EH 1_2016

THE EUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK V O L 2 5 I S S U E 1 / 1 6 • F E B R U A R Y / M A R C H 2 0 1 6 INSIDE: ECR 2016 special issue PATHOLOGY 34 • The big question: Could cancer be contagious? • Revealing tumours at a minuscule level INDUSTRY NEWS 35-36 • China likes Starbucks and foreign medical devices • The IVD market in Europe: up-to-date facts and figures CONTENTS NEWS & MANAGEMENT 1-4 ECR 2016 5-32 LABORATORY 33 PATHOLOGY 34 INDUSTRY NEWS 35-36 www.healthcare-in-europe.com Report: Brenda Marsh From the beginning the accusation somehow beggared belief. A ‘mild’ virus was blamed for causing hide- ous malformations in babies’ heads. Brazil, a country suffering its worst recession since the 1930s, as well as political upheaval, became the focus of a worldwide healthcare scare. Among mosquitoes enjoying a nice environment there one fairly innocuous ‘new kid on the block’ – Aedes aegypti  – which, okay, is a vector for diseases – went hard- ly noticed when it first migrated to this country. Good heat, poor human dwellings surrounded by lots of stagnant water, all offered a comfy place to live and breed in a new country, with plenty of blood around for the ladies. History and origins Aedes aegypti, part of a mosqui- to family, hosts Zika, a flavivirus related to the viruses that transmit yellow fever, dengue, West Nile, and Japanese encephalitis to humans. It was discovered just under 70 years ago, and that’s important to remember. In Uganda in1947, researchers on a Rockefeller Foundation inves- tigation into jungle yellow fever, put a rhesus monkey – numbered 766 – into a cage on a tree plat- form in the Zika Forest. 766 was there to be bitten. Two days later, the feverish monkey was taken to the Foundation’s laboratory and its serum inoculated intracerebrally into mice. 10 days later those mice were ill. The researchers isolated from their brains the transmissible agent, later naming it Zika virus (ZIKV). In early 1948, in the same locale, ZIKV was also isolated from Aedes africanus mosquitoes. Serologic studies showed humans could also Adriana Melo, working in the state of Paraíba, in the poor semi-arid north- east Brazil, identi- fied microcephaly in a 20-week-old foetus . Two weeks later, she found the same diagno- sis for a 24-week-old foe- tus. News also came from Recife, in the neighbouring state Pernambuco, that Dr Ana van der and daughter paediatric neurologist Dr Vanessa van der Linden Mota had observed a peak in microcephaly foetuses and alerted the health min- istry. Suspecting Zika to be the cul- prit in her two microcephaly cases, Melo contacted other specialists in her field and had sent amniotic fluid from the two mothers for analy- sis at a national science research institution in Rio de Janeiro. Three different tests detected the Zika virus in the fluid surrounding the microcephaly foetuses. Melo called for public-health officials to test amniotic fluid. By mid-November the country’s Ministry of Health requested all doctors to report pregnancy cases where red spots appeared on the mother’s skin. Within a short time, the Ministry reported that suspected cases of microcephaly numbered 2,401 in 19 states and the Federal District, with 29 resulting in death. The World Health Organisation (WHO), said to be still ‘stinging’ from criticism that it did not declare an international emer- gency over ebola, issued its i n t e r n a - tional warning regard- ing ZikaV. Aedes became top interna- tional public enemy over- night. Could ZikaV cause such huge harm? Whilst rapid and expensive research is being undertaken globally to find the true cause of microcephaly, as well as a Zika vaccine, there is no big evidence that it could cause such developmental damage in the unborn. Yes, the virus has been found in amniotic fluid and brain tissue in a handful of cases. Also 1970s study showed the virus could replicate in neurons of young mice, causing neuronal destruction and more recent genetic analyses have suggested that strains of Zika virus might be undergoing mutations. However, controversy erupted in Brazil first regarding the very defini- tion of microcephaly - the yardstick by which to measure head circum- ference. After the identification of an excessive number of suspect- ed cases, the Brazilian Ministry of Health declared a reduction in the cephalic perimeter measurement to suspect microcephaly, from 33 cm to 32 cm, instantly lowering cases. Figures plummet become infected. In 1956, ZIKV was transmitted to artificially fed Ae. aegypti mosquitoes and was trans- mitted to laboratory mice and a monkey. Nigeria, 1968: ZIKV was isolated from humans during studies and then also in 1971– ’75; 40% of people in one study had neutral- ising antibody to ZIKV. Human isolates were also obtained from febrile tod- dlers and a sick 10-year- old. 1951-’81: Evidence of human ZIKV infec- tion was reported from Uganda, T a n - z a n i a , C e n t r a l African R e p u b l i c Egypt, , Sierra Leone, and Gabon, as well as parts of Asia – India, Malaysia, Thailand, Vietnam, Indonesia and the Philippines. 2007: An outbreak of ZIKV infect- ing about 75 percent of the popu- lation of Yap Island, Micronesia, revealed Aedes had travelled beyond Africa and Asia. 2011: Aedes alighted in French Polynesia, bringing outbreaks of dengue and chikungunya. 2014: Brazil was alerted to the arrival of a new virus in that country, after the FIFA World Cup. However, genetic analysis of the virus revealed that the strain was most like the one found in the Pacific – from which no football teams had come. Suspicion also fell on an interna- tional canoe event in Rio de Janeiro in August 2014, which drew com- petitors from Pacific islands. On the other hand, some thought it had come overland from Chile, where a traveller returning from Easter Island had a Zika infection. 2015: With 22 years’ experience, obstetrician and gynaecologist Continued on page 2 Scapegoat or villain? The Zika mystery Microcephaly is an uncommon con- dition. In the USA, birth defects tracking systems estimated that the condition ranges from two babies per 10,000 live births to 12 micro- cephaly babies per 10,000 live births – totalling 25,000 microcephalic babies born there per year. First declaring 2,401 microcephaly births, Brazil had to admit to a far lower number of confirmed cases, now reported to be around 460, but 3,850 are still ‘suspected’ and being investigated. Rumours rumours … People want tangible answers. Without them trust is lost. One popular theory among Brazilians has been that expired doses of measles, mumps and rubella vaccine have caused the gross head defects. Just before 2016 dawned, Brazil’s federal government’s central information services tried to address this concern. It stated: it is ‘totally false that an expired batch of rubel- la vaccines, rather than the Zika virus, has caused the microcephaly outbreak’. In addition, health min- ister Marcelo Castro said he held ‘100 percent certainty’ that Zika and microcephaly are linked. Where might he have gained such a positive conviction? © Redmond Durrell / Alamy Stock Foto V O L 25 I S S U E 1 / 16 • F E B R U A R Y / M A R C H 2016 ECR 20165-32

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