THE World Health Organization (WHO) confirmed the first three cases of Zika virus in India, as having been reported from Ahmedabad, which includes a pregnant lady tested this January. All the cases are from the Bapunagar area of the city.
Confirming it as positive the website says that the ”Ministry of Health and Family Welfare-Government of India (MoHFW) reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area, Ahmedabad District, Gujarat, State, India”.
It said, “The routine laboratory surveillance detected a laboratory-confirmed case of Zika virus disease through RT-PCR test at B.J. Medical College, Ahmedabad, and Gujarat. The etiology of this case has been further confirmed through a positive RT-PCR test and sequencing at the national reference laboratory, National Institute of Virology (NIV), Pune on 4 January 2017.
Dr Vijay Kohli, entomologist, Ahmedabad Municipal Corporation, when contacted, said, “ I also read the report a few hours ago and am not equipped with information at the moment. All I can say is that we have to make sure that the surveillance is better and we work towards eradicating the mosquitoes. Ahmedabad has always been the first to report outbreaks .So either we have a lot of illnesses or we are reporting better than other states.”
Ironically the Gujarat government launched its free Gujarat from Malaria by 2022 campaign in Ahmedabad on 24th May, and has made notifiable only cases of dengue, malaria and chikun gunya, not all fever cases.
“We need to be vigilant now. The virus that causes Zika and Dengue are the same. So it will be easy for Zika to spread. We are at a risk .We have to have a surveillance system in place. The government has been keen on the malaria campaign when it should have targeted all non-communicable diseases. Because of a single campaign other serious diseases are ignored,” said Dr Deepak B Saxena Additional Professor, Indian Institute of Public Health (IIPH) Gandhinagar.
“For antenetal mothers this is dangerous. Zika virus causes microcephaly which is a lifelong morbidity,” added Dr Saxena. Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly.
The WHO website also stated that, “An Inter-Ministerial Task Force has been set up under the Chairmanship of Secretary (Health and Family Welfare) together with Secretary (Bio-Technology), and Secretary (Department of Health Research). The Joint Monitoring Group, a technical group tasked to monitor emerging and re-emerging diseases is regularly reviewing the global situation on Zika virus disease.”
“ The Indian Council of Medical Research (ICMR) had tested 34 233 human samples and 12 647 mosquito samples for the presence of Zika virus. Among those, close to 500 mosquitos samples were collected from Bapunagar area, Ahmedabad District, in Gujarat, and were found negative for Zika ,” read the WHO notification on its website. The website also mentions the involvement of The Rashtriya Bal Swasthya Karyakram (RBSK) and states that the RBSK is monitoring cases of microcephaly from 55 sentinel sites in Ahmedabad. As of now, no increase in number of cases or clustering of microcephaly has been reported from these centers.
Health minister Shankar Chaudhary and commissioner of health J.P.Gupta did not respond to calls and messages asking comment on the situation.
Box: Details of the Zika positive cases
· Case 1: During the Acute Febrile Illness (AFI) surveillance between 10 to 16 February 2016, a total of 93 blood samples were collected at BJ Medical College (BJMC), Ahmedabad, Gujarat State. One sample from a 64-year-old male presenting with febrile illness of 8 days’ duration (negative for dengue infection) was found to be positive for Zika virus at BJMC, Ahmedabad. This is the first Zika positive case reported through AFI surveillance at BJMC, Ahmedabad, Gujarat State.
· Case 2: A 34-year-old female, delivered a clinically well baby at BJMC in Ahmedabad on 9 November 2016. During her hospital stay, she developed a low grade fever after delivery. No history of fever during pregnancy and no history of travel for the past three months was reported. A sample from the patient was referred to the Viral Research & Diagnostic Laboratory (VRDL) at the BJMC for dengue testing and thereafter found to be positive for Zika virus. She was discharged after one week (on 16 November 2016). The sample was re-confirmed as Zika virus positive by RT-PCR and sequencing at NIV, Pune.
· Case 3: During the Antenatal clinic (ANC) surveillance between 6 and 12 January 2017, a total of 111 blood samples were collected at BJMC. One sample from a 22-year-old pregnant female in her 37th week of pregnancy has been tested positive for Zika virus disease.
Box 2: WHO ZIKA risk assessment
This report is important as it describes the first cases of Zika virus infections and provides evidence on the circulation of the virus in India. These findings suggest low level transmission of Zika virus and new cases may occur in the future. Efforts to strengthen surveillance should be maintained in order to better characterize the intensity of the viral circulation and geographical spread, and monitor Zika virus related complications. Zika virus is known to be circulating in South East Asia Region and these findings do not change the global risk assessmentThe risk of further spread of Zika virus to areas where the competent vectors, the Aedes mosquitoes, are present is significant given the wide geographical distribution of these mosquitoes in various regions of the world. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.
Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.
Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering.
WHO does not recommend any travel or trade restriction to India based on the current information available.