David Heymann

David L. Heymann, MD, is editor of Control of Communicable Diseases Manual, 20th Edition. Photo courtesy David Heymann

Global infectious disease expert David Heymann, MD, says the spread of the Zika virus and its link to birth defects is “among the most troubling developments of the early 21st century.” Heymann, who chairs the World Health Organization’s emergency committee on Zika and is editor of “Control of Communicable Diseases Manual, 20th Edition,” APHA’s bible on infection control, recently spoke with Public Health Newswire. He talked about a new Zika chapter that’s been added to the renowned manual, a new online subscription for accessing “CCDM” recommendations and the outlook for controlling the virus.

Q: Tell us about the new Zika chapter in “CCDM.” How can it help those working to address the threat?

The new chapter is a very timely addition to the literature to help manage the spread of Zika virus infection, written by two medical experts who are working firsthand with patients and studying the epidemiology of Zika virus infections. While other guidance exists from a range of expert sources, “CCDM” provides it in one place in an easy-to-use format.

The chapter, which is available as part of a new online subscription to “CCDM,” identifies the clinical features of the virus, including signs and symptoms of Zika virus infection and complications such as rare congenital birth defects and other neurological abnormalities. The chapter provides information about disease diagnosis, range of occurrence, incubation period, risk groups and modes of transmission such as via mosquito vector, intrauterine transmission and sexual transmission. The text also includes guidance on preventing mosquito bites, controlling the spread of Zika, managing the patient and patient contacts and reporting requirements. The authors have inserted a useful diagnostic table to help clinicians distinguish between Zika, dengue and chikungunya infections.

Q: How does an online subscription help?

The APHA publishes the manual as a printed publication every four or five years. By publishing “CCDM” as an online subscription, there is no longer a need to wait to introduce new information or new chapters. In fact, the editorial committee and chapter authors will update the chapters on a rotating basis, as needed, with each chapter being reviewed at least every five years and some more frequently. This will provide the most current science and disease developments and give the reader access to the latest information in an accessible format.

Q: If the Zika virus was first identified in the 1940s, why is the manual just now dedicating a chapter to it?

CCDM20Zika was included in earlier editions but in a chapter that covered most of the less-widespread arboviral fevers as a group. Since Zika has become a more important public health threat, and given the need to consolidate current knowledge of the disease to inform prevention and control, the editorial committee decided it was time to give Zika virus a focused treatment by making it the subject of a stand-alone chapter.

Q: In your estimation, what’s the outlook for efforts to contain the Zika virus over the next 12 months?

The spread of the Zika virus and its link to microcephaly is among the most troubling developments of the early 21st century. Never before has there been such a clearly documented link between a mosquito bite and birth defects.

Given this novel threat and its urgency, the world’s public health agencies have moved with great speed in conducting surveillance to identify where there is a risk of Zika infection, providing information to women of child-bearing age and their sexual partners about preventing infection, and stepping up traditional mosquito control efforts, as well as research on new and more effective means of mosquito control.

And research on developing a vaccine is expected to increase during the coming months. Financial and political support for these efforts is essential. The world’s governments must adequately fund and equip public health agencies in order to get ahead of the virus. Meanwhile, investment in vaccine research and subsequent clinical trials is also necessary.

Q: Beyond Zika, what other communicable disease threats keep you awake at night?

“CCDM-20” chronicles more than 130 infections. Many of them can pose a serious risk to human health, which is why the editorial committee is dedicated to this work, which it does pro bono, and to keeping the manual as current as possible.

Possibly one of the most important known communicable disease threats today is the rapid development of antimicrobial resistance, which makes existing medicines less effective in curing infections. Research and development on new antimicrobial agents has slowed and there are many financial and other obstacles, but there is a rapidly growing global effort to remove these obstacles, as well as an understanding that vaccines also have a role to play.

And then there is the unknown — emerging infections such as Zika and Ebola that catch the world unaware and unprepared, and have the potential to greatly harm human health and national economies.

The good news is, however, that no matter what the threat, countries can be prepared if they continue to develop and strengthen their public health capacity in epidemiology, laboratory diagnosis and risk communication.

For more information or to order “CCDM, 20th Edition,” visit www.apha.org/ccdm. The new Zika chapter and subscriptions are available from the online platform.