Should we panic over Zika virus?

The World Health Organization (WHO) recently declared an international public health emergency over the spread of Zika virus in the Americas. While at time of writing, there are no Zika cases reported in Malaysia, the Health Ministry has proactively issued a guideline over this international crisis.

This caution is necessary, seeing that the virus vector is one that we Malaysians are all too familiar with, Aedes aegypti.

Locally, we know this mosquito as the vector for dengue, a virus that is a cause for alarm in Malaysia with the current statistics showing more than 10,000 cases reported in January alone.

We are currently seeing an average of 3,000 cases per week and a total of 14 dengue-related deaths already this year.

With the El Nino phenomenon currently ongoing, the warm weather only provides a conducive breeding ground for these mosquitoes and potentially increases the risk of vector-borne diseases, including Zika.

It should be noted that Zika infection is mostly asymptomatic, i.e. most people would be healthy carriers. The symptoms, if any, are similar to dengue – rash, fever and joint pain – with conjunctivitis being the sole hint to a Zika infection in some cases.

The high alert in South America is due to association of this virus infection with the condition microcephaly in children of women infected by the virus and Guillain-Barré syndrome. The former is a condition of newborns having smaller head circumference and possible neurological disorders to a varying degree with some causing miscarriages or stillborns. The latter is a condition of paralysis in adults.

Zika was first discovered in 1947, and was christened after the forest in Uganda where it was first reported. Over the years, there is little research done on the virus despite its transmission across the globe.

Compared with Ebola and even dengue haemorrhagic fever, the symptoms of Zika infection were usually mild.

Needless to say, we have been taking Zika lightly – until today.

An outbreak was first detected in 2007 in Brazil. That  South American nation alone reported a 20-fold increase in cases of microcephaly in 2015 compared with previous years, with an estimated 1.5 million locals having been infected since May 2015.

This spotlight has accelerated research and publication, with most interest focused on the link between Zika and microcephaly.

Brazil, El Salvador and a growing number of other South American countries have since advised women to put planned pregnancies on hold until 2018.

While there is currently no confirmed biological link between Zika infection with microcephaly, a causal link is strongly suspected. Viral RNA was able to be isolated from brain and placental tissues of congenitally infected newborns and two foetal losses.

The entire Zika virus genome was identified in brain tissue by next-generation sequencing in another case of an aborted foetus.

Analysis of the sequence revealed 99.7% nucleotide identity with a Zika virus strain isolated from a patient from French Polynesia in 2013, and a strain from Sao Paulo from 2015. These findings suggest that a virus originally from Asia triggered the current Brazilian outbreak.

These recent findings highlight a few questions. Have Zika infections been occurring in the Asian region but were largely misdiagnosed? Could there have been co-infection with dengue or chikungunya?

Have we in Asia been unknowingly protected against Zika through cross-protection due to aggressive vaccination campaigns for Japanese Encephilitis? Could Zika have originated from our region, went undetected, and through human global travel traversed the Pacific Ocean?

Would current research in dengue also assist with controlling Zika?

These questions provide the basis for interesting research for virologists in Asia and the world over.

To date, there are a few reported cases of Zika being sexually transmitted as the virus can be found in patient's semen.

Given Malaysia's history with dengue, this news is bleak. Partly to blame is our lax attitude towards health in general and to some extent it also requires a review of our civic mindedness and standard of cleanliness. A great commentary by Debora Diniz sums up what has been on my mind ever since Zika first hit global news… with any such outbreaks, it is always the poor – living in substandard conditions, having poor knowledge in planning pregnancies and lack of access to healthcare – who are most affected.

While we currently do not need to panic about Zika, this outbreak should trigger conversations around the need for a comprehensive sexual and reproductive health education in Malaysia.

We need to start talking about contraception, planning pregnancies, access to safe abortions and giving women the choice on whether we want to have children. More so, if there is a risk to having a differently-abled baby.

The link to microcephaly should also have us reviewing support networks for parents with differently-abled children in general – what is currently in place, what needs to improve and would such support be affordable? 

It is not a simple matter of killing mosquitoes. It is about changing our own paradigms around health, sex, and the environment we live in. – February 17, 2016.

* This is the personal opinion of the writer, organisation or publication and does not necessarily represent the views of The Malaysian Insider.