Zika virus: WHO declares global public health emergency, says causal link to brain defects ‘strongly suspected’
The World Health Organization designated the Zika virus and its
suspected complications in newborns as a public health emergency of
international concern Monday. The action, which the international body
has taken only three times before, paves the way for the mobilization of
more funding and manpower to fight the mosquito-born pathogen spreading
"explosively" through the Americas.
Zika, first identified more
than 50 years ago, has alarmed public health officials in recent months
because of its possible association with thousands of suspected cases of
brain damage in babies. The WHO has estimated that the virus will
reach most of the hemisphere and infect up to 4 million people by year's
end.
[What is Zika? And what are the risks as it spreads?]
WHO
Director-General Margaret Chan said at a media briefing Monday that the
primary reason for the designation was the "strongly suspected" causal
relationship between Zika and the rare congenital condition called
microcephaly. Even before that association is scientifically confirmed
or disproved, members of an 18-member advisory panel said the
seriousness of the cases being reported required action. Chan concurred,
saying the consequences of waiting were too great.
“Even the
clusters of microcephaly alone are enough to declare a public health
emergency because of its heavy burden" on women, families and the
community, Chan said.
In addition, she noted, there is significant concern given the lack
of vaccines and rapid, reliable diagnostic tests, as well as the absence
of any viral immunity in the population since the Americas are being
affected for the first time. A potential link to Zika is also suspected
in adults who have been diagnosed with Guillain-Barré syndrome, a rare
condition that can cause paralysis.
According to the latest
figures on the epicenter of the outbreak, Brazil has 4,000 suspected
cases of microcephaly, with 270 confirmed with evidence of an infection.
[Zika virus and microcephaly: Is a mosquito bite actually responsible for the brain defect?]
The
WHO declaration represents its highest level of alert and is
only invoked in response to the most dire threats. The first time was in
2009 during the H1N1 influenza epidemic that is believed to have
infected up to 200 million worldwide; the second in May 2014 when a
paralyzing form of polio re-emerged in Pakistan and Syria; and the
third in August 2014 with Ebola in West Africa.
Identifying a global public health emergency now allows the WHO to
help coordinate surveillance efforts, such as recording and monitoring
cases of Zika, microcephaly and other neurological complications.
Officials said countries need to standardize their surveillance for
microcephaly, in which an abnormally small head signals incomplete brain
development.
Zika’s emergence as a major concern has taken
infectious disease experts by surprise. The virus has been popping up in
various parts of the world for decades, but individuals have typically
only suffered mild symptoms such as a rash or body aches. Nearly all
those infected in the past recovered fully, though there were rare cases
of complications.
In recent months, however, as reports about
brain-damaged newborns began increasing, health officials have worried
about Zika's impact on fetal development and have focused on trying to
protect pregnant women from the virus. In January, the U.S. Centers for
Disease Control and Prevention issued a travel advisory urging pregnant
women to avoid travel to areas where the virus is actively spreading.
That advisory has been expanded repeatedly and now lists more than two
dozen countries and territories in Central America, South America and
the Caribbean.
[Graphic: What you need to know about the Zika virus]
The WHO
said Monday there is no reason for travel or trade restrictions at this
time. Instead, health officials there reiterated their advice
to pregnant women to wear appropriate clothing, use insect repellent and
take other practical measures, such as sleeping under a bed net to
avoid being bitten.
Anthony Fauci, director of the National
Institute of Allergy and Infectious Diseases, said the WHO’s declaration
is the "official global sounding bell that governments and others need
to start really paying attention to this."
Infectious disease
experts and others have pressured the WHO to escalate its response to
Zika for several months, warning of the mistakes world leaders made
during the Ebola crisis when a lack of coordination delayed quarantines
and treatment. Chan seemed to reflect their calls when she asked
rhetorically during Monday's media briefing, "Can you imagine if we do
not do all these works now and wait until the science comes out, then
people will say, 'Why don't you take action?'"
Bruce Aylward, the WHO's director of outbreaks and health
emergencies, said that the evidence pointing to both a “temporal and
geographic association” between Zika and microcephaly was strong.
"This is definitely the right measure to be taking at this time based on the information available," he said.
Some public health experts said the WHO did not go far enough.
Lawrence
Gostin, a public health and law expert at Georgetown University, said
it was a mistake that WHO did not issue a travel alert for pregnant
women visiting Zika-affected countries. The organization's failure to do
so puts it at odds with the CDC's travel warning to pregnant women.
The
countries affected typically have younger populations, which means more
women of childbearing age who will be worrying about the virus and its
potential harm. Some of these countries have had among the world’s
higher birth rates recently.
From 2011-2015, according to data from the World Bank, Guatemala had
27 births per 1,000 people; Haiti, 25; and Bolivia, 24. The rate in
Brazil – South America’s most populous country by far – was 15 births
per 1,000 people during that same period.
Gostin said parents
concerned for the welfare of their daughters should advise them to avoid
going to affected areas if they are pregnant. "If this wave of Zika
infections is followed by a wave of birth defects in nine months, it
would be unconscionable," he said in a statement.
Some countries
are asking women to indefinitely delay pregnancy. But most Latin
American countries also restrict access to contraception and abortion,
and that puts a heavy and unfair burden on young and often poor women,
he said.
Peter Hotez, dean of the National School of Tropical
Medicine at Baylor College of Medicine in Texas, sees most countries in
the Americas as ill-equipped to preemptively fight the disease. It
already has moved rapidly from South America north into Mexico.
“What
do you do that’s meaningful to prevent microcephaly?” Hotez
asked. “It’s going to go beyond the current health budget of these
countries. You’re going to have to get the buy-in of the presidents of
these nations.”
Zika may even be harder to defeat than Ebola,
according to Hotez. While that virus was more deadly and could spread
from human to human, it was easier to contain by isolating infected
patients and ensuring safe burials. Ebola affected roughly 30,000 people
in four West African countries. Zika could affect millions of people
throughout the entire Western Hemisphere.
“This is more challenging and more complicated because of the vector and what you’re up against,” Hotez noted.
In
an interview with the Reuters news agency, Brazilian Heath Minister
Marcelo Castro said the outbreak is his country is worse than previously
believed because an estimated 80 percent of people who become infected
with the virus do not exhibit known symptoms.
Castro also said every municipality in Brazil will be required to
report all Zika cases to a central database starting next week. In
further controls, Brazil will join other nations in banning blood
donations from people who had the virus.
Castro warned last week
that Brazil was “badly losing” the battle against the mosquito blamed
for spreading Zika and said that more than 220,000 members of Brazil’s
military would be mobilized in eradication efforts. The plans included
distributing mosquito repellent to about 400,000 pregnant women,
according to Brazil’s O Globo newspaper.