By Dr Rafdzah Ahmad Zaki
ZIKV is the last thing that we need right now when we are still losing the battle against dengue. Dr Rafdzah Ahmad Zaki, Public Health Physician (Epidemiology), Department of Social & Preventive Medicine, University of Malaya (UM) talks on Zika virus and its threat to reproductive health.
Dr Rafdzah is also a member of the Julius Centre UM (JCUM), which is one of UM’s research centres and her current study is on dengue surveillance and prediction.
KUALA LUMPUR: Zika virus (ZIKV) is a type of flavivirus and it spreads to people through Aedes mosquito bites.
Since the first discovery of ZIKV in human in the 1950s, series of Zika cases have been recorded in Africa, Americas, Asia and the Pacific.
In current outbreak, Zika was first detected in Brazil in May 2015. Researchers suspect the virus might have arrived in South America during the 2014 World Cup Games.
This virus has now reached more than 30 countries.
THE ZIKA VIRUS SYMPTOMS
The most common symptoms of Zika infection are fever, rash, joint pain, and conjunctivitis (red eyes). Symptoms typically begin two to seven days after being bitten by an infected mosquito.
People sick with Zika usually only need plenty of rest, drink enough fluids, and take simple medicine for pain and fever. Only about one in five people infected with ZIKV will get sick.
Thus, many people might not realize they have been infected but will become carrier and spread the virus to others.
ZIKV infection rarely causes any serious complication or death. However this virus poses a threat to neuro development of fetus. The ZIKV infection also has been linked to the rare Guillain-Barre nerve disorder, which can cause paralysis and in extreme cases it can be fatal.
The World Health Organization (WHO) has declared that Zika is a global public health emergency. WHO puts Zika in the same category of importance as Ebola, Polio and Swine flu. ZIKV is spreading far and fast, with devastating long term consequences especially in reproductive health.
SEXUAL TRANSMISSION OF ZIKV
Transmission of ZIKV through sexual activity has been reported in current and previous outbreaks. After infection, ZIKV might persist in semen though no longer detectable in blood. Although the risk of transmission through this method is very low, this has increased the possibility of the virus spreading in countries even without Aedes mosquito.
The Centre for Disease Control and Prevention (CDC) has issued a guideline for the prevention of sexual transmission of ZIKV. Men who reside or have travelled to an area of active ZIKV transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy.
The CDC also recommended for couples returning from countries affected by the ZIKV should not try for a baby for a month.
CHILD AND MATERNAL HEALTH
Recently, Brazil health authorities have observed an increase in ZIKV infections in the general public as well as an increase in babies born with microcephaly, a condition which often results from abnormal brain development.
The long-term consequences of microcephaly can range from mild developmental delays to severe motor and intellectual deficits, like cerebral palsy. Although more scientific investigation is needed, most health experts agreed that a relationship between ZIKV infection during pregnancy and microcephaly is strongly suspected.
WHO is expecting evidence to confirm a link between ZIKV and microcephaly very soon.
Children with this condition face a reduced life expectancy and often have profound cognitive and developmental problems. Due to the severity of impairment, these children require long-term and specialized care.
Furthermore, the neurological problems on a baby might be underestimated. There were cases where children who have normal size heads but are having neurological lesions and eye lesions. The fear now is that even baby of infected mother who appear normal may suffer from a range of developmental delays.
It is indisputable that women living in ZIKV affected area now fear of getting pregnant. Moreover, in some countries affected with ZIKV, facilities on family planning and birth control are not adequate.
The option of having safe abortion also not available to pregnant women, even due to medical reason and this can be illegal in some countries. This will put women’s life at risk by having unsafe abortion without proper medical attention, and not utilising the health care facilities to avoid being convicted.
The suggestion by various governments that women should avoid pregnancy in order to avoid the possibility of having a child with birth defects, jeopardises women’s reproductive freedom.
On the other hand, sudden increase in children with disability and the need in additional long term medical attention will be a burden to the healthcare system.
However, putting the burden on women to limit the effects of the ZIKV is not a solution. It is unsustainable and does not support women’s reproductive rights. Sexual and reproductive health counselling and facilities should be made available to support affected women.
IS THE THREAT OF ZIKV REAL?
Association between microcephaly and neurological defects with ZIKV yet to be proven scientifically, but countries affected by ZIKV already suffer from social and economic consequences.
The impact of ZIKV on reproductive health in the community is also enormous. Although currently there is no case of ZIKV infection in Malaysia, the potential threat of ZIKV should not be ignored. Our healthcare system should be prepared on the reproductive health needs related to ZIKV.
ZIKV is the last thing that we need right now when we are still losing the battle against dengue. Preventing the virus from infecting our community is the current priority. Although transmission through blood transfusion and sexual activity is possible, mosquito bites remain the primary method of transmission of ZIKV.
Controlling the Aedes mosquito population by destroying their breeding sites is the most proactive action that we can do to prevent ZIKV outbreak in Malaysia.
My role is monitoring trend of current disease outbreak and plan for disease prevention and minimizing disease spread. In doing so, I will keep my knowledge on the virus/disease/outbreak updated.