New Delhi, 02.06.17: Friday’s announcement by the World Health Organization about three Zika cases in Ahmedabad has left the country weak-kneed. And sadly, this doesn’t apply only to the common man, but also to the very doctors of the nation. When we approached doctors for their insights on this new adversary, three of them, who were from premium hospitals of the country, denied to respond; one of them replied to our e-mail with a copy paste from Dr Google. We could do nothing but wonder, is this how we are going to deal with Zika? With unequipped masses and equally unequipped experts?
The Zika cases were reported between November 2016 and February 2017 but the announcement was only made recently. Director general of the Indian Council of Medical Research, Soumya Swaminathan, and other senior officials of the Health Ministry have confirmed being aware of the disease’s diagnoses but they decided against letting the news make it to the public. They apparently did not let the news go out because they didn’t want “people to start panicking,” said one of the health officials this week. However, a delayed announcement hasn’t lessened the panic much. On the contrary, it may have left people with a heightened sense of suspicion about the virus’ seriousness.
This infection, which was first reported in Brazil, has now spread in many countries across the globe and the count has come up to 47, as per WHO.
The three victims of Zika in India included two pregnant women, aged 22 and 34 and one man, aged 64. The 22-year old woman was tested positive for the deadly virus in her 37th week of pregnancy but has delivered a healthy baby. The 34-year old one has already delivered a “clinically well baby” in November 2016. None of the three or any of their family members has reported travelling outside the country.
The happening has raised many issues for us, which primarily include a) pinning the causes of Zika outbreak in India, b) understanding the virus and its lethalness and c) fighting Zika.
Of the doctors we approached, we managed to get insights from four doctors – Dr Wasim Ahmed Sachora, Consultant, Internal Medicine, Columbia Asia Hospital, Ahmedabad, Dr. Harshad Limaye, Consultant Physician, Nanavati Super Speciality Hospital, Mumbai, Dr Manish Mohil, senior consultant, internal medicine, PSRI, New Delhi, and Dr MK Singh, Consultant, Internal Medicine, Paras Hospitals Gurgaon. However, most of them said that as of now, they are only depending on the “theoretical” knowledge that they have of the disease as nothing better is available.
What is Zika?
Zika refers to the name of a virus that is caused by the bite of Aedes mosquitoes, the same breed that is responsible for causing Dengue and Chikungunya. It was first identified in monkeys in 1947 and in humans in 1952, both in Uganda. This virus has been identified to be associated with Guillain-Barre syndrome and with Microcephaly. Its link with other neurological disorders is yet being investigated.
Dr Harshad said that Zika appears to be an imported infection and is not indigenous to our country. As a result of this, we do not have ‘herd immunity’ to the infection.
What are the symptoms of Zika virus?
In most of the cases, close to every four in five, there are no symptoms of Zika, said Dr Harshad. The incubation period of Zika is 10 days, he pointed out, as against Dengue, which has an incubation period of 2 to 7 days. In the cases when symptoms show, they could be such as follows.
“As such, there is no major difference between symptoms of Zika and Dengue as both of them cause fever, body ache, weakness, and myalgia. But Zika is different from Dengue in this respect that it doesn’t cause hemorrhagic manifestation and shock as seen in the patients of Dengue. In addition to the above symptoms, Zika can also cause Conjunctivitis, something not seen in the patients of Dengue,” said Dr Wasim.
“Another difference is that Zika symptoms last for days or weeks and only then they subside, but in Dengue, the fever lasts for a few days to a week and can lead to bleeding and bruising in case of thrombocytopenia,” said Dr MK.
Dr Manish pointed out that in Zika, one can also suffer from encephalitis, which may not occur in other such viral infections. Also, there is a mild joint pain in case of Zika, which is comparable to the pain in Chikungunya. But Dr Manish said that in Zika, the pain is around peripheral joints as this disease impacts the Central Nervous System.
How lethal is Zika?
The measure of the disease’s lethalness is yet to be mapped. With the scanty information that is available in India about Zika, it remains a threat we barely know about. “It is an emerging infection, so we do not know its exact complication rates,” said Dr Harshad. However, the two biggest complications that arise out of Zika are Microcephaly and Guillain-Barre Syndrome.
For pregnant women who get infected with Zika virus, their children are at the risk of the ‘vertical transfer’ of a neurological disorder, Microcephaly. It is a medical condition in which the brain of the child suffers an abnormal growth, resulting in a smaller head than usual. In such children, life expectancy goes down and a normal brain functioning may not be possible. What’s worse, Zika in pregnancy can also lead to still-births.
“But it has to be seen whether all fetes’ inside the wombs of infected women are neurologically affected or not, because most of the development of foetus is completed in first trimester of pregnancy. So, in cases when the infection occurs after the completion of the first trimester, the damage is yet to be ascertained,” said Dr Wasim.
For Dr Harshad, the scare may not be too high as the incidence rates of Microcephaly and GBS are very low, less than a percent. But many studies are yet in progress to understand the harm potential of the disease with respect to these neurological disorders.
Guillain-Barre syndrome, on the other hand, refers to a disorder in which the body’s own immune system attacks its nerves. It can lead to ascending paralysis. But Dr Manish points out that the symptoms of GBS are different from that of a stroke or multiple sclerosis. Though, they are all autoimmune disorders, they attack the nerves in different ways.
Howsoever, all the doctors pointed out the fact that Zika’s fatality rates are negligible as against Dengue and even Chikungunya. The virus has complications that may last long but is not life threatening. However, for many living a life with neurodegenerative disorders may be worse.
Can Zika virus spread sexually?
Yes, it can. Unlike Dengue and Chikungunya, sexual transmission of Zika has been reported in 10 countries. In all the cases that have been reported so far, the sexual transmission of the virus happened from man to woman or to another man but not from a woman to a man in any case. It has been transmitted through vaginal, anal or also perhaps, oral sex. The virus has been found in semen even after two months of disappearing of the symptoms.
Is the announcement too late?
Dr MK believes that as the number of cases hasn’t gone up beyond three, there doesn’t seem any lack of seriousness on the part of authorities. On similar lines, Dr Wasim commented, “There is no need to worry at present.” But, when the experts also don’t have knowledge beyond “theoretical”, will it be the right thing to not worry?
Contrary to the above opinions, Dr Harshad feels that Zika is a disease that can cause much harm to the Indian population as we are a young country and so, the total number of babies born every year is also very high. Even if the incidence rates of Microcephaly remain low, if Zika spreads, nowhere less than multiples of thousands of babies can have the disease every year. India has a particularly conducive environment to the spread of the disease and so, the spread can be very fast and exponential, he added. “As Zika is a new enemy which we don’t know much about yet, we need to be alert and suspicious,” warned Dr Manish. This seems more like the way to think for beginning to fight Zika.
As far as the control measures are concerned, Dr Harshad pointed out that there is yet no vaccination available for Zika, neither is there medication, and in fact, the doctors do not yet even have the diagnostic kits for Zika. The only thing that can be controlled right now is the Aedes mosquito. It is an urban mosquito and even breeds in clear water. Larvicides need to be carried out in public and mosquito repelling remedies need to be adopted at the household level.
Some precautions that you can take are:
- Apply mosquito repellents whenever you are going outdoors, particularly during the day as Aedes is most active during daylight hours. But be cautious about applying them on infants below 2 months of age. For them, use repellents containing 10 per cent DEET. Do not apply them on your palms, near your mouth or eyes. Carefully read the instructions on the bottle especially if you are pregnant or breastfeeding.
- Avoid wearing clothes that are too dark in color as mosquitoes are more attracted towards darker colors. Wear full-sleeved and full-legs clothes during this weather.
- Do home remedies to keep mosquitoes away from your homes. Read them here .
- Use insecticide-treated mosquito nets, particularly for infants or for night-shift workers.
- The steps that the government of India should take/reinforce strictly should be:
- A compulsory implementation of full-coverage uniforms for school students.
- Keeping the mosquito population in check by performing larvicides in public areas frequently. This will control the mosquitoes in their larval stage only.
- Mosquito fogging machines should be sprayed in residential and commercial areas much more frequently.
Courtesy: Sangeeta Soni, The Times of India