Introduction
The Zika virus causes an illness known as Zika virus disease (Zika). The transmission of Zika virus occurs via the bite of an Aedes mosquito that is infected (CDC, 2016). Zika belongs to the genre Flavivirus and the WHO (2015) has identified it as “an emerging mosquito-borne virus.” The virus causes a mild illness that lasts a few days to a week (CDC, 2016; WHO, 2016). Thus, many people with the disease do not seek medical help. However, the greatest concern associated with Zika is microcephaly. This birth defect results from a Zika infection during pregnancy. This defect is because of slow fetal brain development that leads to death or poor intellectual development in affected babies.
Scientists came across Zika virus for the first time in Uganda in the year 1947 (CDC, 2016; WHO, 2016). They named the virus after the forest in which they discovered it; the Zika forest. Since the first documented interaction between man and Zika in 1952, outbreaks have occurred in tropical Africa, the Americas, Pacific Islands, and Southeast Asia (WHO, 2016; CDC, 2016). The Pan African Health Organization (PAHO) confirmed the first infection in Brazil in 2015. In the second month of 2016, the WHO announced the virus as “a Public Health Emergency of International Concern (PHEIC) (CDC, 2016; BBC, 2016).
Public Health Issue Analysis
History
Since its discovery in 1947, the Zika virus has spread geographically and has caused illnesses and outbreaks in different countries over the years (WHO, 2016). In 1952, researchers reported the first human case of the virus in Uganda. A second scenario was seen in Nigeria in 1954 (BBC, 2016; Kindhauser et al., 2016). In the period ranging between 1960 and 1980, researchers detected the virus in mosquitoes and rhesus monkeys in equatorial Africa. They used serological methods to detect sporadic human illness. There is no record of mortalities or hospitalization due to Zika at this time. However, seroprevalence studies showed that there was a widespread exposure of human beings to the virus (Kindhauser et al., 2016).In this timeline, the virus spread geographically from Uganda to Central and West African countries such as Central African Republic, Gabon, Cameroon, Nigeria, Senegal, Cote d’Ivoire, Sierra Leone, and Burkina Faso.
Scientists noted the expansion of Zika virus distribution from Africa to Asian states between the year 1969 and 1983 (Kindhauser et al., 2016). The virus was detected in vectors in tropical Asia in countries such as Pakistan, India, Malaysia, and Indonesia. Similar to the African situation sporadic human infections and widespread exposure to the human population were recorded (Kindhauser et al., 2016). According to Kindhauser et al. (2016), the late detection and rare reports of Zika cases are due to the similarity between the illness with dengue fever and chikungunya infections.
In 2007, health professionals reported the first outbreak of Zika fever in Yap, a Pacific island. Previously, no Zika outbreaks had been seen, and only fourteen incidences of human illnesses were recorded globally (Kindhauser et al., 2016). During this event, 49 of 185 island residents suspected of having Zika infection got a confirmed diagnosis (Kindhauser et al., 2016). Researchers reported a prevalence rate of the Zika infection in the island as approximately 73% (Kindhauser et al., 2016). Since there was no evidence of genetic mutation that explained the transformation of the epidemiological behavior of the microorganism as seen on the island, scientists came up with several suggestions. These explanations include low population immunity, under-reported fever cases, and the frequent co-infection of Zika, chikungunya, and dengue viruses (Kindhauser et al., 2016).
The first documentation of a sexually transmitted case of Zika was made in 2007 in Colorado, USA. In 2012, scientists published the genetic characterization of different virus strains. Consequently, two lineages were classified on a geographical basis; the African and Asian descent (Kindhauser et al., 2016).
After the Yap Island outbreak, other outbreaks were documented in other islands in the Pacific region such as Cook, French Polynesia, Easter, and New Caledoni. Investigations into the French Polynesia outbreak resulted in a hypothesis that linked Zika to congenital defects, autoimmune, and neurological disorders. The rise in the occurrence of the Guillain-Barre syndrome in 2013 was especially significant in the above conclusion (Kindhauser et al., 2016). Although the connection between the two conditions is only suggestive, it challenges the idea that Zika virus leads to only mild sickness. Further investigations into the Pacific Region outbreaks confirmed the several possible routes of human-human transmission including sexual, transplacental, and transfusion transmission (Kindhauser et al., 2016; WHO, 2016).
Zika fever cases started to appear in Brazil in 2015 (Gallagher, 2016; Kindhauser et al., 2016). PAHO in conjunction with the WHO and the CDC investigated numerous suspected cases in the country. The consequent findings indicated a strong correlation between Zika and neurological disorders such as microcephaly. In Brazil, there have been approximately 3, 670 and 404 suspected and confirmed cases of microcephaly respectively (Gallagher, 2016). Other states that reported Zika infections in 2015 include Colombia, Cabo Verde, Suriname, Panama, El Salvador, Mexico, Venezuela, Paraguay, Guatemala, Honduras, and Puerto Rico (Kindhauser, 2016). Several countries have reported occurrences of imported Zika virus cases. Such nations include the USA, France, and Finland (Kindhauser et al., 2016).
The clinical characteristics and the geographical distribution of Zika virus have evolved over time. Initially, the infections were mosquito-borne and endemic with a geographical distribution limited to Africa and Asia. As the infection spread to the Pacific and Americas, mild sickness turned into outbreaks with co-relation to neurological disorders.
Population, Social and Behavioral Factors
Pregnant women with a Zika infection can transfer the virus to their unborn child during the gestational period or at birth (CDC, 2016). The primary route of transmission for this population is a mosquito bite. However, an expectant mother can also obtain the virus from her sexual partner through sexual intercourse. Scientists have found enough evidence to connect Zika infections in pregnant women with microcephaly in infants. Fetuses and infants who come into contact with Zika virus before or during delivery are at risk of getting other health issues associated with the microorganism such as impaired development, eye defects, and hearing problems.
Pregnant mothers who live or are visiting geographical areas where local transmission is prevalent need to take precautions to avoid mosquito bites. It is also advisable to practice abstinence or safe sex during pregnancy if their partners live or have traveled to these regions (CDC, 2016; WHO, 2016).
Whenever a public health tragedy strikes, an interconnection of class and gender issues causes the poor and the marginalized to suffer unequally. Poverty and other forms of social marginalization increase the risk of exposure and consequent suffering to the victim. According to Basu (2016), the poor are at a higher risk of exposure to Zika virus. Economically marginalized neighborhoods are likely to have empty containers, potholes, and receptors that act as favorable sites for mosquito breeding (Basu, 2016). Moreover, water shortages in these areas push their residents to store water with large containers for long periods.
Women who are poor are likely to suffer the consequences of a Zika virus exposure more than their male and economically-empowered counterparts. These women are a higher risk of suffering economic and emotional pain associated with delivering a baby with a neurological disorder that will affect his or her cognitive development and function for the rest of his or her life (Basu, 2016). Furthermore, these women are likely to have little no access to reproductive health and other medical services that they need to raise their awareness of the disease and prevention measures.
Public Health Model
The social ecological model provides a practical framework that can produce positive results in the fight against Zika infection. This model enlightens health professionals as well as individuals on the factors that influence behavior. Thus, it is easier to formulate and develop strategies and programs aimed at solving public health issues by utilizing social environments. Preventive measures such as health education are critical in combating the spread of the Zika virus. The multiple levels of the social environment as seen in the social ecological model provide excellent avenues that health agencies can utilizes in their endeavor to raise awareness about the disease.
Health education needs to take place at the individual, interpersonal, organizational, community and the public policy level. Such an approach not only prompts people to acquire healthier behaviors but it also creates an enabling environment for people to maintain these behavioral changes through favorable health and public policies. For instance, in the US the CDC has increased the public awareness of the Zika virus by making use of the internet and other media platforms to disseminate information at all levels of the social environment. The CDC also works with state and federal governments to set up prevention strategies, policies, and travel advisories to American citizens (CDC, 2016).
Awareness at the public policy level allows governments and decision makers to come up with strategies that address the various social determinants of health, thus, promoting health, and wellness in the public. For instance, various governmental and NGOs have initiatives whereby they give free mosquito nets to residents in tropical regions with an aim of lowering transmissions via mosquito bites.
Public Health Agencies Responses
Health organizations such as the WHO and the CDC have responded to the Zika virus tragedy in a myriad of ways. The WHO has developed the “Zika Strategic Response Framework,” which it utilizes in assisting affected nations. The framework calls for the prioritization of research into the disease, heightened surveillance of Zika virus effects, provision of training on diagnosis, management and control of the infection, and the preparation of clinical management recommendation for caregivers (CDC, 2016). WHO Collaborating Centres also provide support to laboratories and health authority in virus detection and vector control (WHO, 2016).
The CDC responded to the problem by activating the Emergency Operations Center (EOC). The EOC monitors and coordinates responses to the Zika tragedy by converging a team of experts in virology, birth abnormalities, reproductive health, and epidemiology among other fields of expertise. These experts have been working together to develop diagnostic tests for Zika, monitor and study Zika cases, carry out disease surveillance in the US, and offer travel advice to Americans (CDC, 2016). CDC scientists have also been investigating the association between Zika and neurological disorders as well as the persistence of the microorganism in semen and urine in male subjects (CDC, 2016).
Program or Intervention Analysis
In the wake of the Zika crisis in the Americas, the WHO, PAHO, and other health agencies joined hands to develop and implement a risk communication and community involvement intervention in the affected nations. The initiative began with a situational analysis that involved the use of epidemiological and entomological data to evaluate the typology of the affected countries (PAHO, 2016). This was followed by the mobilization of local assets and communities through the Red Cross Red Crescent Societies, women groups, faith-based organization, and other local organizations. Capacity building forums were conducted to empower community organizations with the knowledge, tools, and skills for community mobilization.
Several international health organizations have collaborated to address to facilitate this intervention. The WHO, the International Federation of Red Cross and Red Crescent Societies, UNICEF, and CDC are working together in funding and enhancing community engagement and education (PAHO). These organizations carry out coordinated surveillance and research, and keep governments, healthcare givers, and the public updated on recommendations and progresses in managing and preventing Zika infections.
Public awareness and community mobilization initiatives have contributed significantly to the current state of vigilance that exists among residents in the affected nations. Communities are participating in vector control programs such as getting rid of mosquito breeding sites and distributing insecticides and mosquito nets. Risk communication has promoted knowledge and assisted in the adoption of preventive behavior in the high-risk and general population (PAHO, 2016).
The program has utilized principles of the social cognitive model and the social ecological model to prompt and maintain preventive behavior in the public. People are now more aware of the dangers that Zika virus poses on health. Thus, they can quickly learn and acquire skills and behaviors that protect them from infections. The use of mosquito nets, window screens, insecticides, and other preventive tools has increased in Brazil and other countries. The initiative also targets populations are at a high risk such as pregnant women and economically marginalized persons by promoting access to health education, care services, and preventive tools (PAHO, 2016). Thus, underserved populations are being equipped to deal with and prevent the spread of the virus.
Given the size of the geographical area at is affected by the Zika crisis, implementing the initiative at the individual and community level posed a significant challenge particularly in rural areas. However, the collaboration between international bodies, national organizations, local governments, and community-based associations has promoted awareness and preventive behavior at the grassroots level (PAHO, 2016). Continuous integration of cultural beliefs and practices towards health and sickness in Latin America as well as other affected regions is necessary to promote help-seeking and preventive behavior.
Future Outlook and Conclusion
The future spread of Zika virus relies heavily on the entomological factors associated with the distribution of the Aedes mosquito as well as international travel (Kindhauser et al., 2016). For this reason, control, and preventive measures need to continue targeting health education, healthcare access, economic empowerment as well as disease surveillance and research.
The Zika crisis and its global implications have prompted me to investigate and follow health agencies’ responses and updates targeting the issue. As such, I have gained epidemiological and entomological knowledge that is necessary to offer preventive services and travel advice in my future practice as a public health practitioner.
References
Basu, A. (2016, Jan 26). Zika, poverty, and reproductive health. United Nation Foundation. Retrieved May 30, 2016, from http://unfoundationblog.org/zika-poverty-and-reproductive-health/
Centers for Disease Control and Prevention. (2016, May 24). What the CDC is doing. Retrieved May 30, 2016, from http://www.cdc.gov/zika/cdc-role.html
Centers for Disease Control and Prevention. (2016, May 6). About Zika virus disease. Retrieved May 30, 2016, from http://www.cdc.gov/zika/about/
Centers for Disease Control and Prevention. ( 2016, May 24). For Pregnant Women. Retrieved May 30, 2016, from http://www.cdc.gov/zika/pregnancy/index.html
Gallagher, J. (2016, Apr. 13). Zika outbreak: What you need to know. BBC News.
Kindhauser, M. R., Allen, T., Frank, V., Santhana, R. and Dye, C. (2016). Zika: The origin and spread of a mosquito-borne virus. Bulletin of the World Health Organization 2016.
Pan African Health Organization. (2016, Mar.). Risk communication and community engagement for Zika virus Prevention and control. Retrieved May 30, 2016, from http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=33684&Itemid=270&lang=en
World Health Organization. (2016, Apr. 15). Zika Virus. Retrieved May 30, 2016, from http://www.who.int/mediacentre/factsheets/zika/en/
