U.S. says Islamic State conducted attack on Kabul hospital

WASHINGTON (Reuters) – The United States on Thursday blamed Islamic State militants — not the Taliban — for a gruesome hospital attack in Afghanistan this week that killed two newborn babies, and it renewed calls for Afghans to embrace a troubled peace push with the Taliban insurgency.

But it was unclear if the U.S. declaration would be enough to bolster the peace effort and reverse a decision by the Kabul government to resume offensive operations against the Taliban.

Afghan President Ashraf Ghani ordered the military on Tuesday to switch to “offensive mode” against the Taliban following the hospital attack in Kabul and a suicide bombing in Nangarhar province that killed scores of people.

U.S. Special Representative Zalmay Khalilzad blamed Islamic State for both attacks in a statement issued on Twitter, saying the group opposed any Taliban peace agreement and sought to trigger an Iraq-style sectarian war in Afghanistan.

“Rather than falling into the ISIS trap and delay peace or create obstacles, Afghans must come together to crush this menace and pursue a historic peace opportunity,” Khalilzad said.

“No more excuses. Afghans, and the world, deserve better.”

An affiliate of the Islamic State militant group claimed responsibility for the Nangarhar bombing, according to the SITE Intelligence Group. No one has claimed the hospital attack.

The Taliban denied involvement in either attack, but the government accused the group of fostering an environment in which terrorism thrives or of working with other militant groups who could have been involved, straining U.S. efforts to bring the insurgents and Afghan government together.

The attacks were another setback to U.S. President Donald Trump’s stalled plans to bring peace to Afghanistan and end America’s longest war.

A Feb. 29 U.S.-Taliban deal called for a phased U.S. troop withdrawal and for the Afghan government and Taliban to release some prisoners by March 10, when peace talks were to start.

Intra-Afghan peace talks have yet to occur and there is some bitterness within the Afghan government, which was not a party to the Feb. 29 deal, that the United States undercut their leverage by negotiating directly with the Taliban.

Ghani’s decision to revive offensive operations is supported by many opposition figures, who believe Washington’s sole focus is to keep the U.S. troop withdrawal plan on track to help Trump win a second term in the Nov. 3 U.S. presidential election.

(Reporting by Eric Beech and Phil Stewart; Editing by Mohammad Zargham and Daniel Wallis)

Trump asks U.S. Congress to prohibit late-term abortion

U.S. President Donald Trump gestures during his State of the Union address to a joint session of Congress on Capitol Hill in Washington, U.S., February 5, 2019. REUTERS/Jim Young

WASHINGTON (Reuters) – U.S. President Donald Trump called for curbs on late-term abortion in his State of the Union address on Tuesday, citing controversies over the issue in New York and Virginia.

Using emotive language, Trump waded into what has long been a divisive issue in American politics, even though the procedure was legalized in a Supreme Court ruling more than 40 years ago.

“To defend the dignity of every person, I am asking the Congress to pass legislation to prohibit the late-term abortion of children who can feel pain in the mother’s womb,” Trump said.

“Let us work together to build a culture that cherishes innocent life. Let us reaffirm a fundamental truth: all children – born and unborn – are made in the holy image of God,” he said.

The issue of whether a fetus feels pain has been raised frequently in recent years by abortion opponents pushing for more restrictions in state legislatures. Medical opinion on the issue is not conclusive.

With the confirmation last year of Trump’s pick for the Supreme Court, Justice Brett Kavanaugh, conservatives now have a 5-4 edge on the nation’s highest court, raising fears among abortion rights supporters that the 1973 Roe v Wade ruling could be weakened or overturned.

Currently, laws governing late-term abortions vary state by state.

Trump criticized a New York law enacted last month that provides strong abortion rights protections, including late-term abortions when the mother’s health is endangered.

In his speech, he said lawmakers in the state “cheered with delight” at the law “that would allow a baby to be ripped from the mother’s womb moments before birth.”

The Republican president also seized on a controversy surrounding Virginia Governor Ralph Northam, repeating Republicans’ accusations that Northam, a Democrat, advocated infanticide when he defended a bill that would have lifted restrictions on later-term abortions.

Northam has said his comments were misinterpreted. “Extrapolating otherwise is bad faith,” his spokeswoman, Ofirah Yheskel, said last week.

The embattled Virginia governor is facing a separate controversy over a racist photo in his 1984 medical school yearbook, but has resisted calls to resign.

(Reporting by Makini Brice and Doina Chiacu; Editing by Sonya Hepinstall)

Iowa Governor Kim Reynolds signs ‘Heartbeat Bill’ into law

Supporters of Planned Parenthood (L) rally next to anti-abortion activists outside a Planned Parenthood clinic in Detroit, Michigan, U.S. February 11, 2017. REUTERS/Rebecca Cook
Press Release from Faith2Action
Heartbeat Law–Most Protective Law in the Nation!
 
May 4, 2018 – For Immediate Release
Iowa Governor Kim Reynolds signed the state Heartbeat Bill into law today, legally protecting unborn babies in Iowa whose beating hearts can be detected.
“We thank Gov. Reynolds and the leaders in the Iowa State Senate and House who worked tirelessly to keep hearts beating,” said Janet Porter, President of Faith2Action, who authored the nation’s first Heartbeat Bills at the state and federal level.
“We call on Speaker Paul Ryan to follow Iowa’s lead and call an immediate floor vote on the federal Heartbeat Bill (H.R. 490), now with 171 co-sponsors–more than any pro-life bill in Congress,” declared Porter.
 
Former Majority Leader Tom DeLay testified for the Iowa Heartbeat Bill in committee and has been leading the team fighting for passage of the federal Heartbeat Bill in Washington, sponsored by Congressman Steve King, from Iowa.  “Leaving Congress without ending abortion is my biggest regret–a regret Speaker Ryan doesn’t have to have,” said DeLay.
 
“Speaker Ryan can call for a floor vote to end abortion for every baby whose heartbeat can be heard right now–there’s nothing stopping him,” stated DeLay.
DeLay also offered advice to the Speaker and the Republicans in Congress:  “Nothing will bring out the Republican base in the midterm elections more than keeping your pro-life promises by passing the federal Heartbeat Bill, H.R. 490.”  Leader Delay was fully exonerated from every trumped-up charge against him.
In the last two weeks, more than 300,000 faxes were sent to Speaker Ryan, leadership, and members of Congress calling for a vote of the federal Heartbeat Bill.  Porter added, “In addition to Congress, other states will soon be introducing and passing Heartbeat Bills.  It’s common sense–to ignore a fetal heartbeat is to deny science.” 

New life amid the ruins of Mosul’s maternity hospital

New life amid the ruins of Mosul's maternity hospital

By Raya Jalabi

MOSUL (Reuters) – As yet unnamed twin babies lie in an incubator in a run-down room in Mosul’s main maternity hospital. Less than two weeks old, they are two of seven newborns crammed into a makeshift premature baby ward.

Born just three weeks after Iraqi forces declared that they had finally recaptured the last part of the city from Islamic State, the twins won’t know what it’s like to grow up under the jihadists’ draconian rule. But they are lucky in more ways than one – had they been born months earlier, their chances of survival would have been slim as the hospital’s neo-natal wings had been burned down by the militants.

Al-Khansa Hospital in East Mosul may be a shell of its former self but it is still the city’s main government-run maternity facility. Last month alone, despite severe shortages of medicines and equipment, it delivered nearly 1,400 babies.

When Islamic State took over Mosul in 2014, the hospital stayed open – but residents were only allowed to use a quarter of it.

“We had all these fighters and their wives coming in and giving birth here,” said hospital administrator Dr Aziz, adding that he had lost count of the number of militants’ babies delivered in his facility. “Mosul’s local residents always came second.”

As Iraqi Forces began their campaign to liberate the city from Islamic State control last year, the militants took over al-Khansa, kicking out patients and sometimes shooting at staff to make them leave.

“We kept it open as long as we could,” Aziz said.

Islamic State turned the hospital into a warehouse to store medical supplies – mainly glucose injections and cough syrup. As their defeat looked imminent, they started fires and detonated explosives throughout the hospital.

“They knew exactly what to blow up and how to do the most damage,” Aziz said, walking through the charred remains of the operating theaters.

SHORTAGES OF EVERYTHING

Al-Khansa reopened just weeks after East Mosul was cleared of militants in January. But its needs are still dire.

“We have shortages of everything,” said the hospital’s director, Dr Jamal Younis. “Beds, equipment, medicines.”

At present, the hospital can only handle births and deaths, Younis said. For anything in between, patients have to travel to facilities miles away – an impossible expense for most.

In a hot and crowded room, Um Mohammad sat with her grandson, only a few months old and barely able to move. She said she had been waiting there for 15 days, trying to find $25 to pay for blood tests.

She has been living in a camp since an air strike flattened her house in West Mosul, killing her daughter and five of her grandchildren.

“I can’t take him back to the camp without treatment or a diagnosis,” she said, “but I don’t have the money.”

Al-Khansa has yet to receive funds for reconstruction from the Health Ministry. Instead it had been relying on NGOs and donations from residents and staff – most of whom have not been paid for more than two years, since Baghdad cut salaries to choke off funding to Islamic State.

“When the city was under Isis control, we were forced to come into work every day or they would punish us – seize our houses, beat us, threaten our families,” said Aziz.

“But now, even though we’re still unpaid and the walls have fallen down, we’re happy to come in every day to help our community.”

(Reporting by Raya Jalabi; Editing by Kevin Liffey)

U.S. scientists able to alter genes of human embryos

Juan Carlos Izpisua Belmonte, Professor at Salk Institute's Gene Expression Laboratory and Jun Wu, Salk staff Scientist are pictured in this handout photo obtained by Reuters, August 2, 2017. Salk Institute/Handout via REUTERS

By Deena Beasley

U.S. scientists have succeeded in altering the genes of a human embryo to correct a disease-causing mutation, making it possible to prevent the defect from being passed on to future generations.

The milestone, reported in a paper released online August 2 in Nature, was confirmed last week by Oregon Health and Science University (OHSU), which collaborated with the Salk Institute and Korea’s Institute for Basic Science to use a technique known as CRISPR-Cas9 to correct a genetic mutation for hypertrophic cardiomyopathy.

Until now, published studies using the technique had been done in China with mixed results.

CRISPR-Cas9 works as a type of molecular scissors that can selectively trim away unwanted parts of the genome, and replace it with new stretches of DNA.

“We have demonstrated the possibility to correct mutations in a human embryo in a safe way and with a certain degree of efficiency,” said Juan Carlos Izpisua Belmonte, a professor in Salk’s Gene Expression Laboratory and a co-author of the study.

To increase the success rate, his team introduced the genome editing components along with sperm from a male with the targeted gene defect during the in vitro fertilization process. They found that the embryo used the available healthy copy of the gene to repair the mutated part.

The Salk/OHSU team also found that its gene correction did not cause any detectable mutations in other parts of the genome – a major concern for gene editing.

Still, the technology was not 100 percent successful. It increased the number of repaired embryos from 50%, which would have occurred naturally, to 74%.

The embryos, tested in the laboratory, were allowed to develop for only a few days.

“There is still much to be done to establish the safety of the methods, therefore they should not be adopted clinically,” Robin Lovell-Badge, a professor at London’s Francis Crick Institute who was not involved in the study, said in a statement.

‘UTMOST CAUTION’

Washington’s National Academy of Sciences (NAS) earlier this year softened its previous opposition to the use of gene editing technology in human embryos, which has raised concerns it could be used to create so-called designer babies. There is also a fear of introducing unintended mutations into germline cells.

“No one is thinking about this because it is practically impossible at this point,” Izpisua Belmonte said. “This is still very basic research … let alone something as complex as what nature has done for millions and millions of years of evolution.”

An international group of 11 organizations, including the American Society of Human Genetics and Britain’s Wellcome Trust, on Wednesday issued a policy statement recommending against genome editing that culminates in human implantation and pregnancy, while supporting publicly funded research into its potential clinical applications.

Salk’s Izpisua Belmonte, emphasizing that much more study is needed, said the most important practical application for the new technology could be in correcting genetic mutations in babies either in utero or right after they are born.

“It is crucial that we continue to proceed with the utmost caution, paying the highest attention to ethical considerations,” he said.

SOURCE: http://go.nature.com/2wm4g1v

Nature 2017.

(This story was refiled Refiling with source link at end of story and modifications throughout for professional readers)

Infant mortality and malaria soar in Venezuela, according to government data

Pregnant women lay on beds without sheets during their labour at a maternity hospital in Maracaibo, Venezuela June 19, 2015. REUTERS/Isaac Urrutia

By Alexandra Ulmer

CARACAS (Reuters) – Venezuela’s infant mortality rose 30 percent last year, maternal mortality shot up 65 percent and cases of malaria jumped 76 percent, according to government data, sharp increases reflecting how the country’s deep economic crisis has hammered at citizens’ health.

The statistics, issued on the ministry’s website after nearly two years of data silence from President Nicolas Maduro’s leftist government, also showed a jump in illnesses such as diphtheria and Zika. It was not immediately clear when the ministry posted the data, although local media reported on the statistics on Tuesday.

Recession and currency controls in the oil-exporting South American nation have slashed both local production and imports of foreign goods, and Venezuelans are facing shortages of everything from rice to vaccines. The opposition has organized weeks of protests against Maduro, accusing him of dictatorial rule and calling for elections.

In the health sector, doctors have emigrated in droves and patients have to settle for second-rate treatment or none at all. A leading pharmaceutical association has said roughly 85 percent of medicines are running short. Venezuelans often barter medicine, post pleas on social media, travel to neighboring countries if they can afford it, or line up for hours at pharmacies.

The Health Ministry had stopped releasing figures after July 2015, amid a wider data blackout. It was not clear why it published this latest batch of data.

Its statistics for 2016 showed infant mortality, or death of children aged 0-1, climbed 30.12 percent to 11,466 cases last year. The report cited neonatal sepsis, pneumonia, respiratory distress syndrome, and prematurity as the main causes.

Hospitals often lack basic equipment like incubators, and pregnant women are struggling to eat well, including taking folic acid, factors that can affect a baby’s health.

(To read the story on Venezuelan women seeking sterilizations as crisis sours child-rearing, click http://www.reuters.com/article/us-venezuela-sterilizations-idUSKCN10E1NK)

Maternal mortality, or death while pregnant or within 42 days of the end of a pregnancy, was also up, rising 65.79 percent to 756 deaths, the report said.

The Health Ministry did not respond to a request for further information. Maduro’s government says a coup-mongering elite is hoarding medicines to stoke unrest.

‘TURMOIL’

While Venezuelans are acutely aware of the country’s health issues, the ministry’s statistics bulletin shocked some in the medical community.

“The striking part is turmoil in almost all the categories that this bulletin addresses, with particularly significant increases in the infant and maternal health categories,” said Dr. Julio Castro, an infectious disease specialist and an outspoken critic of the government’s health policies.

Doctors say the health bulletins, meant to be released weekly, should be published in a timely fashion to alert medical practitioners to national trends and threats.

Venezuela, for instance, had controlled diphtheria, a bacterial infection that is fatal in 5 to 10 percent of cases, in the 1990s. Doctors last year sounded the alarm that it had returned, but the government initially said there were no proven cases and admonished those seeking to spread “panic.”

The data now shows diphtheria affected 324 people – up from no cases the previous year.

Diphtheria was once a major global cause of child death but is now increasingly rare thanks to immunizations, and its return showed how vulnerable the country is to health risks.

Reuters documented the case of a 9-year-old girl, Eliannys Vivas, who died of diphtheria earlier this year after being misdiagnosed with asthma, in part because there were no instruments to examine her throat, and shuttled around several run-down hospitals.

(For a story on “Venezuelan girl’s diphtheria death highlights country’s health crisis”, click http://www.reuters.com/article/us-venezuela-health-idUSKBN15P1DA)

There were also 240,613 cases of malaria last year, up 76.4 percent compared with 2015, with most cases of the mosquito-borne disease reported in the rough-and-tumble Bolivar state.

Cases of Zika rose to 59,348 from 71 in 2015, reflecting the spread of the mosquito-borne virus around Latin America last year. There was no data for likely Zika-linked microcephaly, where babies are born with small heads, although doctors say there have been at least several dozen cases.

(To read the story on “Amid government silence, Venezuela’s microcephaly babies struggle”, click http://www.reuters.com/article/us-health-zika-venezuela-idUSKBN12H1NY)

(Reporting by Alexandra Ulmer; Editing by Girish Gupta and Frances Kerry)

Scientists develop fluid-filled artificial womb to help premature babies

An artists impression shows a lamb inside a fluid-filled womb-like bag known as an extra-uterine support device developed by the Children's Hospital of Philadelphia.MANDATORY CREDIT Children's Hospital of Philadelphia handout via REUTERS

By Kate Kelland

LONDON, (Reuters) – Scientists in the United States have developed a fluid-filled womb-like bag known as an extra-uterine support device that could transform care for extremely premature babies, significantly improving chances of survival.

In pre-clinical studies with lambs, the researchers were able to mimic the womb environment and the functions of the placenta, giving premature offspring a crucial opportunity to develop their lungs and other organs.

Around 30,000 babies in the United States alone are born critically early – at between 23 and 26 weeks of gestation, the researchers told reporters in a telephone briefing.

At that age, a human baby weighs little more than 500 grams, its lungs are not able to cope with air and its chances of survival are low. Death rates are up to 70 percent and those who do survive face life-long disability.

“These infants have an urgent need for a bridge between the mother’s womb and the outside world,” said Alan Flake, a specialist surgeon at the Children’s Hospital of Philadelphia who led the development of the new device.

His team’s aim, he said, was to develop an extra-uterine system where extremely premature babies can be suspended in fluid-filled chambers for a vital few weeks to bring them over the 28-week threshold, when their life chances are dramatically improved.

It could take up to another 10 years, but by then he hopes to have a licensed device in which babies born very prematurely are given the chance to develop in fluid-filled chambers, rather than lying in incubators being artificially ventilated.

“This system is potentially far superior to what hospitals can currently do for a 23-week-old baby born at the cusp of viability,” Flake said. “This could establish a new standard of care for this subset of extremely premature infants.”

The team spent three years evolving their system through a series of four prototypes – beginning with a glass incubator tank and progressing to the current fluid-filled bag.

Six preterm lambs tested in the most recent prototype were physiologically equivalent to a 23- or 24-week-gestation human baby and were able to grow in a temperature-controlled, near-sterile environment, Flake said.

The scientists made amniotic fluid in their lab and set up the system so that this flowed into and out of the bag.

Lung development in fetal lambs is very similar in humans, said fetal physiologist Marcus Davey, who worked on team.

“Fetal lungs are designed to function in fluid. We simulate that environment … allowing the lungs and other organs to develop while supplying nutrients and growth factors,” he said.

Flake said the success of the system, details of which were published on Tuesday in the journal Nature Communications, was due to its mimicking life in the uterus as closely as possible.

It has no external pump to drive circulation, because even gentle artificial pressure can fatally overload an underdeveloped heart, and there is no ventilator, because the immature lungs are not yet ready to breathe air.

Instead, the baby’s heart pumps blood via the umbilical cord into a low-resistance oxygenator that acts as a substitute for the placenta in exchanging oxygen and carbon dioxide.

Flake’s team plans to refine the system further and then downsize it for human infants, who are around a third of the size of the lambs used in the study.

(Editing by Tom Heneghan)

Aleppo air strike kills 14 members of one family

A damaged site is pictured after an airstrike in the besieged rebel-held al-Qaterji neighbourhood of Aleppo, Syria October 14, 2016. REUTERS/Abdalrhman Ismail

BEIRUT (Reuters) – Fourteen members of the same family were killed in an air strike in rebel-held eastern Aleppo on Monday, emergency service workers said, as the Syrian government pursued its Russian-backed campaign to capture opposition-held areas of the city.

A list of the dead published by the Civil Defence included several infants, among them two six-week old babies and six other children aged eight or below. The Civil Defence identified the jets as Russian. The attack hit the city’s al-Marjeh area.

The Civil Defence is a rescue service operating in rebel-held areas of Syria. Its workers are known as “White Helmets”.

The campaign has killed several hundred people since it started last month after the collapse of a truce brokered by Russia and the United States. The Syrian Observatory for Human Rights said it had documented the deaths of 448 people in air strikes in eastern Aleppo since then, including 82 children.

Syrian and Russian militaries say they only target militants.

People remove belongings from a damaged site after an air strike Sunday in the rebel-held besieged al-Qaterji neighbourhood of Aleppo, Syria

People remove belongings from a damaged site after an air strike Sunday in the rebel-held besieged al-Qaterji neighbourhood of Aleppo, Syria October 17, 2016. REUTERS/Abdalrhman Ismail

 

Since the campaign was announced on Sept. 22, the government has captured territory from rebels to the north of the city, and also reported advances in the city itself which rebels have in turn said they have mostly repelled.

A Syrian military source said the army had targeted terrorists in three areas of Aleppo on Monday, killing seven of them. The government refers to all rebel fighters as terrorists.

The Observatory said 17 more people were killed in attacks by Russian jets on Sunday night in the al-Qarterji district of rebel-held Aleppo. That included five children, it said.

The monitoring group also said it had recorded the deaths of 82 people including 17 children in government-held areas of western Aleppo as a result of rebel shelling.

(Reporting by Tom Perry and Ellen Francis; Editing by Louise Ireland)

Doctors say Haiti ripe for large Zika outbreak, virus under: reported

Residents in Haiti

By Makini Brice

PORT-AU-PRINCE (Reuters) – Posters warning of the dangers of Zika only reached Haiti’s health ministry in August, six months after the country reported an outbreak, in one example of delayed prevention efforts that have health experts worried a “large epidemic” is looming.

Gabriel Thimothe, a senior health ministry official, said the public service posters would be distributed to hospitals and airports shortly, but that health funding had been cut this year and foreign aid was sparse to fight the mosquito-borne virus that can cause severe birth defects.

Zika infections in pregnant women have been shown to cause microcephaly – a defect in which babies’ heads and brains are undersized – as well as other brain abnormalities.

Widespread fumigation that has limited the virus’ spread in other Caribbean nations such as Cuba only began in Haiti last month. Publicity campaigns have been all but invisible and hospital workers were on strike for much of the year.

“We’re expecting a large epidemic but we don’t know when it will occur,” said Jean-Luc Poncelet, the World Health Organization’s representative in Haiti. “There is under-reporting.”

Such an epidemic could severely strain Haiti’s fragile healthcare system, battered by an earthquake in 2010 that killed 300,000, and still struggling with a cholera epidemic that has sickened nearly 800,000 people.

WHO data show 5,000 suspected cases have been reported in more prosperous neighbor Dominican Republic, which shares the island of Hispaniola with Haiti and has a similar population and climate. Haiti by contrast, has reported 3,000 suspected cases, according to numbers shared by the U.S. Centers for Disease Control and Prevention.

That makes Haiti’s Zika infection rate about 30 per 100,000 people, compared to 82 per 100,000 in Brazil, where the connection between Zika and microcephaly was first detected, and 50 per 100,000 in Dominican Republic

The connection between Zika and microcephaly first came to light last fall in Brazil, which has since confirmed more than 1,800 cases of microcephaly.

RAINY SEASON

In the Dominican Republic there were spikes in infections in March and May, broadly coinciding with rainy seasons on both sides of the island, a time when mosquitoes and diseases they carry normally flourish. In Haiti, the number of cases reported each week generally dropped from February through the rains.

A long strike by medical residents at most public hospitals coincided with that decline, raising the question of whether there were fewer infections or a lack of health workers available to register cases.

A Zika task force, which includes the government and non-governmental organizations, was formed in May, Thimothe said. Several U.S. health officials in Haiti told Reuters that the United States provided $3 million in August to combat Zika in the country, money that was initially intended to be deployed against Ebola in West Africa.

Thimothe said the impact of an explosion of microcephaly cases would be devastating, but denied the condition was more widespread than thought, even though many Haitian women give birth at home rather than in clinics.

His position is supported by WHO data through June, which did not show an uptick in microcephaly or Guillain-Barre syndrome, a neurological disorder that can cause temporary paralysis and has also been linked to Zika.

But Louise Ivers, the senior health and policy advisor for Partners in Health, which along with Haitian organization Zanmi Lasante runs a hospital in the central town of Mirebalais, said she had seen at least 12 cases this year of Guillain-Barre, normally a rare condition.

The same hospital registered two microcephaly cases, including one confirmed to be linked to Zika, this summer.

“Maybe we are too late for prevention. Maybe we just have to manage the consequences,” Ivers said. “This could just be the tip of the iceberg.”

(Additional reporting by Joseph Guyler Delva; Editing by Frank Jack Daniel and Alistair Bell)

U.S. fights Zika mosquitoes with limited arsenal

Zika virus kit

By Julie Steenhuysen

(Reuters) – Over Wynwood, the Miami neighborhood where Zika gained a foothold in the continental United States, low flying planes have been spraying naled, a tightly controlled pesticide often used as a last resort. It appears to be working, killing at least 90 percent of the target mosquitoes.

Across the Biscayne Bay in Miami Beach, wind and high-rise buildings make aerial spraying challenging. So, the effort in the popular tourist destination has focused on ground-sprayed pyrethroids – pesticides that are safer but don’t always work.

The arrival in Florida of Zika, a virus that can cause a crippling birth defect known as microcephaly, has drawn into focus the limitations of the U.S. mosquito control arsenal.

Larvicides reduce future populations relatively safely. But for use against the mature mosquitoes that spread disease, only two classes of pesticides are approved. Each has drawbacks.

Organophosphates, such as naled, are effective. But there are strict controls to limit risk. Pyrethroids are safer but have been used so much that mosquitoes, in many places, are immune.

“That’s really the weak link in much of the United States,” said Michael Doyle, director of the Florida Keys Mosquito Control District. “We’re kind of caught off guard.”

DENGUE PREVIEW

Doyle led a 2009 effort against a dengue outbreak in South Florida, the first in the United States in nearly a century. Authorities threw everything they had at the Aedes aegypti, the same mosquito that carries Zika: backpack fogging, door-to-door yard inspections looking for watery breeding sites and larvicide spraying.

Still, 88 people were infected before the virus was brought under control more than two years later, and there continue to be sporadic cases in Florida.

The outbreak highlighted gaps in the mosquito control arsenal that remain, according to pesticide makers, abatement officials and entomologists. Few companies make pesticides for use in public health outbreaks, a niche market that is expensive to get into, has a limited upside and varies season to season.

Safety testing a new pesticide can cost up to $250 million and take 10 years, said Karen Larson, vice president of regulatory affairs at privately held Clarke Mosquito.

As long as a product remains on the market, companies must continue testing for unforeseen side effects, an expense that some makers have blamed for decisions to abandon products.

“There’s not a lot of profit,” Larson said.

Sales of the Dibrome brand of naled have been estimated at $12 million a year. By comparison, total crop pesticide sales for some companies can exceed $500 million in a single quarter.

Bayer, Dow Chemical, BASF and other agricultural pesticide makers “are not interested in going after a $20 million or $30 million a year market,” said William A. Kuser, investor relations director at Dibrome maker American Vanguard Corp.

The U.S. Environmental Protection Agency has approved several new pesticides in recent years. But it has received few requests for using them against mosquitoes, said Jim Jones, Assistant Administrator for the agency’s Office of Chemical Safety and Pollution Prevention.

“Although it’s of critical importance, the amount one can sell is small and it’s variable, which makes it difficult for business planning,” Jones said. “You can go many years without having much of a market at all, then suddenly, whether it’s because of a nuisance outbreak of mosquitoes or something like West Nile or Zika, the market grows significantly.”

Abatement authorities have pressed for help with the cost of developing mosquito control pesticides. The 1996 U.S. Food Quality Protection Act includes a provision for subsidies to defray the expense of safety testing, but Congress has never funded it.

RISK AND RESISTANCE

At least 49 cases of locally transmitted Zika infections have been reported in Florida, most in Wynwood and Miami Beach. Most people have no symptoms or mild illness.

Because of the microcephaly link, efforts are focused on preventing infection among pregnant women.

In Wynwood, the campaign began with pyrethroids, synthetic versions of a chemical derived from chrysanthemums. Amid signs of resistance, authorities switched to naled.

Developed as nerve agents, organophosphates, at high doses, can cause nausea, convulsions and death. They can be toxic to wildlife, including bees. The EPA considers naled safe at permitted ultra-low concentrations, and it is sprayed annually over 16 million acres in the United States.

But it is banned in Europe, where the risk is seen as unacceptable. In the U.S. territory of Puerto Rico, where Zika is widespread, the governor prohibited naled amid protests over safety concerns.

Although naled killed more than 90 percent of mosquitoes in traps set in Wynwood, the Aedes aegypti’s resilience remains a concern.

“This is truly the cockroach of mosquitoes,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention.

DROPPING PESTICIDES

CDC entomologist Janet McAllister said pyrethroid resistance typically is limited by the mosquito’s small range. When resistance to one pyrethroid develops, another often works.

Still, she said, “we would love to see additional classes of insecticides available because, even in places that may have an effective tool today, that doesn’t mean it is going to last down the road.”

The EPA can fast-track its evaluation of new pesticides and expand the use of old ones. In response to Zika, it expedited new uses for pesticide-treated bed nets and mosquito traps.

Still, development of pesticides is painstaking. Even if the EPA speeds up its evaluation, required safety data can take years to collect. And the expense of ongoing safety testing has prompted companies to drop products.

Bayer CropScience, for example, told distributors it dropped the pyrethroid resmethrin in 2012, rather than do additional testing. Clarke Mosquito gave up temephos, a larvicide, six years ago, because of costs, Larson said.

That decision led to stockpiling in southwest Florida, said Wayne Gale, director of the Lee County Mosquito Control District.

“We purchased just about every bit,” he said.

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Girion)