As Nepal struggles to contain Covid-19, risk of Zika outbreak rises

Aedes aegypti and Aedes albopictus mosquitoes that transmit the dengue virus have been present in almost all districts throughout the country. These mosquitoes also transmit the Zika virus.

And what is concerning is, there has been an outbreak of Zika virus in neighbouring India with which Nepal shares a long open border.

As thousands of people enter the country every day from India, the chances of the virus spreading into Nepal is high, experts say.

“We already have Zika-transmitting vectors which are found in almost all districts throughout the country,” Dr Basudev Pandey, former director at the Epidemiology and Disease Control Division, told the Post. “What is needed is a person infected with the virus for the Aedes mosquitoes to spread the virus.”

Health authorities in Kerala state of India declared a state of alert in all districts on Friday following the detection of 14 cases of the Zika virus.

Doctors say Zika causes microcephaly, a condition in which babies are born with underdeveloped head and brain damage. Zika is also linked to Guillain-Barre syndrome, a condition in which the immune system attacks the nerves causing muscle weakness and sometimes paralysis.

“Due to the high mobility of people between the two countries, Nepal is highly vulnerable to outbreak of any disease seen in India,” said Pandey, who is also an expert on vector-borne diseases including dengue and the Zika virus. “And what is concerning is we already have vectors of the virus.”

 

In 2018, the Ministry of Health and Population had carried out a risk assessment survey with technical and financial support from the World Health Organisation, which showed that Nepal was a high-risk country for dengue and Zika outbreaks.

Two experts deployed from the UN health agency in Nepal inspected places across the Kathmandu Valley and had found eggs, larvae and pupae of Aedes aegypti and albopictus mosquitoes, and warned of looming threats of outbreaks.

“Authorities should step up surveillance to monitor the presence of the virus,” Dr Sher Bahadur Pun, chief of Clinical Research Unit at the Sukraraj Tropical and Infectious Disease Hospital, told the Post. “Though Zika is a mild disease, it has grave consequences on the fetus. We should not ignore the risk.”

As the entire focus of the authorities is on the containment and management of Covid-19 cases, Nepal could face an outbreak of the Zika virus, which seems mild but gives lasting impacts.

Even if the coronavirus is a severe and deadly disease, its long term impact is not known.

According to Pun, many people infected with the Zika virus show mild symptoms like fever, rashes and red eyes.

“Studies show that pregnant women and their foetuses are at high risk,” said Pun. “If infected with the Zika virus during pregnancy, it leads to congenital defects in the newborn, which is called microcephaly. The brain of an infant is small and underdeveloped. Imagine what would happen, if hundreds of such children were born.”

 

Despite the high risk of the outbreak, concerned authorities in Nepal have done nothing. Even after the experts from the UN health agency warned of possible outbreaks, authorities have not taken the risks seriously.

Officials at the Epidemiology and Disease Control Division concede that the government doesn't even have testing kits to carry out surveillance.

“Yes, with the several new cases of the Zika virus detected in India, we are at high risk of a Zika outbreak,” Lila Bikram Thapa, an official at the Epidemiology and Disease Control Division, told the Post. “We have alerted all the health agencies about the possible risks.”

However, health workers are focused on the containment and management of coronavirus cases. Along with the coronavirus cases, they have to deal with regular health problems, monsoon-related problems and contain possible outbreaks.

Thapa said that surveillance should be stepped up to minimise the risk of an outbreak. For that testing is required but the authorities lack the testing kits.

“We don’t have testing kits,” said Thapa. “We have not yet purchased testing kits, as we didn’t have any cases so far. But now having such kits is necessary.”

Doctors say Zika virus symptoms match those of the dengue virus—mild fever, rashes, muscle pain, headache, red eyes and general feeling of discomfort. Aedes mosquitos are day biters and lay eggs in clear water accumulated in used tires, flower pots, discarded plastic cups and bottles among other things.

 

“Even if we don’t have testing kits, tests for Zika can be done in the polymerase chain reaction labs,” said Pun. “As testing of the coronavirus has declined, authorities can use those technologies to test Zika virus for surveillance purposes.”

Zika virus was first identified in Uganda in 1947 in monkeys, according to the UN health agency. It was later detected in humans. Brazil saw the worst outbreak of the virus in 2015 and it has then spread to 24 other countries. The WHO had declared Zika outbreak an international health emergency in 2016.

Officials say what is concerning now is the vectors carrying dengue and Zika viruses are thriving in places where they did not earlier, largely due to climate change. A study by the National Health Research Council has shown that changing climate patterns are increasing the risk of diseases like dengue, chikungunya, Zika and yellow fever.

Nepal witnessed a dengue outbreak in 2019, which killed at least seven and infected thousands.