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Zika virus: Emerging public health crisis
A few cases of Zika virus have been reported in India. This should serve as a wake-up call for our health planners who must invest in primary healthcare
Zika virus is yet to make its perceptible presence felt in India. But given the thriving clan of Aedes mosquitoes, Zika fever outbreak will always remain a potential threat to the country. In this scenario, Zika would be joining its rivals — dengue, chikungunia and yellow fever — in its spread sooner than later. Lest Zika catches up with us unawares, a lowdown on the impending virus is not out of place. Zika virus belongs to the Flaviviridae virus family, which is also the cause for dengue, chickunguinia and yellow fever. It was first identified in 1947 from Zika forest of Uganda in some monkeys. It was later found in humans in 1952. Outbreak of Zika has been recorded since then in the equatorial belt of Africa, the US, Asia and the Pacific. In early 2015, a widespread epidemic of Zika fever, caused by the Zika virus started in Brazil and spread to the South and North America. In November 2016, the World Health Organisation (WHO) announced the end of the Zika epidemic.
During this epidemic, there was evidence from Brazil that the virus can cause birth defects as well as neurological problems. This forced the WHO to declare the outbreak a public health emergency of international concern in February 2016. This epidemic finally ended in November 2016 after causing millions of infected cases and a global state of panic. Zika Virus was first identified in India in 1953 in Pune during an investigation of case for Japanese encephalitis. From 2016 to 2017 three cases were reported from Ahmedabad, Gujarat. Recently cases have also been reported from Krishnagiri district of Tamil Nadu. However, till date, no deaths have been reported in India due to Zika virus disease.
The Aedes mosquito bites in the daytime and has adapted itself to living around human beings. It breeds in clean water and the females breed needs blood to mature the eggs. A pregnant woman, if infected with this virus, it can pass to the fetus. This leads to damage and
abnormality of the nervous system in the newborn. The virus can also get transmitted through sexual intercourse and possibly by transfusion of blood. Zika virus can affect all age groups but is most commonly found in people between the age group of 20 and 29 years. Infection of Zika virus may be suspected based on symptoms and recent history of travel to an area with reported active Zika virus transmission.
The diagnosis is confirmed by laboratory tests of blood and other body fluids, such as urine, saliva or semen. Most people infected with this virus won't have symptoms or will have only mild symptoms such as fever, rash, headache, joint pain, red eyes and muscle pain. The symptoms are self-limiting and lasts for two to seven days. Very few people die from the disease. Complications that may occur include severe neurological disorders, especially in the newborn child if the mother is infected during pregnancy. This may manifest as microcephaly which means having a small head and brain in the fetus. It has been found to lead to Guillain-Barre Syndrome in adults, which results in paralysis of the limbs, sometimes leading to respiratory failure. The virus, isolated from the three cases in Ahmedabad, was of the older strain which did not cause these complications.
The cases reported in India are only a handful till now. It is worth noting that more than 200 suspected cases were screened in Tamil Nadu and only one was found as positive. Similarly, more than 40,000 cases were tested in Ahmedabad, leading to three cases being found to be positive. Considering the omnipresence of the culprit Aedes and the high prevalence of other Flaviviridae diseases, these numbers are miniscule. However, considering the ease with which the Aedes mosquito breeds and spreads in our country, there is a potential for an outbreak starting anytime.
Before we understand, how to protect ourselves from the mosquito, we should know about its habits and its life-cycle. The mosquito becomes infective approximately seven days after it has bitten a person carrying the virus. Once infected, a mosquito remains infective for its life and passes on the virus to the eggs it lays. The mosquito can lay eggs about three times in its lifespan, and about 100 eggs are produced each time. Peak biting time is at dawn and dusk — two hours after sunrise and two hours before sunset. Adult mosquitoes usually rest indoors in dark areas (closets, under beds, behind curtains).
Household protection is of utmost importance for the whole community. Unused items need to be discarded, water from various containers should be drained out. Flower vases, coolers or any other water storage apparatus either should be emptied daily or covered properly.
Individual protection from the mosquito can be achieved by following a few simple steps. Wearing full sleeves and full-length clothes to cover limbs helps. Repellents ointments may be applied to exposed skin or to clothing, in accordance with the label of instructions. Insecticide-treated mosquito nets afford good protection for those who sleep during the day (viz infants, elderly). Household insecticide aerosol products, mosquito coils or insecticide vaporisers may also reduce mosquito bites. Household fixtures, such as window and door screens can also prevent mosquitoes from entering the house.
If every citizen of the country takes the basic precaution, we can easily eradicate the mosquito-bourne deadly diseases like Zika virus, dengue or chikungunia from spreading.
(The writer is with critical care unit, Aakash Healthcare)
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