ZIKA VIRUS UPDATE ************************ 4 May 2016
Photo: Kuhn and Rossmann research groups,
Purdue University, USA, in Guardian
Update on clinical findings related to Zika
Scientists have worked out the structure of the Zika virus in a breakthrough that will aid the development of treatments to combat infection. As well as aiding the design of vaccines and therapeutic drugs, scientists hope that the discovery will help develop better diagnostic tests for the virus, and throw light on the way the virus infects cells. Science DOI: 10.1126/science.aaf5316; Guardian 31 March 2016
The World Health Organization announced on 7 April 2016 that Zika does cause microcephaly (based on 1,000 cases in six countries) and Guillain-Barré syndrome (based on 400 cases). CNN Antenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes; a causal relationship has been shown to exist, most notably with microcephaly and other serious brain anomalies. Several causal links were identified, including Zika virus in the brain tissue of affected fetuses and infants. Efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection are limited because many questions critical to prevention efforts remain. What is still uncertain is the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman’s risk of adverse pregnancy or birth outcomes. New England Journal of Medicine, 13 April 2016
CDC reports that transmission of Zika infection can occur through three routes:
(1) A pregnant woman can pass Zika virus to her fetus during pregnancy. A pregnant woman already infected with Zika virus near the time of delivery can pass on the virus to her newborn around the time of birth. To date, there are no reports of infants getting Zika virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.
(2) Zika virus can be spread through sexual contact by a man to his sex partners. In known cases of sexual transmission, the men developed Zika virus symptoms. These cases showed the virus can be spread when the man has symptoms, before symptoms start and after symptoms resolve. The virus is present in semen longer than in blood.
(3) There have been multiple reports of blood transfusion transmission cases in Brazil. These reports are currently being investigated. During the French Polynesian outbreak, 2.8% of blood donors tested positive for Zika and in previous outbreaks, the virus has been found in blood donors.
US Centers for Disease Control and Prevention (CDC) are recommending the following to pregnant women: use mosquito repellent, cover up, avoid travel to Zika-stricken regions, and either abstain from sex or rely on condoms.Centers for Disease Control and Prevention, USA, 15 April 2016
In Paraíba, one of the nine Brazilian states within the epicentre of the epidemic, 21 medical centres collaborate via telemedicine in a paediatric cardiology network. To support research on microcephaly, from 1-31 December 2015 a Network task force measured the head circumference of the 16,208 neonates born between 2012 and 2015. A much higher than expected incidence of microcephaly was observed, varying from 2% to 8% depending on which of three classification criteria were used. These findings raised questions about the diagnosis of the condition and its notification… and also the possible role of poor nutrition. They conclude: "At this stage, follow-up studies in the children diagnosed with microcephaly are mandatory prior to concluding what problem we are actually facing." Bulletin of World Health OrganizationE-pub: 4 February 2016
A study of 23 babies born in Pernambuco, Brazil, in 2015, all but one of whom were born to women who had a rash symptomatic of Zika infection during pregnancy found that "the brain damage caused by Zika virus infection in these children was extremely severe, indicating a poor prognosis for neurological function. This scenario might be the worst one in the disease severity spectrum." All 23 babies had a CT scan that showed signs of brain calcification, malformations of cortical development, decreased brain volume, and abnormally enlarged brain cavities. The majority of babies had brain damage that was “extremely severe, indicating a poor prognosis for neurological function”. Underdevelopment of the cerebellum, which plays an important role in motor control, and the brainstem which connects the cerebrum with the spinal cord and communicates messages from the brain to the rest of the body, was also observed. This was an observational study so no definitive conclusions can be drawn. BMJ, 16 April 2016
Various headlines in February 2016 reported that the Pope seemed to be condoning contraception in cases of Zika. Here is how CNN reported it, quoting his actual words: At a press conference aboard a flight from Mexico to Rome, the Pope was asked whether the church should consider contraception the "lesser of two evils" compared with the possibility of women aborting fetuses infected with Zika. The Pope first answered by calling abortion an "absolute evil" and a "crime." "It is to kill someone in order to save another. This is what the Mafia does," Francis said. "On the other hand, avoiding pregnancy is not an absolute evil." The Pope then pointed to a narrow historical exception to the church's ban on most forms of birth control: a predecessor, Pope Paul VI, allowed African nuns to use contraceptives "in cases of rape," Francis said. "In certain cases ... such as the one I mentioned of Blessed Paul VI, it was clear," the Pope said. The Guardian reporting him saying that abortion was an "illegitimate response" to the Zika virus and argued that terminating pregnancies would confirm international community’s failure to contain disease. “Not only is increased access to abortion and abortifacients an illegitimate response to this crisis, but since it terminates the life of a child it is fundamentally not preventative." CNN, 18 February 2016; Guardian, 18 February 2016
The Zika virus has undergone significant genetic changes in the past few decades. Researchers who performed a detailed genetic analysis on the Zika virus have found some clues to help explain how the virus evolved from causing a relatively benign illness to becoming a worldwide threat, according to a study published online April 15, 2016 in the journal Cell Host & Microbe. Investigators have speculated that Zika virus may have evolved only in recent years to become more neurotropic, better at replicating, and more transmissible to humans. The latest epidemic has linked the virus to fetal brain-development disorders and new modes of transmission, including infection through sexual contact and from mother to fetus. The researchers compared individual genetic differences among 41 strains of Zika virus. In sequencing the virus, the team identified substantial DNA changes between the strains, showing a major split between the Asian and African lineages, as well as the human and mosquito versions. Interestingly, the researchers found that the human strains share a genetic sequence more similar to the 1966 Malaysian strain than the 1968 Nigerian strain, which suggests that the Zika virus strains in the recent human outbreak are evolved from the Asian lineage. The researchers also found a key viral protein that varied the most between the Asian human strain and the African mosquito strain. This indicates that the virus likely underwent a structural change at some point. “We suspect these mutations could help the virus replicate more efficiently, evade the body’s immune response or invade new tissues that provide a safe harbour for it to spread.” The researchers’ next step will be to analyse the viral strains causing the current epidemic and look for genetic targets for drug and vaccine development. MDLinx, 19 April 2016
Tags: Zika virus, research, clinical findings
Dr Adriana Melo with a patient, in Zika: the film Zika, the Film 30-minute film
by Vozes da Igualdade, March 2016, in Portuguese with English subtitles
The film follows a number of women who were infected with Zika at different times during their pregnancies. It was filmed in the maternity clinic of Dr Adriana Melo, Faculty of Medical Sciences, Campina Grande Paraíba. Dr Melo diagnosed the first case of Zika-related syndrome in Paraíba in 2014. The film opens with her doing an ultrasound scan for a woman in late pregnancy who has a diagnosis of uncertain severity, and they talk about taking one step at a time, and the fact that the woman is helping with research and finding answers in the hopes other women do not have to go through this situation in the future. Dr Melo then does a scan for another woman whose diagnosis is very severe microcephaly, whose baby would not survive, and whose life is at risk due to serious fluid retention. She is going to have a late abortion. The film then moves on to interview a number of women, all young, some still adolescents, with babies with Zika-related syndrome, who talk about their pregnancies, how they coped with the news, and their feelings and those of their husbands about their decision to continue the pregnancy since the birth of their babies. A heart-stopping film.
WEI President Ortoleva at CSW Zika, microcephaly, women’s rights, and disability rights
by Stephanie Ortoleva, Founder and President, WomenEnabled International
The news is filled with discussions regarding the Zika virus, microcephaly, access to abortion, and women’s sexual and reproductive rights – sometimes from a medical perspective, sometimes from a community health perspective, sometimes from a women’s rights perspective, and occasionally from a disability rights perspective… Women Enabled International (WEI) sets out a more nuanced perspective to frame a discussion that reflects the inherent rights and dignity of all affected by the Zika virus, based on an intersectional disability and women’s human rights perspective.
The impact of microcephaly on a child’s physical and mental development can vary considerably. In more severe cases, microcephaly can lead to significant learning and memory difficulties, as well as physical complications, such as seizures. However, some children with microcephaly have average intelligence and no physical symptoms beyond a smaller than average head.
Recent studies suggest that, in addition to microcephaly, the Zika virus may also increase risk of miscarriage and stillbirth, as well as other possible pregnancy-related complications such as poorly developed placentas, low or no amniotic fluid, and severe growth restriction.
Women must not be expected to have the sole responsibility for caring for children born with microcephaly; states must ensure that families of children with microcephaly have the support, training, and services necessary for raising a child with a disability. Services and facilities in communities affected by the Zika virus must also be responsive to the needs of pregnant women exposed to Zika and their families. It is essential that communities respond and adapt to meet a growing number of families who may require assistance and support services based in their communities to minimize the risk of isolation, segregation, and stigma for women who give birth to children with microcephaly.
Women affected by Zika should not be pressured or coerced to abort, nor should they be restricted from obtaining an abortion. The dignity and humanity of children with disabilities, including children with microcephaly, must be respected, and they must get the care they need. Reports indicate that babies with microcephaly are at risk of abandonment by their parents, especially after the first year or two of life; this suggests that rates of abandoned children may rise rapidly over the next few years. It is essential that States allocate sufficient resources to training and support programs to empower families of children with microcephaly to care for their children in their home to minimize the risk of abandonment. States must also allocate sufficient resources and support to public and private institutions to ensure appropriate care to a growing number of children who may require State assistance.
Sexuality Policy Watch 8 April 2016
…The Brazilian state’s response to the Zika crisis has been decidedly skewed. On the one hand, it has been quite rapid, efficient and well funded with regard to biomedical and epidemiological research. Since late 2015, roughly 35 million dollars have been channelled to domestic research groups working in partnership with international institutions. One main outcome of these investments is that Fiocruz, the main Brazilian public health foundation, has announced that a rapid test for Zika may be available as early as June. Furthermore research findings have been pouring in since January and, in partnership with PAHO/WHO, an epidemiological situation room has been established that provides weekly updates on Dengue, Zika and Chicungunya, including information regarding “microcephaly” (in Portuguese).
…However, when we look at the public health response at the ground level, where women are coping with the reproductive effects of Zika and also the symptoms and side effects of Dengue and Chikungunya, the situation becomes dire. Press reports keep pouring in from all over the country, including the most dramatically affected areas, relating the difficulties women face in accessing health care, both for themselves and their babies. In early March, UN Women, in partnership with PAHO and UNFPA, convened a meeting of women’s organizations, particularly those based in the regions where the epidemics are more severe. The reports brought to the meeting dramatically demonstrated that while women are at the centre of the epidemics in day-to-day life, their voices and experiences are not being taken seriously by the state response in the realm of health care.
If this poor response is obvious in the more conventional areas of maternal and child health care, the failures with regards to sexual and reproductive health are even more drastic. No additional effort has been made, for example, to expand access to contraceptives in the most affected areas. These problems have their origin in the gradual abandonment of the SRHR agenda in recent years, but they also reflect the impact of thepolitical crisis on the executive branch’s implementation capacity. In response to these failures, a Women’s Situation Room has been established to assess the Zika crisis, which will meet periodically, with the support of the above mentioned UN agencies.
In this somber scenario, one positive policy development must be mentioned: the Ministry of Social Development has issued an ordinance granting access to a social security benefit known as the BCP (with the value of the monthly minimum wage: US$ 300) for all mothers of babies affected by Zika-related congenital syndrome. Although the amount is not enough to ensure the quality of life of these women and their children, the measure is to be praised. It should also be noted that this was adopted in direct response to the claims made by Anis when it proposed an appeal to the Brazilian Supreme Court in relation to the Zika crisis and its effects on women’s lives, health and reproductive rights.
The Anis proposal is moving forward in partnership with the National Association of Public Defenders (ANADEP). At this stage, according to Débora Diniz:
"The appeal is at an intermediate stage of finalization. National and international opinions of experts from various fields of knowledge – medicine, psychology, history of medicine, basic science – are being collected in order to be attached to the briefing that will accompany the appeal to the Supreme Court."
It should be noted that an enormous amount of responsibility will be placed on the Supreme Court as the final guarantor of constitutional premises in the complex processing of the current political crisis (in Portuguese). This means that the Anis and ANEDEP legal challenge will face many obstacles. Nevertheless, it is a major step forward.
Tags: Brazil, Zika virus, priority on research, monthly benefit for affected woman and babies
Speaking at a human rights seminar in Port-of-Spain, the head of the Equal Opportunities Commission (EOC) Lynette Seebaran-Suite said it is legal to have an abortion in Trinidad & Tobago if the woman has the Zika virus, as this is a therapeutic indication. She continued: “There is a clearance there for the doctors. Even if it is that the legislature does not want to act the Minister of Health can issue protocols. The problem is that the doctors do not want to have to face prosecution of doing the procedure and having the police charge them.” Minister of Health Deyalsingh at a press conference two weeks ago said he was “ending the discussion of abortion” but, after Prime Minister Dr Keith Rowley said the matter remained open for discussion, said that he was “misquoted” and he cannot stop a national discussion.
Also at the seminar, Chief Justice Ivor Archie said: “It disturbs me greatly when I hear a Government Minister attempt to shut down a conversation. You can’t tell people what to talk about. Whether you like it or not it is an issue. And the fact that it makes you uncomfortable... suggests that it is something that we need to have a conversation about.”
Seebaran-Suite, an attorney, said sexual and reproductive health and rights means a woman has the right to decide the number and spacing of children, have information and services around facility, right to contraception and right to access abortion. She stressed it is a human rights issue and related to gender because it is a procedure only women need and it is prohibited.
Chairman of the Coalition Against Domestic Violence Diana Mahabir-Wyatt said issues such as rights to abortion and assisted suicide are determined by politician’s fear of religious bodies “all of which are dominated by men”. “None of which have wombs,” she added.