Undoubtedly 2016 has been a remarkable year so far. More than 20% of global stocks (worth $15 trillion). One of the worst blizzards lashed Washington DC on 22nd January, leaving hundreds of thousands of people without power and damage is estimated in the billions of dollars. New York City’s Central Park got buried under 27 inches of snow. A strong El Nino has been repeatedly slamming the west coast of the US with brutal storms. Camus may have called it a charming beginning.
Not to be undone, the mighty mosquito has made a spectacular comeback, not that she ever went away. She has brought focus to a severe crippling disease that irreversibly damages the brain of the new born. A pandemic of this virus infection has hit Latin America and the Caribbean and that potentially threatens the rest of the world, including India. Brazil has been severely hit by this virus and more than 4000 babies have been born with unusually small brains. Forty babies have died. This is the ‘Zika ‘virus named after the forest in Uganda where it was first incidentally identified in 1947. Zika is an RNA virus that is termed an ‘arbovirus’ because it is transmitted by arthropods such as mosquitoes. The other arboviruses producing significant clinical diseases are the chikungunya (alphavirus) and dengue (flavivirus). Both of these not unlike Zika are transmitted by the aedes female mosquito.
Dengue has captured print and electronic space because of its ability to kill a minority of patients while chikungunya which leads to debilitating joint pains that linger on for months has been largely ignored by the media. The Zika virus that circulated initially in primates for thousands of years has finally exploded in humans with vengeance. These viruses predate the emergence of Homo sapiens as do the aedes mosquitoes. The female mosquitoes learnt to lay their eggs in any water filled container near human habitat a millennia ago. They also taught themselves how best to feed on humans regardless of sex or doctrine. Neither the mosquito nor the Zika/dengue virus has a predilection for any particular religion or caste. They, as all of Mother Nature, are least concerned whether their victim is a Catholic or Sunni, Brahmin or Dalit, Shia or a Sikh, a believer or non-believer. A model conduct that has somehow has eluded the best of men down the ages.
Mercifully Zika has not in the last half century caused hemorrhagic fever or death. It manifests as a mild viral fever accompanied with muscle ache, eye pain and a rash. There is laboratory evidence, however, that Zika virus can enhance antibody-dependent infection of the dengue virus, but clinical ramifications of this phenomenon is as yet unclear. Zika is essentially a mild or asymptomatic dengue like disease, but an association with Guillain–Barre syndrome (a form of paralysis) and other neurological conditions has recently been observed in French Polynesia. El Salvador has reported 46 cases of Guillain Barre Syndrome in just December of 2015, which has prompted the WHO to investigate whether the increase in incidence is related to a regional Zika outbreak. But it is the explosive epidemic in Brazil where a 20-fold increase in incidence of microcephaly has been noted in just a year from 2014 to 2015. This is the first time that a flavivirus has been implicated in a birth development defect. The Zika virus could also be associated with defects in hearing and vision despite not suffering brain damage or a small head. Most health authorities in the territory are recommending precautions against mosquito bites in pregnant women despite concrete proof that Zika interferes with brain growth in human babies. It is imperative that scientists quickly confirm the alleged causal link between Zika infection of pregnant women and underdeveloped brains. This is easier said than done because dengue and chickungunya imitate the clinical picture of zika and worse may coexist. Specific tests to detect dengue or chikungunya are not always easily available while there is still no commercial test to confirm Zika any where in the world. Serological tests that detect antibodies could be misleading for diagnosis due to similarities in their structure. The highly sophisticated polymerase-chain-reaction assay can distinguish the 3 viruses but Zika specific tests are not widely available.
Management consists of bed rest and supportive care. Aspirin must always be avoided keeping dengue in mind and a rising hematocrit suggesting imminent hemorrhage would mandate specific life saving measures. Lingering joint pains in chikungunya require requisite treatment. The problem is that Zika also has no specific anti-dote and thus preventing mosquito bites becomes the mainstay in Zika treatment. There are no vaccines in development, and if available would not be effective adequately apart from not being cost-effective.
Most Indian cities are infested by mosquitoes right through the year and suffer regular pandemics of dengue and chikungunya. We already have all the ingredients; the nimble mosquitoes and the arboviruses. The potential for the entry of the Zika virus into India would be no more difficult than the refugees that have streamed into Europe the past few months. Maybe it has already sneaked in. It is still not clear as to how Zika landed in Brazil from Africa in the first place. Some have suggested that the 2014 World Cup may have facilitated entry into Brazil, when hundreds of thousands visitors flew into the country. The Summer Olympics are less than half a year away; most if not all sports federations across the globe should be scrambling to ensure that athletes avoid mosquito bites by whatever means necessary when in Brazil. This would include insect repellents, apartment screens, full sleeves, pants etc. The spectators arriving from across the globe too need to be informed about the horror of giving birth to an infant with a small head in case they get infected while pregnant. The bad news is that medical authorities have no clue as to which phase of pregnancy is most susceptible. It should be the first three months but there is as yet no data. It would be prudent for pregnant women not to travel to Latin America or the Caribbean till matters get clearer. Indian health authorities will have to be on constant alert for any surge in babies with small heads. There is the distinct albeit horrendous probability that some time in the near future pregnant women would be advised against international travel to almost the entire world. There have been dozens of deaths of infants with small brains and also while still in the womb. Epidemiologists estimate that almost 15 lakh (1.5 million) Brazilians have been infected with Zika. The situation is grim enough for several Latin Health American ministries to consider advising women against pregnancy for the next coupler of years. The Centers for Disease Control and Prevention in the United States has already warned pregnant women against making a trip to countries considered hot beds of Zika. It has said in a report that ‘the increased occurrence of microcephaly associated with cerebral damage characteristically seen in congenital infections in Zika-virus areas is suggestive of a possible relationship.” The director general of the World Health Organization is convening an emergency meeting in Geneva early next week in view of the Zika virus “spreading explosively” and accepting that “the level of alarm is extremely high.”
The exact pathogenesis of Zika virus infection remains to be completely unraveled. There are multiple questions hanging in the air. Has the virus transformed in the last 60 years? Did the virus mutate in Brazil? Does a preceding dengue infection facilitate Zika virus invasion of the embryonic brain? The exact cause for irreversible brain damage remains elusive. There is no vaccine or cure for Zika while not more than 20% infected persons will develop any symptoms.
We are staring at an epidemic of babies born with small damaged brains as we scramble to close the gaps. The Indian authorities would do well to sit up and notice the looming Zika invasion. The Zika virus has considerable potential to penetrate our borders to play havoc amid the ideal conditions provided both for it and the mosquitoes.With Dengue in, can Zika be far behind ? But the mandarins must ensure that no knee jerk reactions benefitting big business are taken.
There is the tantalizing probability that somehow this virus has been introduced into the ecosystem when millions of genetically modified male mosquitoes were released in Brazil very recently. The GMO mosquito or the ‘mutant mosquito’ is infected with a genetic material that ensures its off spring subsequent to mating with the wild female mosquito,died young. It has been reported that more than 95% mosquitoes were dead in 6 months when such male mutant mosquitoes were released in the Cayman Islands. Is it a mere coincidence that the Zika virus has not only suddenly emerged in Latin America but also has the capability of irreversibly denting the embryonic human brain and the nervous system?
Undoubtedly Brazil is the epicentre of the Zika epidemic with more than a million cases reported. It is also the centre for trials of genetically engineered mosquitoes. Mika virus has been detected in 18 of 26 states in Brazil. It has also been reported that the strain of male mosquitoes released in Brazil affect larvae which die in the absence of antibiotics in the environment, but an estimated 3-4% of larvae are expected to survive in the absence of tetracycline. There is further evidence that up to 15% of GMO mosquitoes will actually survive due to tetracycline being present in the environment because even small levels of tetracycline can interfere with the death gene installed in the GMO mosquitoes. The latest headlines are screaming that the first case in the US was sexually transmitted by as male who had acquired Zika on a visit to Latin America. Panic is further being amplified by highlighting that Zika can be spread by blood transfusions. Zika is rapidly becoming the biggest scare globally and will soon place ISIL in the sidelines. National governments are scrambling to form an action strategy and invariably the main solutions being propped are :-
- Release more genetically modified mosquitoes.
- Urgent development of a vaccine.
- Use chemicals and pesticides to destroy all mosquitoes
All three measures satisfy big business the most; Big Biotech, Big Pharma with vaccines,and pesticide makers like Monsanto.