Zika Virus: A Physician’s Perspective

BRIAN FOY, MD, works with vectors and vector-borne pathogens, and his research spans both basic and applied biology. Dr. Foy’s undergraduate training at Notre Dame was in medicalentomology, anthropology and ecology, and his graduate school training at Tulane was in molecular and cellular biology, immunology and tropical medicine research. Dr. Foy’s expertise as a researcher prepared him for many forays outside the U.S., but what it could not prepare him for was exposure to the Zika virus during a 2008 trip to Senegal. Upon his return, the doctor unknowingly passed the virus to his wife, making the Colorado couple the first known case of sexually acquired Zika in the United States. As a physician, researcher and now a patient, Dr. Foy offers unique insights into the search to find a vaccine for this potentially dangerous and highly contagious illness.

BSTQ: Tell us about your background in Zika research.

Dr. Foy: Prior to my fateful trip to Senegal, I had done a lot of research on arbovirus infections in mosquitoes, mostly with Sindbis, o’nyong-nyong, dengue and West Nile viruses. On that trip, of course, my graduate student and I came down with symptoms that seemed to me at the time to be the result of an arbovirus infection, and then my wife became ill with very similar symptoms about a week after my symptoms arose. Following that, I spent two years following up that now well-documented report, and eventually discovered that we had all been infected with Zika virus. Subsequently, I obtained some isolates of Zika virus, began doing some simple experiments in the lab and wrote a grant to the National Institutes of Health to get funding to study Zika virus sexual transmission, but that first grant was rejected.After a report in 2015 described the 2013 Tahiti outbreak confirmed our supposition that Zika virus could be sexually transmitted, I rewrote my grant, and it was recently funded. In addition, my wife and I have donated our blood to several research groups that needed it for diagnostics and therapeutics research.

BSTQ: Have you or your wife had any lingering health problems since your infection?

Dr. Foy: My arthralgia lasted longer than any other of my symptoms — at least a month. My wife’s symptoms were worse than mine, and not only did she have long-term arthralgia in her wrists and thumb joints, to this day, she has lingering aching and weakness in those joints that she ascribes to being infected with Zika virus.

BSTQ: Where is the greatest risk of infection in the U.S.?

Dr. Foy: If by mosquitoes, most of the risk is concentrated in South Florida and Gulf Coast states on the U.S. mainland. Outside of the mainland, Puerto Rico is obviously a hotspot for Zika virus mosquito transmission, and Hawaii is at risk. If through sex, that could be anywhere an infected traveler travels.

BSTQ: Are there any research breakthroughs on the horizon?

Dr. Foy: I’m particularly interested in research that is looking at why microcephaly cases seemed to be so prevalent in the northeast of Brazil relative to other highly infected areas (South Pacific islands, parts of Colombia, Puerto Rico, etc.). Was it simply that there was an unfortunate confluence of many pregnant women in the region where there was a large outbreak of a new virus and people didn’t yet know it could infect fetuses? Or were there/are there other important risk factors that we don’t yet understand? Similarly, data from lab studies are showing that previous exposure and antibody-based immunity to other flaviviruses, like dengue viruses, can enhance Zika virus infection in cells. The big question is how much this influences disease presentation in communities that have many dengue immune people.

BSTQ: What is your research focused on?

Dr. Foy: Currently, we are working to understand Zika virus sexual transmission. I have also been working with my colleagues and publishing papers to understand Zika virus transmission in mosquitoes, and developing Zika virus diagnostic assays.

BSTQ: Where are we in terms of developing a vaccine?

Dr. Foy: I’m no expert on this, but it seems to me from the news and scientific reports that early Zika virus vaccine studies are very promising, and human vaccine trials are imminent.