ZIKA Virus Epidemic – Health Warning – Pregnant women should postpone travel to affected areas – Including Brazil : Foetus malformation risk. On 15th Jan 2016 the US Centres For Disease Control and Prevention (CDC) issued a Health Advisory regarding the mosquito borne ZIKA virus. The warning is for women travelling to the affected areas (see map below) who are pregnant or contemplating becoming pregnant.
This recently identified disease has rapidly spread across the world and is now present in the Americas, Asia, Africa and Oceana/Pacific Islands. It is transmitted by the same daytime-active mosquitoes that spread dengue and chikungunya fevers. Global warming and increased international travel are constantly opening up new parts of the word to these mosquitoes – and also to the human diseases they transmit.
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The virus causing this disease was first identified as its causative agent in the Zika forest in Uganda. Until recently it remained mainly in Africa with occasional small and sporadic outbreaks in Asia. In May 2015 locally transmitted Zika infections were identified in the North East of Brazil and currently it has been identified in the countries shown in the map below.
The disease caused by the Zika virus is like a milder form of Dengue fever. In the regions where the Aedes mosquito is found the incidence of Zika infections have been increasing rapidly from the origin in Africa. This fast development of the epidemic is promoted by the lack of any resistance to this new virus in the populations of these areas. Only 1 in 4 of those infected actually show symptoms.
These symptoms typically include mild fever, rash, conjunctivitis (pink eye) and muscle pain. More serious manifestations have sporadically been found in patients with pre-existing diseases or other health conditions and have sometimes led to death. There has been an increase in the number of cases of the autoimmune condition, Guillain-Barré syndrome (GBS) in areas where the Zika virus has been epidemic (e.g. in Brazil and French Polynesia). The symptoms of this syndrome are muscular weakness, tingling in the arms and legs. Severe complications can occur if respiratory muscles become infected. These patients require intensive care.
It has been estimated by the Health Authorities in Brazil that there have been between 500,000 and 1.5 million cases of the disease since it was first identified in the country in 2015. During this same period there has been a rapid increase in the number of cases of Microcephaly which is a malformation of a child’s head.
Normally an average of 163 cases of Microcephaly occur in a normal year in Brazil. However in the short time since the outbreak of the Zika epidemic this has increased to 3500 cases. In some cases of Microcephaly the authorities have also identified the presence of the Zika virus. Microcephaly is a neurodevelopmental disorder in which the head is significantly smaller than would be expected in a healthy individual.
At the moment the evidence is not sufficient to prove a causal linkage between Zika and foetal development problems and deaths. However the cooincidence is sufficient to have led to the CDC’s first ever travel advisory for pregnant women: “Until more is known and out of an abundance of caution, pregnant women should consider postponing travel to any area where Zika virus transmission is ongoing“. Full details can be found on the CDC link here.
At the same time as the CDC issued this advisory the first US case of a baby born with microcephaly with evidence of a Zika infection was reported in Hawaii. The mother had been living in Brazil in 2015 and the baby contracted the disease while in the womb. The CDC reported: “We do not yet understand the full spectrum of outcomes that might be associated with infection during pregnancy, nor the factors that might increase risk to the foetus. Additional studies are planned to learn more about the risks of Zika virus infection during pregnancy“.
The CDC has good reason to be cautious. It was only May 2015 when the WHO reported the first local transmission of the Zika virus in the Western Hemisphere. Since then it has been rampant – infecting large populations in countries where the Aedes mosquitoes are endemic. The maps above show where these mosquitoes are currently found in the USA. Infectious diseases do not respect border control agencies and the spread of the epidemic into the USA is quite likely. There is a useful fact sheet about the mosquito here.
According to the CDC: “No specific antiviral treatment is available for Zika virus disease” therefore it is important to focus on prevention through:
- Avoiding mosquito bites.
- Using air conditioning or window and door screens when indoors.
- Wearing long sleeves and trousers, and use insect repellents when outdoors. Most repellents, including DEET, can be used on children older than two months. Pregnant and lactating women can use all Environmental Protection Agency (EPA)-registered insect repellents, including DEET, according to the product label. (info from CDC)
At the time of writing this article the World Health Organisation (WHO) had not joined the CDC in issuing a travel warning for pregnant women to Zika infected areas. They provided the following information on Jan 5th 2016: On 28 November 2015, the Ministry of Health of Brazil established a relationship between an increase in cases of microcephaly in newborns and Zika virus infections in the country’s northeast. According to a preliminary analysis of research carried out by Brazilian authorities, the greatest risk of microcephaly and malformations appears to be associated with infection during the first trimester of pregnancy. (Link here)
Their advice from 6th January includes he following precautions (Link here):
- Avoid allowing standing water in outdoor containers (flower pots, bottles, and containers that collect water) so that they do not become mosquito breeding sites.
- Cover domestic water tanks so that mosquitoes cannot get in.
- Avoid accumulating garbage: Put it in closed plastic bags and keep it in closed containers.
- Unblock drains that could accumulate standing water.
- Use screens and mosquito nets in windows and doors to reduce contact between mosquitoes and people.
- Cover exposed skin with long-sleeved shirts, trousers, and hats
- Use repellents recommended by the health authorities (and apply them as indicated on the label)
- Sleep under mosquito nets.
Chris Duggleby started his scientific career studying Bacteriology, Virology and Immunology at the Manchester University Medical School. From there he went on to spend over 35 in the chemicals and oil industries which included setting up a polymers research and development group in Geneva, Switzerland for a major international chemicals company. Following an MBA from Warwick University he went on to lead a number of international manufacturing and marketing operations in the Chemicals, Plastics and Oil industries. His work involved living and working in Europe, Asia, the USA, the Middle East, and Russia. More recently he was invited to take on a senior leadership position in the Audit Department of the BP International Oil Group. Here he used his global change and risk management experience to help the group reshape its management structures and processes following a major environmental disaster in the Gulf of Mexico. He has now retired to focus on writing about risk management and producing music in his studios near London, in the Alps and Cape Town. If you are interested in risk management check out his RiskTuition.com or BizChangers.com (management of change) sites. He has also recently launched the JointVentureRisk.com site.
If you found this article interesting please consider taking a look at some of my other recent reports on similar subjects.
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