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Three Zika cases are found in India after random tests

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2654 (Published 31 May 2017) Cite this as: BMJ 2017;357:j2654

Re: Three Zika cases are found in India after random tests

The article on the detection of Zika virus in India by Dr. Cousins is really interesting and alarming.[1] As of now, ZIKV has affected almost 84 countries (2), and India is the new addition to this list. It is yet not clear how the virus got its foothold in India and whether these cases are autochthonous or were acquired after traveling to an endemic country. Although all these cases have been reported to have recovered, it serves as a wake-up call to the concerned authorities including both government and private sectors to be prepared for the worst case scenario. Given the fact that many parts of the country don’t even have enough facilities to diagnose the infection, some cases might just go undetected while the virus continues to spread. The most frightening fact is that fetus of the asymptomatic pregnant woman may get affected.

India is already fighting with numerous communicable diseases in the face of poverty, improper sanitation and lack of essential health services. Almost every year, India suffers from an epidemic of mosquito-borne diseases including dengue and chikungunya contributing enormously to mortality and morbidity leaving the health system overstrained and overstretched at its peak time. The emergence of ZIKV poses yet another great challenge to the health stakeholders and calls for an urgent action from the government to take adequate preventive measures to prevent it from spreading further.

India being the world’s second most populous nation with a high prevalence of Aedes mosquito-borne diseases is vulnerable to this new epidemic and consequence of it can be disastrous. However, Ebola outbreak was contained successfully with prompt action and collaboration of various organizations in the recent past. Unlike Ebola, ZIKA virus is a ‘silent killer’ as most of the cases are asymptomatic. The challenges of the Indian Government towards tackling this disease include the extensive cross-border travel, favorable breeding conditions for Aedes mosquitoes and inability to control mosquito breeding in the past for dengue outbreaks due to an inadequate surveillance system costing many lives. Along with that, there is a lack of uniformity in evaluating and reporting on suspected cases. The potential solutions could be creating awareness in the community regarding the transmission of the virus, breeding of the mosquitoes, the clinical manifestations of the disease, sensitizing the general population to seek health care promptly, and establishing & providing an easily accessible notification system to the physicians including those who work in resource-limited settings. Finally, initiating a rigorous vector surveillance to detect areas with a high mosquito, strengthening monitoring system to track all the probable cases, equipping the tertiary care hospital laboratories with the necessary tools for the diagnosis of the disease and additionally international airports displaying the vital information regarding the disease would help to combat the disease successfully.

References:
1) Cousins S. Three Zika Cases are found in India after random tests. BMJ 2017;357:j2654
2) Zika virus classification table. http://www.who.int/emergencies/zika-virus/classification-table-13-april-... [Last accessed on May 30, 2017]

Competing interests: No competing interests

08 June 2017
DHRUBAJYOTI BANDYOPADHYAY
Doctor
Arshna Qureshi, Adrija Hajra
Mount Sinai St Luk'e Roosevelt Hospital
New York