Fernando Ysern, MD, FAAP
September 6, 2016
Love in the Time of Cholera is an award-winning novel written by the Colombian Nobel Prize Laureate Gabriel Garcia Marquez. The novel, which also became a major motion picture, tells a love story set in a South American country being devastated by a cholera epidemic. The major theme is the enduring romance, but the cholera epidemic is ever present and affects every aspect of the story.
I am a primary care pediatrician, and like most of my colleagues, practicing pediatrics is my enduring love story. But just like the novel, this story now takes place in the shadow of an epidemic that threatens the health and well-being of my patients and community. You see, I live in Puerto Rico, and aside from all the economic, social and political problems that you may have read in the news about our island, we have a new threat that spread through South America and is beginning to move through the United States and other countries.
Congenital Zika Virus Infection is what we fear and are trying to prevent with vector control programs and barrier methods to decrease the transmission of the virus through sexual contact. Both strategies are far from foolproof, but they're the only ones we have available to contain the spread of Zika at the present moment. These strategies are our "first responder" methods for this crisis.
We have had the Aedes aegypti mosquito in Puerto Rico for years, spreading dengue fever and, last year, chikungunya. Our current vector control programs have had minimal success in eradicating this mosquito. Fourteen states also have Aedes aegypti and 30 have Aedes albopictus, which can also transmit flaviviruses like dengue, Zika, as well as yellow fever.
"First of all, 80 percent of infected persons show no signs or symptoms of infection, therefore making it more difficult to track and contain the disease."
Making matters worse, the Zika virus can be transmitted sexually. I am also an adolescent medicine specialist and know how difficult it can be to convince teens to use barrier methods to avoid pregnancy and sexually transmitted diseases. It's not impossible, but it is time-consuming and quite inefficient. To convince teens and young adults that they too must use barrier methods when having relations with their established partner, especially if the woman is pregnant, is an even bigger and more time-consuming task.
Most of my patients’ parents do not yet fully grasp the threat Zika presents to our unborn children. Many of our colleagues and, sadly, our political leaders appear to be in denial. Why else would they have left for summer session without funding additional Zika control measures at a critical point in the virus’ spread? The threat of babies being born with Congenital Zika Infection is still considered something foreign to us. This is a problem facing other countries like Brazil, which must now deal with babies born with microcephaly and its resulting hearing, vision, and feeding disorders; arthrogryposis; club feet; seizures; central nervous system abnormalities and developmental delays. Well, it has arrived in our country, starting with Puerto Rico but steadily heading to other regions.
"Many of our colleagues and, sadly, our political leaders appear to be in denial. Why else would they have left for summer session without funding additional Zika control measures at a critical point in the virus’ spread?"
As I continue to see patients in my practice, I have to adapt to a new reality. I ask my new parents, “Were you tested for Zika? Are you currently pregnant? Are you using mosquito repellents and barrier methods throughout all your pregnancy?” When the parents bring their child into the office with a fever, rash, headache, conjunctivitis, body aches, joint pains and so forth, I cannot assume that it is a roseola, hand, foot, and mouth disease or any other common childhood illness. My repertoire of questions about family illness has just been expanded: “Does anybody have any of the previously described symptoms? Were they tested for Zika? Do you know the result? Is any family member pregnant? Are there mosquitoes in the house, and do you apply repellents to your child in an appropriate manner?”
I recently saw a 19-year-old young woman who came to our emergency department with nausea, vomiting, fever, headache and a macular rash. After the labs came in, the resulting conversation unfolded: "All your signs and symptoms are highly suggestive that you have Zika. I did a test that will be sent to the Centers for Disease Control and Prevention, and we should know in a few days if you do have it.
“Also, your pregnancy test came back,” I continued. “It's positive."
It took a moment for the initial shock of the news to settle in. "Will my baby be born OK?" she asked. "I do not know,” I said. “I wish I knew."
I wish the whole country knew that we are living and practicing pediatrics in the Times of Zika.
Fernando Ysern MD, FAAP is president of the Puerto Rico Chapter of the American Academy of Pediatrics (AAP). He has served on the Private Payers Advocacy Advisory Committee of the AAP, is currently a medical consultant to the Puerto Rico’s Health Department Vaccine Program, served as Chairman of the Board of Triple S Insurance Company, Chair of the Pediatric Department of the HIMA hospital, President of the Health and Welfare Committee of the Caguas Municipal Assembly and has worked for over 30 years at the Grupo Pediátrico de Caguas.