A Different Kind of “Swat” Team

About 4 years ago I went to spend a few days volunteering in Haiti with the organization, Live Beyond. Just before I left, I got a group email from the trip organizers about an outbreak of the Chikungunya virus. “The Chicken WHAT?” I had never heard of it. I was already taking malaria prophylaxis, and had read up on Chagas and Dengue which are also endemic. Seriously, another horrible mosquito borne illness? This was before anyone was talking about Zika. As it turned out, I saw a lot of Chikungunya on that trip and the patients were really SICK. Chikungunya is a mosquito-borne viral disease first described in southern Tanzania in 1952 and the name comes from an African dialect that means “to become contorted” because of the painful arthralgias. The Haitian Creole word for it means “the broken bone disease” because the joint pain is so bad it feels like a fracture. A few months later, my niece, an ICU nurse from Austin, Texas, got Chikungunya on a trip to Puerto Rico and suffered with joint pain for months.

The fact is that Chikungunya, West Nile virus, and Zika are not just problems for third world countries. They are endemic in my home state of Texas. I’m grateful for the huge investment that Houston and the surrounding communities spend on mosquito control and identifying outbreaks. They are good at their jobs. Several years ago my daughter and her roommate became ill with high fever and chills but labs didn’t show the flu. I was worried about the situation and went to sit on the porch of their tiny rental house to think about it, and a mosquito bit me. The timing was like a TV medical show episode. I immediately called the county public health department, and within minutes I was talking to an actual person who was able to tell me whether the mosquito traps near that address had been identified as carrying West Nile or anything else I should be worried about. That’s a fantastic return on tax dollars. I can now count 4 patients in the Wound Center who have had West Nile meningoencephalitis with long term neurological deficits (all of them on some type of immunosuppressive medication).

The June issue of “Texas Medicine” (such a great little publication!) has an informative article about the way that Texas copes with deadly vector borne diseases. People need to wear mosquito repellent, get rid of standing water, and if you are someone who has to take immunosuppressive medication (even for a condition like psoriasis), wear long sleeves and long pants in high risk areas. Remember that the Zika-carrying mosquitoes feed all day, not just in the evening. Baylor College of Medicine has a National School of Tropical Medicine that offers a diploma in tropical medicine. Physicians have 3 years to complete 4 classes, each of which are a few weeks long. I used to give lectures on decompression sickness to the students when I was on the faculty at U.T. Houston and I was impressed with the program. The take-home message from the Texas Medicine article is that these diseases are frequently misdiagnosed, seriously under-reported and are definitely not rare.