Global Independent Analytics
Natalia Rezende
Natalia Rezende

Location: Brazil

Specialization: Politics, International relations

Zika Virus in Brazil: One Virus, Many Theories

The Zika virus is prompting worldwide concern because of its rapid spread across the globe.

The Zika virus is transmitted through an infected Aedes aegypti mosquito, the same insect that transmits dengue and yellow fever. Aedes aegypti mosquitoes are currently present in much of the Americas, Africa and in some Asian countries. According to WHO, people with the Zika virus usually have symptoms that can include mild fever, skin rashes, conjunctivitis, muscle and joint pain, malaise or headaches. Currently the virus has been linked to babies born with underdeveloped brains. The virus does not appear for 10 days and 70% of those infected do not need to be hospitalized.

The Zika virus is prompting worldwide concern because of its rapid spread across the globe. The virus has been detected in 23 countries in the Americas alone (with Cuba being a notable exception), and the mosquito is found in 41 countries in world. The first case of the Zika virus case in Europe had been confirmed: the tourist had recently returned from Colombia, she is one of seven cases confirmed in Europe. In the US, a mother who had a baby with microcephaly (a neurodevelopmental disorder),had recently returned from Brazil, where it is believed she was infected. The US has registered up to now 52 cases of Zika, all acquired abroad in Latin American countries, mainly in Brazil. South African authorities confirmed the first case of Zika virus in the country. India has already started testing for the virus because the country has had Zika before, but until now only one case was reported. Even Chile, the country where according to WHO people have no probability of being infected via Aedes aegypti mosquitoes, reported that a man recently arrived from Colombia has been diagnosed with the Zika virus.

According to WHO, there is growing evidence to Zika’s link to microcephaly. However, this direct connection has not been confirmed yet and the risks at different stages of pregnancy are still unknown. Brazil is investigating this potential link between the Zika infection and microcephaly, and is looking into more than 4,300 suspected cases of births with underdeveloped brains. Researchers have identified evidence of Zika infection in 41 of these cases so far, but have not proven that the virus can cause microcephaly. Brazil says the number of babies born with suspected microcephaly or abnormally small heads since October has now reached nearly 4,000. Just 150 babies were born with microcephaly in 2014. There appears to be a rise therefore in babies born with microcephaly but the link between microcephaly and Zika is still not proven.

There is no scientific documentation of Zika-related birth defects in Africa, which is strange since that is where the virus originated. In Colombia – the second country with the highest number of Zika cases- where more than 5,000 pregnant women are infected with the Zika virus, the government has not reported any case of microcephaly.

So, the Zika virus that is linked to babies being born with underdeveloped brains occurs only in Brazil? Many scientific theories emerged since the first few cases were detected in Brazil and several scientists say that there is no connection between the Zika virus and microcephaly cases.  

 

Arguments and theories about Microcephaly cases in Brazil that must be considered
 

The crisis with an abundance of cases of microcephaly first appeared in the Brazilian state of Pernambuco, with a maximum peak of cases in November 2015. But it was not due to Zika nor was it an epidemic. The Brazilian Ministry of Health, SUS, and associated institutes, are looking into what caused the microcephaly cases and at what continues to cause the current crisis of microcephaly throughout Brazil. The maximum peak in the number of cases in Pernambuco would correspond to the first quarter of gestation, between January and April 2015, that resulted in births of babies with microcephalus. This was due to the vaccination of women in the fertile period against measles with the triple vaccine, which contains the live rubella virus.[1]

The alarming number of cases, which began to appear between August and October 2015, caused the Ministry of Health to investigate the issue and it created a compulsory reserve where notifications of microcephaly throughout the country are collected. The obligation to notify the authorities, demanded by the Ministry of Health, increased the peak and extended the graphical curve around its maximum of cases of microcephalus. In November 2014, the Health Ministry included vaccinations against diphtheria, tetanus and pertussis in the pre-natal protocol demanded of pregnant women in their last trimester of pregnancy - from the sixth month of pregnancy.

The maximum peak in Dengue cases in the state of Pernambuco is between the end of March and April 2015 and this would mean that we have the same mosquito causing both and that the virus affects the fetus in the first three months of pregnancy. If it does, then we would see a maximum peak in the graph of microcephaly between the end of December and the beginning of January 2016. But that is not what happened. We saw a peak in microcephaly in November 2015. That alone would rule out Zika as the main cause of microcephaly.

Another considerable hypothesis argues the opposite: the Zika virus is caused by microcephaly in newborns in the northeast of Brazil.  It seems to be a strong case made by the Ministry of Health. According to researchers, it is possible that the virus underwent mutations in the country, after it first appeared in 2014. This would explain why other locations that have suffered from Zika epidemics in the past, such as the French Polynesia, have no recorded cases of microcephaly.[2] But what would cause microcephaly?

One year before the Zika virus came to Brazil, French Polynesia in the Pacific Ocean faced an epidemic of the virus, but there were not recorded cases of microcephaly. It appears that in Polynesia, where there was an outbreak of a lower proportion, the researchers have not related Zika to microcephaly.

Naturally, the many cases of microcephaly put the whole world in alert. But some Brazilian scientists suspect that, at least in part, this increase in the number of cases has to do with problems in the way official statistics are gathered.

The microcephaly records in Brazil show no more than 150 per year before the Zika epidemic began in 2015. But studies show that there were more cases of microcephaly than those released by the Ministry of Health; two research groups have estimated that before the Zika epidemic, Brazil had at least six thousand babies with microcephaly per year. This would mean that this is not a new phenomenon, it was only discovered recently.  Between 2010 to 2014, the Ministry of Health registered between 139 to 175 cases of microcephaly each year. The notification only became compulsory in October of last year, before an increase in births of babies born with the small head, of up to 32 cm of circumference, was seen Pernambuco and Rio Grande do Norte. In Paraíba, one of the studies analyzed databases of newborns before the epidemic and found a gap between the number of cases of microcephaly recorded. As said earlier, before 2015, the notification of microcephaly cases was not mandatory, and scientists suspect that many cases weren’t announced and that’s why the number of babies with microcephly was smaller than now - so they believe that the number of cases varied little.

More than 5,000 suspected cases of microcephaly were recorded from October until now. 1,200 have been analyzed. Of these, 765 are babies with a head smaller than normal, but they did not have brain damage, i.e, there is nothing to indicate at this point that they are not healthy. In 462 cases of microcephaly brain damage was confirmed - in only 41 of them it was possible to make the link with the virus Zika - the mother had the virus. Nearly four thousand cases are still under review.

The United States registered up to now 52 cases of Zika. All contracted abroad in Latin American countries, such as Brazil and Venezuela. A scientist from neurological Research Institute of Children of Seattle is receiving exams of Brazilian children with microcephaly and says that the global alert against Zika is real.

In Brazil, the Health Ministry says it is acting, while the researches are advancing. "What we can do is being done. Prevention is seeking to avoid the proliferation of the mosquito and prevent the contact of the mosquito with pregnant women. This is not the time of reassuring messages, it is a moment of national emergency", said Cláudio Maierovitch, director of Communicable Diseases Center of Health Ministry.

The resurgence of the abortion debate

The concern of the health community is the fact that Zika virus is spreading in regions where abortions are often illegal and the sexual education programs are practically non-existent. Around 24 million women do not have access to modern birth control methods.

Health experts also fear that doubts over the risks of Zika, together with the lack of options women have when deciding about their pregnancies, could lead to a rise in the number of clandestine abortions. According to a study conducted by the Guttmacher Institute, which researches sexual issues, an estimated 56% of pregnancies in the region are not planned. The lack of a safe abortion option is a problem particularly in regions where rape is common.

At the moment, Ecuador, Colombia, Dominican Republic, El Salvador, Honduras, Jamaica, Panama and the US territory of Puerto Rico have all asked women to try to avoid getting pregnant for up to almost two years in some extreme cases.

Health authorities in these countries have still not introduced specific pregnancy prevention programs as recommended by the Pan American Health Organization (PAHO). Not only are there no contraceptives available and no access to abortion, but there is also a lack of information and knowledge on prenatal signs. Organizations of women and reproductive rights movements called on the Brazilian government to relax abortion laws.

Mexico, Belize and Panama allow abortions if the fetus is malformed; in Brazil, women are permitted to undergo the procedure if anencephaly – the absence of major portions of the brain and skull during development – is detected. In other countries, such as Argentina, abortions are allowed if a doctor decides that the pregnancy poses a health or psychological risk to the mother. Abortion is legal in Puerto Rico, which is subject to US federal law.

Experience has taught us that despite the legal restrictions, when there is an unwanted pregnancy, especially among girls, and there are no other options, they end up finding unsafe ways to abort, which puts their health and lives at risk.

The World mobilization and the Brazilian Government’s response

The strategy of the Pan American Health Organization, and the Regional Office of WHO is to enhance technical cooperation between members states. The EU allocated €10 million to studies about the mutation of the Zika virus, and Brazil and US will start study the link between Zika virus and develop a vaccine against the virus.

In the last Saturday, at least 200,000 army, navy and air force troops were mobilized in Brazil to teach people how to eliminate and prevent the Aedes aegypti mosquito that spreads the Zika virus.[3] In addition, the Federal Government has been investing money in programs of study and sending agents to inspect risky places and advise people on how to combat of the mosquito. The President, the Vice President, and 25 Ministers are traveling through towns in Brazil with the campaign Zero Zika[4] to guide the kids to take care with and avoid standing water, because the mosquito's larvae develop in stagnant water, whether clean or dirty.“One mosquito can’t defeat 204 millions of people”, said the President Dilma Rousseff. As of now, the  many cases of microcephaly do not appear to be linked to Zika.

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