We are barely a month into 2016, and already it seems we have found our illness du jour. ZIKA VIRUS! I will admit that Zika virus is relatively new to me despite being an infectious disease specialist. When I first heard of it in 2014 through an online news report out of Brazil, I had to check my trusty Mandell, a two-volume infectious disease textbook to verify the existence of this virus. Indeed, there it was in a small table titled Less Commonly Recognized Flaviviral Infections. The table featured other unknown to me flaviviruses such as Apoi, Moduc, and Negishi. My head hurt! I thought about my next infectious disease boards in 2019 and wondered if these names would stick in my head somewhere just in case. I reviewed the clinical syndrome (fever, rash, and arthralgia), the geographic distribution (South East Asia, East/Central Africa) and the vector (Aedes aegyptus mosquito). A quick Medline search revealed that the medical/scientific community had known about this virus since the 1940s, that it was named for a forest in Uganda, and that there was speculation of a non-vector borne transmission of the virus by human to human (specifically husband to wife presumably via sex) in 2008 in the United States.
I remember thinking of what a pest the mosquito is and of all the various viruses that cause illness it carries to us. But back then I was predicting a dengue (which can cause a hemorrhagic fever reminiscent of Ebola virus) and/or a chikungunya (which can lead to debilitating arthritis) epidemic in the US. Both were already making a splash in the Caribbean and indeed I had diagnosed my first patient with chikungunya that year. She was a returning traveler from Puerto Rico and when her test came back positive, I was in communication with our local health department who needed to go to her neighbourhood and spray lest any local mosquitoes (also Aedes species) would bite her and transmit her virus locally.
I had gotten tired of waiting for dengue to arrive in style in the US having seen my first patient with it in 2007 (a returning traveler from Nicaragua) and I told anyone who would listen that Chikungunya was coming. Well, Zika fool me! Fast-forward to 2016 and it’s indeed remarkable how Zika has taken the Western hemisphere by storm. I was in Brazil in 2014 for the FIFA World Cup now that I think of it and remember sitting with journalists and commenting about how we were all going to get dengue and take it back to our respective countries. Little did we know that the reverse would happen — that somebody would bring to Brazil the gift of an unknown-to-them virus. The Summer Olympics this year are going to be interesting that’s for sure.
Unlike the Ebola hysteria I do believe that this time the average person on the street in the United States will be at risk of infection if this virus makes its way up here. Right now, we have winter working in our favour but if we don’t get a handle on the mosquito situation down south (as in South America) before summer time, we will all need to be aware of avoiding being bitten because the tropical Aedes aegypti has cousins up here (Aedes albopictus) and in Europe for that matter that can do as fine a job transmitting illnesses to humans. Fair enough, the majority of Zika infected people will not have any symptoms (yes!) and the approximately 20% who will have common “flu-like symptoms” but what has actually caught the attention of the world is not just the exponential spread of this infection to naïve people but also the possible association of maternal Zika virus infection with congenital microcephaly that results in fetal loss, neonatal death, and at best a disabled child. Now that’s scary.
As a mosquito magnet myself, of course I’m concerned. Last I checked mosquitoes don’t buzz around with a sign saying “hey, I carry dengue”, or “hey West Nile virus on board here”, or “hey this is the St. Louis encephalitis express coming right up” thus I doubt a Zika carrying mosquito will announce itself before it feeds on my blood and leaves me a present. Even when I apply 100% DEET as I do when I’m in Ghana, mosquitoes just swarm me. When one thinks of the scariest or deadliest animal, one doesn’t think of the mosquito but Lord knows a “harmless” mosquito bite has the potential to kill more humans than even other humans killing humans and that’s saying a lot with all our inhumanity towards each other.
But you know what. I’m not really troubled that we will have a Zika disaster on our hands here in the United States. Sure, of course we will get a number of imported cases, and yes certain states might see local transmissions, and yes we may have a few microencephalic babies (if indeed Zika is responsible for that), and yes all of that can be devastating to the people affected, but I fully trust that most states in the US have good surveillance and decent enough health departments and resources to control mosquito populations, educate the public, and provide access to mosquito repellant. We’ve known about this virus for about sixty years and have not bothered to develop any meaningful treatment for it so I don’t expect any to be found this year. In fact I will be very angry if one is because that would just be a reminder of how little black and brown people matter in this world.
Already, I feel that we are playing catch-up as if we didn’t see this coming. In truth, we could have been proactive. We didn’t need Zika to come to the Americas and threaten to kill or disable our babies to remind us that mosquitoes are pests that need to be controlled. Zika, dengue, chikungunya are all carried by the same pest and the latter two have caused increasing infections in new geographic regions in the past few years, so one can’t really be surprised.
It makes sense. Zika took a strong-hold because the people of the Americas have zero immunity. Zika took a strong-hold in poverty-stricken areas of Brazil where street gutters flood and citizens have make-shift reservoirs to store water that is in poor supply all of which increase the breeding grounds of mosquitoes. I left a bucket of shallow water out in the garden last summer and for a few weeks to come all I had to do was walk through the yard to be bitten mercilessly. Imagine if those were disease carrying mosquitoes. So, yikes at all that standing water. Yikes at climate change/global warming lengthening the seasons that mosquitoes are out amongst us. Yikes at poor people not being able to afford mosquito repellents, mosquito netting, and perhaps the luxury of long sleeve clothing in tropical weather.
Now, we must do the right thing. Help those countries with poor public health infrastructures get rid of their mosquito problems by attacking the root cause – poverty. Just as Ebola ravaged war-torn countries while better equipped countries like Nigeria (and that’s not saying much) were able to prevent an epidemic, it’s going to boil down to money and resources.
Mal – aria, Italian for bad air, another mosquito borne parasitic infection that is responsible for the deaths of about a half million people around the world every year still, used to be a scourge for the U.S. and Southern Europe. I recall reading once that probably a million soldiers in the American civil war acquired malaria. That was barely a little over a century ago. Now in your average U.S. hospital a malaria case is rare, usually presents in a returning traveller, and unfortunately often takes some time for someone to think “hey, this person might have malaria”. I would love for other countries to have the luxury of being nonchalant about these vector-borne illnesses. So no, I’m not too concerned for people in the U.S. or in Europe being afflicted en mass with Zika. We can handle it. We will prepare for the worst and hope for the best.
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