Following the Zika outbreak in Rajasthan last year, the US Centres for Disease Control and Prevention (CDC) hasissued a Level 2 travel Alert “Practice enhanced precautions” saying that “an outbreak of Zika has been reported in India. Zika is endemic (regularly found) in India. However, there is an unusual increase in the number of Zika cases in Rajasthan and surrounding states. Pregnant women should NOT travel to areas with risk of Zika saying that Zika is endemic in India”.
The Union Health Ministry has asked the CDC to “withdraw or modify” its Zika alert issued against travel to India because the outbreak was localized unlike the 2015-16 Zika virus epidemic in Brazil, which had been declared as a Public Health Emergency of International Concern by the World Health Organization (WHO) because of evidence that Zika can cause birth defects as well as neurological problems.
Reportedly, the government took strong exception to the use of the word “endemic” especially when Zika outbreaks in the country have been localized and contained within small areas, be it in Gujarat where three cases were reported last year, in Tamil Nadu or the more recent one in Rajasthan (Indian Express).
The ICMR-National Institute of Virology (NIV) sequenced 5 Zika virus strains collected at different time points of the outbreak in Jaipur and suggested that the Zika virus strains in the Rajasthan outbreak were less virulent than the Brazil strain and also did not have the mutations known to cause fetal microcephaly and high transmissibility of Zika virus in Aedes mosquitoes.
The WHO puts India in category 2 in the classification of Zika’s prevalence, which indicates an ongoing transmission of the virus.
While we have asked CDC to downplay the threat, we ourselves cannot let our guard down. While there is no cause for alarm, we all have to be on high alert - the public, the healthcare provides, the concerned authorities for possible future outbreaks.
This was the third outbreak of Zika virus in India in less than two years.
In January-February 2017, the first three cases of laboratory-confirmed Zika virus infection in India were detected in Ahmedabad, Gujarat. In July, in the same year, transmission of Zika virus was also confirmed from Krishnagiri District in Tamil Nadu.
Zika is now here to stay and we must anticipate and be prepared to prevent any more outbreaks, which may occur anytime in the near future and anywhere in the country. Otherwise, a contained outbreak such as the Rajasthan Zika outbreak may well turn into an epidemic.
Monitoring systems should be in place to pre-empt any future outbreaks. Disease surveillance should be continual and not episodic. It is also of utmost importance to increase public awareness about these diseases so that they can take due precautions.
Viruses also undergo evolution. The next Zika virus to cause an outbreak could be a more virulent form of the virus.
This should be of great concern to all, especially the public health authorities given India’s huge population, a climate that is favorable to vector-borne diseases and India being a major travel destination for tourists.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA