Editorial
Another kind of Zika public health emergency
Published: 11 February 2017
A
year ago, on Feb 1, 2016, WHO declared the Zika virus epidemic a public
health emergency. In a brave show of leadership no doubt spurred by the
embarrassment of failing to act sooner on the Ebola outbreak threats,
Director-General Margaret Chan sounded the alarm about the potential
links between Zika virus and rising neurological disorders despite a
lack of conclusive data. By doing so she stimulated an international
collective effort, scientific research, and funding that helped
stabilise the crisis.
A year on she has reflected on the rightness of
that decision, writing in a commentary on WHO's website
that it strengthened integrated surveillance for mosquito-borne
viruses, and accelerated understanding of the modes of transmission and
the abnormalities associated with congenital Zika virus syndrome. The
coordination that occurred between international and national
authorities and health professionals, especially in Latin American
countries, to detect, diagnose, and characterise cases of microcephaly
is commendable.
But the warm glow of that reflection must
be tempered by the challenges ahead. It would be tempting to laud the
Zika response as a success and redirect attention to other emergent
issues. To do so would ignore the continued spread of Zika virus and its
under-appreciated long-term effects. As WHO shifts direction under a
new Director-General, we need even bolder Zika leadership that keeps
victims and their families firmly on our public health agenda.
As of Feb 1, 2017, the number of countries reporting a Zika virus outbreak
since 2015 has grown to 59, 48 of them in North and South America.
Seven countries have reported active local transmission of the virus in
2016 or 2017. 13 countries report person-to-person transmission. New
affected areas have emerged including Angola, already struggling under
yellow fever and cholera epidemics, which reported its first two cases
in January.
Continued geographical spread of Zika virus
would be a challenge enough were it not for the anticipated long-term
effects. Chan's commentary says WHO “must be ready for the long-haul”
but misses the opportunity to urge and specify international attention,
research, and resources for the individuals left devastated by Zika
virus. It leaves invisible the needs of thousands of children, their
families, and future families; and overlooks the responsibility of the
world's community to support them.
Indeed, Zika can only
be considered a long-term epidemic. 6 months ago Bruce Aylward, then
head of WHO's outbreaks and health emergencies cluster, told The Lancet
that “we don't know what the full spectrum of the Zika-caused
congenital defects will be. Will apparently unaffected children whose
mothers had Zika virus infection in pregnancy develop normally? Will
they be able to walk and talk normally? Will they be mentally impaired
or have other problems that only become evident years later?” We still
don't know. Fully supported research to understand, track, and address
the long-term sequelae of congenital, perinatal, and paediatric Zika
virus infection on children's development must be prioritised.
Currently,
almost 3000 cases of Zika-related microcephaly or other CNS defects
have been recorded in 29 countries. Brazil has been hardest hit: 2366
babies have been born to Zika-infected women and their families, many
already vulnerable and lacking the resources to shoulder the burdens of
care. Whereas some of these affected children will lead normal lives,
many others with congenital Zika virus syndrome will experience severe
disability and need long-term medical attention. Medical interventions
could involve intensive physical therapy, treatments for neurological
impairments, feeding tubes, and others.
The US Centers for Disease
Control has estimated the costs of treating such children to be tens of
millions of dollars. And microcephaly is likely to represent only a
portion of those affected. Others will be born blind or deaf, or
suffering from seizures, irritability, or swallowing disorders. Even in
the absence of microcephaly, congenital brain abnormalities might be
present. That Zika virus infection can trigger the autoimmune disorder
Guillain-Barré syndrome in adults worsens the long-term effects. A
portion of those affected will die without access to respiratory and
intensive care; many more will live with disability.
Adding to Zika's
economic drain on societies because of lost productivity due to
neurological deficits, these medical consequences amount to another kind
of Zika public health emergency.
As the world waits for a
vaccine, public health efforts will necessarily focus on prevention in
the form of mosquito control and travel advisories. But health agencies
like WHO, public health researchers, and policy makers must also not
forget the individuals affected. They require our unrelenting attention.
For The Lancet's Zika virus resource centre see http://www.thelancet.com/campaigns/zika
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