From UPSC perspective, the following things are important :
Prelims level : Nothing Much
Mains level : Ebola outbreak in Congo
The health emergency declared by the WHO can counter the risk of a global spread
- After holding itself back on three occasions, the World Health Organization has declared the Ebola virus disease outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern.
- The outbreak in Congo, officially declared on August 1, 2018, has killed nearly 1,700 people and made more than 2,500 people ill.
- While cases in other areas are reducing, Beni is the new hotspot.
- The announcement of the health emergency comes amid renewed concerns that the virus could spread to other countries.
- A single imported case of Ebola in Goma, a city in Congo with two million people and with an international airport bordering Rwanda, served as a trigger to finally declare a global emergency.
- Surprisingly, the spread to neighbouring Uganda last month did not seem to change the way the WHO assessed the situation.
- Even when a handful of Ebola cases were confirmed in Uganda, all the infected people had travelled from Congo and there had been no local transmission or spread within Uganda — one of the criteria used by the WHO to assess if an outbreak is a global emergency.
- This is the fifth time that the WHO has declared a global emergency. The earlier occasions were in February 2016 for Zika outbreaks in the Americas, August 2014 for Ebola outbreaks in western Africa, the spread of polio in May 2014, and the H1N1 pandemic in April 2009.
- Declaring an event as a global emergency is meant to stop the spread of the pathogen to other countries and to ensure a coordinated international response.
- There have been several challenges in interrupting the virus transmission cycle and containing the spread — reluctance in the community, attacks on health workers, delays in case-detection and isolation, and challenges in contact-tracing.
- But compared with the situation during 2014-2016, the availability of a candidate vaccine has greatly helped.
- Though the vaccine has not been licensed in any country, the ring vaccination strategy where people who come into contact with infected people, as well as the contacts of those contacts are immunised, has helped .
- Of the nearly 94,000 people at risk who were vaccinated till March 25, 2019, only 71 got infected compared with 880 unvaccinated who got infected.
- The vaccine had 97.5% efficacy; a majority of those who got infected despite being vaccinated were high-risk contacts.
Shortage of Vaccine
- Owing to vaccine shortage, the WHO’s expert group on immunisation has recommended reducing the individual dose to meet the demand.
- What is equally important is for the G7 countries to fulfil their promise to the WHO to contain the spread.
- The agency received only less than half of the $100 million that was requested to tackle the crisis. The global emergency now declared may probably bring in the funding.A
Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources
From the UPSC perspective, the following things are important:
Prelims level: Zika virus & associated facts
Mains level: Reports of Zika virus spread in India & how to tackle the situation
Risk from Zika
- The Indian Council of Medical Research (ICMR) recently announced that the Zika virus strains causing the outbreak in Jaipur, Rajasthan, cannot cause microcephaly
- Epidemiological, clinical, and experimental data have indicated that microcephaly and a range of other birth defects (such as miscarriages and ocular disease) could be caused by the Zika virus passing from a pregnant woman to her foetus
- There is not a specific Zika virus strain — or mutation — linked to microcephaly
- All Zika virus strains could possibly cause birth defects
Why ICMR announcement is flawed?
- This conclusion was based on a genetic sequencing of viruses isolated from the outbreak
- The problem with this conclusion is that the research was based on infection in mouse brains — not humans — and contains no epidemiological or clinical support
- Numerous other studies suggest that all Zika virus strains may have the capacity to infect foetuses and cause neurological disease
Support for ICMR claim
- According to the Centers for Disease Control and Prevention in the U.S., only 5-10% of Zika virus infections during pregnancies lead to Zika-associated birth defects, and the rates of microcephaly are much lower
Other associated risks
- It is also difficult to determine how extensive Zika virus outbreaks will be in India
- If the Zika virus has been silently spreading in the country, as it did throughout most of Asia for the last 50 years, then enough people may be immune to the virus to prevent large outbreaks
- Pregnant women and their families, including those planning to get pregnant, should take great caution to avoid mosquitoes
- Those infected should be isolated in order to contain the spreading of the virus
- Zika-associated birth defects could be a serious public health crisis in India
- Despite the recent announcement suggesting that the Jaipur Zika virus strains cannot cause foetal microcephaly, all possible measures to control transmission and monitor pregnancies should be taken
Mains Paper 3: Science & Technology | Achievements of Indians in science & technology
From UPSC perspective, the following things are important:
Prelims level: Drugs Controller General of India, Zika vaccine, WHO
Mains level: India’s rise in innovations in Pharma sector
Phase-I clinical trials for a Zika vaccine to start soon
- The Drugs Controller General of India has granted permission to an Indian firm to conduct Phase-I clinical trials for a Zika vaccine
- Phase I trials ascertain the safety, tolerability and physiological action of a compound inside the body
- Zika is an infection spread by the Aedes egypti mosquito
- Infections in pregnant women can cause children to be born with brain deficiencies
- World Health Organisation (WHO) had declared the Zika virus to be a Public Health Emergency of International Concern on February 1, 2016
- This was done post an outbreak in Brazil and other Latin American countries and its association with birth defects (microcephaly) in newborns
- It ceased to be a Public Health Emergency on November 18, 2016
Drugs Controller General of India
- Drug Controller General of India under the gamut of Central Drugs Standard Control Organization is responsible for approval of licenses of specified categories of drugs such as blood and blood products, IV fluids, vaccines and sera in India
- DCGI lays down the standard and quality of manufacturing, selling, import and distribution of drugs in India
- It acts as appellate authority in case of any dispute regarding the quality of drugs
- Under the Drug and Cosmetics Act, the regulation of manufacture, sale, and distribution of Drugs is primarily the concern of the State authorities
- The Central Authorities are responsible for approval of New Drugs, Clinical Trials in the country, laying down the standards for Drugs, control over the quality of imported Drugs, coordination of the activities of State Drug Control Organisations
- Indian Pharmacopoeial Commission is an Autonomous Institution under the Ministry of Health & Family Welfare, Govt. of India dedicated for setting of standards for drugs, pharmaceuticals and healthcare devices/ technologies etc besides providing Reference Substances and Training
- Alert! The Indian Medical Association (IMA) has issued a Zika alert in the country
- Context: Local mosquito transmission of Zika virus infection has been reported in Singapore
- Local mosquito transmission: Mosquitoes in the area are infected with the Zika virus and are spreading it to humans
- IMA: Asked physicians and the people to be aware and vigilant
- Not to ignore dengue or chikungunya-like symptoms with red eyes
- Travellers to Singapore protect themselves from mosquito bites
- Pregnant woman: Can pass the Zika virus to her foetus and an infection during pregnancy can cause serious birth defects
- Everything you wnat to about Zika here
- Tests were performed on rhesus monkeys
- Zika virus strains from both Brazil and Puerto Rico were used for developing the vaccines
- None of the vaccinated monkeys developed infection when later challenged with Zika virus
- Background: Zika, which was discovered in Uganda in 1947, took the world by surprise when it emerged in the Americas last year with devastating effects
- Zika is mainly transmitted by the Aedes aegypti mosquito, but it has also been shown to spread through sexual contact
- Colombia has been the second hardest-hit country by the disease after Brazil
- But it is also the first country in the Americas to declare the end of the epidemic
- Candidate Zika vaccine has to be tested on pregnant women
- Hence, it has to be found to be very safe in men and non-pregnant women
- Hence, WHO has stated in a report that developing a vaccine that uses inactivated viruses will be a priority
- Why? Inactivated virus in vaccine cannot multiply and hence considered safe for use in pregnant women
- News: Phase 1 clinical trial of vaccine for the Zika virus to start soon
- Might take a couple of years to know whether the vaccine could actually work against Zika
- Current vaccine developed by US based Inovio and South Korean GeneOne Life Science
- Already tested on animals and found to have robust responses
- Context: An open letter signed by 150 international doctors, scientists and researchers called for the upcoming Olympic Games in Rio de Janeiro to be moved or postponed
- Reason: To press on with the Games in Rio, the second most affected city in Brazil by the Zika crisis, would be irresponsible and unethical
- Concern: Global health- the Brazilian strain of Zika virus harms health in ways that science has not observed before
- News: Researchers in the U.S. have found that virus severely damages a type of neural stem cell that gives rise to the brain’s cerebral cortex
- Study: How the virus entering nervous system of foetus?
- Report findings: Zika virus infects neuronal cells in dish that are counterparts to those that form the cortex during human brain development
- Context: Findings may correlate with disrupted brain development, but direct evidence for a link between Zika virus and microcephaly is more likely to come from clinical studies
- Several questions remain: For instance, why are the symptoms in adults so mild? How is the virus entering the nervous system of the developing foetus?
- Context: Dispatching soldiers to help keep the Zika virus out of Cuba, calling on the entire country to help kill the mosquito that carries the disease
- Cuba’s fight: To prevent the arrival of the virus had been hampered by “the inadequate technical quality” of efforts against the mosquito
- Insufficient work to clean up areas where the mosquito propagates and poor weather conditions
- Relevance: Cuba has yet to report a case of Zika, which is suspected of causing birth defects in Brazil
- Efforts: Door to door fumigation of homes and offices by young army recruits and civilian workers who are supposed to maintain a careful record of places they’ve fumigated
- Context: help includes the fast-tracking of vaccines, diagnostics and research studies into how it spreads
- Funds for: $25 million for WHO and used to control the mosquito-borne virus Zika
- Way forward: funds to come from member states and in meantime it has tapped a new emergency contingency fund for $2 million to finance its initial operations
- Context: New and potentially controversial techniques including releasing GM or irradiated mosquitos could be deployed to hamper the spread of Zika virus
- Background: Zika is a disease transmitted by the Aedes aegypti mosquito
- More than 13 countries in the Americas have reported sporadic infections
- WHO’s advice: To boost the use of both old and new approaches to mosquito control as most immediate line of defence
- WHO Advisory Group recommended: field trials and risk assessment to evaluate the impact of this new tool on disease transmission
- Relevance: Infection in pregnant women linked repeatedly with a condition in babies called microcephaly and an illness in adults called Guillain-Barré syndrome
- Trial results: shown that such releases could reduce an insect population by up to 90%
- Context: The Lancet estimates that India reports at least 50,000 malaria-related deaths annually
- What’s in the news? – The Union Health Ministry announced a plan to eliminate malaria from the country by 2030
- The policy intervention will have deliverables and time-bound targets
- How? – India will be divided into 3 categories as per malaria prevalence — low, moderate and endemic States
- The Ministry will depend on civil society organisations to improve surveillance
- States with relatively good capacity and health infrastructure may usher malaria elimination sooner
- Context: Whenever the planet has faced a major climate change event, species have moved around and their pathogens have come into contact with species with no resistance.
- What expert says? The increased global movement of people is probably as great an influence as climate change for the spread of infectious diseases
- WHO’s context: Changes in climate mean a redrawn landscape for vector and water-borne diseases
- How Transmission? The warmer and wetter conditions facilitate the transmission of mosquito-borne diseases
- So, it’s plausible that climate conditions have added the spread of Zika
Such tests would progress quickly as the life span of the Aedes aegypti mosquito was 15 days.
- Gangabishan Bhikulal Investment and Trading Ltd. (GBIT), a sister company of the Maharashtra Hybrid Company (Mahyco)
- It is planning to scale up trials to find out whether genetically engineered mosquitoes can be a useful tool to check the growth of the insect
- It should be noted here that GBIT was the company that first brought Bt cotton to India
- Now, GBIT has been breeding male mosquitoes
- The company is expected to ask the take the government’s permission to start larger trials later this year
World Health Organization declares global emergency.
- A person in Texas has been infected with the Zika virus — the first case of the virus being transmitted in the U.S..
- During the current outbreak of Zika which has been linked to birth defects in the Americas.
- The Zika virus is usually spread through mosquito bites, but investigators have been exploring the possibility of the virus spreading through sexual contact.
- That gives the plausibility of spread, but the science is clear to date that Zika virus is primarily transmitted to people through the bite of an infected mosquito.
Integrated Disease Surveillance Programme (IDSP) through its community and hospital based data gathering mechanism would track clustering of acute febrile illness and seek primary case.
- The Health Ministry issued health advisory, appointing National Centre for Disease Control (NCDC), as the nodal agency for investigation of outbreak- should the situation arise.
- This comes in the backdrop of the WHO designating the Zika virus and its suspected complications in newborns as a public health emergency of international concern.
- WHO has reported 22 countries and territories in Americas from where local transmission of Zika virus has been reported.
- Microcephaly in the newborn and other neurological syndromes (Guillain Barre Syndrome) have been found temporally associated with Zika virus infection.
- Rapid Response Teams (RRTs) shall be activated at Central and State surveillance units.
WHO estimates there could be up to 4 million cases of Zika in the Americas in the next year.
- The WHO has announced that the explosive spread of the Zika virus in the Americas is an “extraordinary event” that merits being declared an international emergency.
- The agency convened an emergency meeting of independent experts.
- To assess the outbreak after noting a suspicious link between Zika’s arrival in Brazil last year and a surge in the number of babies born with abnormally small heads.
- The last such public health emergency was declared for the devastating 2014 Ebola outbreak in West Africa, which killed more than 11,000 people.
- Such emergency declarations are meant as an international SOS signal.
- Centre has constituted a special, technical group to monitor the spread of Zika in other countries.
- It is focusing on especially strengthening the surveillance system.
- There should be an increased focus on prevention to control the spread of the Aedes mosquito, which transmits Zika virus.
- There have been no reports of outbreaks of Zika in India though there is concern that given the ubiquity of air travel, carriers of the virus may arrive in India.
As of now, cases have been reported in 23 countries and territories in the Americas region.
- The WHO expects the Zika virus, which is spreading through the Americas, to affect between 3 million and 4 million people, a disease.
- The WHO’s director-general said the spread of the mosquito-borne disease had gone from a mild threat to one of alarming proportions.
- There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes.
- An estimated 80 per cent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.
- Zika was linked to a foetal deformation known as microcephaly, in which infants are born with abnormally small heads.
- The United States has expanded a travel warning for pregnant women.
- In the last few days, the country has seen over thousands of birth defects.
- The defects are blamed on the spread of mosquito-borne Zika virus.
- Babies across the region, and at least one in the United States, have been born with abnormally smaller heads — a condition doctors call microcephaly, which can cause brain damage.
- The scare has struck hardest in Brazil, which hosts the summer Olympic Games in August.
Everything you wanted to know about Zika virus
The World Health Organization (WHO) expects that Zika virus, a mosquito-borne disease, spreading through the Americas, to affect between 3 million and 4 million people. Let’s analyse this in brief!
Where was the first Zika virus outbreak identified?
- Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever.
- It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania.
- Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific.
Trivia : Do you know why is it called Zika Virus?
It was first isolated from Rhesus monkeys in Zika forest near Lake Victoria in Uganda.
Find Out why was Ebola virus named as such?
What makes this outbreak different?
- The current outbreak, the first ever in the western hemisphere, is a big deal for a number of reasons
- We now know that it’s not adults who have the most to lose but their unborn babies
- Microcephaly is a condition where a baby is born with an abnormally small head and brain defects
- Worldwide it affects only 1 in 30,000 to one in 250,000 newborns
- In Brazil there are usually a few hundred cases annually at most, but since October 2015, there have been 3,500 new microcephaly cases
But, what is microcephaly?
- Microcephaly is a rare condition where a baby has an abnormally small head.
- This is due to abnormal brain development of the baby in the womb or during infancy.
- Babies and children with microcephaly often have challenges with their brain development as they grow older.
- Microcephaly can be caused by a variety of environmental and genetic factors such as Downs syndrome; exposure to drugs, alcohol or other toxins in the womb; and rubella infection during pregnancy.
How does the Zika virus spread?
- Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions
- This is the same mosquito that transmits dengue, chikungunya and yellow fever
- Zika virus disease outbreaks were reported for the first time from the Pacific in 2007 and 2013 (Yap and French Polynesia, respectively), and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde)
How bad is it now?
- As of January 23, 2016, the Zika virus has spread to 21 countries and territories of the Americas
- It’s speculated that the virus must have arrived in Brazil along with the throngs that swept in during the 2014 FIFA World Cup
- Things look so grim that governments of 4 South American countries are now advising women to not get pregnant until the situation is brought under control
- The WHO has predicted that the virus is likely to spread all over North and South America, except for Chile and Canada where the Aedes aegypti mosquito is not present
- The reason that the WHO thinks these countries are so susceptible is that their populations have not been exposed to the virus before and hence have no immunity
Is there a cure?
- No, there isn’t. There exists medication for symptomatic relief but these are quite useless now that we know about the microcephaly link
- Research on the Zika virus is still quite primitive
- Given its generic symptoms in adults, it’s very easy to miss or misdiagnose
- Moreover, the virus doesn’t seem to show effects in common lab animals like mice and rats. Getting monkeys is extremely tough because of restrictions on primate research
- Vaccine development and antiviral drug discovery efforts are on but this takes time, and with the Zika virus, we’ll be starting from scratch
Does Brazil have a way out?
- Brazil needs an immediate plan of action for more than one reason
- Rio de Janeiro is frantically spraying insecticides at the parade grounds where the annual carnival celebrations will commence soon
- In August, the city is due to host the Olympics
What about India?
- India is one of the Aedes aegyptis’s many homes but the Zika virus itself has not ever been detected in our country so far
- However, in a study in the 1950s, healthy individuals from 6 Indian states showed passive immunity to the virus
- This means that though their blood contained antibodies against the virus, this was not because they were exposed to the virus
- Usually passive immunity is acquired through vaccines, from mother-to-child transmissions or breast milk
- In the case of India, where the Zika virus is not known to exist, the antibodies probably arose from exposure to similar viruses
- Nevertheless, theoretically, Zika can spread anywhere that the mosquito exists
- That means India, too. Indians are just as susceptible if they travel to high-risk countries
Is there something more that you wanted to know which we did not answer yet? Drop in with your questions.
Published with inputs from Arun | Image - Outbreaknews