FEATURE: How concerned should you be about Zika?

A mother and her daughter in Barranquilla, Colombia. National authorities are going door to door to control mosquitoes that can carry Zika, Dengue and Chikungunya. PAHO/WHO Joshua E. Cogan

29 July 2016 – The announcement that the United States might have discovered its first cases of locally-transmitted Zika virus, and concerns raised by some of the athletes headed to the Olympic Games in Rio, are renewing fears about the disease, which the United Nations’ health agency declared a ‘public health emergency of international concern’ in February 2016.

While the UN World Health Organization (WHO) has addressed some of these concerns, it agrees that Zika poses a health threat, particularly to pregnant women and couples trying to conceive.

Given that the virus represents a new type of public health concern with mosquito-borne Zika virus transmission in 64 countries and territories since 2015, UN officials have said it requires a unique and integrated response – and greater funding.

Although we still need to know more about Zika, we have a fairly good understanding of what people and communities at risk can do to protect themselves from infection,“ Mr. Peter Graaff, WHO Director Emergency Operations and Ebola Response, told the UN News Centre.

“We continue to monitor the situation closely so we can shape our guidance for governments, health workers and the general public as to how best to protect and promote health.”

Recife: Fears of microcephaly

The greatest risk from Zika is not the effect of the virus on adults – most people will not even know they have the virus, and those who do, have a mild illness – but on the fetus of a mother infected with Zika during pregnancy.

The most talked about condition linked to Zika is microcephaly, a condition where a baby is born with a small head. Other effects are impairments of sight or hearing, stiffness of muscles that affect movement, or seizures.

“Microcephaly can be a devastating diagnosis for an expecting woman, her partner and her family. That’s why WHO and partners are helping countries expand their capacity to prevent and manage medical complications caused by Zika virus infection,” said Mr. Graaff.

In Brazil, the epicentre of the Zika outbreak, at least 1,709 babies have been diagnosed either during pregnancy or after birth with microcephaly potentially linked to the virus, while national authorities report that nearly 3,200 cases are still under investigation.

Despite a lack of evidence, studies have shown that between one and 30 per cent of women infected with Zika during pregnancy may have a child with microcephaly.  

Recife is Brazil’s hardest hit area, with nearly one-third of confirmed microcephaly cases. The area’s rain and humidity make the Aedes aegypti mosquito – which also spreads dengue, chikungunya and yellow fever – abundant, and poverty exasperates the negatives, including a lack of medical and transportation services, or housing with screens to keep out the mosquitoes.

It was here that an unusually high number of microcephaly cases were found when the virus was first identified in the Americas in 2015.

Now it is one of the areas where WHO and partners are focusing support, to help the families whose babies have microcephaly. Often, the burden of care falls on young and poor mothers, who need to dedicate all of their time to taking care of the child.

The Lessa de Andrade polyclinic in Recife provides support to the overall development of the babies.

“We encourage babies with microcephaly to do things they cannot yet do,” Consuelo Figueira, the occupational therapist at Lessa de Andrade, told WHO.

Babies with microcephaly work on their motor skills with the help of occupational therapists. PAHO/WHO H. Ruiz

In one photo, she is working on motor skills with a baby lying on a blown-up ball and reaching for a colourful toy.   

“We assist in making the movements the children need to make and can’t because of the condition. We always use stimulation, with playful, interesting objects.”

UN system seeks funding for Zika response

Last month, WHO and partners revised the Zika Strategic Response Plan, which sets out the activities that will be taken to address the Zika outbreak through December 2017.

The Plan, which is estimated at around $122 million, places a greater focus on detecting the virus, preventing its spread, managing medical complications caused by Zika virus infection and expanding health systems’ capacities for that purpose.   

As the Zika response moves from an acute emergency to longer-term programmes “funding sources will also need to shift from emergency to longer-term national and international development and technical assistance programmes,” according to the Response Plan.

In May of this year, Secretary-General Ban Ki-moon established the UN Zika Response Multi-Partner Trust Fund (MPTF) to finance critical unfunded priorities related to the Zika outbreak.

The Fund provides a “rapid, flexible and accountable platform” to support the Strategic Response Plan. Donors will contribute to a central point and an Advisory Committee will direct funds to the highest-priority activities in the affected countries, ranging from surveillance to prevention, to care and support for individuals, families and communities in affected countries.

The Advisory Committee for the Fund is chaired by Dr. David Nabarro, who previously served as the Secretary-General’s Special Envoy on Ebola and is currently the Special Adviser to the Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change. 

“We were gratified by the tremendous success of the Ebola Multi-Partner Trust Fund which enabled funds to be rapidly directed to projects that were needed to stop the Ebola outbreak”, said Dr. Nabarro. 

“We are hopeful that with the expanding knowledge about the Zika outbreaks and its devastating consequences for women and children, donors appreciate the importance of urgent support for the Zika Multi-Partner Trust Fund.”

UN and the Olympics

The biggest international sporting event is due to begin next week – the Rio 2016 Olympics – followed by the Paralympic Games in September.

WHO has said that the international spread of Zika will not be substantially altered by travel to the Games. People continue to travel to Brazil for a multitude of reasons already, with travel o the Games representing less than one percent of all international travel to Zika-affected areas, according to numbers cited by the UN.

In addition, it is winter in Brazil, meaning low season for mosquitos.

“We continue to learn about the virus, in particular because of efforts in the research community to share their findings as quickly and openly as possible. Whenever the evidence changes, we update our guidance,” Nyka Alexander, a spokesperson for WHO, said in a telephone interview from the UN agency’s headquarters in Geneva.

People travelling to Rio de Janeiro have been advised to take the same precautions as anyone travelling to an area where Zika might be active: avoid mosquitoes by wearing long sleeves, using insect repellent, choose accommodations with screens on windows and doors, follow travel advisories and practice safer sex. Pregnant women are advised not to travel to the Games.

“To prevent the onward transmission of Zika and adverse pregnancy and fetal outcomes, all returning travellers should practice safer sex, including through the correct and consistent use of condoms, or abstaining from sex for at least eight weeks,” according to WHO, who upped the time to eight weeks from four back in May. For men who have had Zika-like symptoms, the organization recommends using condoms or abstaining from sex for six months. 

There remain many uncertainties and some misconceptions. According to Ms. Alexander, one of these misconceptions is the idea that Zika stays in a woman’s body long-term, and can remerge if she becomes pregnant. As far as we know today, a woman who has recovered from Zika can consider her body free of Zika after 6 weeks, and people who have had Zika cannot catch the virus a second time.

Since there is no treatment, vaccine or rapid test for Zika virus infections, scientists are racing to develop a safe and effective vaccine. This could take at least 3 years.

”While we are awaiting a vaccine and tests that will help people know with more certainty if they have Zika or not, people should continue to inform themselves about the virus, and how to protect themselves,” said Ms. Alexander.

“One upside, if we can say that, is that controlling the Aedes mosquito helps to combat Zika, but also dengue, chikungunya and yellow fever which are also carried by the same mosquito. It is not wasted efforts.”


News Tracker: past stories on this issue

New Zika response strategy to focus on preventing, managing medical complications – UN health agency

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