From the Backyard to the Bedroom – Zika Virus Pandemic Hits Home

A “mild” illness takes off…

In early February 2015, doctors in the impoverished northeastern part of Brazil noticed a surge in the number of people complaining about a mild illness, with and without fever, characterized by rash, fatigue, joint pains, and red eyes. The illness was brief and recovery was spontaneous. A mild form of dengue, a mosquito-borne disease hyper-endemic throughout the country, was initially suspected, but tests were negative in the vast majority of samples. Chikungunya, another mosquito-borne disease first detected in Africa in 1952, had hopped to Brazil in September 2014 and was likewise suspected. Again, tests results were negative.
At the end of March, Brazil informed WHO that nearly 7,000 cases of an illness characterized by skin rash had been reported in six northeastern states. Laboratories had performed a battery of tests on more than 400 blood samples. 13% of the samples were positive for dengue, but negative for several other viruses known to cause skin rash. The causative agent remained elusive.
The first promising clue came in late April from a laboratory in Bahia State where researchers began to suspect that the disease might be spread by the area’s ubiquitous and dense mosquito population. On a long shot, they tested for Zika, an exotic and poorly understood virus, carried by mosquitoes, that had never been seen in the Americas. Though the results were positive, doubts remained. Testing for Zika is technically challenging as the virus cross-reacts immunologically with dengue and chikungunya viruses, both present in Brazil at that time.
A week later, on 7 May, tests conducted at Brazil’s national reference laboratory conclusively identified Zika in several samples. A new mosquito-borne disease had indeed arrived in the Americas, though no one knew what that might mean.                                                                                                         
–from the World Health Organization


Over the course of human history, many diseases have come and gone and in their wake have wreaked widespread devastation. Some like the Spanish flu, wiped out entire continents. Others, like the 2014 Ebola Outbreak, while largely confined to a few African nations, claimed thousands of victims (and a few in the United States as well). Still others reared their ugly head for a brief time in history, and then mankind found a way to virtually eradicate such diseases as polio, measles and diphtheria.

Up until 2007, the Zika Virus was virtually unheard of in the United States and confined mostly to equatorial regions from Africa to Southeast Asia. But around that time, the Virus hopped a ride somewhere and ended up in French Polynesia, then the Easter Islands, and onto Mexico, the Caribbean and finally to South America. In mid-2015, the Pan American World Health Organization declared an emergency regarding the Zika virus as it hit pandemic levels. And now in May of 2016, the CDC finds itself investigating more than 450 cases in the United States and has unleashed an army of disease investigators around the country to learn more about the disease and most importantly try to prevent the further spread of the disease.

Clearly the Zika outbreak has become serious enough that the CDC and dozens of other organizations are amassing huge resources to combat the disease, and President Obama has also appropriated $1.8 billion to try and fight the disease. There are 452 individuals in the United States reported to be infected with Zika Virus. With the torrential rains/flooding in the southern part of the United States and the warmer weather, the conditions are ripe for that number to grow to exponentially.

During the Ebola outbreak, I had the opportunity to educate some of my colleagues (who expressed fear of the disease as they had children and were worried that Ebola landing on the shores of the United States was truly a frightening development.) In light of this, we have compiled a FAQ summary of the latest findings of the Centers for Disease Control (CDC), the World Health Organization (WHO) and other governmental, public and private medical research establishments.

What is the Zika Virus?
The Zika Virus is a member of the Flaviviridae (Flavivirus) family of viruses. It is a single-stranded RNA virus. It’s named after the Zika Forest where it was first discovered in 1947 in a Rhesus Monkey. Zika is similar to other flaviviruses that cause yellow fever and dengue fever. Recent gene sequencing of the virus has led scientists to believe that one single genetic change (in a protein) occurred in one of the two main lines of the virus, leading to more aggressive infection rates in humans.

How does one get the Zika virus and how does it spread?
The primary mode of transmission is through mosquitos that have been infected by feeding on the blood of an individual (or mammal) that has the virus. These vectors (mosquitos referred to as Aedes Aegypti) then transmit the virus through bites on subsequent individuals. Aedes typically “feeds” aggressively in the morning and afternoon while other mosquitos launch their biting activity during the evening hours.
Additionally, it has been determined that the virus can be transmitted through sexual contact as well.

What happens when an individual is infected by the Zika Virus?
For many individuals, no symptoms are apparent. However, one in five people will show symptoms which can be rash, joint aches, muscle aches, and conjunctivitis (red discoloration of the eye). The symptoms usually subside and the individual recovers completely. It rarely causes any serious ramifications and rarely causes death. Symptoms last from 2-7 days. The virus persists in blood for about a week after that and in urine for about 10-14 days after symptoms appear. Hence, urine tests show a greater window of diagnosis than a typical blood test.

On the other hand, there are far more serious complications related to pregnant woman who become infected. Zika infection has been associated with microcephaly in fetal development. Babies born with microcephaly have abnormal skull and brain development. About 25,000 babies a year are born with microcephaly. As a result of abnormal brain growth, fluid and calcification fills the space that brain tissue would normally occupy and the skull collapses into the smaller head shape characteristic of microcephaly. CDC recommends that women who may have been exposed to Zika while pregnant have fetal ultra sounds and/or amniocentesis testing to determine fetal health.

So if a pregnant woman avoids mosquito bites, she will have nothing to worry about?
This is false. There are other modes of infection. The CDC and other health organizations have reported that pregnant women have become infected with the Zika Virus through sexual transmission via their partners who have traveled to areas such as South America where the virus infection rate has reached pandemic levels.

Can breast feeding spread the disease?
This has not been determined with absolute certainty, but the CDC states that it is not likely transmitted through breast milk.

Are there other levels of transmission?
Yes, cases have been reported where the virus has been transmitted through blood transfusion.

Are there other serious issues associated with Zika Virus?
Yes. It now appears that Zika infections have been associated with Guillane Barre’ syndrome—a rare neurological disorder where the body’s immune system attacks the myelin sheath covering the nerves, leading to neurological problems. It’s not clear how Zika contributes to this, but more and more cases are appearing in those infected with Zika virus.

How do you determine if you have been infected with the Zika virus?
Diagnostic tests using Real Time Polymerase Chain Reaction (RT PCR) can detect viral RNA from Zika virus in blood or urine specimens. There are also immunological tests to determine immunoglobulin levels in the blood. Since the virus survives longer in urine though, testing on it rather than blood can widen the window of diagnosis.

So, is there a treatment or cure for those infected with Zika? What about a vaccine?
There is currently no known treatment or cure for Zika virus infections. Many scientists are working around the clock to come up with a vaccine. We will update in the near future.

What is the best way to prevent the disease?
Avoid mosquito bites as much as possible. Repellants are an effective way and most are safe for pregnant women. Moreover, make sure pools of water do not form around living areas. Pots, buckets, and gutters are all places where mosquitos breed. Wear long sleeves and long pants to reduce the chance of bites from infected mosquitos. And use air conditioning and screened doors and windows to help reduce chances of transmission.

Regarding travel to areas where the outbreak is pandemic, such as South America, extreme caution should be taken. Travelers infected with Zika can not only spread the disease upon return home (via mosquito transmission), but can also transmit the virus to partners through sexual contact. If a partner is pregnant, her fetus has increased risk of microcephaly during fetal development.

Is there a way to invest in companies developing cures/vaccines/treatments?
Yes… but while a noble endeavor, beware! – many are not exactly blue chip stable companies. When the Ebola outbreak occurred, a company called Lakeland Industries (which made the protective garments/suits used in treating infectious disease) soared from $5 a share to $30 a share. After the outbreak subsided, it promptly returned to $5 a share. Such is the “seasonal” opportunity when it comes to diseases, diagnostics, therapies, and solutions. But if one can identify the veteran tool-makers (the more-established and proven companies in the healthcare sector) working on solutions, there are opportunities with diagnostics, anti-virals, vaccines, and vector control. See the World Health Organization’s “Current Zika Product Pipeline” at http://www.who.int/csr/research-and-development/zika-rd-pipeline.pdf

Specific to Zika, some of the companies working on a variety of solutions include:

• Inovio (INO) Pharmaceuticals – working to develop a vaccine, has traded between $2/share and $15 per share. It rallied sharply from $3 to its current price of $7, on the news it was working on a Zika vaccine.

• Intrexon (XON) – working on a novel strategy to create a mutated strain of the Aedes mosquito for release into the environment. These strains of mosquitos are sterile and cannot reproduce, thus substantially depleting the mosquito population and limiting the mode of transmission.

• Quest Diagnostics – received Emergency Use Authorization from the FDA to test patients in the U.S. using its Zika RT-PCR test developed by subsidiary, Focus Diagnostics, Inc.

Important to note, however, is that both Inovio and Intrexon are losing money and are projected to lose money this year. These companies will trade with great volatility, and when the outbreak subsides, might revert to lower price levels.

And while diagnostics seem a safer investment, consider that all diagnostics are subject to stringent regulations that can include the FDA, CMS, and CLIA, as well as successes and failures driven by utilization and reimbursement. And Mergers and Acquisitions can also impact investments. Focus Diagnostics includes reference lab and product manufacturing businesses. Right now, it appears the Zika testing will be proprietary testing performed only by Focus (Quest). However, as other companies receive FDA approval for manufactured tests (sold to hospitals and laboratories), the market changes. Quest expects to complete the sale of the (Focus) product manufacturing business to Diasorin in the second quarter of 2016, but will continue to wholly own the Focus reference laboratory business that developed the Zika RT-PCR test as well as intellectual property related to the test. So you can see how important it is to do research on the companies and products they produce/provide, as well as keeping an eye on other companies/competitors and the highly unpredictable regulatory requirements and timelines.

Where can I get more details on Zika Virus?
The Centers for Disease Control and Prevention (CDC) has a website with pages of details on Zika Virus, travel alerts, preventive measures and other strategies they are employing to inform people and stop the spread of the virus.

• The World Health Organization (WHO) also has several resources accessible through their website: http://www.who.int/emergencies/zika-virus/history/en/

• WHO also has an intriguing timeline on the history and progression of Zika over the past several decades: http://www.who.int/emergencies/zika-virus/history/en/

Local health authorities and medical centers are also excellent resources for updates on the outbreak.

Regards,

David Lerman
Jodie Warner

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