Sun | Jan 21, 2018

Delay pregnancy - ZIKV continues to pose serious threat to global health

Published:Wednesday | June 15, 2016 | 12:00 AMAnastasia Cunningham
A baby born with microcephaly.
Dr Christopher Tufton, minister of health

With more than 60 countries in the Americas and Caribbean now fighting a Zika virus (ZIKV) outbreak, the World Health Organization (WHO) has urged persons living in these areas to delay pregnancy - a move that could affect millions of couples.

With the mosquito-borne virus new to the region, WHO estimates that as much as 70 per cent of a country's population may be infected over time.

Transmitted by the bite of an infected aedes aegypti mosquito as well as sexually between partners, ZIKV can be passed from an infected pregnant woman to her foetus during pregnancy or at delivery, which can lead to microcephaly in the child.




Microcephaly is an abnormal growth of the brain and stunting of the growth of the head of the foetus. Babies who develop microcephaly in the womb may not live to full term, may be born prematurely, may be stillborn, or may survive but with life-long disability.

In addition to microcephaly, other problems have been detected among foetuses and infants infected with the Zika virus before birth, such as eye defects, hearing loss, and impaired growth.

Scientists continue to study the full range of other potential health problems that ZIKV infection may cause during pregnancy.

The new advice from WHO is effectively an acknowledgement that, with no vaccine available, delaying pregnancy is the best option for couples to avoid having babies with birth defects. Vaccines are now being developed.

"In order to prevent adverse pregnancy and foetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, be correctly informed and oriented to consider delaying pregnancy," WHO guidelines stated last week.

As of June 1, microcephaly and other central nervous-system malformations potentially linked to ZIKV infection or suggestive of congenital infection have been reported by 11 countries or territories.




With more than 40,000 pregnancies occurring in Jamaica each year, in January, before the country reported its first ZIKV case, the health ministry had joined other countries in advising women to delay becoming pregnant for the next six to 12 months, and those already pregnant to take extra precaution to prevent being bitten by mosquitoes.

The country had also ramped up its birth-control campaign through the National Family Planning Board.

With 21 confirmed ZIKV cases and 1,519 suspected cases, last week, Jamaica's ministry of health announced that as part of its Prevention of Mother to Child Transmission Programme to monitor pregnant women and their babies, all pregnant women will be required to be tested for the Zika virus. Two of the confirmed cases are pregnant women.

"When a woman is tested positive for being pregnant and she has to go through the initial stages of testing, we are going to require her to also do a Zika test, so that we can track, as part of the monitoring," Minister of Health Dr Christopher Tufton disclosed to the House of Representatives last week Tuesday.

The ministry will also be providing bed nets to all pregnant women who visit the antenatal clinics.

ZIKV is also linked to the autoimmune diseases Guillain-Barre syndrome (also known as GBS), and acute disseminated encephalomyelitis (more popularly known as ADEM), which targets the peripheral nerves and can cause temporary paralysis.

To date, 13 countries or territories have reported an increased incidence of GBS and/or a laboratory confirmation of a Zika-virus infection among GBS cases.




In the meantime, the rapid spread of ZIKV has caused fears ahead of the upcoming Olympics in Rio, Brazil, ground zero for the outbreak in the region since the virus began spreading last year, with a high percentage of the population significantly affected.

Margaret Chan, director-general of WHO, has asked a panel of experts to consider whether the Olympics should be held as scheduled in Brazil from August 5-21.

In February, WHO had declared the Zika-virus outbreak a public-health emergency of international concern. There have been only three other such designations in recent history - Influenza A (H1N1) in 2009, the resurgence of polio in 2014, and the Ebola outbreak in 2014.

ZIKV is transmitted from human to human by the bite of infected mosquitoes of the aedes species, particularly the aedes aegypti, which also transmits dengue fever, chikungunya (chik-V) and yellow fever. There are no treatments for the disease, only the symptoms associated with it.

Among the symptoms of ZIKV are high fever, joint and muscle pain, red eyes, headache, swelling in lower limb and weakness.




A milder version of chik-V, the Zika virus is considered a self-limiting disease, in that symptoms last for four to seven days. It does not have long-term effects (outside of the mentioned medical complications than can develop); one in four persons who become infected do not display any symptoms; of the persons who are infected, approximately one in 1,000 may have severe symptoms; and approximately 50 per cent of symptomatic persons may be sick enough to need a doctor. However, unlike other mosquito-borne diseases, it is the only one linked to major medical complications.

If a blood sample is not taken within the first five days of the illness, a confirmatory test cannot be done. According to Tufton, few of the suspected cases who visit their doctor will have a blood sample taken to confirm a ZIKV infection.

Persons who suspect they may have the Zika virus are urged to visit a health centre or their general practitioner.

A class-one notifiable disease, health officials must report any suspected cases they come across within 24 hours.

The Jamaican Government continues its multi-prong, multi-sectoral operation in the fight to control the spread of the virus, as well as reduce the breeding of the vector mainly responsible for the spread of the disease.