A Guam visit to battle Zika virus and discover new mosquitoes

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There are few places on earth where you can search in water-filled canoes for one of the most dangerous mosquitoes on the planet less than a stone’s throw from tourists posing for selfies alongside their inflatable novelty swans in the nearby lagoon.

Guam is the place to go if you need to tick that off your “to do” list!

I was fortunate to be invited to speak at the Pacific Island Health Officers Association (PIHOA) Regional Zika Summit and Vector Control Workshop in Guam 25-29 June 2017. The theme of the summit was “Break Down the Silos for Preparedness and Management of Emergencies and Disasters in United States Affiliated Islands” and had objectives to critical analyze the regional responses to recent mosquito-borne disease outbreaks while developing policies to strengthening public health emergency response and preparedness systems and capabilities within the region.

The tranquil lagoons of the Pacific Islands may seem a very long way from the hustle and bustle of the busy South American cities that held the 2016 Olympics but just as Zika virus was grabbing the attention of sports reporters everywhere, health authorities active in the Pacific were growing concerned too.

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The Pacific has been far from free of mosquito-borne disease outbreaks. Previous outbreaks of dengue, chikungunya and even Ross River virus had struck numerous times. While sometimes widespread, at other times outbreaks were more sporadic or isolated. As is the case for many non-endemic countries, outbreaks are prompted by movement of infected travelers and the prevalence of local mosquitoes.

Across the region there are four mosquitoes of primary concern, Aedes aegypti, Aedes albopictus, Aedes polynesiensis and Aedes hensilli. The greatest concerns are associated with Aedes aegypti and in those countries where the mosquito is present, the risks of mosquito-borne disease outbreak are greatest. For this reason alone, it is imperative that good entomological surveillance data is collected to confirm the distribution of these mosquitoes but also to develop strategies to eradicate, where possible, Aedes aegypti should it be introduced to new jurisdictions.

With a growing interest in developing mosquito surveillance and control programs for exotic mosquitoes here in Australia, it was a perfect opportunity for me to get a closer look at how the threats of these mosquitoes and associated outbreaks of disease are managed.

On the third day of the meeting, vector control took centre stage. A brilliant day of talks from each of the jurisdictions on the disease outbreaks they’ve faced and how they’re preparing for future threats. There were presentations from the United States Affiliated Pacific Islands (USAPI) including Guam, the Federated States of Micronesia (Yap, Kosrea, Chuuk, Pohnpei), the Commonwealth of the Northern Marianas (CNMI), the Republic of Palau, the Republic of Marshall Islands (RMI), and American Samoa.

Hearing from these teams doing their best to protect their local communities from the threat of mosquito-borne disease, with only limited resources, was quite eye opening. There was passion and dedication but each territory faced unique challenges to ensure the burden of disease is minimised.

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Just outside the workshop venue were a series of water-filled canoes. Most contained larvae!

There is little doubt that climate variability will have a strong role to play in the impacts of mosquito-borne disease across the region in the future but there are so many other issues that could be contributing to increased risk too. One of the biggest problems is rubbish.

Time and time again, the issue of accumulated waste, especially car bodies and discarded tyres, was raised as a major problem. As many of the key pest mosquitoes love these objects that trap water, treatment of these increasing stockpiles becomes more of a concern. Community wide cleanups can help reduce the sources of many mosquitoes but the rubbish more often than not remains on the island and requires continued management to ensure is not becoming a home to millions of mosquitoes.

It is a reminder that successful mosquito control relies on much more than just insecticides. An integrated approach is critical.

There was a “hands on” session of surveillance and control. Coordinated by PIHOA’s Eileen Jefferies and Elodie Vajda, the workshop was a great success. It provided an opportunity for many to see how to prepare ovitraps and BGS traps (one of the most widely used mosquito traps) and discuss the various considerations for choosing and using the right insecticides to reduce mosquito-borne disease risk. Workshop attendees were also the luck recipients of a selection of cleaver public awareness material produced in Guam, from personal fans and anatomically incorrect plush mosquitoes to Frisbees and mosquito-themes Pokemon cards!

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Guam “mozzie” team: Elodie Vajda, Claire Baradi, Michelle Lastimoza, Eileen Jefferies and me

Following the summit, there was a chance to visit the new Guam “Mosquito Laboratory”, newly established as part of the Guam Environmental Public Health Laboratory (GEPHL). I’ll go out of my way to visit any mosquito laboratory but I was particularly keen to see this one as one of my previous students was playing a key role in establishing the mosquito rearing and identification laboratories. Elodie has been doing an amazing job and it was brilliant to geek out with her over some hard core mosquito taxomony as we tried to ID a couple of tricky specimens. [Make sure you check out our recent paper on the potential impact of climate change on malaria outbreaks in Ethiopia]

It actually turned out that one of their “tricky specimens” was a new species record for Guam – an exotic mosquito Wyeomyia mitchellii! The paper reporting this finding has just been published “New Record of Wyeomyia mitchellii (Diptera: Culicidae) on Guam, United States“.

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Mosquito-borne disease in the Pacific isn’t going anywhere and it’s important that once the focus fades from Zika virus, dengue and chikungunya viruses will again take centre stage and their potential impacts are significant. With the added risks that come with gaps in the understanding of local pest and vector species, the prevalence of insecticide resistance among local mosquitoes, climate variability and a struggle to secure adequate funding, challenges lay ahead in ensuring the burden of mosquito-borne disease doesn’t increase.

A modified version of this article appears in the latest issue (Winter 2017; 12(1)) of Mosquito Bites Magazine, (a publication of the Mosquito Control Association of Australia)

 

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Summer summary of mosquito media madness

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Summer is always a busy time for me. As well as plenty of time sloshing about in the wetlands, there is often lots of interest from mosquito-curious media. There has been some intense bursts of activity in previous summers but the 2015-2016 was particularly interesting.

I certainly covered some new ground this summer. I responded to over 160 individual media requests in the past 6 months. From flies and food safety to the emergence of Zika virus. Here is a wrap from my media adventures and some valuable lessons learned for future science and public health communication.

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The good news of new virus discoveries

Usually, the discovery of a new mosquito-borne virus brings with it new concern for public health. This time though, there was some good news.

Towards the end of 2015, a paper reporting on a collaborative research project between University of Queensland, QLD Health and University of Sydney was published in Virology. This was the first publication detailing the discovery of Parramatta River virus, an insect specific virus that exclusively infects the mosquito Aedes vigilax. This virus does not infect people and poses no health risk.

A joint media release was issued by University of Queensland and University of Sydney and there was plenty of media attention. Not surprising given the usual negative associations with mosquito-borne pathogens!

There were dozens of articles, much of the attention focused on the team at University of QLD. Dr Jody Hobson-Peters was kept busy with local media including ABC and Brisbane Times. It was a great experience sharing the research with colleagues in Queensland, particularly great seeing so much exposure for PhD student Breeanna McLean and her newly published research.

I was surprised at how little attention there was in the news from Sydney media. The lesson here though was more about bad timing than uninteresting research. A couple of weeks after the initial media release, I forwarded around a few emails and sent out a couple of tweets and next thing you know, we made the front page of the local newspaper, the Parramatta Advertiser (see above). It was some great local coverage, not only about the virus discovery but it also provided an opportunity to raise awareness of mosquitoes and mosquito-borne disease on the eve of summer!

Lesson learned: A good reminder that if your research isn’t picked up immediately, give it another shot a few weeks later. Timing may make all the difference but perseverance does too!

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To stop sickness, swat or spray

Just in time for Christmas lunch and summer holiday picnics, I published an article on flies and food safety at The Conversation. I really expected this article to slip under the radar of most people. Coming out on Christmas eve doesn’t seem likely many would be clicking about on the internet but within a few days over 600,000 people had clicked on the piece!

Many of those clicks were thanks to the article being shared by IFLS but there was also plenty of interest from local media and I was busy with interview requests from ABC Local Radio across the country. Who doesn’t love hearing about how flies poop and vomit on your food? I was even interviewed by Grey Nomad Magazine!

Lesson learned: Applying a little science to seasonal urban myths and common uncertainties can prove popular and may be a good opportunity to promote a little science!

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Rain, rain everywhere with mozzies soon to come

With all the talk of El Nino and predictions of a hot and dry summer for the east coast of Australia, the summer was actually reasonably mild and extremely wet. Sydney was particularly battered by a series of storms and intense rainfall early in 2016.

More water generally means more mosquitoes. In response to the rain, many media outlets were interested in chatting about the prospects of a bumper mosquito problem. As well as talking about the prospects of an increase in mosquito-borne disease risk, it was a great opportunity to talk about personal protection measures.

There were some radio, print and tv spots that provided opportunities to talk about how to choose and use the right repellents.

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In 2015 I published a paper in the Medical Journal of Australia explaining that health authorities need to provide more guidance on how the community can get mosquito repellents working more effectively.

Typical health warnings and media release from health authorities (usually limited to grabs on news bulletins) but when there is an opportunity to do longer form radio interviews, there is a chance to put an emphasis on aspect of public health messages. The hook to get these longer spots is giving more than just warnings, by mixing up some interesting things about mosquitoes, you can catch a little extra attention and sneak in the public health messages between the fun and fascinating facts about mosquitoes!

One news outlet was really insistent in grabbing a hold of me for some comments ahead of the evening bulletin. They even sent a crew to meet me in the city while I was taking the kids along to the Sydney Festival!

Lesson learned: When doing tv for the evening news, it is ok to wear a t-shirt, shorts and runners just so long as you have a rain jacket handy to make you like like you could have just stepped straight out of the wetlands!

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From African forests to South American cities

While many of us were keeping our eyes on the developing outbreak of mosquito-borne Zika virus in South America towards the end of 2015, it wasn’t until February 2016 that the situation really grabbed the attention of the world’s media.

In late January, I published a piece at The Conversation titled “Does Zika virus pose a threat to Australia?” It prompted a little interest but it was the media conference coordinated by University of Sydney Media and Communications together with Australian Science Media Centre (AusSMC) that coincided with the announcement of the World Health Organization that the Zika virus outbreak was a Public Health Emergency of International Concern.

Together with colleagues from the University of Sydney’s Marie Bashir Institute of Infectious Disease and Biosecurity, I spoke at a media conference broadcast nationally on ABC News 24. There was a huge amount of media stories stemming from this media conference with over 500 individual articles identified across radio, tv, print and online. During the days and weeks following, I felt like I was spending more time at the ABC studios in Ultimo than I was in our lab! There were days when I spent hours on the phone doing radio interviews.

There were a couple of great longer form interviews that I really appreciated the opportunity to contribute to such as ABC Radio National’s Health Report and Rear Vision. There were also a couple of podcasts too, check out Science on Top and Flash Forward.

This flood of media requests also exposed me to a few more new experiences. There were live tv appearances on Sunrise, ABC News 24 and Sky News but probably one of the most interesting was my spot on Channel Ten’s The Project. It was interesting for a number of reasons.

Firstly, I was warned early on that one of the guests on the panel was comedian Jimmy Carr, a somewhat controversial figure notorious for jokes a little too close to bad taste. I’m not typically one to play the “wacky scientist” during interviews but what I was most cautious of was not being seen to be treating a very serious disease outbreak too lightly. I was determined to play the straight guy. In the end the interview turned ok but there were a couple of awkward moments that, luckily, ended up being edited out.

Secondly, simply doing the interview was unusual. It was a pre-recorded interview with me in a tiny room at the Channel Ten studio in Sydney and the panel in the Melbourne studio. I was sitting in front of a green-screen, staring down the camera with an earpiece blasting away in my ear. I have done live crosses before but they’re all been one-on-one interviews. This time it was with the panel and I found it incredibly difficult to get the feel for each of the panelists when they were asking questions. Missing that eye-to-eye contact was a disconcerting experience. Luckily, all turned out well in the end.

Lesson learned: Lots (I mean LOTS) learned while dealing with the interest in Zika virus! Probably another post in itself…but I would say that managing this volume of media wasn’t easy and it did eat up a lot of time (even though communicating public health messages is central to my “day job”) but this was important work.

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A morning with Dr Karl!

When it comes to science communicators in Australia, there are few with a higher profile than Dr Karl Kruszelnicki. We’d spoken on a number of occasions about mosquitoes but I’d never actually met him in person before. “Dr Karl” invited me to hang out for a morning recording interviews for ABC News 24, ABC Local Radio and also guest on his national “Science Talk” segment on Triple J’s Mornings Show with Zan Rowe.

The experience of a behind-the-scenes perspective on Karl’s hectic schedule and how he manages the frenetic pace of work at the ABC was an eye opener. Doing the hour long segment on Triple J was great, enlightening to get questions from a slice of the Australian community I don’t usually cross paths with when doing the usual community engagement. I good reminder of just how much anxiety there can be within the community when news of international disease outbreaks occur. Not surprising given the thousands of Australians travelling to South America each month….with more to come later this year when the Rio Olympic Games kick off!

You can listen to the segment here and you can also follow Dr Karl on Twitter.

Lesson learned: From a public health perspective, this is a great reminder that the concerns and anxieties around infectious disease can change depending on the sector of the community you’re dealing with. The core messages may remain the same but you’ll always need to consider your audience when fine tuning your public health messages.

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So, was all this worth it?

It was stressful. It was fun. It eroded much of my time that may have been spent in other ways but I see this as “doing my job” perhaps a little more than pure research scientists do. But how does all this convert into tangible metrics. How do you measure the reach and economics of all these media activities?

I’m fortunate to be supported by the University of Sydney media and communications team that helps out by providing some data on the metrics of my media activities each summer. What was all this time and effort worth?

Between November 2015 and Match 2016, I was quoted in over 160 media items. This adds up to a cumulative audience of around 8.9 million people, that is quite some reach! How much was it worth? Based on current advertising rates, about $1.6 million.

I’ve written before about how we can better value science and public health communication. Collecting these types of metrics can be useful for a range of purposes. Recently, I’ve been including media engagement as an “in kind” contribution to grant applications with valuation calculated on average media coverage that may be expected.

The lesson here is to take the time to record your media activities, not just so you have a list to demonstrate quantity but also so you can assess audience and value to your media activities. Work with your media and communications departments to see what extra information you can collect.

Got any other tips? Share them via Twitter!

 

 

 

 

 

Can social media help translate research to practice and promote informed public health messages?

I’m a Senior Investigator with the Centre for Infectious Diseases and Microbiology – Public Health. One of our primary focuses is translating research into improved public health outcomes. With NSW Population Health and Health Services Research Support Program assisting our work, we’re exploring new ways to achieve this objective. My experience of using social media was selected to be showcased among other case studies in 2015. 


Nuisance-biting mosquitoes and mosquito-borne disease are concerns for local authorities in Australia. 2015 saw the largest outbreak of mosquito-borne Ross River virus disease for more than 20 years with over 9,500 cases nationwide. In NSW, there were 1,633 cases compared to the annual average since 1993 of 742 cases per year. Notwithstanding the current outbreak, other endemic, as well as exotic, mosquito-borne pathogens represent future threats to public health.

As there is no large-scale mosquito control program in NSW, reducing the contact between mosquitoes and people is primarily achieved through the promotion of personal protection measures. NSW Health promotes the use of topical insect repellents in combination with behavioural change to avoid natural mosquito habitats and the creation of mosquito habitats around the home. This information is typically provided in the form of posters, brochures, online factsheets, and seasonal or outbreak-triggered public health messages issued by Local Health Districts or the NSW Ministry of Health.

With the emergence of new communications technologies, particularly the rise in popularity of social media, there are new opportunities for public health communications.

The aim of the current research was to determine the reach of public health messages through social media by tracking engagement, audience and relative value as assessed by media monitoring organisations and metrics provided by hosting services of social media platforms.

Assessing activities and processes

Dr Cameron Webb (CIDM-PH) has focused much attention on filling the gaps between current public health messages and findings from recent research into topical mosquito repellents.[1] For example, while public health messages provide accurate information on the insect repellents that provide the best protection, there is a paucity of information provided on how best these products should be used by individuals and those they care for.

Dr Webb’s engagement with mass media, online media (e.g. The Conversation), a personal blog (e.g. Mosquito Research and Management) and social media (e.g. Twitter) has resulted in substantial exposure of focused and informed public health messages. From mid-2014 through to the end of 2015, Dr Webb participated in over 80 mass media articles and interviews in print, online, radio and television media with public health information reaching an estimated audience of over 10 million people.[2] The focus of his messaging around mosquito-borne disease was to highlight the best way for the community to choose and use mosquito repellents; stressing the importance of active ingredients and application methods. This fills a gap in the current provision of public health information while also augmenting public health alerts and messages associated with the 2015 outbreak of Ross River virus disease.

Social media has become a “go to” source of information for much of the community. Information shared on Facebook, Twitter, Instagram, and YouTube has the potential to shape the habitats and behaviour of the community. Dr Webb is active on Twitter (currently followed by over 4,500 people); he uses the platform to engage with the social media accounts of journalists and broadcasters to establish a voice of authority in the field of mosquito-borne disease prevention and extend the reach and exposure of public health messages broadcast through mass media. Using Twitter to share links to informed articles following interviews reached hundreds of thousands of people by being shared by the social media accounts of journalists, media outlets, government organisations and community groups. During the 2014-2015 summer, tweets by Dr Webb reached an estimate 1.28 million people.[3]

Dr Webb regularly writes open access articles on his website, attracting around 250 daily visitors with over 117,000 article views.[4] In addition to his personal website, Dr Webb regularly contributes articles to The Conversation (a website for academics to share expert opinion and write about their latest research). His articles have attracted over 120,000 readers. However, one article “why mosquitoes seem to bite some people more” (published 26 January 2015) has alone been read by over 1.3 million people.[5] This “non-scholarly” writing not only establishes CIDM-PH scientists as authorities in public health matters but can also assist in directing the public to official health guidance provided on official websites and other sources.

Dr Webb’s activities provide a framework for how health authorities may engage with social media to extend public health messages. Organisations or individuals can connect health authority information with the community through media outlets. He has been invited to share his experiences in this field at local and international conferences and workshops including those coordinated by the Public Health Association of Australia, Australian Entomological Society and Entomological Society of America. In addition, Dr Webb has been invited to provide lectures on the benefits of social media for public health advocacy to undergraduate and post-graduate students at the University of Sydney.

While traditional messaging provided by health authorities will remain a staple in public health campaigns, social media provides a connection between traditional and emerging media and communication organisations. This increased connectivity between public health advocates, the media and community has the potential to greatly improve the awareness of mosquito-borne disease and increase the rate of uptake and application of strategic personal protection measures.

References

  1. Webb C.E. (2015). Are we doing enough to promote the effective use of mosquito repellents? Medical Journal of Australia, 202(3): 128-129.
  2. Estimated audience reported by Kobi Print, Media and Public Relations, University of Sydney, 23 April 2015, based on data provided by media monitoring organisation isentia.
  3. Estimated from total “tweet impressions” for the period October 2014 through April 2015 provided by Twitter Analytics (https://analytics.twitter.com/user/Mozziebites/home accessed 30 April 2015)
  4. Data provided by WordPress statistics (accessed 18 December 2015)
  5. Data provided by The Conversation metrics (accessed 18 December 2015)

This article was originally published by NSW Health showcasing some of the work within the NSW Population Health and Health Services Research Support Program. You can see the original article here.

Zika virus: Resources, references and recommendations

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The following is a collection of almost 100 links to news stories, resources, references and recommendations associated with mosquito-borne Zika virus and the current outbreak in the Americas.

What is Zika? What are the health threats and why an outbreak now?

Zika virus (CDC). Essential resource. Click.

Zika virus (WHO). Essential resource. Click.

Zika virus spreading explosively, says World Health Organisation (The Guardian). Coverage of statement by WHO Director General that the explosive outbreak of Zika virus in the Americas as “deeply concerning” and that an emergency committee has been convened. Click.

WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain-Barré syndrome (WHO). Click.

Zika virus declared a global health emergency by WHO (ABC News). Click.

Zika Virus Spreads to New Areas — Region of the Americas, May 2015–January 2016 (CDC). Click.

WHO early response to Zika virus praised by Australian experts (The World Today). Click.

First report of autochthonous transmission of Zika virus in Brazil (Memórias do Instituto Oswaldo Cruz). Click.

How a Medical Mystery in Brazil Led Doctors to Zika (New York Times). A summary of how health officials investigating a spike in cases of birth defects put together the link to a mosquito-borne disease. Click.

Explainer: where did Zika virus come from and why is it a problem in Brazil? (The Conversation). A good, brief summary of the emergence of Zika virus in Brazil and the health risks it poses. Click.

Zika virus outbreak: What you need to know (New Scientist). A good summary of issues associated with Zika virus outbreak. Click.

Zika outbreak: What you need to know (BBC). A good summary of what is known of Zika virus and its health risks. Click.

What to Know About Zika Virus (The Atlantic). Click.

Zika virus, explained in 6 charts and maps (Vox). Useful collection of infographics on Zika virus, current and historic outbreak distributions and health impacts. Click.

An Illustrated Guide To The Zika Outbreak (Huffington Post). Click.

Why it’s wrong to compare Zika to Ebola (The Conversation). Whats the difference between Ebola and Zika viruses? What are the implications of outbreaks and declarations of public health emergencies? Click.

Zika fever: panic won’t help us (The Guardian). Editorial highlighting the horror and unexpectedness of the Zika virus outbreak in Brazil and how we should move forward in mosquito control. Click.

What we still don’t know about Zika virus (Mashable). There are plenty of gaps in our understanding of Zika virus. Click.

The human cost of Zika is clear, but will Brazil’s economy suffer too? (The Conversation). Outbreaks of infectious diseases can have greater impacts than the human illness alone. Click.

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Zika virus and its vectors

Mosquitoes: The Zika vector (Radio National). Why do we need to know how many mosquitoes can spread Zika virus and what is it about the mosquitoes that do that make them such an important pest? Click.

Natural-born killers: mosquito-borne diseases (SMH). What is it that makes mosquitoes such effective vectors of pathogens? Click.

Zika Virus in Gabon (Central Africa) – 2007: A New Threat from Aedes albopictus? (PLOS Neglected Tropical Diseases). Click.

Oral Susceptibility of Singapore Aedes (Stegomyia) aegypti (Linnaeus) to Zika Virus (PLOS Neglected Tropical Diseases). Click.

Aedes (Stegomyia) albopictus (Skuse): A Potential Vector of Zika Virus in Singapore (PLOS Neglected Tropical Diseases). Click.

Potential of selected Senegalese Aedes spp. mosquitoes (Diptera: Culicidae) to transmit Zika virus (BMC Infectious Diseases). Click.

Genetic Characterization of Zika Virus Strains: Geographic Expansion of the Asian Lineage (PLOS Neglected Tropical Diseases). Click.

Molecular Evolution of Zika Virus during Its Emergence in the 20th Century (PLOS Neglected Tropical Diseases). Click.

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The spike in cases of microcephaly and its suspected links to Zika virus infection of those pregnant has been raising greatest concern. (Image: BBC)

Zika virus, pregnancy and microcephaly

Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015 (CDC). Click.

Microcephaly in Brazil: is it occurring in greater numbers than normal or not? (Virology Down Under). Great post highlighting the gaps in our understanding of links between microcephaly and Zika virus. Click.

Proving that the Zika virus causes microcephaly (The Conversation).  What questions must be answered to confirm a link between Zika virus and microcephaly. Click.

Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016 (CDC). Click.

CDC: Link between Zika, microcephaly looks “stronger and stronger” (Reuters). Click.

Facts about Microcephaly (CDC). What are the impacts, causes and treatments associated with microcephaly? Click.

Zika virus outbreak raises Pacific, Americas travel concerns for pregnant women (Stuff NZ). Implications for those travelling in Pacific while pregnant. Click.

Safely avoiding mosquito bites when pregnant (Mosquito Research and Management). My tips on safe and effective avoidance of mosquito bites while pregnant. Click.

13 Things Pregnant Women Should Actually Know About Zika (Buzzfeed). Some good advice, most importantly, don’t panic. Don’t even panic if you’re pregnant and bitten by a mosquito. Click.

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Zika virus and the threat to Australia

Does Zika virus pose a threat to Australia? (The Conversation). An overview of why, and why not, Zika virus poses a risk to Australia. Click.

The Threat to Australia: The Rise Of Zika Virus (Popular Science). Article from 2014 highlighting potential risk to Australia of Zika virus following detection of imported cases. Click.

Zika Virus Explained: Aussie Mozzies, Bali Risks And Pregnancy (Huffington Post). Good summary of risks posed to Australia and Australian travellers. Click.

Zika virus: Risk of a widespread outbreak in Australia ‘low’, experts say (ABC News). A summary of reasons why there won’t be a major outbreak of Zika virus in Australia. Click.

Zika talkback with Dr Karl on Triple J (ABC). I join Dr Karl for talkback on Zika virus, advice to travellers and the risks of outbreak in Australia. Click.

Zika virus alert (NSW Health). Factsheet on Zika virus and risk to NSW. Click.

Little chance of Zika outbreak in NSW (Sky News). There is unlikely to be a major outbreak of Zika virus across Australia’s most populated region. Click.

Two Aussies confirmed with Zika as US records first case of virus transmitted through sex (The Mercury). Click.

Zika virus mosquitoes found in Sydney: Airport increases insecticide spraying of incoming passengers (Daily Telegraph). Report of recent detection of Aedes aegypti at Sydney airport by Department of Agriculture and Water Resources. Click.

Queensland announces $1.4 million program to fight Zika. (Brisbane Times). Queensland authorities announce response plan; increasing monitoring and research into Zika virus.  Click.

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Zika virus entering Australia

Zika virus and Travel Alert for Australians (Smart Traveller). Click.

Imported Zika Virus Infection from the Cook Islands into Australia, 2014 (PLOS Current Outbreaks). Click.

Zika Virus Infection Acquired During Brief Travel to Indonesia (Am J Trop Med Hyg). Published report from 2013 of Australian traveller exposed to Zika virus in Indonesia. Click.

Aussie diagnosed with Zika after Bali monkey bite, experts warn of missed cases (SMH). Report of 2015 case os suspected infection following monkey bite in Bali. Click.

Zika Virus Infection In Australia Following A Monkey Bite In Indonesia (Southeast Asian Journal of Tropical Medicine and Public Health). Abstracted from published case report of suspected Zika virus infection following monkey bite. Click.

Six cases of Zika virus in Australia last year as pregnant women warned not to travel (SMH). Summary of recent imported cases of Zika virus infection in Australian travellers. Click.

Health Department confirms WA Zika case (The West Australian). Report of imported case of Zika virus infection in returning traveller to Western Australia. Click.

Zika virus: Queensland woman, child confirmed as contracting illness (ABC News). Imported cases of Zika virus infection with travellers returning to QLD from El Salvador. (ABC News). Click.

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Zika outbreaks in the Pacific

Zika Virus Outside Africa (Emerging Infectious Diseases). Summary of outbreaks in regions outside Africa with specific discussion of the first outbreak in Pacific. Click.

Zika Virus Outbreak on Yap Island, Federated States of Micronesia (New England Journal of Medicine). Click.

Zika virus: following the path of dengue and chikungunya? (The Lancet). Good paper, including useful maps, of activity of three critical mosquito-borne pathogens. Click.

Rapid spread of emerging Zika virus in the Pacific area (Clinical Microbiology and Infection). Publication reporting on the 2013 outbreak of Zika virus in the Pacific. Click.

Notes on Zika virus – an emerging pathogen now present in the South Pacific (Australian and New Zealand Journal of Public Health). An article assessing the risks of Zika virus to New Zealand. Although no suitable vectors exist there, a relatively larger volume of infected travellers would be expected to occur given the strong links to Pacific Islands. Click.

Tonga declares Zika outbreak (Sky News). Zika is impacting more regions than the Americas in 2016. Click.

Australia to help Pacific fight Zika (SBS News). How can Australian authorities take their expertise in mosquito monitoring, mosquito control and vaccine development to assist outbreak of Zika virus. Click.

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Zika virus and sex: An unusual route of transmission

Probable Non–Vector-borne Transmission of Zika Virus, Colorado, USA (Emerging Infectious Diseases). First documented case of transmission of Zika virus through direct contact between people. Click.

Potential Sexual Transmission of Zika Virus (Emerging Infectious Diseases). Publication from 2015 on suspected sexual transmission of Zika virus. Click.

Zika virus infection ‘through sex’ reported in US (BBC). Suspected case of sexually transmitted Zika virus in Texas in 2016. Click.

CDC: To avoid Zika exposure, consider no sex (The Washington Post). Coverage of CDC guidance on avoiding sexual transmission risk of Zika virus. Click.

Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016 (CDC). Click.

Zika: Why the virus isn’t an STI despite being passed on after sexual contact (Independent).  Only where sex is the predominant route of transmission, and the infection is maintained in the human population by sexual transmission, is a pathogen considered a STI and that definition does not apply to Zika virus. Click.

Brazil finds Zika in saliva, urine; expert warns against kissing (SMH). Detection of Zika virus in saliva and urine doesn’t necessarily mean these are pathways of transmission. Authorities advising against kissing? Click.

Zika and the 2016 Rio Olympics

Zika Outbreak Means It Is Now Time To Cancel Rio Olympics (Forbes). Is the threat of Zika virus really so great that the Rio Olympics should be cancelled? Click.

NYU Bioethicist, Amid Zika Threat, Wants to Reschedule Rio Olympics: ‘What the Hell’s the Difference?’ (New York Magazine). With so many unanswered questions, and little confidence the outbreak is under control, is it really ethical to go ahead with the Rio Olympics? Click.

Brazil minister says no plans to cancel Rio Games (AP). Click.

Zika virus will not hamper Rio Olympics says IOC president Thomas Bach (ABC News). Click.

IOC says it will issue advisory on Zika virus spreading across South America ahead of Rio Olympics (ABC News). Click.

Zika crisis and economic woes bring gloom to Brazil’s Olympic buildup (The Guardian). Click.

Zika scare: Olympic athletes need mosquito nets as Bushman sponsors team (SMH). Click.

Zika Virus Rio Olympics: How Australian Athletes Will Fight Potential Infection (Huffington Post). Click.

Bushman named as official insect repellent of Australian Olympic team (mUmBRELLA). One of Australia’s leading mosquito repellent manufacturers to support the athletes and officials travelling to Rio Olympics. Click.

MosquitoControl_Brazil_Getty_AFP_ERNESTO_BENAVIDES

Battling mosquitoes and the Zika virus outbreak

How Can We Slow The Epidemic Of Zika Infections? (Forbes). Now that the outbreak of Zika virus has been documented, what strategies are available to slow the spread and increasing numbers of cases? Click.

The world needs a Zika vaccine: Getting one will take years (STAT). We won’t have a Zika virus vaccine anytime soon. Here is an explanation why. Click.

Brazil Zika virus: ‘War’ declared on deadly mosquitoes (BBC). How are authorities battling the outbreak of Zika virus in Brazil? Click.

Mosquito Wars Update: Would You Choose GMO ‘Mutants,’ Pesticides Or Dengue And Zika Viruses? (Forbes). The outbreak of Zika virus has focused the attention of health authorities on options for future mosquito-borne disease management strategies. Click.

Brazil sends in 200,000 soldiers to stop the spread of the Zika virus outbreak which has seen huge numbers of babies born with small heads and cast a shadow over the Olympics (Daily Mail). Click.

Here’s what it will take to stop the Zika virus (Vox). Summary of critical issues to address to better understand and stop the Zika virus outbreak. Click.

Curbing Zika Virus: Mosquito Control (Popular Science). Well supported article on options for mosquito control and mosquito-borne disease management. Click.

7 ways the war on Zika mosquitoes could be won (New Scientist). Overview of the different approaches available to beat the Zika virus outbreak and mosquito-borne disease more generally. Click.

In Australia, a New Tactic in Battle Against Zika Virus: Mosquito Breeding (New York Times). Overview of emerging technologies developed in Australia to battle dengue but could be incorporated into the Zika virus response. Click.

Zika virus: pesticides are not a long-term solution says leading entomologist (The Guardian). Spraying insecticides can sometimes be a blunt instrument unless there is an understanding of where best to target mosquito populations. Click.

Zika outbreak revives calls for spraying with banned pesticide DDT (STAT). Outbreaks of mosquito-borne disease often prompt calls to return to DDT as teh insecticide of choice to control mosquitoes. Click.

Insecticide to be sprayed inside planes from Zika affected regions (The Guardian). Aircraft should already be treated with insecticides to stop movement of mosquitoes from one country to the next, hitchhiking in planes but efforts have been boosted in wake of Zika virus fears. Click.

Bats and Mosquitoes

Illustration by Golly Bard

Be careful what you wish for

Let’s Kill All the Mosquitoes (Slate). Emergence of another mosquito-borne disease, another opportunity to call for killing mosquitoes off completely. Click.

Why Eradicating Earth’s Mosquitoes To Fight Disease Is Probably a Bad Idea (Vice). Don’t be so sure that eradicating mosquitoes is the answer, or at least it won’t have consequences. Click.

Would it be wrong to eradicate mosquitoes? (BBC). What could be the unexpected consequences of sending mosquitoes extinct? Click.

Sights on world’s deadliest animal as Zika virus spreads (The New Daily). Wiping out all mosquitoes is probably a bad idea but perhaps we could knock off just a few and greatly improve the health of the planet? Click.

There’s one (or more) in every crowd…

Is Zika Virus the Next Tool For Forced Sterilization, Vaccination and Depopulation? (Activist Post). Oh boy. Click.

Health experts slam anti-vaxxers’ zika virus conspiracy theory as ‘absurd’ (News.com.au). No, immunization programs didn’t cause the Zika virus outbreak and increases in microcephaly. Click.

Concerning Correlation: GMO Mosquitoes Caused Zika Virus Outbreak? (21st Centuray Wire). Bonkers. Click.

No, GM Mosquitoes Didn’t Start The Zika Outbreak (Discover Magazine). Wonderful article debunking one of the most common conspiracy theories associated with the Zika virus outbreak. Click.

Got any more useful links? Tweet them through to me!

Photo of sign from Zika Forest taken from here.

Safely avoiding mosquito bites when pregnant

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Hundreds of millions of people fall ill due to mosquito-borne pathogens every year but the recent rise in birth defects associated with Zika virus emerging in the Americas has health authorities on alert.

Zika virus is transmitted by mosquitoes, primarily by the Yellow Fever mosquito, Aedes aegypti. Since its discovery in Africa around 70 years ago it has avoided the public health spotlight due to the relatively mild illness it causes. Throughout Africa and Asia it is overshadowed in importance by the diseases caused by malaria parasites as well as dengue and chikungunya viruses.

For background on the rise of Zika virus, see my article for The Conversation.

Zika and the health risks to those pregnant and their unborn children

While Zika virus has yet to be fully confirmed as the causative agent in birth defects (such as microcephaly), there is clearly enough concern among health authorities in many parts of the world to issue warnings to those pregnant to avoid travel to countries experiencing an outbreak of Zika virus.

Authorities in Columbia and El Salvador have even gone so far as to advise residents to avoid falling pregnant for up to two years.

The Australian Government issued the following advice via their SmartTraveller website:

“Until more is known about Zika virus, and taking a very cautious approach, we advise women who are pregnant (in any trimester) or who plan to become pregnant to consider postponing travel to any area where Zika virus transmission is ongoing. If you do decide to travel, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.”

For many, the option of not travelling will be easy. But what if you still want to travel? What if you’re doing business in some of these countries? What if you need to travel to visit family? Cancelling a trip isn’t always the easiest options.

Reducing risk of mosquito-borne disease while travelling

Irrespective of the current Zika outbreak, travelling while pregnant brings various health and safety risks.  Other mosquito-borne diseases, such as malaria and dengue, also pose a risk to pregnant women and their unborn children. These serious risks existed long before Zika virus grabbed the public health spotlight.

Unfortunately, there is no vaccine currently available for Zika virus. Vaccines are in development for dengue viruses and anti-malaria drugs are available so consult your local travel health clinic.

While travelling, staying indoors as much as possible, particularly air-conditioned accommodation, will greatly reduce exposure to mosquitoes. This may not be how you expected to spend your time during a South American holiday!

Many people associate mosquito-borne disease with wetland or jungle environments but as Zika virus is spread by mosquitoes found in urban habitats (e.g. water-filled containers), travellers should not be complacent if only visiting cities. Some of the biggest recent outbreaks of mosquito-borne disease have been in major metropolitan regions in the Americas and Asia.

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Mosquito control in Brazil, a striking image of the battle against container-inhabting mosquitoes (Image: Ernesto Benavides via International Business Times)

If you’re staying at a high end resort, chances are there will be a well established insect control program. This typically includes widespread spraying for insecticides to knock down any mosquito populations. This may not completely remove risk but it will substantially lower potential exposure to mosquitoes. Again, don’t be complacent and take special care to avoid mosquitoes if taking a day trip to local villages or other tourist attractions.

Sleeping under a bed net is usually recommended in regions where malaria is an annual problem but this may not offer that much protection against Zika virus as the mosquitoes that spread the virus primarily bite during the day. If you’re planning on taking some afternoon naps, make sure it is under a bed net. A range of insecticide treated bed nets are available from your local camping store.

There is also an ever increasing range of “pre-treated” insect repellent clothing but evidence is scarce on just how effective these are at preventing bites. Treating clothing with insecticide (e.g permethrin) yourself would be a better option but don’t expect that wearing treated clothing means you don’t have to put insect repellents on exposed skin.

Safe and effective use of mosquito repellents

There will be anxiety among many about using insect repellents while pregnant. Are they safe? Will they impact the baby?

Without doubt, the most commonly used, safe and effective mosquito repellents is DEET (I’ve written about these repellents extensively, see here and here but I’ll summarize below). This is found in lots of major commercial brands and is a mainstay in the recommendations issued by health authorities the world over. Problem is, it can be hard to find information on how to choose and use the repellent that’s right for you and your situation.

The first point to remember is that the the strength of the formulation determines how long you’re protected against mosquito bite, not how many mosquitoes are kept away. For example, a 10% DEET based repellent may provide 2h protection, a 20% formulation may provide 4h protection. When choosing a repellent, think about how long you need protection for and how frequently you’re happy to reapply.

Secondly, the repellent must be applied as an even coverage on all exposed skin. If there are “gaps” in the application, mosquitoes are sneaky enough to pick a spot to bite. In the case of the mosquitoes that spread Zika, dengue and chikungunya viruses, pay special attention to application around the lower legs and feet, that’s where they like to bite.

Be sure to reapply repellent after swimming or sweaty exercise too.

There is no need to apply mosquito repellents to skin under clothing.

Are repellents safe to use when pregnant?

Health authorities and regulatory agencies rarely provide specific warnings on the use of insect repellents by those pregnant. While there haven’t been many clinical trials, these papers (here and here) demonstrate a lack of documented significant health risk associated with the used of DEET-based repellents. Most notably, a study of almost 900 women using mosquito repellent in the second or third trimester and no adverse neurologic, gastrointestinal, or dermatologic effects were observed in women or their infants for a year after birth.

It is important to balance the distinct lack of evidence of major health risks associated with repellents to the rapid rise in microcephaly in Brazil. Repellents can stop mosquitoes bites, stop mosquito bites and remove the risk of infection. If you use registered mosquito repellents as directed on the label, they are effective and safe.

Common sense must prevail. Even if you’re concerned about the use of repellents, make some compromises while still protecting yourself for infection. Choose a lower dose DEET-based repellent and reply more often. This is a better approach than trying a repellent that hasn’t been proven effective.

I’m often asked what formulation works best. There are aerosol sprays, roll-ons, pump-pack sprays, creams, gels, lotions and even towelettes. There really haven’t been many scientific studies looking at which if these formulations work best, and for good reason. As the active ingredients in these formulations are the same, it doesn’t really matter. The critical issue is to choose a formulation that you’re most comfortable using to ensure you get a good coverage over exposed skin. I like creams and pump-pack sprays but I generally apply the product to my hands first and them spread across skin.

Always ensure you avoid getting repellent in your eyes or any cuts or abrasions.

I don’t like the smell or feel of mosquito repellents!

There is often a temptation for those who dislike DEET to use a “natural“, plant-based repellents. Notwithstanding that these products provide shorter periods of protection, tea-tree oil (particularly when used in home-made concoctions) also has the potential to cause skin irritation. While plant-based mosquito repellents may offer some protection against nuisance-biting mosquitoes, they shouldn’t be relied on to prevent mosquito bites in regions of mosquito-bore disease outbreaks.

Many health authorities recommend para-Menthane-3,8-diol (PMD), a product commonly known as “oil of lemon eucalyptus”. This is not an essential oil but rather the by product of the distillation process of Corymbia citriodora. The product does repel a range of biting insects and there is no evidence suggesting it should not be used in pregnancy. However, in Australia, this product is generally more difficult to find in grocery stores and pharmacies than DEET- or picaridin-based repellent formulations.

It would be brilliant if there was a non-topical options for stopping mosquito bites. Unfortunately, there is nothing that has been proven effective. Do not rely on mosquito repellent wrist bands as they do not provide adequate protection against mosquitoes. Also, remember that there is nothing you can eat or drink that will stop you being bitten by mosquitoes.

Rounding out the advice on mosquito repellents, make sure you pack some before you leave. You can never be sure of what products will be available at your destination or whether it has gone through the process of registration (e.g. APVMA in Australia or EPA-registered in the U.S.). It is not unheard of for mosquito repellent stock to sell out during outbreaks of disease.

Lastly, if you’re travelling to regions experiencing dengue, chikungunya and Zika virus outbreaks, don’t necessarily expect to be swarmed by mosquitoes in the same way you will around many of Australia’s coastal wetlands. Don’t be complacent if there are only a few about, remember, it only take one bite to transmit a pathogen. Don’t wait until you notice mosquitoes biting, wake up and put on that repellent.

There is a great set of questions with answers provided by the CDC for pregnant travellers on Zika risk and prevention and here is another reminder of the travel advice provided by the CDC and Australian Government for pregnant women.

If planning to travel while pregnant, consult your local doctor or travel health clinic for advice.

Want to learn more about the amazing world of Australian mosquitoes? Check out “A Field Guide to Mosquitoes of Australia” out now through CSIRO Publishing. Over 200 pages containing a pictorial guide to almost 100 different mosquitoes along with tips on beating their bite and protecting your family from the health risks of mosquitoes. You can order online or through your favourite local bookstore or online retailer.

 

 

Does Zika virus pose a threat to Australia?

They’re small, spindly insects but their threat never dwindles – the bites of mosquitoes threaten death and disease in many parts of the world. The emergence of a little-known virus, Zika, from an African forest, is the latest to alarm the public, politicians and health authorities because of its potential link to birth defects.

What is Zika virus?

Zika virus is a mosquito-borne virus closely related to dengue and Yellow Fever viruses. Discovered almost 70 years ago in a Ugandan forest, the virus generally only causes a mild illness. Symptoms include rash, fever, joint pain and conjunctivitis.

Severe symptoms aren’t common and the illness was never thought to be fatal.

Despite detection throughout Africa and Asia, the virus rarely entered the spotlight of scientific research. It was overshadowed by the spread and impact of dengue and chikungunya viruses, which infect millions of people across the regions.

In the last decade, Zika virus outbreaks have occurred in the Pacific, with reports of severe illness. But again, Zika was considered a lesser threat than dengue and chikungunya viruses.

Everything changed in 2015 when Zika virus reached the Americas.

New outbreaks and severe symptoms

Since the first local Zika virus infection, cases have been reported from at least 19 countries or territories in the Americas, with more than one million suspected cases.

Rapid spread of an emerging mosquito-borne pathogen is news enough but people are also panicked by reports of more serious consequences of Zika virus infections, including post-viral Guillain-Barré Syndrome, an autoimmune condition where there person’s nerves are attacked by their own body.

Of most concern has been the rapid rise in rates of microcephaly, a birth defect which causes babies to be born with unusually small heads, in regions where Zika virus has been circulating.

While the role of Zika virus as the cause of microcephaly has not yet been confirmed, there is growing evidence of a connection between the two where pregnant women have been infected with the virus.

Babies born with microcephaly, and those who died shortly after birth, have tested positive for the virus, and there are close regional associations between clusters of birth defects and Zika virus.

There is enough concern for the Centres for Disease Control to issue health warnings to pregnant women planning to travel to these regions. [This also includes the Australian Government] Some health authorities are even advising people to postpone pregnancies.

There is no vaccine for Zika virus. Stopping mosquito bites is the only way to prevent infection.

Is Australia at risk of a Zika virus outbreak?

There is little doubt the virus can make it to Australia. There have already been a number of infections reported in travellers arriving in Australia from the Cook Islands and Indonesia.

Mosquito-borne viruses generally aren’t spread from person to person. Only through the bite of an infected mosquito can the virus be transmitted.

In the case of Zika, there have been some unusual cases of transmission, including through sex and the bite of an infected monkey. Despite these unusual circumstances, mosquitoes will still play the most important role in any local transmission.

While dozens of mosquitoes are capable of spreading local mosquito-borne pathogens, such as Ross River virus, only one of the 300 or so mosquitoes found in Australia can transmit Zika virus: Aedes aegypti, the Yellow Fever Mosquito, which is only found in north Queensland.

The Yellow Fever mosquito, Aedes aegypti, is critical to the spread of Zika virus in many regions of the world, including Australia.

For local Aedes aegypti to spread Zika virus, they must bite an infected traveller shortly after they return from a country where the virus is circulating.

While the chances of this happening are small, there is then a risk of a local outbreak occurring as the infected mosquito bites people who’ve never left the country.

This is the process that occurs in outbreaks of dengue in Far North Queensland. If we can get outbreaks of dengue, there is no reason we cannot, or won’t, get an outbreak of Zika in the future.

How to reduce the risk of transmission

Fortunately, authorities are well placed to contain an outbreak of Zika virus, as the required strategies are the same as management of dengue outbreaks.

Perhaps the real message here for Australian authorities is that they need to work diligently to keep exotic mosquitoes out of the country.

While Aedes aegypti may not become established in southern cities, even with a changing climate, there is great potential that Aedes albopictus, better known as the Asian Tiger Mosquito, could become established in southern cities. As well as a vector of Zika virus, it can spread dengue and chikungunya viruses and be a significant nuisance-biting pest. Keeping this mosquito out of our cities is critical.

Australians planning travel to South and Central America, including the Rio Olympics, should take precautions to avoid mosquito bites. Irrespective of Zika virus, mosquito-borne dengue and chikungunya viruses have infected millions of people, causing thousands of deaths, in the last few years and are reason alone to pack mosquito repellents. Be prepared to cover up with long sleeved shorts and long pants if in regions where risk is high.

The ConversationThis article was originally published on The Conversation. Read the original article.