Zika virus declared a public health emergency

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The Zika virus outbreak should be considered a “public health emergency of international concern”, the World Health Organisation has said. The Independent reports that the global health body made its decision after an emergency meeting in Geneva to discuss the “explosive” nature of the virus. The rare move signals the seriousness of the outbreak and usually triggers increased money and efforts to stop the outbreak, as well as prompting research into possible treatments and vaccines.

The last time a global emergency was declared was following the Ebola outbreak in December 2013, which is thought to have led to more than 11,000 deaths. Health experts have said the Zika outbreak could be far worse and WHO officials have predicted that as many as four million people could be infected with the virus this year.

The report says the outbreak of Zika, which is transmitted by mosquitoes, began in Brazil last May and has moved into more than 20 countries in Latin America. The main concern is Zika’s possible link to microcephaly, a condition that causes babies to be born with brain damage and unusually small heads. Reported cases of microcephaly are rising sharply in Brazil though researchers have yet to establish a direct link. Colombia has also seen a rise in the number of patients diagnosed with a rare neurological disorder which can cause paralysis.

Following a meeting of an International Health Regulations Emergency Committee, WHO director general Dr Margaret Chan said the causal relationship between infection during pregnancy and microcephaly in babies is “strongly suspected” but not scientifically proven. The committee advised that the association between the virus and constitutes an “extraordinary event”.

Chan said that a coordinated international response was needed to investigate and understand the relationship between the virus and the condition. Patterns of spread of the virus, the lack of vaccines and reliable diagnostic tests are also cause for concern, she added.

Chan said the committee found no public health justification for restrictions on travel or trade to prevent the threat of Zika virus, the report said. “At present the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals – especially pregnant women,” she said.

 

Winter travellers are bringing Zika virus back to US, Europe and further afield. A pregnant woman was diagnosed with Zika virus after visiting a country stricken with the mosquito-borne illness that may cause birth defects, New York City health officials say. NBC News reports that according to New York City Commissioner of Health Mary Bassett, the woman was diagnosed with the virus recently, bringing the city’s total of residents diagnosed with the disease to three.

Officials wouldn’t say where the people had recently travelled, describing the locations as areas where the “virus transmission is ongoing.” Bassett said that because of that, she reminded New Yorkers to be careful when picking winter vacation destinations. The species of mosquito that transmits the virus is also not seen in the northeast, though it is prevalent in the southern US.

The US Centres for Disease Control and Prevention has expanded its warning for pregnant women thinking of visiting 22 countries, most in Latin America and the Caribbean.

The report says the virus has been linked with microcephaly which can leave affected newborns with unusually small heads and abnormal brain development. The condition can usually be observed via an ultrasound in the first trimester of pregnancy.

 

Cases of the mosquito-transmitted Zika virus have been reported in Germany following confirmation a Danish tourist has also tested positive for the illness, reports The Independent. Authorities said the patient in Denmark is not the first Zika case in Europe, with confirmed cases in both Germany and Britain, according to Romit Jan from the European Centre for Disease Prevention and Control in Stockholm.

A World Health Organisation statement released on 21 January says: “Between 4 and 12 January 2016, the National IHR Focal Point for Germany notified PAHO/WHO of two cases of Zika virus infection in German nationals who had returned from Haiti to Germany in late December.”

WHO says samples from both patients were collected and sent for laboratory testing at the national reference centre for tropical diseases in Germany. While one of the cases was confirmed by both RT-PCR and serology, the other was confirmed only by serology.

Anhus University Hospital in Denmark said a patient was discovered to have the virus after running a fever, a headache and muscle aches.

The report says Public Health England has confirmed “a total of 6 cases have been diagnosed in UK travellers” returning from Colombia, Suriname and Guyana. A Zika virus case was also confirmed in Sweden last summer, said Sara Rorbecker of the Swedish Public Health Agency.

The report says the Zika virus is not a notifiable disease in the EU, meaning EU countries are not required to report cases to the ECDC. Therefore, there is wide variation on reporting by member states.

 

The poverty-stricken city Recife, Brazil, near the Equator is at the centre of the nightmarish health crisis that has set off alarms across the Western Hemisphere. The New York Times reports that mothers began showing up at the Oswaldo Cruz Hospital with their affected babies as early as September, stunning doctors and leaving even the most experienced among them scrambling to figure out what was going on.

Before last fall, medical reports of babies born with microcephaly were so uncommon in Brazil that only about 150 cases were registered each year in the entire country. Now Brazilian officials are investigating thousands of them, and they contend that the mosquito-borne Zika virus is the cause.

The report says virus specialists are racing to understand the connection, if any, between Zika and the rash of microcephaly cases in Brazil, an undertaking that international officials warn could take six months or more. But whatever the cause, “There is no doubt that Brazil is experiencing a significant increase in microcephaly,” said an official for Brazil’s Health Ministry who was not authorised to speak publicly. “We wouldn’t have declared this situation a health emergency if this increase had not been detected.”

The report sasys Zika epidemic has spread much faster than science’s understanding of it. Researchers here believe that the virus made the leap from Polynesia to Brazil during the 2014 World Cup soccer tournament. Since then, as many as 1.5m people in Brazil are believed to have been infected, and the virus has spread to more than 20 countries and territories in the Americas.

The most common symptoms are relatively mild, like fever and joint pain, and most people with the virus feel no ill effects at all. But as Zika continued to spread across Brazil, particularly here in the northeast, doctors began to encounter a steady stream of women cradling babies with unusually small heads.

“I saw this dramatic increase in cases with my own eyes,” Dr Vanessa van der Linden, a neurologist in Recife who was among the first doctors to detect an increase in microcephaly cases last year, said in the report. She said she was shocked when the babies began appearing at the public hospital where she works, the Hospital Barão de Lucena, and at her private practice. Altogether, she has examined about 60 cases in the last six months, she said — 10 times the rate of cases she came across in previous years. “I never witnessed anything like it,” van der Linden said.

She began suspecting a new cause for the microcephaly after testing the mothers for other possible factors, like toxoplasmosis, HIV and rubella. None of the tests showed that these ailments could have been responsible, prompting researchers to examine the link to Zika. “This is an emergency because the situation is unprecedented,” van der Linden said.

The report says the full extent of the crisis is still far from clear. Reporting microcephaly became mandatory across the country only in the last few months, after officials documented the jump in cases here in the northeast. Brazilian officials said this week that reported cases of microcephaly had now climbed to 4,180 since October, a 7% increase from the previous tally last week. Officials have examined more than 700 of the cases. In 462 of them, either no microcephaly was found, or it was caused by something other than an infection, like alcohol or drug abuse by the mother during pregnancy, a spokes for the Health Ministry said.

So far, infections have been confirmed as the cause of 270 cases of microcephaly. Yet even in that group, the Zika virus was found in only six infants. Officials warned against reading too much into that number, though, because the Zika virus has a very short period during which it can be detected properly. “When an infant is identified as a suspect, the infection had to occur six to seven months earlier,” said Claudio Maierovitch, director of the department of surveillance of communicable diseases at Brazil’s Health Ministry. “The chances of detecting it are tiny,” he said.

Officials are still investigating 3,448 other cases.

 

Children are also suffering serious damage to their eyesight and possibly their hearing, doctors are quoted in a Channel News Asia report as saying.

Half of the 135 babies being evaluated at a rehabilitation centre in Recife have limited vision due to deformed optic nerves and retinas, and many are cross-eyed, ophthalmologist Camila Ventura said. “Their eyes are scarred for life,” said Ventura. “Between 40% and 50% of them have serious eyesight defects.”

 

Companies and scientists are racing to create a Zika vaccine as concern grows, reports Reuters Health. The report says the WHO, stung by criticism that it reacted too slowly to West Africa’s Ebola epidemic, has convened an emergency meeting to help determine its response to the spread of the virus. Also, the US Centres for Disease Control and Prevention has activated an emergency operations centre staffed around the clock to address Zika.

Vaccine developers have made clear a vaccine for widespread public use is at least months, if not years, away, the report says. The closest prospect may be from a consortium including drugmaker Inovio Pharmaceuticals Inc that could have a vaccine ready for emergency use before year-end, according to one of its lead developers.

Canadian scientist Gary Kobinger is quoted in the report as saying that the first stage of testing on humans could begin as early as August. If successful, the vaccine might be used during a public health emergency by October or November, said Kobinger, who helped develop a trial vaccine for the Ebola virus.

And privately owned vaccine developer Hawaii Biotech Inc said it began a formal programme to test a Zika vaccine last fall as the virus started to gain traction in Brazil, although it has no timetable yet for clinical trials. “Right now, we are in the pre-clinical stage, as I suspect everyone is,” CEO Dr Elliot Parks said in the report.

 

Zika is not that likely to come to South Africa, according to National Institute for Communicable Diseases deputy director Professor Lucille Blumberg in a report in The Times. However, she warned that pregnant women should not travel to South America or the Caribbean, where the virus is present.

The virus is spread by the Aedesaegypti mosquito, which is present in South Africa. The mosquito here, however, is slightly different, the report says. “It is not known if it is even able to transmit the virus to humans,” said Blumberg. The local aegypti mosquito does not like to bite people, she said. For the disease to spread in South Africa, said Blumberg, someone would have to contract Zika in South America or the Caribbean and travel back home and be bitten by the Aedes aegypti mosquito here while still infectious.

 

Zika has been sexually transmitted in Texas, the CDC said. It is the first known case of the virus being locally acquired in the continental US in the current outbreak, reports CNN.

The case, announced by Dallas County health officials, involved a patient who had sex with someone who had recently returned from Venezuela infected with the mosquito-borne virus. The CDC said it confirmed the test results showing Zika present in the blood of a “non-traveller in the continental US.” They stressed that there was no risk to a developing foetus in this instance.

Based on that, the CDC says it will soon provide guidance on sexual transmission, with a “focus on the male sexual partners of women who are or who may be pregnant.”

CDC director Tom Frieden is quoted as saying: “There have been isolated cases of spread through blood transfusion or sexual contact and that’s not very surprising. The virus is in the blood for about a week. How long it would remain in the semen is something that needs to be studied and we’re working on that now.”

Frieden added that studies on sexual transmission are not easy studies to do, but the CDC is continuing to explore that avenue of transmission. “What we know is the vast majority of spread is going to be from mosquitoes,” Frieden added. “The bottom line is mosquitoes are the real culprit here.”

 

Campaigners are, meanwhile, calling on Latin American governments to rethink their policies on contraception and abortion because of the spread of the virus, which they fear will lead to a rise in women’s deaths from unsafe abortions as well as the predicted surge in brain-damaged babies.

The Guardian reports that several governments in the region have advised women to postpone getting pregnant for up to two years, which reproductive health groups say is impossible in countries where birth control is not easily available and many women fall pregnant through sexual violence.

“We are calling for governments to expand access to contraception, particularly for groups that have low incomes,” said Giselle Carino, deputy director of the International Planned Parenthood Federation’s (IPPF) western hemisphere region in the report. “Then they must expand access to safe abortion services and we need an awareness campaign so women know about the risk of Zika and are aware of their options if they find themselves pregnant.”

The IPPF says advice from governments including in Colombia, El Salvador and Ecuador to delay becoming pregnant because of the risk of microcephaly is unreasonable in a region where around half of all pregnancies are unplanned and sexual assault is prevalent. The report says in Brazil, the message was echoed by a group of lawyers, academics and scientists. Anis, a feminist bio-ethical research institute, plans on taking a case to Brazil’s Supreme Court to guarantee access to contraception, access to early diagnostic testing, and the right to safe and legal abortion in cases of microcephaly.

Abortion is illegal in Brazil except in cases of rape, when it is permitted up to 20 weeks into the pregnancy or where there is a risk to the mother’s life.

The report says Latin America has some of the most restrictive abortion laws in the world – 95% of abortions carried out there are performed in unsafe conditions. The Guttmacher Foundation’s research shows that about 23m women have an unmet need for contraception and account for 75% of pregnancies in the region.

Backstreet abortions are bound to rise unless governments change their stance, says Katja Iversen, CEO of the global advocacy organisation Women Deliver in the report. “It is definitely, definitely a concern because it (public concern about the Zika virus) is so prominent right now and people are scared. It is a cheap shot for governments to say postpone your next pregnancy if you don’t make contraception and access to safe abortion readily available,” Iversen said.

The report says she criticised the World Health Organisation for focusing exclusively on the spread of the virus. “Wouldn’t it be wonderful to see WHO’s reproductive health department involved as well,” she said. During the Ebola outbreak, the frontline health workers and those hardest hit were women, she said.

“It is interesting to see how the focus is on the big epidemic, but even though women are carrying the burden, they are still an asterisk. Yes, it is about a mosquito carrying a dangerous virus, but it is also about a health system failing women.”

The report says in the US and the UK, doctors have been given guidance on screening pregnant women who have returned from Latin America after contact with the Zika virus. Professor Mark Kilby, spokesperson for the Royal College of Obstetricians and Gynaecologists and a professor of foetal medicine in Birmingham, said that where there is suspicion a foetus could have microcephaly, pregnant women would be offered ultrasound screening from 20 weeks every two to four weeks.

Screening is possible in some Latin American countries such as Argentina and Chile, he said, but a definitive diagnosis would not be made before 24 weeks and more likely in the final three months, by which time abortion – which would be offered in the UK – would be illegal across most of the affected region.

Rodrigo Stabeli, vice-president of research at the Instituto Fiocruz, Brazil’s prestigious public health research centre, estimates that by the end of the year there will be about 16,000 cases of microcephaly across the country. While the prognosis varies on a case-to-case basis, some of the babies born with the condition will have short, painful lives, he said.

The report says following a lawsuit brought by Anis in 2012, the Supreme Court legalised abortion in cases of anencephaly, a condition in which a major portion of the brain is missing. One of the judges who voted in favour of the reform argued that the condition was “incompatible with life”. Other judges have used this ruling to justify abortion in cases in which other health complications have made the foetus unviable.

However, the report quotes Brazil’s federal medical council as saying that “in the case of foetuses with microcephaly, in principle there is no incompatibility with life”.

Beatriz Galli, a senior policy adviser for the women’s reproductive rights group Ipas, argues that although federal law guarantees women’s rights to contraceptives, in practice access is often limited. Sterilisation has to be paid for, and health clinics rarely supply the morning-after pill, despite it supposedly being available at no charge. “In Brazil, it is not true to say there is totally free access to contraception for all levels of society, especially the most vulnerable,” she said.

Full report in The Independent
WHO statement
Full NBC News report
Full report in The Independent
Full report in The New York Times
Full Channel News Asia report
Full Reuters Health report
Full report in The Times
Full CNN report
Full report in The Guardian


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