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Hopkins to open multidisciplinary center focused on Zika

Lara Gaffney, a Johns Hopkins University student who interned with the Department of Environmental Health at the Baltimore City Health Department this summer, worked to help prevent the spread of the Zika virus. She demonstrates how she uses a mosquito trap.
Lara Gaffney, a Johns Hopkins University student who interned with the Department of Environmental Health at the Baltimore City Health Department this summer, worked to help prevent the spread of the Zika virus. She demonstrates how she uses a mosquito trap. (Lloyd Fox)

Johns Hopkins Medicine plans to open what officials said will be the world's first multidisciplinary Zika center, allowing infected patients to get care and researchers to investigate the virus in one place.

The rapid spread of the Zika virus has alarmed public health officials and doctors because the mosquito-borne virus causes microcephaly, which stunts the brains and skulls of fetuses in infected pregnant women, and potentially causes other birth defects. Infection also has been connected to stillbirths and miscarriages.

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"Patients will no longer be required to travel to multiple centers for care relating to the Zika virus," said Dr. William May, associate professor of ophthalmology at the Johns Hopkins Wilmer Eye Institute, in a statement. "Physicians and staff members in various departments at Johns Hopkins will be available to provide comprehensive care to patients within one institution."

The Wilmer Institute led development of what will be known as the Johns Hopkins Wilmer Zika Center, which will bring together experts from Hopkins Medicine and from Hopkins' Bloomberg School of Public Health, in such specialties as epidemiology, infectious disease, maternal-fetal medicine, ophthalmology, orthopedics, pediatrics, physiotherapy, psychiatry and social work.

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Medical experts from Brazil, which has been affected heavily by the Zika virus, also will participate in the research.

Wilmer got involved after a study in Brazil linked Zika to eye abnormalities in more than half of the babies born to mothers infected with the virus. There also have been a few cases of Zika-related eye problems documented in adults, said Dr. Peter J. McDonnell, the institute's director and a professor of ophthalmology.

He said Wilmer experts would be able to diagnose and treat Zika-related eye issues such as cataracts, inflammation and other vision issues through the center.

"If we get a lot of these babies born here, and infected adults, we want everyone to know that we are ready to get them in," McDonnell said. "Many, many babies will have eye problems."

There is no vaccine or specific treatment for Zika, though researchers continue to study the virus and develop therapies. Pregnant women infected with the virus are monitored using ultrasound equipment, according to guidelines from U.S. Centers for Disease Control and Prevention.

Pediatric and adult patients likely will be referred to the center by doctors throughout the Hopkins system and beyond, and patients also will be able to make appointments directly.

The center, which opened two weeks ago at the Wilmer Institute, already has seen patients with Zika. Some pregnant women still are being evaluated for potential problems.

Patients have come from around the state and from outside of Maryland, said Dr. Jeanne S. Sheffield, director of the Hopkins' Division of Maternal-Fetal Medicine. She also expects infected mothers from other countries to travel to the United States for care, or even to give birth.

"It's an ideal set-up for pregnant women exposed to Zika," Sheffield said. "We have people who can do initial evaluations, people in pediatrics, ophthalmologists and others who can consult and follow-up with kids. This set-up allows us to communicate about anyone who comes in and tests positive."

Once babies are born, a team of specialists could confer on the best path of treatment for brains, eyes and other affected organs, Sheffield said.

Not every baby born to a woman infected with Zika has microcephaly or other problems, Sheffield said. Some women may have testing done at Hopkins but return only if a problem develops later or after giving birth, she said. Some healthy newborns may need intermittent evaluation to determine if growth remains normal.

Sheffield and Maryland public health officials said out-of-state patients visiting the new center will pose little risk to local residents because they may no longer be infectious and able to spread the disease. They also will be here temporarily and their numbers are expected to be limited.

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Health officials noted that Zika is already in the state; Maryland has 64 known travel-related cases.

There have been 2,260 cases of Zika reported nationally, including 529 pregnant women, as of Aug. 17, according to the CDC. The cases are mostly travel-related and sexually transmitted, though more than 40 cases have emerged in Florida of people bitten by mosquitoes and infected.

Most are in the Miami area, but the Florida Department of Health reported Tuesday that a case was identified in Pinellas, almost 300 miles away. Department representatives are doing door-to-door testing and outreach to determine if there is another regional outbreak.

In addition to the Zika cases in Maryland, the state recently identified the year's first case of West Nile virus, which can cause serious illness and even death in a small number of those infected. Symptoms including rash and fever are similar to those of Zika.

Christopher Garrett, a spokesman for the Maryland health department, said the extra surveillance provided by the Hopkins center "could only be a benefit to public health."

Public health officials have been warning the public to cover up and use bug spray to avoid infection. The CDC issued a rare recommendation to pregnant women to avoid travel to the Miami area. The government also has warned pregnant women and their partners to avoid countries in Central and South America, where there are many more cases of Zika.

The U.S. Department of Health and Human Services also declared a public health emergency in Puerto Rico earlier this month because of the threat to pregnant women there. There have been more than 10,000 cases of Zika reported in the U.S. territory, including 1,035 pregnant women.

Dr. Hal C. Lawrence, executive vice president and CEO of the American College of Obstetricians and Gynecologists, praised the Hopkins model for providing care to those infected.

"The new Johns Hopkins Wilmer Zika Center is a great model of coordinated, patient-centered care and speaks to how important it is for health care professionals and researchers to collaborate, particularly in the face of an epidemic like Zika," he wrote in an email.

"New research on the virus emerges nearly every week," Lawrence continued. "One of the more recent studies was able to identify specific areas of the fetal brain targeted by Zika that can cause serious damage leading to a range of other abnormalities beyond microcephaly. This is an important finding but there is still so much more we have to learn in order to effectively treat patients and, ultimately, find a cure."

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