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Zika stands to infect 4 million Americans by the end of the year, and the number of children born with conditions related to the disease may one of the biggest impacts on child health care since HIV and AIDS in the 1990s.
That is the verdict drawn by Peter Hotez, the dean of Baylor College of Medicine's National School of Tropical Medicine, in a special communications article published online by JAMA Pediatrics. Hotez called Zika "the virus from hell," for what it does to the developing brains of unborn babies.
The birth defect known as microcephaly has been widely publicized since public health officials connected it to the virus earlier this year. However, doctors and scientists are just beginning to grasp the range of effects the disease has on fetuses and developing children, and that microcephaly is just the "tip of the iceberg," Hotez said.
Zika causes microcephaly because it attacks the stem cells that become brain cells. In babies affected by the virus, the brain simply does not develop. The developing skull simply "implodes" around the brain, which is only developing minimally.
"So I think people don't often appreciate how devastating Zika virus is," Hotez said. Because the virus appears to attack the neural stem cells, there is a range of potential effects beyond microcephaly that are possible, and that we simply have not seen yet. Children may even be vulnerable to the effects if they are infected after they are born, since the brain continues to develop in infancy.
Hotez said he fears the disease is already gaining a foothold in the Gulf Coast region and is calling for more monitoring of vulnerable areas.
"My concern is that Zika could already be here on the Gulf Coast, it is just that nobody is looking, because none of the country and local health departments have funding to conduct active surveillance," Hotez told CNBC in an interview. "So I am quite worried that Zika is already here, and that we have no programs in place to actively look for it."
There are three things that contribute to a Zika outbreak: the presence of the Aedes aegypti mosquito, crowded human dwellings, and poverty. The Asian tiger mosquito, Aedes albopictus, is also capable of spreading the disease, but is far less efficient than its relative.
All three conditions are present in many cities across the Gulf Coast of the United States. The combined population of Houston and Galveston, Texas, along with New Orleans and the entire state of Florida total about 60 million people, the article noted. Out of that, about 1 million pregnancies could be at risk for the virus.
This includes educating the public about getting tests for the disease if symptoms such as fevers arise, as well as more aggressively testing mosquito populations. It is also going to require a cohort of pediatricians and pediatric neurologists to sort out the effects, and new programs will need to be put in place to assist the children who live with the effects of the disease.
Hotez has been studying the potential economic effects of the disease with a group of colleagues from Johns Hopkins and Yale. They have not published their findings yet, but Hotez told CNBC that "if we get significant attack rates on the Gulf coast, the costs could run into the billions of dollars."
Hotez is also skeptical that a vaccine will come to market any time soon, despite news reports on Monday that one has been approved for human trials.
"Yes, we are going to move very quickly into phase one clinical trials in healthy adult volunteers — I don't doubt that," he said. "The thing that is not being said is that things are going to grind to a screeching halt after that."
We know this virus can cause Guillain-Barre syndrome in some people," which is an autoimmune disease, he said. "So the FDA will almost certainly require prolonged studies to show that this vaccine also does not cause Guillain-Barre."
In addition, the most likely candidates for the vaccine will be pregnant women and women who are trying to become pregnant. "And if you think of a regulatory hurdle," Hotez added, proving the vaccine is safe for those women "is the highest bar there is."
"It is a long way of saying, we are not going to have a vaccine in time for this epidemic," he said.