Threat in Pakistan and possible solutions

Islamabad

Recent emergence of Zika virus has caused uproar among media and public after its outbreaks that have been reported in tropical Africa, Southeast Asia, the Pacific Islands, and most recently in the Americas. Because the mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will continue to spread.

Keeping in view the presence of Zika virus vector in Pakistan, the health planners are on high alert and are forced to think about developing an urgent strategy to avoid its possible appearance and spread in Pakistan. As we take into account the presence of ‘aedes aegypti’, the same vector for dengue fever, more we need to think about the serious nature of the alert, said Assistant District Health Officer at ICT Health Department Dr Muhammad Najeeb Durrani while talking to ‘The News’ on Tuesday.

As looking into the disease’s appearance and possibility of its transmission in Pakistan, we epidemiologically know that international air travel remains a most important risk factor, he said. “We have learnt from the appearance of emergence of H1N1 a Pandemic Virus’s evolution in the world, that had emerged in the month of April 2009 in California in US and with an unprecedented speed, by the month of June 2009 the virus had reached every country of the world due to the rapid transit of people from the infected area to other parts of the globe.”

Dr. Durrani who is an epidemiologist and Member Global Outbreak Alert & Response Network (GOARN) added that internationally a travel alert of level 2 has already been issued for people travelling to regions and certain countries where Zika virus transmission is ongoing. People who are at high risk like pregnant ladies should avoid going to these countries, he said.

Zika virus is spread to people primarily through the bite of an infected ‘aedes’ species mosquito. The most common symptoms of Zika virus disease (or Zika) are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week. There is no vaccine to prevent or medicine to treat Zika. Severe disease requiring hospitalization is uncommon and deaths are rare, he said.

To a query, he said the health departments in Pakistan have a hand on experience of 10 years of dealing with the same vector that causes Zika Virus, ‘aedes aegypti’ that has been responsible for causing dengue fever in most parts of the country. As such the mechanism is there for vector control to avoid dengue fever outbreak and the same measures are needed for the control of the Zika virus if that emerges in Pakistan, he said.

Dr. Durrani said that the disease has zero mortality except presenting as microcephaly in the new born affecting the babies before they are born and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes. However the Zika outbreak in Brazil is being associated with Guillain-Barre syndrome (GBS) that is a rare disorder in which a person’s own immune system starts damaging the nerve cells, causing muscle weakness and sometimes, paralysis, he said.

To a query, he said in national perspective, human surveillance is needed to be strengthened. It hat has been observed that the policy makers are at the moment thinking to enhance vector efforts where as in the current scenario, we need enhanced human surveillance because a single case of Zika virus might bring the virus from the endemic country to Pakistan. Only a few cases are enough to infect the local flocks of ‘aedes’ mosquitoes in a specific area or locality that would possibly be transmitted to other areas through both the infected vector and the infected host, explained Dr. Durrani.

He believes that to avoid Zika outbreak, the most important thing is to catch the first case of the infection immediately after incidence. Pregnant women are at maximum risk. As there is no incidence of the disease in Pakistan so far but health planners must think of possibility of its appearance in near future and for surveillance and to contain the virus in an emerged index case, steps needed to monitor working in labour rooms of hospitals, maternity centres and home based deliveries being conducted by traditional birth attendants, said Dr. Durrani.

He said we must have a level of enhanced surveillance to contain the virus if that appears to prevent the local mosquitoes from getting infected.

He said that there is a need of taking measures for capacity building of healthcare workers especially those associated with taking care of pregnant ladies. Obstetricians, gynaecologists, birth attendants, lady health workers and community health workers should be given training for the purpose, he said.

On social mobilisation, he said launching of careful public awareness campaigns with right messages can play important role in vector elimination however, there should not be panic among general public.

Dr. Durrani said that a high level of vigilance is required to be exercised in all over the country and the flights coming from affected countries of Latin America and other endemic areas need to be effectively monitored to contain the arriving suspected cases in quarantine. “So far the current self-illness declaration form being given to passengers inside the flights is not at all sufficient, rather deficient as that may not be able to reach an infected person coming from the endemic area and having symptoms,” he said.

He, like many other health experts, said that the ministry of health should develop a group of experts comprising of epidemiologists, clinicians, pathologists, virologists, paediatricians, entomologists, health planners, gynaecologists, obstetricians and officials from WHO and UNICEF in the core capacity to look forward, plan and take pre-emptive measures to counter any situation arising from the emergence of the disease in the country in coming days.