AS CASES OF ZIKA infection continue to rise in the Caribbean, with Jamaica today confirming its first case, Caribbean residents have become increasingly concerned about taking preventative action against becoming infected.
At a press conference called by the Caribbean Public Health Agency (CARPHA) last Monday, Executive Director Dr. C. James Hospedales warned Caribbean governments against letting their guard down — a warning that comes just months after the crippling Caribbean outbreak of Chikungunya in 2015.
ZIK-V, the mosquito-borne virus that causes the Zika infection, was first discovered in 1947 among rhesus monkeys in Uganda’s Zika forest. The first case of infection in humans was recorded in 1952 during brief outbreaks in Africa and South East Asia, but it was not until 2007 that the virus became more commonly known, when cases began appearing in the Pacific Islands.
What is new, is Zika’s appearance in the Americas. The virus was first detected in 2014 with a case in Chile and, after spreading to Brazil in 2015, the virus has continued to scatter into several countries in the Americas and the Caribbean.
While most people infected with ZIK-V show little or no symptoms, the virus can cause rash, fever, headache, muscle aches, joint pain, and conjunctivitis. The symptoms are typically mild and last only 2-7 days.
What is of concern, however, are the noted increases in cases of microcephaly and Guillain-Barre Syndrome following ZIK-V infection. Brazilian mothers who were infected with ZIK-V during pregnancy, particularly during their first trimester, have disproportionately given birth to babies with microcephaly — a condition in which infants are born with small brains and heads. More recently, the virus was suspected to be associated with an increase in cases of Guillain-Barre syndrome, a nerve disorder that causes muscle weakness and limb paralysis.
Diagnosis and treatment
ZIK-V is primarily transmitted by the Aedes Egypti mosquito; the mosquito also responsible for transmitting the chikungunya, dengue fever, and yellow fever viruses. On February 3, a case of sexual-transmission of the Zika virus was documented in Texas, coming on the heels of warnings by international health agencies that sexually-active adults should use condoms in and after visiting Zika-affected countries. Doctors estimate that the virus can be sexually transmitted up to a month after a patient first becomes infected.
The symptoms of ZIK-V infection are similar to many other illnesses, including other mosquito-borne viruses, so diagnosis can be difficult. The most effective way to diagnose the infection is through Polymerase Chain Reaction (PCR) testing, which is currently not widely available in public health systems across the region.
Currently, there is no vaccine available for either prevention or treatment of ZIK-V infection, but one developer is apparently making moves for one to be available by year-end. Treatment is usually palliative, and patients are advised to supplement with fluids and rest.
The Caribbean impact
ZIK-V has been identified in five CARPHA member states in addition to two other Caribbean countries; Guyana, Barbados, Haiti, Jamaica and Suriname, along with Puerto Rico and Martinique. The region has particularly ideal conditions for a wide-scale spread of ZIK-V, notably an abundant mosquito population, and heavy travel links between affected countries.
The importance of intervening with prevention strategies is critical. CARPHA and regional partners are hoping that these strategies will not only reduce the spread of the disease, but also reduce the risk of economic losses throughout the Caribbean. Even as airlines have already begun refunding tickets to visitors booked to travel to the affected Caribbean countries, the Caribbean Tourism Organization (CTO) and Caribbean Hotel and Tourism Association (CHTA) are said to be working with CARPHA to put a plan in place to prevent the spread of ZIK-V both to visitors and locals in the affected regions.
As a start, CARPHA is working to set up surveillance systems for ZIK-V throughout the Caribbean. The organization has also developed the capacity for PCR testing, and has been receiving samples from many of its member states.
Patients with a ZIK-V infection require special attention if they are pregnant or presenting with neurological symptoms, and CARPHA is currently piloting a system to document these kinds of cases, beginning with Barbados.
The health agency is also working to promote prevention methods through vector control and bite prevention. These methods include promoting public awareness within the tourism industry, in partnership with the CTO and CHTA.
There is still much that is unknown about the Zika virus, and it is not clear how the epidemic will be shaped. As more information is discovered, organizations like CARPHA will have to work to respond to these changes in a timely manner to prevent further outbreaks and complications from the disease.