Dr. Muhammad Najeeb Durrani, Assistant DHO, Epidemiologist, Member Global Outbreak Alert & Response Network
Recent emergence of Zika virus has caused uproar amongst media and public. Outbreaks of Zika have been reported in tropical Africa, Southeast Asia, the Pacific Islands, and most recently in the Americas. Because the mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will continue to spread.
Keeping in view the presence of Zika virus vector’s presence in Pakistan, the Health Planners are on high alert and are forced to think about developing an urgent strategy to devise means for its possible appearance and spread in Pakistan. As we take into account the presence of Aedes aegypti, the same vector for dengue fever more we need to think about the serious nature of the alert.
Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika virus disease (or Zika) are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week. There is no vaccine to prevent or medicine to treat Zika. Severe disease requiring hospitalization is uncommon and deaths are rare.
As looking into the disease’s appearance and its transmission in Pakistan, we epidemiologically know that International Air Travel remains a most important risk factor , as we look back into recent past we have learnt from the appearance of emergence of H1N1 a Pandemic Virus’s evolution in the world, that had emerged in the month of April 2009 in California in US and with an un-precedented speed by the month of June 2009 the virus had reached every country of the world due to the rapid transit of people from the infected area to other parts of the globe. Currently CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. People who are at high risk like pregnant ladies should avoid going to these countries.
But Still we are fortunate that we have a hand on experience of 10 years of dealing with the same vector that causes Zika Virus i.e., the Aedes aegypti the has been responsible for causing Dengue Fever in most parts of the country. As such the mechanism is there for the vector Control and amongst other province the Punjab Government has revolutionized the Vector Control aspect of the disease, same measures are needed for the control of the Zika Virus if that emerges in Pakistan. Secondly the disease has zero mortality except presenting as Microcephaly in the new born affecting the babies before they are born and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes. However the outbreak in Brazil also led to the reports of the virus also causing Guillain-Barre syndrome (GBS) discovered amongst the new born. Guillain-Barré syndrome is a rare disorder where a person’s own immune system damages the nerve cells, causing muscle weakness and sometimes, paralysis. These symptoms can last a few weeks or several months. Zika virus can be passed from mother to her baby during pregnancy. This mode of transmission is being investigated. To date, there are no reports of infants getting Zika through breastfeeding.
In National Perspective, what is needed is to strengthen the following areas;
Enhanced Human Surveillance
It hat has been observed that the policy makers are at the moment thinking to enhance vector efforts where as in the current scenario We need not to stress too much on vector control strategies that we are quite self-sufficient however what is needed is the Human Surveillance for cases of Zika virus and how to offer epidemiological outreach response to that to contain the disease as it appears in the form of a single index case that might bring the virus in her body from the endemic country and how to mitigate its effects. Only a few cases are enough to infect the local flocks of Aedes mosquitoes in a specific area or locality that would likely be transmitted to other areas through both infected vector and the infected host.
Who is a risk, these are the pregnant ladies. So far we do not have an incidence of Disease in Pakistan but must thing of possibility of its appearance in near future and to this where the disease would appear, that would be a labor room of a hospital or maternity center or a home based delivery being conducted by a traditional birth attendant, how to contain the virus in the emerged index case etc. We must have a level of enhanced surveillance to contain the virus if that appears to prevent the local mosquitoes from getting infected.
Social Mobilization
Launching of care full public awareness campaigns with right messages so that any kind of fear may be alleviated amongst general public.
Capacity Building of Health Manpower
Especially those associated with taking care of the pregnant ladies e.g., Obstetricians, Gynecologist, Birth Attendants, lady Health Workers and Community Health Workers.
Rapid lab Testing ability
That is currently not available in the country but soon the NIH would acquire the capacity with the assistance of WHO and would use other five influenza labs for that purpose in all the provinces of the including AJK.
Vigilance at the ports
Accordingly a high level of vigilance is required to be exercised in all over the country and monitoring the flights coming from affect countries of Latin America and other endemic areas need to be effectively monitor to contain the arriving suspected cases in quarantine. So far the current self-illness declaration form being given to passengers inside the flights is not at all sufficient, rather deficient as that may not be able to reach an infected person coming from the endemic area and having symptoms.
In the end it is advisable that the ministry of Health should develop a group of experts comprising of Epidemiologists, Clinicians, Pathologists/ Virologists, Pediatricians, Entomologists, Health Planners, Gynecologists/ Obstetricians and officials including from WHO and UNICEF be developed in the core capacity to look forward, plan and take pre-emptive measures to counter any situation arising from the emergence of the disease in the country in coming days.
