In nine months, the growing Zika outbreak in Florida will present a grave new challenge to the nation's health system — babies born to mothers infected with the virus that causes severe birth defects, many of which we have yet to discover.
There are nearly 1,400 pregnant women in the US and its territories known to have contracted Zika to date. More than 500 of those women live in the continental 48 states and 70 of them are in Florida. Experts estimate that by September we can expect eight women to get infected in their first trimester from Florida's local outbreak.
"Given the number we're seeing, we know there are going to be babies born to these moms," said Dr. Sonja Rasmussen, the director of the public health dissemination division at the US Centers for Disease Control and Prevention in Atlanta. "We want these babies to be able to develop to their full potential and we expect that some of them are going to have severe birth defects."
Most people experience mild or no symptoms after they've been infected, but during pregnancy the virus can have severe impacts on the fetus. The most well-known is microcephaly, a condition where the newborn's head is abnormally small and their brain is underdeveloped.
Researchers now believe babies born to mothers with Zika face a 13 percent chance of being born with a smaller head size, and in some cases it may not be visible as a fetus or immediately at birth. Babies with microcephaly could end up with vision and hearing problems or experience seizures, developmental delays, and intellectual disabilities.
But while pictures of microcephaly have gotten the public's attention, the effects of Zika on newborns will span far beyond small head size. Zika was discovered 50 years ago but it wasn't until the outbreak in Brazil last year that it was linked to microcephaly, and researchers are only beginning to discover other developmental issues connected with the disease.
"[There are a] large number of infants who were exposed to Zika infection during pregnancy that at birth don't show microcephaly," said Don Bailey, early childhood development fellow at RTI International. "But I think we're all thinking that a substantial proportion of babies will have more subtle cognitive problems."
Bailey believes that the majority of babies born to mothers infected with Zika won't have microcephaly but a whole host of milder developmental issues such as ADHD, learning disabilities and vision problems.
In early August, a study linked Zika to a rare set of joint deformities called arthrogryposis that leads to problems moving limbs. This week a study of brain scans and ultrasound pictures published in the journal Radiology showed the severity of the infection in babies' brains. But experts agree there is a lot more to learn, especially as more babies are born.
Bailey said more resources need to go into those kind of studies and to improve care for affected babies and mothers, as opposed to mosquito control and vaccine development. "We're behind in that sense," he said.
In terms of care, children will almost certainly need support from an interdisciplinary team of professionals, in areas like vision, hearing, and developmental disabilities. According to Bailey, a common plan would be the best solution, as opposed to having families see each specialist independently.
In its latest update to its interim guidance for infants, the CDC recommends testing for all infants born in the US to mothers with Zika or who exhibit symptoms associated with Zika syndromes. The health agency also recommends initial evaluations after birth, including physical and neurologic exams.
According to the CDC, infants who exhibit signs of the syndrome should go through coordinated evaluations by multidisciplinary specialists within the first month they are born and continuously throughout their first year. Dr. Rasmussen at the CDC, said they are working with state and local partners to ensure they have the information to execute this.
Florida's Department of Health has said children with Zika born with developmental delays or birth defects will be enrolled in an already existing Early Steps program for infants and toddlers with developmental delays. They get access to an Individualized Family Support Plan and families will receive support as well. According to the health department, uninsured patients will be covered by the program.
But not everyone thinks the state and country are actually ready for what's coming. Dr. Mobeen Rathore, a pediatric infectious disease specialist at University of Florida, does not feel the state is as prepared as it should be considering how many experts will need to be involved in caring for a Zika newborn immediately after birth and for the foreseeable future.
"I'm not certain that most communities are prepared to receive babies, babies born to Zika virus infected moms, who may have congenital issues," he said. "I think we have the expertise, but we may not have the organization."
While many experts believe there will be far fewer pregnancies in the U.S. than in other countries due to better access to contraception and abortion, lots more coordinating work has to happen before these babies start to arrive.
"[It's like a] disaster we know is going to happen and we've had months to prepare for it and if we're not prepared for it, shame on us," Rathore said. "It's not like a hurricane that quickly develops, we're probably better prepared for that."
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