Nearly six months after the first case of Zika was confirmed in Ahmedabad, the Ministry of Health and Family Welfare issued its first press release about the presence of the virus in India on Thursday evening. The health ministry said that since World Health Organisation had declared that Zika was no longer a “Public Health Emergency of International Concern”, health officials handled the three cases and took subsequent action as per the ministry’s “existing protocol”. However, a look at this protocol shows that health officials did not follow their own guidelines.
Three cases of Zika infection were confirmed in Ahmedabad city in January and February this year. But the news became public only when the WHO issued a note about the cases on May 26. The government’s cloak and dagger response to the Zika infection has been heavily criticised by health rights activists. The government has claimed that the cases of infection were not made public to “avoid panic”. Moreover, the Gujarat state government did not want a health scare to interrupt Vibrant Gujarat, a summit to attract big foreign investors to the state, said a report in The Hindu.
Zika is a viral disease transmitted by the bite of an Aedes mosquito and can also be transmitted sexually. The Zika virus generally causes a mild and temporary infection in adults with symptoms like fever and rashes. But Zika infections have also been linked to incidences of Guillain-Barré syndrome, a nervous system disorder caused by a person’s own immune system attacking nerve cells, causing muscle weakness, and sometimes, paralysis. The biggest danger from the Zika virus is to pregnant women and their foetuses. Zika infections in pregnant women can lead to congenital defects in their newborns such as microcephaly, in which the brain of the infant is small and underdeveloped.
The WHO declared Zika a “Public Health Emergency of International Concern” in February 2016, after a severe outbreak in Brazil led to many children being born with microcephaly. In November 2016, the WHO declared an end to the emergency.
The Indian government’s existing protocols in the event of Zika infections are given on the health ministry’s website in a document called National Guidelines for Zika Virus Disease. But it is evident the the government has not followed its own guidelines in many aspects listed below.
Informing the press
What the guidelines say:
In case there is a local transmission of Zika, like in Ahmedabad, the guidelines say that the health secretary or a representative nominated by him shall address the media. Further, it allows for “regular briefings/press releases” to keep the media updated on the developments.
What happened:
The Health Ministry issued a press release about Zika infections in India on June 1, almost five months after the first infection was detected on January 4, and five days after the WHO announcement.
The government’s defence in its press note is that on March 17, Minister of State for Health and Family Welfare Anupriya Patel answered a question on Zika virus infection raised by R Vanaroja in the Lok Sabha. However, Patel referred to just one case. The government made no effort to inform Parliament about the other two cases.
Deployment of district health officers
What the guidelines say:
On detection of a laboratory confirmed case of Zika, state and district authorities will undertake epidemiological investigations and reconfirm that the case is indeed one of local transmission. This would involve mapping of the area for a three-km radius around where the case has been found and to declare it an “affected area”. Local authorities will develop a microplan to carry out surveillance activity. The Model Microplan for containing local transmission of Zika virus disease is listed in an annexure to the guidelines.
What happened:
As Scroll.in reported, the Gujarat government did not inform the local Ahmedabad municipal authority about the infection. The municipal commissioner said the corporation found out about the infections from the WHO last week. Dr Bhavin Joshi, additional medical officer of the Ahmedabad Municipal Corporation, told Scroll.in that the Indian Council of Medical Research did not inform them about the real purpose of the sudden surveillance, which the corporation staff carried out in January and February. “We were told that the surveillance is being carried out as a national exercise to control malaria,” he said. “There was no mention of Zika virus or cases to us.”
Intensified fever surveillance
What the guidelines say:
District health officers shall intensify the fever surveillance within a radius of three-km radius of the “affected area”. Pregnant women who have fever shall also be examined. It also mentions active entomological surveillance, which means collecting Aedes mosquitoes and checking if they are infected with the Zika virus. The district health workers shall check for people suffering from acute neurological illnesses in the area. Any person is suffering from Guillain Barre Syndrome should also be tested for Zika virus.
What happened:
The health ministry in its June 1 press release said that the government carried out active fever surveillance and entomological surveillance. However, there is no mention of any surveillance of people suffering from neurological disorders. The ministry said that in January, the government carried out a house to house campaign involving indoor fogging, anti-larval and health education covering a population of approximately 1.25 lakh in Bapu Nagar, Ahmedabad where the two cases of Zika were detected. But Ahmedadad municipal authorities said local health workers were told to conduct a surveillance to control malaria. This kind of surveillance does not involve checking for neurological illnesses.
Enhanced surveillance and risk communication strategy
What the guidelines say:
The health authorities shall target schools, colleges, workplaces, community dwellings within the geographical area of three-km radius where the Zika cases were found. The risk communication shall involve distribution of pamphlets, announcements using a mike, mass SMS, etc.
ASHA workers shall conduct house to house surveillance and give information on reporting fever cases and mosquito control. It shall involve imparting information on using condoms to reduce the risk of sexual transmission of Zika. The health workers will also give information to help people make an informed choice of delaying pregnancy to prevent a possible adverse pregnancy outcome. Zika could cause microcephaly in children. The workers will give pregnant women information on their right to abortion following ultrasonic evidence of microcephaly.
For vector control, the local authorities shall carry out special campaigns via local regional language newspapers, magazines, radio, television, or via outdoor publicity such as hoardings, announcing on mikes, drum beating, rallies, or traditional folk media.
What happened:
Since the local authorities were not informed about the Zika infection in the community, they had little chance to inform the local community about the risks related to the disease. It is important to note that none of the other vector borne diseases such as dengue, malaria, chikungunya are transmitted sexually and so a surveillance and communication strategy for controlling Zika infection would be completely different as reflected in the Model Microplan formulated by the central government.
The Gujarat Health Commissioner, JP Gupta told Scroll.in that the public was not informed about the Zika cases since there was “no public health crisis”.
Informing neighbouring districts
What the guidelines say:
The state government should alert all neighbouring districts and and increase surveillance where there is a clustering of fever cases. Awareness needs to be created in the community for them to report fever cases.
What happened:
The Gujarat Health Commissioner JP Gupta told Scroll.in that the state authorities did not inform the local health authorities in Ahmedabad city about Zika cases – there is little chance they informed neighbouring districts.
Provide mosquito nets/pesticide
What the guidelines say:
State units of the National Vector Borne Disease Control Programme shall mobilise required quantities of bednets, and pesticides to control the mosquito population in the area.
What happened:
The bednets and pesticides were provided at the pretext of a malaria control programme.
Blood banks safety
What the guidelines say:
Blood banks in and around the “affected area” shall be alerted not to accept any donors from the area and people who visited that area where there is a possible Zika transmission. Based on two probable cases of Zika virus transmission in Brazil, the WHO said that in countries where Zika infection has occurred, the blood supply during an outbreak should be maintained by increasing blood collections in non-affected areas.
What happened: It is unclear whether blood banks were informed about Zika virus infection in the area. It is not mentioned in the government’s press release.
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