The Zika virus: Chronicle of a viral outbreak foretold
Where in the world is the Zika virus? Pretty much all over, or at least it has the potential of being so. Why? Because infected people can get into countries where even the mosquito that carries the disease (Aedes aegypti) can’t. For example, the World Health Organization predicts that the virus will eventually reach all of the Americas – except Canada and Chile – and new and as yet isolated cases have been confirmed in Costa Rica and Saint Martin (which counts as France) as recently as Jan. 21st. but like Tony Shalhoub said of California in Bartonk Fink, “mosquitoes breed in swamps. This is a desert.” Like the desert, Canada for example is not a mosquito-friendly country, but then again Denmark isn’t either. And yet, the Aarhus University Hospital in Arhaus, Denmark reported a case of Zika virus – which may not even be the first or only in Europe – in a tourist returning from Southern and Central America.
(Given the WHO’s prediction – and for once they just might be right – keeping track of the geographical progress of the Zika virus is kind of a moot point. Thankfully, the CDC regularly updates a Zika travel information webpage.)
Of course, the chances of an outbreak in Canada or Denmark are slim and none. The Zika virus is mostly transmitted when an infected mosquito bites a person. If that a person is then bitten by another mosquito, that mosquito can them become infected and spread the disease to more humans. But if there are no more mosquitoes around the risk of transmission is low. That is why people in the Americas are so susceptible; a climate conducive to mosquito-breeding plus lack of built-up immunity in humans (before 2015 most if not all Zika outbreaks occurred in Aarhus University Hospital) equals the proverbial perfect storm for an outbreak. Speaking of Africa, Brazils – with more than 1 million cases reported – is now to the Zika virus what West Africa was to Ebola. How much so? Brazilian newspapers are quoting health minister Marcelo Castro as saying “the mosquito has been here in Brazil for three decades, and we are badly losing the battle against the mosquito.”
Brazil: Ground Zero
In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil – the first time the virus was seen in the Americas. The appearance of Zika in Brazil coincided with an increase of cases of microcephaly, which would prove not to be a coincidence at all.
What is microcephaly?
· A birth defect in which a newborn’s head is considerably smaller than normal.
· A head size smaller than that of other children of the same age and sex.
· Chromosomal abnormalities.
· Decreased oxygen to the fetal brain.
· Infections of the fetus during pregnancy.
· Exposure to drugs, alcohol or certain toxic chemicals in the womb.
· Severe malnutrition.
· Uncontrolled phenylketonuria.
· Infections like rubella, toxoplasmosis, or cytomegalovirus.
· Developmental delays; e.g., in speech and movement.
· Coordination and balance difficulties. Dwarfism or short stature.
· Facial distortions.
· Mental retardation.
To the causes/risk factors of microcephaly we may now add the Zika virus; becoming pregnant in countries with the virus; traveling to said countries while pregnant. We said the virus is mostly transmitted through the bite of an infected mosquito. And while it doesn’t appear to be a person-to-person airborne disease, it is possibly to become sick through infected blood or sexual contact. Moreover, it can be rarely transmitted from mother to child at birth. But regardless of whether the baby is born with the Zika virus or not, the fact that the mother has it raises the newborn’s risk for microcephaly, as the approximately 4,000 cases in Brazil can attest.
Therefore, the CDC issued a level 2 travel alert recommending pregnant women (in any trimester) and women trying to become pregnant to consider postponing travel plans to any area with ongoing Zika transmission, and – if they must travel – talk to a doctor about the risk of pregnancy and Zika virus, as well as follow steps to prevent mosquito bites. Countries and territories with active Zika virus transmission include:
· Dominican Republic
· El Salvador
· French Guiana
· Puerto Rico
· Saint Martin
· U.S. Virgin Islands
· Cape Verde.
That’s as far as pregnant women traveling to those areas. Local governments of affected countries are taking more unprecedented measures. For instance, the Salvadorian government has asked women to refrain from getting pregnant for the next two years – which is actually sage advice under any circumstances –, an example followed by Brazil, Colombia, and Jamaica.
Steps to prevent mosquito bites include:
· Wearing long-sleeved shirts and long pants.
· Staying in places with air conditioning or that use window and door screens to keep mosquitoes outside.
· Using Environmental Protection Agency (EPA)-registered insect repellents.
- Always follow product label instructions.
- Reapply insect repellent every few hours.
- Do not spray repellent on the skin under clothing.
- If you are also using sunscreen, apply the sunscreen before the insect repellent.
- Do not use insect repellent on babies younger than 2 months of age.
- Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.
- Adults should spray insect repellent onto their hands and then apply to a child’s face.
· Dressing children in clothing that covers arms and legs.
· Covering cribs, strollers, and baby carriers with mosquito netting.
· Treating clothing and gear with permethrin or purchase permethrin-treated items.
- Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.
- If treating items yourself, follow the product instructions carefully.
- Do not use permethrin products directly on the skin as they are intended to treat clothing.
· Sleeping under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.
By way of example, many Brazilian mothers are opting for mosquito-resistant clothing – to protect their children against not only the Zika virus, but dengue and chikungunya as well. Since there is always profit to be made during a crisis, a company called GBaby is producing baby clothes with nanotechnology and micro-capsules that release a natural repellent made from citronella oil. “Sales exploded. Today we have delivery problems,” commercial director at GBaby Fábio Pereira said. If by delivery problems he referred to babies being born with birth defects or to moving merchandise around was not made clear.
In the United States
No locally transmitted Zika cases have been reported in the continental United States, but cases have been reported in returning travelers in Los Angeles County, Arkansas and Virginia – which could lead to local spread of the virus in some areas of the United States. Areas in the South, like Florida, are considered particularly vulnerable due to warm, humid climate and poor inhabitants who live without air-conditioning or proper window screens. According to the National Institutes of Health, researchers calculate that “about 200 million Americans—more than 60 percent of the population—reside in areas of the United States that might be conducive to the spread of Zika virus during warmer months through biting mosquitoes, including areas along the East and West Coasts and much of the Midwest.” Furthermore, “another 22.7 million people live in humid, subtropical parts of the country that might support the spread of Zika virus all year round, including southern Texas and Florida.”
Director of NIH’s National Institute for Allergy and Infectious Diseases Anthony Fauci says that “it is unlikely that we will have a major outbreak of Zika in this country,” and adds that in a New England Journal of Medicine essay that more research into Zika virus and its interactions with its mosquito, human, and non-human primate hosts is sorely needed. Sadly, information may not spread as rapidly as the virus. For example, former health minister and member of the non-governmental Organization to Defend National Epidemiology Dr. Jose Felix Oletta of Venezuela is worried about the lack of information on the virus provided by the local government. He calls Zika “a public menace” but complains that there are no official statistics on it.
Back to the U.S., president Barack Obama has urged the quick development of tests, vaccines and treatments to fight the mosquito-transmitted Zika virus. Once again drawing comparisons to Ebola, “we’ve got no drugs and we've got no vaccines. It's a case of déjà vu because that's exactly what we were saying with Ebola,” professor of global health at the University of Oxford Trudie Lang said. Obama “emphasized the need to accelerate research efforts to make available better diagnostic tests, to develop vaccines and therapeutics, and to ensure that all Americans have information about the Zika virus and steps they can take to better protect themselves from infection,” the White House said in a statement.
Since there is no treatment for the Zika virus, the next best thing is to get ready for its more-or-less imminent arrival. In addition to the above mentioned steps to avoid mosquito bites, we can help eliminate breeding spots by emptying standing water from flowerpots, buckets, and other containers. Infected people should avoid mosquito bites for the first week of illness to reduce the risk of transmission. Management of the disease basically comes down to relieving the symptoms. This includes getting plenty of rest, drinking plenty of fluids to stave off dehydration, and taking medicines like acetaminophen or paracetamol to relieve fever or pain (aspirin, ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. talk to a physician before taking additional medication).
Related: Early symptoms of zika virus