Zika virus a threat to PH

THE ZIKA virus is “spreading explosively,” according to the World Health Organization (WHO). It is carried by Aedes aegypti, the same mosquito that transmits dengue, and shares its symptoms, albeit milder. An outbreak was reported in Brazil in April 2015, and it has since spread to over 20 countries in the Americas. The WHO forecasts that it can infect as many as 4 million people.

Most Zika cases are mild and self-limiting; as much as 80 percent of those afflicted will not even realize they have it, and will show no symptoms. Some will have low-grade fever, a rash, eye redness and pain, and other flu-like symptoms that will subside within days.

But Zika’s association with severe birth defects makes its rapid spread disconcerting. In Brazil, over 4,000 cases of microcephaly—a condition in which babies are born with abnormally small heads and incomplete brain development—have been linked to it. While some Brazilian scholars have disputed this relationship, suggesting that it is the increased awareness and misdiagnosis that is leading to more detected cases of microcephaly, most officials say caution is needed until more information is known.

Another potential complication of Zika is Guillain-Barré syndrome (GBS), a neurologic condition marked by rapid muscle weakness. First reported in French Polynesia, this possible link between GBS and Zika is also being taken seriously by health officials as Zika-affected countries like Brazil and El Salvador are reporting “unusual increases” in GBS cases. Again, there is not enough information to establish a definitive link between the two conditions, but experts are scrambling to know more.

Zika has actually been around for more than 60 years, with rare and isolated case reports coming from Southeast Asia and Africa. (The virus is named after the Zika forest in Uganda, where it was first isolated in 1947.) In 2007, an outbreak was reported on Yap island in Micronesia—49 confirmed cases with no reported deaths or hospitalizations. But it is only in 2015 that the virus reached pandemic proportions (a pandemic is “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”).

Already, the US Centers for Disease Control and Prevention has issued a Level 2 alert for people traveling to affected areas, and some airlines are offering refunds for pregnant customers. Brazilian officials have moved swiftly to ease fears over the upcoming Olympics: They say that the Games will not be affected, and that by then, the drier and cooler season will make mosquito control easier. But this has not stopped pundits from speculating that the Rio Olympics can be compromised.

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As the world grapples with the threat of a Zika pandemic, we in the Philippines must be vigilant. Zika has already been documented to have reached our shores: As early as 1953, serologic reports established its presence in the country. In a 2015 journal, health officials in Cebu and their collaborators reported the detection of Zika in the blood samples of a 10-year-old boy who had a fever in 2012. While the mechanism of the virus—as well as the reasons it has gone pandemic in South America—remains poorly understood now, the widespread presence of Aedes aegypti in the Philippines makes it easy for viruses like Zika to take root. El Niño, with its warmer temperatures, is believed to further raise Filipinos’ vulnerability to mosquito-borne diseases.

The Philippines stands to benefit from the heightened global attention to Zika that will hopefully bring in much-needed resources to conduct research, first to establish its connection to microcephaly, GBS, and other possible complications, and second to come up with technologies to rapidly diagnose, treat and eventually prevent the infection (sadly, this attention is not always there for “neglected tropical diseases” like filariasis). As of now, even just testing for Zika requires specialized tests that are available only in a few labs nationwide.

Like many mosquito-borne viruses such as dengue, there is no cure for Zika, only “supportive therapy” such as increased fluid intake and rest until the disease subsides. But research can reveal more specific treatment protocols. As for prevention, while scholars estimate that it would take years to develop a vaccine against Zika, the recent development of a dengue vaccine and its potential to stamp out a disease that has killed many Filipinos underscore the value of this initiative.

But in many ways, we are already in the business of preventing Zika. Because its vector is the same dengue-carrying mosquito, the measures we have against this old threat are the same ones we need to combat Zika. The Department of Health calls these the “4S”: search and destroy (eliminate pockets of stagnant water regardless of size—from old tires to flower vases); self-protection (wearing long clothes and using insect repellant); seeking early consultation; and selective use of fogging. Zika’s emergent threat should make us redouble these efforts.

And the government must inform Filipino workers in the Americas and elsewhere about Zika. Pregnant women must be especially warned to be vigilant. Surveillance of those returning to the Philippines from affected areas and manifesting symptoms should be considered, though given the mild and asymptomatic cases, the cost-effectiveness of this measure should also be factored in. Finally, the general public must be reassured that Zika is a mild disease but that there is need for vigilance given its potential complications. By preempting sensational reporting, the government will also be able to mitigate the “scare” that accompanied past epidemics.

Zika isn’t the first “emerging disease,” and in the wake of climate change and further globalization, it won’t be the last. But with a strong public health system and an informed public, we can go a long way in defending ourselves from it and saving many lives.

Gideon Lasco is a physician and medical anthropologist. Visit his website on health, culture and society at www.gideonlasco.com.