Although the World Health Organization (WHO) announced there would be additional meetings to review the public health risks associated with the 2016 Olympics scheduled to commence on August 5th in Rio, no new updates have been released to date (30 June). WHO’s recommendations in May indicated that holding the Olympics in Brazil would not appreciably alter the risk of spread of Zika. Pregnant women were advised not to travel to any Zika-affected regions and other Olympic attendees should avoid mosquito exposure, unprotected sex and travel to poor regions of Brazil more affected by Zika. The Rio Olympic Committee leadership have openly stated they will follow any WHO recommendations including, presumably, canceling the event. WHO maintains that it isn’t within their mandate to make decisions regarding the Olympics. If you are mind-numbingly frustrated with WHO’s handling of this looming issue, you might find a kindred spirit in Richard Horton’s June offline commentary—WHO’s Phoney War..1
On a more positive note, 15 Latin American institutions are partnering with the US NIH in the ZIP Study (Zika in Infants and Pregnancy) and will enroll and evaluate ~10,000 pregnant women and their infants in the coming year. The findings from this ambitious study will add to our growing knowledge of the neurologic effects of Zika. An interesting report from Brazil that evaluated the timeline from peak numbers of acute exanthematous infections to associated neurologic Zika sequelae concluded that first trimester Zika exposure is associated with microcephaly2. In a recent Viewpoint article, Gold and Josephson advocate for educating frontline healthcare workers, particularly Emergency Medicine personnel, to assure they are primed to recognize early signs of Guillain Barre Syndrome (GBS) if/when the Zika epidemic makes it to North America.3 This seems sound advice but when placed in the context of the potential burden of GBS at 0.24 cases/1,000 (the incidence seen in the French Polynesian outbreak) it is difficult to fathom how we would cope with the deluge. For example, in neurologically well-resourced Rochester, NY this would mean about 50 cases of GBS. Fifty GBS cases distributed over several temperate months would severely challenge our Neuro-ICU bed capacity even if only half of the cases required high level care to say nothing of exhausting IVIG supplies and plasmapheresis access. A daunting thought. Physicians interested in learning more about Zika and other emerging infectious diseases should check out the Tofo Advanced Study week on Dengue, Zika, Chikungunya and other arboviruses to be held in Mozambique in late August.
There are numerous opportunities out there for further professional development and education in neurology. Graduate students, post docs and junior faculty worldwide who are interested in expanding their research expertise and knowledge of NeuroAIDS and mental health conditions should check out a new opportunity made available through an NIMH-funded mentoring program at Johns Hopkins. In addition to a 16-week, web-based course addressing both clinical and basic science topics relevant to NeuroAIDS, the Translational Research in NeuroAIDS and Mental Health (TRNAMH) Program offers opportunities for eligible trainees to undertake research experiences in faculty laboratories as well as pilot funding for individual research projects. Deadline for registration is August 23rd and the course starts August 30th. Keep an eye on the “Extra Extra” section of this blog for similar opportunities.
- Horton R. WHO’s Phoney War. Lancet 2016;387:2276.
- Paploski IA, Prates AP, Cardoso CW, et al. Time Lags between Exanthematous Illness Attributed to Zika Virus, Guillain-Barre Syndrome, and Microcephaly, Salvador, Brazil. Emerging infectious diseases 2016;22.
- Gold CA, Josephson SA. Anticipating the Challenges of Zika Virus and the Incidence of Guillain-Barre Syndrome. JAMA Neurol. Published online June 06, 2016. doi:10.1001/jamaneurol.2016.1268.