Mysterious and Fast-Moving, Zika Virus Has World’s Health Leaders Scrambling

By Lena H. Sun and Brady Dennis -The Washington Post • Sunday February 14, 2016

Global health authorities and government officials are mobilizing to battle the fast-spreading Zika virus, sending rapid-response teams to affected regions, issuing travel warnings for pregnant women, accelerating vaccine trials and even deploying mosquito-fighting troops to hard-hit areas in Brazil.

Stung by criticism that the world’s response to the Ebola epidemic was halting and disjointed, officials in Latin America, the United States and Europe say they are determined to do better against a new foe that, in some ways, is more daunting than the hemorrhagic virus that killed 11,000 people in West Africa.

But their efforts are being hobbled by a fundamental lack of understanding of the disease that has spread to nearly three dozen countries and is moving so quickly that some experts estimate it could infect as many as 3 million to 4 million people within 12 months.

Unlike the highly lethal Ebola, which had been studied extensively by the time it emerged in Guinea in late 2013, Zika wasn’t considered a menace. Most infected people didn’t even show symptoms. For decades, Zika got little scrutiny before showing up in Brazil last May.

Now, for the first time, Zika is suspected of being the culprit behind a constellation of devastating birth defects, most notably microcephaly, a condition in which babies are born with head and brain abnormalities. In adults, the virus has been associated with another rare condition, called Guillain-Barré syndrome, that can result in paralysis and even death. But, even at this point, scientists are not able to say definitively that Zika is the cause of the problems.

The mystery surrounding the virus — officials aren’t sure what will turn up next — makes it “much more insidious, cunning and evil” than Ebola, said Bruce Aylward, a World Health Organization official who helped coordinate the organization’s Ebola response and is now leading the Zika effort.

The urgency to understand the virus, along with pressure not to repeat its slow-footed reaction to the devastating Ebola crisis, prompted the WHO to move faster this time to declare a global public health emergency.

“This emergency is because of what’s unknown,” said David Heymann, an infectious-disease professor at the London School of Hygiene and Tropical Medicine and chairman of the expert committee that urged the World Health Organization to call a global health emergency. “The Ebola emergency was because of what was known.”

But declaring an emergency is just the beginning, and many public health experts are pressing for quick and aggressive steps. There has been no public announcement yet of a strategic plan with a timetable and cost estimate to make it work, said Lawrence Gostin, a global health law professor at Georgetown University.

Diagnosing Zika in pregnant women also is challenging. The virus stays in the blood only for about a week. After that, it’s difficult to know if a woman was infected because the tests used aren’t sensitive enough to differentiate between Zika and two related viruses on a routine basis. Those other viruses, dengue and chikungunya, are transmitted by the same type of mosquito, and many of the Zika-affected countries continue to battle outbreaks of those viruses.

The CDC has sent out material to state labs and health departments to perform 30,000 tests for Zika. It’s getting ready to send out material for tens of thousands more tests. But that’s not going to be enough to promptly test all the pregnant women who will be returning from Zika-affected countries, Frieden said during recent congressional testimony.

In any given year, 30 million to 40 million people travel back and forth between the United States and South America and the Caribbean, including half a million pregnant women.

Meanwhile, affected countries are struggling to put in place systems to detect signs of microcephaly and Guillain-Barré syndrome, and to brace for the far-reaching effect on families trying to care for infants who might have disabilities. In poor countries, that will be especially difficult.

“These women will need care that may be beyond what we can provide in a place like Haiti,” said Joia Mukherjee, chief medical officer for Partners in Health, a Boston-based nonprofit that provides health care in Haiti. There aren’t enough ultrasound machines to screen pregnant women, or specialists to provide long-term support for disabled children.

“This is going to be a huge burden to a poor family,” she said.

As health experts grapple with the latest epidemic, some say that the biggest lesson from Ebola — the importance of building robust health systems so countries are prepared for newly emerging diseases — has not yet been learned.

“We can’t keep being caught off guard and unprepared,” said Georgetown’s Gostin. “There are going to be global health emergencies, and we need to have funding already mobilized, planning already done. . . . None of that is happening.”

EDITOR’S COMMENT: “There are now reported cases in China and Russia.”



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