WASHINGTON -- Public health officials explained to a Senate panel on Wednesday how the federal money they have been seeking since February would be spent.
"Our bottom line is we're trying to do everything we can to protect pregnant women," Rear Adm. Anne Schuchat, MD, principal deputy director at the CDC, told a roundtable meeting of the Senate Committee on Homeland Security and Governmental Affairs.
She and other witnesses explained the need for increasing resources to scale up research on the virus, develop vaccines, improve diagnostic tests, ramp up mosquito control, and expand access to contraception.
The discussion took place 1 day after Senate Democrats blocked a $1.1 billion bill to fight the virus. Democrats argued that the bill was loaded with "poison pills" including provisions that would limit contraception availability, according to The New York Times.
To date, there are 481 pregnant women in the U.S. and its territories with laboratory-confirmed Zika, Schuchat said.
Schuchat noted that delays in diagnosis are a significant concern for pregnant women. The "shipping-testing-confirming" cycle -- which can involve multiple types of tests -- can leave some women waiting weeks to learn their infection-status.
"We don't know how to prevent Zika, but we know how to prevent pregnancy," said Christopher Zahn, MD, vice president of practice activities at the American College of Obstetricians and Gynecologists (ACOG), quoting CDC director Tom Frieden, MD, MPH.
"Access to contraception both domestically and abroad is crucial to address this issue," he added.
Zahn then described the challenge facing his members who are on the front-lines counseling pregnant patients who have the virus, and patients who want to travel and also get pregnant.
"We're trying to provide answers based on very limited evidence," he said.
Zahn noted that the risk that an infected woman's fetus will be affected is estimated at 1% to 13%, depending on the time of infection, although small studies from Brazil are suggesting it could be as high as 29%.
To put those figures in perspective, the risk of a congenital heart defect is roughly 1%, he added.
David O'Connor, PhD, professor of pathology and laboratory medicine at the University of Wisconsin in Madison, who has been examining the impact of the virus in primate models, agreed that the virus is "understudied" and needs more research.
Then he shared what he did know.
Recent Findings
First, he noted that the virus appears to persist in the blood for "considerably longer" in pregnant women than in non-pregnant humans and monkeys.
In pregnant nonhuman primates, infected with the virus, about three-fourths have shown an "extended duration" of virus in the blood, "which we hypothesize is due to the fetus being infected and shedding virus back into the mother's bloodstream."
For O'Connor, these results would suggest that fetal infection could have impacts beyond microcephaly.
"Microcephaly is very vivid, its very obvious, it's tragic, but what we don't know right now is what the spectrum of other Zika-associated birth defects might include," he said.
Schuchat also noted that babies who are born "looking healthy" could face developmental problems later on.
Since most infants whose mothers were infected with the virus are 1 year old at most, O'Connor said mild but significant issues may be discovered as these infants reach developmental milestone and will need to be addressed.
O'Connor also noted that some scientists are seeing a relationship between Zika and another mosquito-born illness, dengue. Researchers have noted that a history of dengue infection appears to predispose individuals to worse Zika outcomes.
"We don't know if the reciprocal might be true, if people who are infected with Zika or eventually receive a Zika vaccine [once one is available] are going to be at increased risk for a severe dengue complication."
Recommendations
For those women who are trying to get pregnant and have been infected, Zahn said that ACOG currently recommends delaying sexual activity for 8 weeks, Zahn said. For men, the group recommends waiting 6 months, because evidence suggest that the virus persists longer in semen than the bloodstream.
"For pregnant women with positive or inconclusive tests we also recommend doing serial ultrasounds to look for the impact" of the virus, he said.
He noted that, even with all this testing, determining whether a fetus has been affected, even at 30 or 40 weeks, is challenging.
Schuchat told MedPage Today that travelers to Zika-infected areas should continue to take precautions against mosquito bites for 3 weeks following their return to the U.S., "to protect the mosquitoes around your home from the virus that you might be silently carrying" and that might then transmit it to other people.
Zahn stressed, "We need resources to be able to look at protection and prevention strategies and treatment efforts," including vaccines, he noted, even though those efforts may take a few years to pay off.
In February, the White House requested $1.9 billion in emergency funding to combat the virus.
In April, seeing Congress' lack of action, the administration redirected $589 million, originally budgeted to fight Ebola, towards Zika research and prevention.
Democrats and Republicans appear now to be at an impasse and are unlikely to agree on legislation before the July 4 recess. And any bill would have to be approved in the House.
Public Health Experts to Senate: Here's What We Need on Zika
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