The spread of Zika virus across Latin America, with its apparent tragic consequences for the babies of infected pregnant women, has parallels with the emergence of AIDS more than 30 years ago, a senior epidemiologist on the frontline in Brazil said.
Wilson Savino, director of the Oswaldo Cruz Institute in Rio de Janeiro, said the current state of scientific ignorance around the virus and its effects resembles that over HIV — the human immunodeficiency virus which gives rise to AIDS — in the early 1980s.
“Back then, the scientific and medical community did not know what was going on until many people had died and considerable research had been undertaken,” Savino said. “Then it turned out to be a global health issue. In Brazil, although we have identified the Zika virus, we don’t know much about it compared with dengue or yellow fever. The degree of ignorance is comparable to what we faced 32 years ago.”
“This is a major health incident in the history of Brazil. We face a very serious problem for which scientific knowledge is far from sufficient. The scientific community has the responsibility to discover as much as possible as rapidly as possible,” Savino added.
Savino is one of three senior Brazilian researchers and officials who were asked by the Guardian to shed light on how a disease initially classified as harmless came to be implicated in the outbreak of microcephaly — the birth of babies with small heads and underdeveloped brains — which has now been designated by the WHO as a public health emergency of international concern.
Zika virus was first identified in Uganda in 1947. It is thought to have arrived in Brazil in 2014, possibly with visitors to the World Cup. There are now an estimated 1.5 million cases of Zika infection and the number is growing fast, though nobody knows how widespread the disease is because there are no symptoms in about 80 percent of cases.
In the rest, it can lead to fever, aching joints, muscle pains, sore eyes, itching skin and rashes and is now suspected as a cause of the spike in microcephaly cases in Brazil, although without scientific certainty. Cases of microcephaly have risen from fewer than 150 in 2014 to more than 4,000 in the past three months, but skeptics suggest this could simply reflect a previous under-reporting of abnormalities, which are also found in nations without Zika.
“The fear is real. The scare is real,” said Gubio Soares Campos, a virologist at the Biology Institute of the Federal University of Bahia, who was one of two researchers who first identified Zika in Brazil in April last year.
“People have to really be careful right now because we do not yet know whether there will be other major consequences,” Soares Campos said.
Pregnant women needed to be very vigilant, avoiding mosquito bites especially in the first months of pregnancy, he said.
“We can’t confirm yet that only the Aedes aegypti is transmitting the disease. This needs to be investigated and scientifically proven. Those who affirm this are wrong, because the truth is that we don’t know. It could be transmitted by other mosquitoes,” he said.
Health officials needed to wage war on mosquitoes on the streets, with information to the public and a campaign to reduce the numbers of insects and larvae, Soares Campos said.
A blood test for infection and antiviral drugs that pregnant women could take must be investigated.
Scientists need to know whether it is possible to get Zika more than once, or if one infection conveys lasting immunity.
“It’s very important to know this now, more important than the vaccine,” Soares Campos said. “If people develop immunity, then most of the population will already be protected if there is another outbreak. This would put the government and the people a lot more at ease.”
He was critical of the Brazilian government, which had been slow to fund research, particularly into ways of controlling disease-transmitting mosquitoes.
“There is too much bureaucracy. The Brazilian government needs to be more agile with this,” he said.
Brazilian Ministry of Health department of communicable disease surveillance Director Claudio Maierovitch said that “we don’t have any doubt about the link between Zika and microcephaly.”
“The sudden increase in microcephaly happened exactly in the places where Zika had hit between seven and 10 months earlier. So the time frame fits. Also, the majority of women who have given birth to children with microcephaly have described the symptoms of Zika at the beginning of their pregnancies, such as skin rashes and fever,” Maierovitch said.
Antibodies to the virus had also been found in infants born with microcephaly.
“The main thing now is to combat the mosquitoes,” Maierovitch said.
“This is being done with a huge national mobilization, including state companies, government ministries, city mayors and the army. Basically, the risk is anything that collects still water in the open, be it rain water, drinking water or something else,” he said.
“These receptacles need to be removed or covered. Water tanks need to be protected with lids or nets so that mosquitoes can’t lay eggs. If that is not possible, then larvicide should be applied to prevent them from attracting mosquitoes. This could apply to uncovered cisterns, pools, fountains in public parks and buildings that hold water without proper drainage. Even drinking water can be treated with larvicide,” Maierovitch said.
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