New Delhi: Soon after National Technical Advisory Group on Immunisation (NTAGI) chief, Dr NK Arora noted how India should be ‘ready to fight’ the Zika virus in case of an ‘outbreak’. The remarks came after a five-year-old girl in Karnataka became the first confirmed Zika virus case in the state. ETHealthworld spoke to doctors about the preventive measure to contain the vector-borne viral disease caused by the Zika virus which is spread through Aedes aegypti mosquito bites.
Elucidating about the complications due to the Zika virus, Dr Aditya S Chowti, Senior Consultant – Internal Medicine, Fortis Hospital, Cunningham Road, Bangalore, said, “The Zika virus is spread through mosquito Aedes aegypti mosquito, commonly seen in tropical regions, is the mosquito that can spread Zika fever, and we commonly see symptoms akin to viral fever, a nonspecific viral fever. The most common signs and symptoms are fever, rashes, joint pains, particularly in the small joints of the hands and feet, body aches, headache, and conjunctivitis. Other symptoms can also include abdominal pain, fatigue, or a general feeling of discomfort. There are some specific complications. In rare cases, it can cause a nervous system complication, which we call Guillain-Barre syndrome. It can be possible even in people who don’t show blatant symptoms of the infection.”
Adding to it Dr Jeevan Aggarwal, Associate Director, Internal Medicine, Max Super Speciality Hospital, Shalimar Bagh informed that no specific treatment exists, paracetamol (acetaminophen) and rest may help with the symptoms and admission to a hospital is rarely necessary.
Highlighting the preventive measures Dr Aggarwal said, “Efforts to prevent bites include the use of N-diethylmetatoluamide (DEET) or picaridin-based insect repellent, covering much of the body with clothing, mosquito nets, and getting rid of standing water where mosquitoes reproduce.”
Doctors also alerted that pregnant women must be careful regarding this disease, as the Zika virus can be passed from a pregnant person to their foetus. It can cause serious neurodevelopmental abnormalities.
Pregnancy complications due to Zika virus infections
Zika has a possible association with congenital malformations. Women who are pregnant or planning to become pregnant should take proper preventive measures by avoiding travel to areas where there had been active Zika transmission is being reported or places where there are cases reported of dengue, malaria & chikungunya.
“Pregnant women should be extra cautious as infants born to them can suffer from microcephaly and eye complications, though the females themselves may suffer a mild illness. The foetus can be protected only by preventing infection in the mother,” Dr Kaneria stated.
Highlighting the complications of the Zika virus in pregnant women, Dr Chowti said, “Pregnant women must be careful regarding this disease, as there is an increased risk of miscarriage, including serious birth defects in infants. So, it is best to have some preventive measures to prevent contracting this disease. Everyone must take the necessary methods to prevent mosquito bites. Also, ensure that the mosquitoes’ breeding grounds are destroyed or not allowed to happen.”
Adding further, Dr Aggarwal said, “Zika virus can spread by vertical (or ‘mother-to-child’) transmission, during pregnancy or at delivery. Infection during pregnancy has been linked to changes in the neuronal development of the unborn child. Severe progressions of infection have been linked to the development of microcephaly in the unborn child, while mild infections potentially can lead to neurocognitive disorders later in life. Congenital brain abnormalities other than microcephaly have also been reported after a Zika outbreak.”
Sharing his thoughts on preventing outbreaks, Dr Nikhil Mathur, Group Chief of Medical Services, CARE Hospitals Group said, Firstly, the mosquito outbreak should be contained at the local authorities level with anti-mosquito fumigation drives. Citizens should also take necessary precautions by securing all mosquito breeding sites at home & outside.”
Commenting on the threat of mosquito outbreaks Dr Mala Kaneria, Consultant Infectious Diseases, Jaslok Hospital & Research Centre said, “Since mosquitoes are ubiquitous, there is the potential for transmission through much of the tropical and subtropical world and beyond. Outbreaks can occur if a mosquito infected with Zika infects a number of individuals during a blood meal and also if a mosquito feeds on an infected patient during the period of viremia and subsequently bites other individuals.”
Dr Kaneria added that the primary prevention strategy is preventing the proliferation of mosquitoes and using measures to prevent mosquito bites. He also noted that infected males should use abstinence or condoms for 8-12 days after infection, as the virus may be present in the semen for a while.
Until recently, awareness about the Zika virus was lacking among the general public, now knowing the epidemiology & transmission of the virus, immediate attention on creating protocols for appropriate syndrome diagnosis, especially in pregnant women with appropriate microbiological investigation needs to be emphasised among all healthcare set up to the rural sectors.
Zika virus outbreaks have happened in Uganda, Tropical Africa, Southeast Asia & the pacific islands. The probability of an outbreak in India is more in endemic regions like Maharashtra, Gujarat, Madhya Pradesh, Rajasthan & Kerala and also noted that the virus has been silently spreading to others areas. Speaking on the possibility of an outbreak, Dr Malathi M, Associate Consultant Infectious Diseases and HIC officer, Meenakshi Mission Hospital and Research Centre, Madurai stated, “The retrospective surveillance for Zika by ICMR demonstrates that the silent spread of this virus to almost all parts of India occurred with a predominance of the more recent 2018 Rajasthan Zika strain.”
“The healthcare sector should invest more in initiating and adapting the existing platform of molecular techniques in the laboratory setup to identify Zika infection. Healthcare professionals should be aware of the clinical features of Zika and should take part in the surveillance. More importantly, the government should engage the private & public health sectors in performing Zika virus surveillance. This can be initiated in a phased manner in endemic areas followed by other areas. Adequate mosquito control (Aedes) with help of the entomologist team should be encouraged and awareness should reach the rural scale similar to doing a dengue investigation,” opined Dr Malathi M.
Recently a few cases have been reported in India, the most recent being reported from Karnataka Raichur district. Commenting on the Zika virus case from Karnataka, Dr Mathur concluded, “Govt agencies are working towards developing vaccines to prevent the Zika virus. In some places, the case might go undetected and hence reports might vary. As for now, it is too early to comment on whether this will be an outbreak.”
While government agencies are working towards developing vaccines to prevent the Zika virus and since there is no specific treatment plan apart from symptomatic management, prevention will be the key to curbing the outbreak. Keeping healthcare authorities on alert and staying prepared with adequate measures at both public & private hospital levels. Fever cases with rash, conjunctivitis and other viral symptoms need to be properly evaluated by screening both blood & urine samples for an accurate diagnosis of the Zika virus. Awareness drives across high-risk cities & districts to curb the eventuality of an outbreak.