Sure Hope the WHO is 100 Percent Correct

Because Florida and Four Million Canadians Need It

SCIENTISTS PARKING ONLY
Credit: evan p. cordes on flickr (CC-by-2.0) Red text added by RoseWrites on Nov. 18th, 2016

Over the past week, it became clear to me that biggest impediment to solving our evolving Zika crisis is the want for some scientists to derail the work of others.

Perhaps the motivation is career-related, money-related, grudge-related, I don't know –  but it's a huge problem that will cost lives.

Since Florida is still tallying Zika cases, I felt I should reach out to Aileen M. Marty, M.D., F.A.C.P., professor of Infectious Diseases in the Department of Medicine at the FIU Herbert Wertheim College of Medicine.
 
I saw her on a news report and kept her name in the back of my mind.
 
I had no idea she was also a member of  WHO's Advisory Group on Mass Gatherings, Risk Assessments, Command & Control, EID (Emerging Infectious Diseases) until she responded to my first email. 
 
The following is what I wrote to her with the subject line, Concerns About Wolbachia-Infected Mosquito Release in Florida:
 
I've corresponded with Drs. Constância Ayres, Walter Leal, Michael Diamond, and some experts here in Canada about Zika over the past few months. 
 
I am extremely concerned about the use of Wolbachia-infected mosquitoes in Florida for the following reasons:
 
If Culex prove to be a formidable vector in Florida, then Wolbachia could be problematic. Culex were shown to be even more susceptible to West Nile virus and naturally-infected Culex were shown to be better vectors of malaria. These results were unexpected, of course.
 
My sense is that if Culex acquires Wolbachia (naturally) when Aedes die off or via other organisms or parasites, they could become even more susceptible to the Zika virus. 
 
As you know, West Nile virus is more related to ZIKV than the hemorrhagic flaviviruses. Even though the CDC keeps lumping Zika in with dengue.
 
I included the citations (with clickable links) to those studies in my piece: Zika: The Warnings About Wolbachia and Culex Our Health Authorities are Ignoring
 
Do you have any opinion about this that I could add to my article?

Dr. Aileen Marty Replied to Me

November 14th, 2016:

Dear Rose: 

I am currently at the ASTMH 65th annual meeting working specifically on Arboviral diseases.

To answer your questions, first, West Nile is not more closely related to Zika than Dengue.  West Nile is a subtype of Japanese B encephalitis virus and is in fact LESS related to Zika than Dengue. 

Also, all evidence thus far reveal that Culex mosquitoes (while rarely having been found to harbor Zika virus) are not good vectors of Zika because the Zika virus does not appear to replicate easily in Culex as it does in other types of mosquitos such as Aedes sp. Mosquitos. 

Also, Wolbachia does not kill mosquitoes; not even genetically modified Wolbachia.  I have many more comments but I have to return to the conference and this computer is almost out of power. 

I will be back in Florida on Thursday you can reach me in my office then and we can chat. 

Hurry
Credit: Georgie Pauwels on flickr (CC-by-2.0)

Realizing She Must Have Been in a Hurry

I Immediately Wrote Her Back to Explain Some More

Dear Dr. Marty,

Thank you for responding so quickly.
 
Just to clarify, Zika is more related to West Nile virus than Zika is related to dengue. I was not trying compare West Nile to dengue at all.
 
And respectfully, I have to disagree with you. 
 
I am in agreement with Dr. Fiona Hunter, Canadian medical entomologist and Dr. Constância Ayres, entomologist and lead research scientist at the Recife branch of Brazil’s foremost public-health research institute, the Oswaldo Cruz Foundation (Fiocruz).
 
At the Zika Symposium, 2016 International Congress of Entomology, Dr. Hunter stated (scroll to 1:03:16 mark): 
"If you look at the support for the phylogenetic placement [of Zika virus], there is 99 percent support for that node saying ... that the clade includes West Nile, Saint Louis encephalitis, and Zika virus." 

Zika Symposium

2016 International Congress of Entomology

I Even Included This Screenshot of Dr. Hunter

And Zika's Phylogenetic Clade With WNV and SLE

Screenshot of Dr. Fiona Hunter Explaining the Phylogenetic Placement of Zika
Credit: Screenshot of Zika Symposium Where Dr. Hunter Explains Zika's Phylogenetic Placement [Fair Use]

I Continued With a Quote From Dr. Hunter

"The fact that there are no data as far as I can tell that Aedes aegypti is driving this Zika epidemic just flabbergasts me." ~ Dr. Fiona Hunter, medical entomologist at Canada's Brock University[1] 

 
At 30:15 mark (same video) Dr. Aryes completely debunks earlier studies that pointed to only Aedes as a vector. In fact, Culex wasn't even looked at. At 44:21 she stated: 
"Why, in the human environment, only Aedes aegypti is the villain ... Culex perfuscus has a transmission rate 10 times higher than Aedes aegypti ... but this species, in discussions, was completely ignored... Zika is more related to the viruses transmitted by Culex." 
Furthermore, no pools of Aedes aegypti  were associated with other recent outbreaks of Zika, such as the 2007 epidemic in Micronesia when approximately 70% of Yap Island’s population of 7,300 was infected. 
 
Dr. Ayres contacted researchers in the region to identify which mosquito species was most abundant there. Their answer was Culex quinquefasciatus, which had not been investigated as a Zika vector.

"Actually, there are very few A. aegypti mosquitoes in Micronesia. There are other species of Aedes in the region, but A. aegypti is very rare on most of the islands and is completely absent from the islands where the vast majority of cases of Zika occurred

The problem is that until now everyone who studied the circulation of Zika virus only looked at species of Aedes. It was assumed these mosquitoes must be Zika vectors because they were already well-known vectors of dengue, chikungunya and yellow fever." ~ Dr. Ayres[2]

"Some populations [of Culex] have already adapted to living side-by-side with humans ... and are as efficient at biting humans as Aedes aegypti. Larvae will develop in sewers and pit latrines and adults live in people's houses." ~ Dina Fonseca, entomologist at Rutgers University, New Jersey[3]

The conclusion (published March 3rd, 2016) in Differential Susceptibilities of Aedes aegypti and Aedes albopictus from the Americas to Zika Virus[4] states:
"This study suggests that although susceptible to infection, Ae. aegypti and Ae. albopictus were unexpectedly low competent vectors for ZIKV [Zika virus]."
RE: " Also, Wolbachia does not kill mosquitoes; not even genetically modified Wolbachia."
I have no idea what you mean by this.
  
My point with Wolbachia is that once those mosquitoes die (and eventually they do), that Wolbachia can survive for at least a week. 
"The bacteria is tough enough to survive for at least a week after its host's death, allowing it to spread to new organisms." ~ Dr. John TimmerPh.D. in Molecular and Cell Biology from the University of California, Berkeley[5]
And Jason Rasgon, associate professor, Penn State entomology departmart (who has investigated Wolbachia for over 10 years) investigated whether the Wolbachia could help control the spread of West Nile Virus (WNV) by Culex mosquitoes. He was expecting Wolbachia to block WNV, but it didn't. 

"We had to repeat it a couple times before we actually believed the result," Rasgon said. Culex mosquitoes treated with Wolbachia were MORE LIKELY to carry the virus."[6]

A February 5th, 2014 study called Wolbachia Increases Susceptibility to Plasmodium Infection in a Natural System[7] by F. ZéléA. NicotA. BerthomieuM. WeillO. Duron, and A. Rivero stated: 

"These results suggest that naturally Wolbachia-infected mosquitoes may, in fact, be better vectors of malaria than Wolbachia-free ones."

I Continued With This Impassioned Plea

Don't you think that there is a real risk of Culex becoming infected naturally with Wolbachia and then (as with West Nile and malaria) Culex become even MORE likely to be infected with Zika and to therefore infect more humans? 

In my mind, Wolbachia could, in fact, be the one thing that has been overlooked. And when I checked out filariasis on a global map, I was shocked by the similarities between its prevalence and Zika's path. I think Dr. Ayres might have said something about this previously,  I tend to hang on her every word. 

There is a ring of truth about everything Dr. Ayres has stated and I wish I could say the same for the CDC, WHO, and Health Canada.

I sincerely feel there is divide in the scientific community right now. And I've kept as open a mind as I can to all of the evidence. But I think there was (is?) a dangerous type of "group think" within the WHO. I sense the CDC and WHO wanted to appease the IOC and so perhaps evidence has been ignored for too long. 

Wolbachia cannot be taken back, so I sincerely hope that honest evaluations are being done on Culex to:

a) Look for Zika in all Culex species of Florida. 

b) Determine what effect Wolbachia has on Culex when they are naturally infected.

Thank you for reading this letter in full.

ultrasound
Credit: Zach Chisholm on flickr (CC-by-2.0)

Her Response to Me Had Me Shaking My Head

My Thoughts are in Square Brackets:

Hi Rose:  It is so interesting you sent me to a presentation that begins with Steve Higgs, current president of the ASTMH (which is where I am).  [Who cares about Steve Higgs? Right now, I'm thinking about the women grappling with the heartbreaking decision of whether or not to abort their babies.]

I had a lovely chat with him yesterday morning (before your e-mail) specifically regarding Zika. [Again, Dr. Marty rubbing shoulders with Steve Higgs doesn't impress me one bit].

First, please see the following data from https://www.viprbrc.org/brc/home.spg?decorator=vipr  which reveals the following sets of genomes for Zika https://www.viprbrc.org/brc/vipr_genome_search.spg?method=SubmitForm&blockId=2721&decorator=flavi

and provides a phylogenetic tree (https://files.acrobat.com/a/preview/46c2359d-3039-4798-bc24-9c525754a64a) that demonstrates no increased genetic link between West Nile and Zika than between Zika and Dengue.

I do find the links you sent quite interesting.  And I would like to offer the following comments:

  1. Regarding your reference to the Globe article that states, "The fact that there are no data as far as I can tell that Aedes aegypti is driving this Zika epidemic just flabbergasts me." ~ Dr. Fiona Hunter, medical entomologist at Canada's Brock University  The article was written BEFORE we captured mosquitoes infected with Zika and is thus, solidly out of date.  That said, I agree that there is a lot more to the story than simple mosquito transmission.
  2. Regarding your comment about the video of the Sep 27, 2016 Zika symposium at the 2015 [sic] International Congress of Entomology (that begins with Steve’s lecture) where you note, "At 30:15 mark (same video) Dr. Aryes completely debunks earlier studies that pointed to only Aedes as a vector. In fact, Culex wasn't even looked at."  There are now several papers examining Culex as a possible vector for Zika, and none of them support Culex as currently capable vector for Zika (though it is certainly possible that there is some species of Culex out there that might be able to, the data does not currently support that view).  Here are some you should look at: Vector Competence of American Mosquitoes for Three Strains of Zika Virus http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005101;  Culex mosquitoes are experimentally unable to transmit Zika virus. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22573; Experimental investigation of the susceptibility of Italian Culex pipiens mosquitoes to Zika virus infection. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22568; and Culex quinquefasciatus from Rio de Janeiro Is Not Competent to Transmit the Local Zika Virus. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004993 
  3. Regarding the next part of her lecture where as you note, "At 44:21 she stated: "Why, in the human environment, only Aedes aegypti is the [mention] ... Culex perfuscus has a transmission rate 10 times higher than Aedes aegypti ... but this species, in discussions, was completely ignored... Zika is more related to the viruses transmitted by Culex." ~ Dr. Constancia Ayres" I totally agree with her (and with you), we must never close our minds to thinking that by identifying ONE possible vector (or mode of transmission) that there are not other potential vectors (or modes of transmission).  
  4. Regarding "Furthermore, no pools of A. aegypti  were associated with other outbreaks of Zika, such as the 2007 epidemic in Micronesia, in the western Pacific, when approximately 70% of Yap Island’s population of 7,300 was infected. Dr. Ayres contacted researchers in the region to identify which mosquito species was most abundant there. Their answer was C. quinquefasciatus, which had not been investigated as a Zika vector." Same answer as for #3.
  5. Regarding "Actually, there are very few A. aegypti mosquitoes in Micronesia. There are other species of Aedes in the region, but A. aegypti is very rare on most of the islands and is completely absent from the islands where the vast majority of cases of Zika occurred. The problem is that until now everyone who studied the circulation of Zika virus only looked at species of Aedes. It was assumed these mosquitoes must be Zika vectors because they were already well-known vectors of dengue, chikungunya and yellow fever." ~ Dr. Ayres" Same answer as for #3.
  6. Regarding "Some populations [of Culex] have already adapted to living side-by-side with humans ... and are as efficient at biting humans as Aedes aegypti. Larvae will develop in sewers and pit latrines and adults live in people's houses." ~ Dina Fonseca, entomologist at Rutgers University, New Jersey " Same answer as for #2 and #3.
  7. Regarding, "The conclusion (published March 3rd, 2016) in Differential Susceptibilities of Aedes aegypti and Aedes albopictus from the Americas to Zika Virus states: "This study suggests that although susceptible to infection, Ae. aegypti and Ae. albopictus were unexpectedly low competent vectors for ZIKV."  Yes, that is correct I have never been one to agree with those who pointed to ‘only Ae aegypti and Ae. Albopictus’ for Zika, in fact I have often lectured about the many other Aedes species that are known to be able to vector Zika (and that in an ASTMH journal peer reviewed article it was pointed out that one species of Anopheline and one species of Mansoni mosquitoes were discovered positive for Zika).  None of that, however, changes my thoughts regarding my original answer to your question from yesterday.  
  8. Regarding Wolbachia, I was responding to your original statement, i.e. "If Culex prove to be a formidable vector in Florida, then Wolbachia could be problematic. Culex were shown to be even more susceptible to West Nile virus and naturally-infected Culex were shown to be better vectors of malaria. These results were unexpected, of course. My sense is that if Culex acquires Wolbachia (naturally) when Aedes die off or via other organisms or parasites, they could become even more susceptible to the Zika virus." I am so sorry but none of what you have written makes sense. You are misunderstanding a lot of complex scientific data. In fact you have recompiled the data in a way that has no basis in fact. First, go back my answer to #2.  Then, and most importantly, Culex pipiens mosquito complex is a group of evolutionarily closely related species of mosquitoes.  This complex includes the very important C. pipiens and Culex quinquefasciatus, both NATURALLY infected by the cytoplasmically inherited Wolbachia symbiont. In other words, Culex already HAVE Wolbachia.  In fact, Wolbachia helps the mosquito survive.
  9. Thus, No, no I do not think at ALL that there is any real risk of Culex becoming infected naturally with Wolbachia (BECAUSE it is already infected naturally with Wolbachia!) Nor does the Wolbachia in any way impact Culex to make the mosquito more likely to be infected with Zika (if anything it may be one of the reasons it is a poor vector for Zika).

I hope you find this information of value.  All the best, Aileen

I Wrote the Following Response

And I Have Not Heard Anything Back From Anyone:

Dear Dr. Marty,

Zika Virus "Unexpected Error" Prompt From Dr. Marty's 1st LinkCredit: Screenshot by RoseWritesThe first link you sent me yielded an "unexpected error" prompt (see screenshot at right).
 
The second link doesn't (for me) reveal anything that I can tell which compares Zika to West Nile or the other flaviviruses that target the nervous system.
 
And the third link shows Zika and dengue but not West Nile and has an "unclassified flavivirus" (see screenshot below).
 
2016 List Shows Zika and Dengue and Unclassified Virus From Dr. Marty's 3rd LinkCredit: Screenshot by RoseWrites
Not only does Drs. Ayres and Hunter point out the the similarities between Zika and West Nile, but I found this opinion too:
 
Duane Gubler, a virologist at Duke-NUS Medical School in Singapore, agreed that Culex is a plausible carrier.
 
He noted that several ZIKV relatives spread by Culex mosquitoes, including the West Nile virus, target the nervous system, which Zika also seems to do.[8]   
 
In Latin America, most vector control methods are targeted at A. aegypti. Those efforts have made barely a dent in curtailing spread of the Zika virus so far, notes Paul Reiter, an entomologist at the Pasteur Institute in Paris. Targeting multiple vectors at once will only make the job harder. [8]
 
As for Dr. Fiona Hunter's quote being "solidly out of date" RE: "The fact that there are no data as far as I can tell that Aedes aegypti is driving this Zika epidemic just flabbergasts me."
 
We are still talking about the 2015 outbreak in Brazil. So, it's not out-of-date, in fact it highlights that early on, there was an decided path taken to "hold onto" even older evidence that only pointed to Aedes as a vector.
 
I understand there are a wide range of genetic differences among mosquitoes, about 40 strains of Zika, and different types of Wolbachia. I have looked at other studies and first noted the research out of China on Sept. 10th, 2016 (which had zero press).[9]
 
We can mix and match strains and mosquitoes and hybrids and come up with our desired result, it seems.
 
To quote Pedro Lagerblad de Oliveira who commented on Dr. Walter S. Leal's piece:
 
"Reading the published papers do not provide an immediate explanation for the discrepant results from different groups. Of course, although experimental errors can not be excluded, data can be reconciled as differences in virus and or mosquito strains (or even symbiont microbiota) can explain the distinct findings from each group. If Zika transmission was merely an academic question, I would say that time would solve the question. However, this is a major threat for global public health, and transmission mediated by one or two species calls for very distinct control strategies. Therefore, I would add to this report that there this debate needs urgently to evolve in the experimental field, ideally as collaborative research, but at least with exchange of virus and mosquitoes strains, and rigorous comparisons of the methodology."[10]
 
In all fairness, I've seen the same divide in prosthetics and in ophthalmology. I sense there is a tendency to ignore the raw data and to remain in comfortable scientific cliques. 
 
Since Wolbachia is already present in Culex (and I "get" that), then is it a different type of Wolbachia or perhaps because Culex quinquefasciatus appears to possess two mitochondrial types in Brazil?[11] 
 
Because on the surface, how could two independent teams come to the conclusion that Wolbachia enhanced West Nile and malaria if there isn't something different? Based on your reasoning, this would be impossible.
 
Just a reminder: 
We had to repeat it a couple times before we actually believed the result," Rasgon said. Culex mosquitoes treated with Wolbachia were MORE LIKELY to carry the virus." Source: https://psmag.com/tackling-west-nile-with-bacteria-may-worsen-the-disease-31fe9fd23371#.h3b4uwgrs 
A February 5th, 2014 study called Wolbachia Increases Susceptibility to Plasmodium Infection in a Natural System by F. ZéléA. NicotA. BerthomieuM. WeillO. Duron, and A. Rivero stated: "These results suggest that naturally Wolbachia-infected mosquitoes may, in fact, be BETTER VECTORS of malaria than Wolbachia-free ones." Source: http://rspb.royalsocietypublishing.org/content/281/1779/20132837
 
The study which suggested Culex in Brazil possess two mitochondrial types also stated: "This fact should be taken into consideration in investigations of disease distribution and in aspects of blood-hosts in those locations."[11]
 
I still feel it would be prudent to look for Zika in the Culex mosquitoes of Florida (I'm guessing they do already for West Nile virus) and see whether or not Wolbachia in Culex there yields any "alarming" results. I hope I'm wrong, but wouldn't it be a relief to know for sure?
 
This virus has surprised many scientists and every possibility should be considered (especially when employing an eradication method that is permanent).
 
I appreciate your considerable time and effort to enlighten me. I continue to research this (for the sake of global public health).
 
Famous Quote of Dr. Amos N. Wilson, American Psychologist and Author
Credit: Created by RoseWrites on Nov. 18th, 2016 Using Pixlr and Fair Use Image of Dr. Amos N. Wilson

Los Angeles Times is Keeping My Commentary

ABC News Removed My Posts and Disqus Banned Me

Rose Webster's Response to Comment on New Zika findings reveal how virus does its damage, and two weapons that might help fight it
Credit: Screenshot of my response to tlshell2 on L.A. Times article [Fair Use]

Is This Why ABC Removed My Posts?

Bill Gates Funds Wolbachia-Infected Mosquito Releases

Bill Gates Buys Attention of ABC News?
Credit: Screenshot of "Bill Gates Buys Attention of ABC News?" article [Fair Use]

Sorry Florida and Canadian Snowbirds, I Tried

Pensacola Beach, Florida
Credit: Olin Gilbert on flickr (CC-by-2.0)

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