

In Salvador, there were roughly 50 reported cases of Guillain-Barre in July alone, far more than would typically be expected, Dr. Albert Ko, a tropical disease expert from Yale University who is studying Zika in the coastal city of Salvador, recently told a research symposium.

“Throughout Brazil, doctors have seen strange, atypical, neurological manifestations,” Ko said told the symposium.

Zika exposed patients have had other neurological problems as well, including acute disseminated encephalomyelitis, which causes inflammation of the myelin, the protective sheath covering nerve fibers in the brain and spinal cord. Other patients experienced tingling, prickling or burning sensations, which are often markers of peripheral nerve damage.

In addition to Brazil and French Polynesia, at least 11 more countries and territories have reported hundreds of cases of Guillain-Barre syndrome linked to Zika. In Brazil, Guillain-Barre cases jumped 19 percent to 1,708 last year.

El Salvador, a country that has an annual average of 196 cases of Guillain-Barre, reported 118 cases in six weeks in December and January.

Zika’s arrival in Colombia in October 2015 was associated with another increase in Guillain-Barre cases. The country typically reports 242 cases of the syndrome a year, or about five a week. But in the five weeks starting in mid-December, Colombia reported 86 cases of Guillain-Barre, or about 17 a week.

Dr. Carlos Pardo-Villamizar, a neurologist at Johns Hopkins University School of Medicine, is studying Zika complications with colleagues in five Colombian research centers. They have seen cases of encephalitis, myelitis and facial paralysis associated with Zika and want to understand what is triggering these complications.

They also want to study whether prior infection with dengue or chikungunya – two related viruses – are contributing to neurological disorders seen in patients with Zika.

Scientists are turning their attention next to Puerto Rico, where Zika is expected to infect hundreds of thousands of residents by year-end.

More cases hold the potential for “a better sense of the full spectrum of disease that Zika is capable of causing,” said Dr. Amesh Adalja of the Center for Health Security at the University of Pittsburgh Medical Center.

(Reporting by Julie Steenhuysen; additional reporting by Anthony Boadle in Brasilia, Brazil; Editing by Michele Gershberg and Lisa Girion)

Mosquitoes’ rapid spread poses threat beyond Zika

LONDON (Reuters) – As the world focuses on Zika’s rapid advance in the Americas, experts warn the virus that originated in Africa is just one of a growing number of continent-jumping diseases carried by mosquitoes threatening swathes of humanity.

The battle against the insects on the streets of Brazil is the latest in an ancient war between humankind and the Culicidae, or mosquito, family which the pests frequently win.

Today, mosquito invaders are turning up with increasing regularity from Washington DC to Strasbourg, challenging the notion that the diseases they carry will remain confined to the tropics, scientists documenting the cases told Reuters.

Ironically, humans have rolled out the red carpet for the invaders by transporting them around the world and providing a trash-strewn urban landscape that suits them to perfection.

The Aedes aegypti species blamed for transmitting Zika breeds in car tyres, tin cans, dog bowls and cemetery flower vases. And its females are great at spreading disease as they take multiple bites to satisfy their hunger for the protein in human blood they need to develop their eggs.

Around the world, disease-carrying mosquitoes are advancing at speed, taking viruses such as dengue and Zika, plus a host of lesser-known ills such as chikungunya and St. Louis encephalitis, into new territories from Europe to the Pacific.

“The concern is that we have these species spreading everywhere. Today the focus is on Zika but they can carry many different viruses and pathogens,” said Anna-Bella Failloux, head of the department that tracks mosquito viruses at France’s Institut Pasteur.

In 2014, there was a large outbreak of chikungunya, which causes fever and joint pains, in the Caribbean, where it had not been seen before, while the same virus sickened Italians in 2007 in a wake-up call for public health officials.

Europe has seen the re-emergence of malaria in Greece for the first time in decades and the appearance of West Nile fever in eastern parts of the continent.

Out in the Atlantic, the Madeira archipelago reported more than 2,000 cases of dengue in 2012, in a sign of the northerly advance of what – at least until Zika – has been the world’s fastest-spreading tropical disease.

In the past 40 years, six new invasive mosquito species have become established in Europe, with five arriving since 1990, driven in large part by the international trade in used vehicle tyres. Mosquitoes lay their eggs in the tyres and they hatch when rain moistens them at their destination.

North American health experts are also racing to keep up, with the first appearance of Aedes japonicus, an invasive mosquito, in western Canada last November and Aedes aegypti found in Washington DC, apparently after spending the winter in sewers or Metro subway stations.

SPREAD UNPRECEDENTED

The speed of change in mosquito-borne diseases since the late 1990s has been unprecedented, according to Jolyon Medlock, a medical entomologist at Public Health England, a government agency.

For many experts, the biggest potential threat is Aedes albopictus, otherwise known as the Asian tiger mosquito, which is expanding its range widely and is capable of spreading more than 25 viruses, including Zika.

“There is strong evidence that Aedes albopictus is now out-competing aegypti in some areas and becoming more dominant,” said Ralph Harbach, an entomologist at London’s Natural History Museum, who has been studying mosquitoes since 1976.

In the United States, Aedes albopictus has been found as far north as Massachusetts and as far west as California. In Europe it has reached Paris and Strasbourg.

Adding to the challenge for public health authorities are the blurred lines between diseases carried by different mosquitoes, as shown by research in Brazil this month that another common mosquito, Culex quinquefasciatus, may also be able to carry Zika.

Both Aedes aegypti and Culex quinquefasciatus probably first arrived in the Americas from Africa on slave ships, scientists believe. In the centuries since, commerce has shuttled other species around the world, while air travel has exposed millions of people to new diseases.

“You’ve got a global movement of mosquitoes and a huge increase in human travel. Humans are moving the pathogens around and the mosquitoes are waiting there to transmit them,” said Medlock.

Human incursions into tropical forests have aggravated the problem. Deforestation in Malaysia, for example, is blamed for a steep rise in human cases of a type of malaria usually found in monkeys.

DON’T KILL THE GOOD GUYS

There have been some victories against mosquitoes, thanks to insecticide-treated bed nets and vaccines against viruses like yellow fever and Japanese encephalitis, as well as a new one for dengue approved in December.

But mosquitoes still kill around 725,000 people a year, mostly due to malaria, or 50 percent more than are killed by other humans, according to the Bill & Melinda Gates Foundation.

Climate change adds a further twist. A 2 to 3 degree Celsius rise in temperature can increase the number of people at risk of malaria by 3 to 5 percent, or more than 100 million, according to the World Health Organization.

Hotter weather also speeds up the mosquito breeding cycle from around two weeks at 25 degrees to 7 to 8 days at 28 degrees, according to the Institut Pasteur’s Failloux.

So is it time to wipe out mosquitoes altogether?

Aggressive action in the 1950s and 1960s, including the use of the pesticide DDT, certainly pushed them back for a while.

Today, genetic modification, radiation and targeted bacteria are being considered.

Trying to eliminate all mosquitoes, however, would make no sense, since there are 3,549 species and fewer than 200 bite humans.

“It might be possible to wipe out a few species but we don’t want to wipe out the good guys because a lot of them serve as food for frogs, fish and bats,” said Harbach. “Many also visit flowers to feed on nectar and may play a role in pollination.”

Some are even our friends. Harbach has a soft spot for the Toxorhynchites genus, which have a convenient penchant for eating Aedes aegypti larvae.

(Editing by Giles Elgood)

CDC director calls Zika in Puerto Rico a ‘challenge and crisis’

SAN JUAN, PUERTO RICO (Reuters) – During a tour of Zika preparations in Puerto Rico, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, called Zika a “tremendous challenge and crisis” and said protecting pregnant women from the virus is a top priority.

In Brazil, Zika has been linked to a spike in cases of microcephaly, a birth defect marked by small head size and underdeveloped brains.

“Until a few months ago, no one had any idea that Zika could cause birth defects,” Frieden told reporters Tuesday at a briefing in Puerto Rico’s health department.

Frieden has been working with CDC staff and the Puerto Rican government on strategies to protect pregnant from becoming infected with the mosquito-borne virus, which Frieden called a top priority.

In Puerto Rico, the Aedes aegypti mosquito that carries Zika is widespread, and Frieden said controlling it will require a multi-pronged approach involving government, municipalities, neighbors, families and society at large.

Cases of Zika are doubling weekly in Puerto Rico, and the CDC expects hundreds of thousands of individuals will become infected, including thousands of pregnant women.

To protect pregnant women, Frieden recommended using insect repellent daily and reliably.

He also suggested adding window screens and air conditioning, where possible. And he called for reducing standing water in and around homes to eliminate mosquito breeding habitats.

Frieden’s comments, delivered mostly in Spanish, followed two days of briefings with staff at the CDC’s Emergency Operations Center in San Juan. CDC researchers are monitoring the outbreak and studying the best ways to prevent Zika infections through education campaigns, and the distribution of Zika prevention kits for pregnant women.

Much remains unknown about Zika, including whether the virus actually causes microcephaly in babies. Brazil said it has confirmed more than 640 cases of microcephaly, and considers most of them to be related to Zika infections in the mothers. Brazil is investigating more than 4,200 additional suspected cases of microcephaly.

At the CDC’s Dengue Branch in Puerto Rico, scientists are conducting research on the most effective mosquito control measures, and processing diagnostic tests from blood samples delivered daily to the laboratory.

Dr. Jorge Munoz, branch director, said in an interview they are capable of processing 400 to 500 blood samples a week. Scientists at the laboratory developed a triple test that can detect Zika, dengue and chikungunya – three different viruses carried by the Aedes aegypti mosquito that is endemic in Puerto Rico.

The test will be crucial in helping to quickly sort out whether Zika was the cause of an infection or whether it was dengue and chikungunya, which also cause infection and illness.

“Puerto Rico is in a very different situation from the rest of the United States,” Frieden told the briefing.

Besides the high density of Aedes aegypti mosquitoes, Puerto Rico has a lot of housing without window screens or air conditioning.

“The combination of those two things, when you add Zika in, means the likelihood of a very large number of cases,” Frieden said.

“In rest of the United States, we may see clusters,” he said. But if Zika behaves the way chikungunya and dengue have, “we will not see widespread transmission.”

(Reporting by Julie Steenhuysen; Editing by Bernard Orr)

Zika response in focus with new evidence of birth defect link

GENEVA/WASHINGTON (Reuters) – Evidence mounted on Friday linking Zika to the birth defect microcephaly, and the U.N. health agency set a review of travel advice related to the outbreak of the virus while U.S. officials planned strategy to control the mosquitoes that spread it.

The virus is capable of rapidly infecting and harming developing fetal brain cells, scientists said in a study that provided insight into how the virus might cause microcephaly in fetuses.

The researchers said the study, published on Friday in the journal Cell Stem Cell, does not prove a direct causal link between Zika and microcephaly in newborns, a condition defined by unusually small heads that can result in developmental problems. But they said it does identify where the virus may be inflicting the most damage in developing fetuses.

Zika has been linked to numerous cases of microcephaly in Brazil, where the current outbreak began. The virus is spreading rapidly in Latin America and in Caribbean nations, prompting the World Health Organization last month to declare a global public health emergency.

The WHO on Friday said there is accumulating evidence of a link between the virus and microcephaly as well as a rare disorder called Guillain-Barre syndrome in which the immune system attacks part of the nervous system.

The WHO’s Emergency Committee will meet Tuesday to review “evolving information” and its recommendations on travel, trade and mosquito control in what is thought to be high season for transmission of the virus in the southern hemisphere.

The WHO last month advised pregnant women to consider delaying travel to areas where Zika is spreading.

Travel to Brazil has been a particular concern because the Summer Olympics will be held in Rio de Janeiro in August.

Dr. Bruce Aylward, WHO’s executive director for outbreaks and health emergencies, said recently published studies in the Lancet medical journal on microcephaly and by the U.S. Centers for Disease Control and Prevention (CDC) on Guillain-Barre had strengthened the case that Zika is responsible.

The White House and the CDC will bring together U.S. state and local officials on April 1 for a summit at the CDC’s Atlanta headquarters to urgently craft a plan to attack the hard-to-control mosquito that spreads the virus.

The White House is inviting officials involved in mosquito control and public health to discuss how best to track and control the spread of the virus and respond when people are infected.

U.S. federal health officials expect the first locally transmitted cases of the Zika virus in the continental United States by June or July.

“We can’t say for sure that we’re not going to have a major outbreak in the United States. I do not think we will, but we will be prepared for it anyway,” Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said at an event presented by the Harvard T.H. Chan School of Public Health in collaboration with Reuters.

MICROCEPHALY OUTSIDE BRAZIL

There were fresh signs on Friday of Zika-linked microcephaly cases outside Brazil. The first microcephaly case linked to Zika was reported in Colombia.

In addition, doctors in Venezuela reported their first suspected Zika-linked microcephaly case in a fetus that died whose mother likely was infected with the virus.

Much remains unknown about Zika, including whether the virus actually causes microcephaly. Brazil said it has confirmed more than 640 microcephaly cases and considers most to be related to Zika infections in the mothers. Brazil is investigating more than 4,200 additional suspected microcephaly cases.

The study in Cell Stem Cell showed that Zika infects a kind of neural stem cell that gives rise to the cerebral cortex, the brain’s outer layer responsible for intellectual capabilities and higher mental functions.

These cells, exposed to the virus in laboratory dishes, became infected within three days, turned into “virus factories” for viral replication and died more quickly than normal, the researchers said.

Florida State University researcher Hengli Tang, the study’s lead author, told Reuters the study suggests the virus would be capable of doing the damage seen in microcephaly.

French scientists, in a retrospective study of a 2013-2014 Zika outbreak in French Polynesia, said last week they had proved a link between Zika and Guillain-Barre, suggesting countries hit by the Zika outbreak will see a rise in the neurological condition.

“The important thing is the data is moving in one direction. And that’s the reason we’ve asked the Emergency Committee again next week to convene and look at these data,” the WHO’s Aylward said, referring to a group of independent experts chaired by David Heymann.

(Reporting by Stephanie Nebehay in Geneva and Roberta Rampton in Washington; Additional reporting by Andrew M. Seaman and Bill Berkrot in New York, Alexandra Ulmer and Corina Pons in Caracas and Julia Symmes Cobb in Bogota; Writing by Will Dunham; Editing by Michele Gershberg and Leslie Adler)

U.S. officials investigating 14 new cases of Zika possibly being spread through sex

Health officials are investigating more than a dozen new reports of the Zika virus possibly being transmitted sexually, suggesting the method may be more probable than originally believed.

The virus is most commonly spread when an infected mosquito bites a person, but the Centers for Disease Control and Prevention (CDC) announced Tuesday that United States public health departments had received 14 new reports about the virus potentially being spread through sex.

Several of those cases involved pregnant women, the CDC said.

Earlier this month, the World Health Organization (WHO) declared a Public Health Emergency of International Concern in response to the Zika virus. Scientists are still investigating whether the virus can lead to microcephaly, a rare condition in which children are born with unusually small heads, or Guillain-Barre Syndrome, a nervous system illness that can cause paralysis.

The WHO says the evidence about a potential link between Zika and the disorders “remains circumstantial,” though a growing amount of data that suggests the virus plays a “causal role.”

There is currently no vaccine against Zika, though the WHO says some are being developed.

The CDC maintains the best way to prevent Zika infections is to prevent mosquito bites, and has issued travel notices for several countries where the virus is currently being transmitted.

However, the new reports about possible sexual transmission prompted the organization to reiterate its advisories for people who have traveled to those countries. The CDC says pregnant women and their partners should use condoms throughout their pregnancy, or abstain entirely.

The CDC said it has confirmed two cases of Zika in women whose only possible exposure to the virus was “sexual contact” with infected men who had recently traveled to countries where mosquitos are known to be transmitting Zika. Another four potential cases are currently awaiting confirmation from lab tests, and the other cases are currently being investigated.

“These new reports suggest sexual transmission may be a more likely means of transmission for Zika virus than previously considered,” the CDC said in a news release.

In all 14 cases, the CDC said the travelers were male and began displaying symptoms about two weeks before their “non-traveling female partner” reported an illness. The CDC says Zika stays in semen longer than blood, though scientists do not know exactly how long the virus lingers.

The CDC says it’s not yet known if women can transmit Zika to their partners through sex.

To date, the CDC has not reported any instances of people acquiring Zika from mosquitos in the United States. However, there have been 82 cases of people getting sick after returning home.

The organization says only about 1 in 5 people infected with Zika display symptoms, and they usually experience a mild illness that lasts about a week.

Fijian islands still cut off after cyclone, fear of Zika and Dengue outbreaks

SYDNEY (Reuters) – Fiji sent boats on Tuesday carrying desperately needed aid to remote islands and coastal villages devastated by a powerful cyclone which killed at least 29 people, as aid workers warned of possible outbreaks of Zika and Dengue viruses.

There are fears the death toll could rise in the nation of 900,000 people when communication resumes with the smaller islands hit by Cyclone Winston on Saturday.

Aerial footage of outlying islands taken by the Royal New Zealand Air Force, and posted on the Fiji government’s official website, showed whole villages flattened and flooded after Winston’s destructive winds, up to 200 mph, tore through the archipelago of 300 islands. Thousands of Fijians live in tin or wooden shacks in low-lying coastal areas.

Authorities have warned of “catastrophic” damage to Koro Island, Fiji’s seventh-largest island, and more than 8,000 people continue to shelter in evacuation centers across the country.

Prime Minister Frank Bainimarama reassured Fijians that the government was doing all it could amid growing criticism of the slow emergency response in some parts of the country.

“We realize the desperate position that you are in,” Bainimarama said in a statement after visiting an evacuation center. “We will not rest until we have reached you and given you the helping hand you so badly need and deserve.”

“Unfortunately the recovery process will take time, perhaps a long time,” he added. “Almost no part of our nation has been left unscarred.”

Aid workers warned of potential outbreaks of the Zika and Dengue viruses, both carried by mosquitoes which will breed in the stagnant water left by the storm.

“The threat of dengue and Zika in the coming days in Fiji is real,” said Chris Hagarty, senior health program manager at Plan International Australia.

“The period immediately following a disaster of this scale can be a particularly dangerous one.”

The World Health Organization declared a Zika outbreak in South America an international health emergency on Feb. 1, citing a “strongly suspected” relationship between Zika infection in pregnancy and microcephaly, a condition marked by unusually small heads that can result in developmental problems.

Much remains unknown about Zika, including whether the virus actually causes microcephaly. Brazil has confirmed more than 500 cases of microcephaly, and considers most of them related to Zika infections in mothers. Brazil is investigating more than 3,900 additional suspected cases of microcephaly.

Fiji’s international airport at Nadi has reopened and an aeromedical evacuation team was being sent to outer islands on Tuesday to provide urgent support and supplies, including water and hygiene kits, medicines and access to shelter.

(Editing by Michael Perry)

Cuba deploys army in effort to avoid Zika virus

HAVANA (Reuters) – Cuban President Raul Castro called on the entire Cuban population to help eradicate the mosquitoes that carry the Zika virus on Monday and ordered 9,000 army troops to help stave off the disease.

Cuba has yet to detect a case of Zika but the outbreak is affecting large parts of Latin America and the Caribbean and is likely to spread to all countries in the Americas except for Canada and Chile, the World Health Organization (WHO) has said.

“It’s necessary for every single Cuban to take up this battle as a personal matter,” Castro wrote in a national message sounding the alarm over Zika, which is carried by mosquitoes that transmit the virus to humans and which is suspected of causing birth defects after infecting pregnant women.

Cubans should clean up potential environments for the Aedes genus of mosquitoes, said Castro, who also is general of the armed forces.

“The Revolutionary Armed Forces will assign more than 9,000 troops, among them active duty officers and reserve officers … to the anti-vector and cleanup efforts, with the additional support of 200 officers of the National Revolutionary Police,” Castro said.

The ruling Communist Party and the government have adopted an action plan under the direction of the Health Ministry to deal with the Zika that will also help combat the mosquito-borne diseases dengue and chikungunya, Castro said.

One Health Ministry employee, who asked not to be identified as she was not authorized to talk with journalists, said the country’s vast network of neighborhood doctors and clinics were watching for Zika symptoms and suspected cases would be quarantined in hospital wards prepared for an eventual outbreak.

“There are no confirmed cases yet but there will be. To date there have been two suspected cases that turned out negative,” said the employee, who has real-time access to epidemiological data.

The government, which has fumigated neighborhoods and homes for decades to contain dengue, put doctors on alert for the virus weeks ago and ramped up mosquito eradication efforts.

Military officers could be seen over the weekend, clip boards instead of rifles in hand, directing fumigation in Havana.

The WHO declared the outbreak an international health emergency on Feb. 1, citing a “strongly suspected” relationship between Zika infection in pregnancy and microcephaly, a condition marked by abnormally small head size.

However, much remains unknown about Zika, including whether the virus actually causes microcephaly.

(Reporting by Marc Frank and Daniel Trotta; Editing by Bill Trott)

Zika-hit Puerto Rico prepares to import all of its blood supplies

WASHINGTON (Reuters) – New guidelines barring the collection of blood in areas with outbreaks of the mosquito-borne Zika virus will be put to the test first in cash-strapped Puerto Rico, where health officials have two weeks to start importing the island’s supply.

The U.S. Food and Drug Administration said earlier this week that areas with active domestic transmission of Zika virus should stop collecting blood locally.

Puerto Rico has reported a small number of cases of local transmission, and U.S. health officials expect many thousands of residents to be infected once the mosquito season reaches its peak this summer.

Local health officials fear switching to imports could undermine the island’s voluntary donation network, which provides the bulk of its needs. The new guidelines will require Puerto Rico to obtain its entire supply from the continental United States at a cost of up to $100,000 a week, said Jose O. Alsina, vice president and chief operating officer of Puerto Rico’s Banco de Sangre de Servicios Mutuos, the island’s largest blood bank.

The U.S. territory is struggling with about $70 billion in debt and a 45 percent poverty rate. The island has already defaulted on some debt payments and its Governor Alejandro Garcia Padilla has warned that the government is close to running out of money.

Alsina said its eight blood banks can’t afford to buy blood and make payroll, which includes about 400 drivers, phlebotomists, nurses and others. Blood bank officials are asking the government to help pay for the imports so they can maintain their infrastructure until local collection can resume. They also have asked for extra time to collect blood locally before having to import it all.

“Laying off people, even for a short time, would be devastating,” Alsina said.

The FDA said that it recognized the new rules would create hardships but stressed they were necessary to ensure safety. The Zika virus has been found in blood, and experts are concerned about the possibility that it could be transmitted through transfusion.

The FDA “is actively engaged in conversations with local health authorities and blood collection establishments in Puerto Rico in order to minimize the impact to the greatest extent possible,” said agency spokeswoman Tara Goodin.

The Zika outbreak began in Brazil last year and has spread rapidly through the Americas. The World Health Organization declared it a global health emergency earlier this month because the virus is suspected of causing microcephaly, a birth defect marked by unusually small heads that can cause developmental disabilities.

President Barack Obama has asked Congress to approve $1.8 billion in supplemental emergency funding to help combat the virus, with $250 million designated for Puerto Rico.

Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, has told lawmakers some of the funds should finance the development of a blood screening test that he hoped could be available in six to 12 months.

TEMPORARY TEST

In the meantime, researchers at the Blood Systems Research Institute (BSRI), a unit of the blood and transfusion services company Blood Systems Inc, are evaluating the possibility of refining an existing Zika test to temporarily screen blood from Puerto Rico.

The test was developed nearly a decade ago by the CDC and has been used mainly for research purposes. Dr. Michael Busch, director of the BSRI said he believes his institute could refine the test and screen the Puerto Rican blood supply until a commercial test becomes available later this year.

Busch said the institute is in discussions with the FDA and believes it could scale up capacity to test Puerto Rican blood donations and submit an application for approval by the end of March. The CDC test could screen the average amount of blood Puerto Rico uses per week but not much more, Busch said.

The U.S. Virgin Islands and American Samoa also have been identified by CDC as areas with active Zika transmission, but both already import their blood supply from the continental United States and Hawaii, respectively, the FDA said.

U.S. health officials expect to see localized outbreaks in the southeastern United States later this year.

The further the virus spreads, the greater the area that will need to be supplied by Zika-free regions of the country, potentially squeezing overall blood supply.

OneBlood, which collects most of the blood used in Florida, said it will implement a screening test as soon as one is authorized by the FDA. The organization is in “close contact” with the FDA, CDC and Florida Department of health “should additional measures be needed,” said spokesman Pat Michaels.

(Reporting by Toni Clarke; Editing by Michele Gershberg and Lisa Girion)