What Has Happened With Zika?

I don’t know if I should rejoice at the fact that Zika is no longer news (...). This also means less attention – and less resources-

I don’t know if I should rejoice at the fact that Zika is no longer news. On one hand, this media silence is due to the fact that, fortunately, the number of new cases has decreased and the World Health Organisation (WHO) has not reported autochthonous transmission in new countries since May 2017 (the last one was India). However this also means less attention – and less resources- to the virus and to the affected families, which have certainly not ceased to exist.

Too often, diseases are treated like fashions that come and go

Too often, diseases are treated like fashions that come and go, saturating media with alerts on new epidemics, particularly when it involves “morbid” situations such as microcephaly and other severe anomalies in new-born babies. Indeed, the virus has dramatic consequences on maternal, reproductive and child health (miscarriages, stillbirths, neonates with neurological and ocular alterations, among others).

The virus has dramatic consequences on maternal, reproductive and child health

Unfortunately, the Zika virus has joined a group of infectious diseases that disproportionately affect women in reproductive age, the so-called TORCHS (Toxoplasmoxis, Rubella, Cytomegalovirus, Herpes simplex, varicella and Syphilis). Because of this, the WHO declared Zika a public health emergency of international concern in February 2016, until November of the same year.

Now, barely one year after the emergency was called to an end, can we lower our guard? The answer is clear: No

Now, barely one year after the emergency was called to an end, can we lower our guard? The answer is clear: No. We cannot let one single infected woman escape without diagnosis, we cannot forget the families that have already given birth, and we certainly cannot forget the babies, many of them asymptomatic but that will need a close follow-up during their first years of life. 

In endemic countries (i.e. with ongoing mosquito-borne transmission), the poorest populations living in peri-urban areas have been the most affected and are those that face the greatest obstacles to deal with this new reality. In our settings, although non-endemic, we also encounter vulnerable populations: young women with several children, without a stable partner and without a job, who travel to their country of origin where there is ongoing virus transmission and that must face all this information during their pregnancy without adequate family support.

One cannot talk about Zika without talking about family planning

A disease cannot be considered as an isolated event; it is strongly associated with social determinants. Therefore, one cannot talk about Zika without talking about family planning. Unfortunately, the countries most affected by this epidemic are also those with fragile family planning services, let alone their restrictive abortion laws. Let’s not forget that in Brazil, the country most affected by the epidemic, abortion is only legal in cases of rape or anencephaly (absence of a major portion of the brain), and women that practice abortion for other motives can be condemned for up to three years of prison.   

Because of this, it is important that, from here, we continue to follow the women potentially exposed to Zika, which is essential for the early detection of cases and the possible consequences. Now, although the peak of consultations for exposure risk is over, we must continue recommending women not to travel to endemic areas if pregnant or planning a pregnancy in the following months, continue diagnosing the cases, and continue evaluating long-term consequences.

At ISGlobal we have been collecting data of all women exposed to the virus

For two years, at ISGlobal we have been collecting data of all women exposed to the virus and having attended a Clinic service (Maternity, Tropical Medicine , the Sant Joan de Deu Hospital, or the Traveller Attention Service), in order to analyse risk factors and document antenatal and postnatal development. The coordinated action between the different services and hospitals has been key to guarantee the best health care as well as a reliable and optimal data collection.  

A quick search in Pubmed, one of the most used search engines among the scientific community, reveals more than 3,400 published articles containing the word ‘Zika’; however, only 378 of them had been published before 2016. As usual, this can be interpreted in two ways:  on one hand, the little information generated during 69 years after its discovery in 1947; on the other hand, it shows the great capacity to generate scientific evidence in response to a health emergency situation, as happened previously with Ebola.

We have already seen, with Ebola and Zika, that research in times of peace is fundamental, not only when it is too late

Now, we need to maintain funding for these emerging diseases so we can find answers to unresolved questions, including the development of a safe and effective vaccine. We have already seen, with Ebola and Zika, that research in times of peace is fundamental, not only when it is too late. Let us hope that other families do not have to go through the same ordeal in order to give them proper attention and funds.