38f474a-1Q&A: World Health Organization’s representative, Dr Ornella Lincetto, talks to Kuensel’s Kinga Dema on the risks of Zika virus diseases and what measures Bhutan could take in the event of the rapid outbreak of the virus.

It is not even in the region yet. Why should Bhutan worry about the Zika virus?

Bhutan should be worried about the Zika virus because the Aedes mosquito, primarily Aedes aegypti, which transmits this viral disease, is present in all countries in the South East region, including Bhutan.

As of January 27, 2016, 22 countries and territories in the Americas were reporting local transmission of Zika virus, including reported outbreaks in six countries. In the past years, there were confirmed cases of Zika virus in India, Indonesia, and Thailand.

Should we worry only if India begins reporting Zika outbreak? 

We should not wait till the outbreak to happen in India. Bhutanese are travelling all over the world and Bhutan receives tourists from different countries. Therefore, there are chances that the travellers might import the virus from an endemic area and introduce it in Bhutan.

We share a 450km-long open and porous border with Indian states of Assam and West Bengal and, also, there is a high influx of migrant workers (about 50,000-70,000 annually) from India. The Aedes mosquito, which also transmit dengue and chikungunya virus, are found in all these border states and the chances of importing the virus is very high if there is an outbreak in India.

What happens even if a single case is detected or reported in Bhutan? When Ebola surfaced, health officials indicated that even if a single case were detected in Bhutan, it would be a public health emergency. 

If a single case is reported in Bhutan (and even before that to be better prepared) the following measures should be taken:

Improve the control of mosquito population: removing sites where mosquitos breed by emptying, cleaning and covering containers holding water such as buckets, flower pots and used tyres, and applying larvicides to treat standing water sites; spray insecticides to kill adult mosquitoes. Avoid mosquito bites by putting on repellent, wearing clothes that cover as much of the body as possible, putting screens and close doors and windows, and sleeping under mosquito nets.

Enhance information and surveillance of pregnant women as they may transmit the virus to their baby with risk of microcephaly and malformation if they get infected during pregnancy.

To minimize contact between mosquitoes and patients infected with dengue, chikungunya, or Zika, people who are ill and suspected of having one of these diseases should be protected by mosquito netting while sleeping or at rest.

WHO has been working with the health ministry to be prepared for an event like this:

By improving the capacity for surveillance and for monitoring the virus’s geographic spread, and by improving the laboratory capacity to test for cases;

By working to inform health care providers about the protocols for proper response;

By distributing updated information to the general public, to travellers, and to public health partners at the international level; and

By controlling mosquito and working actively with everyone to eliminate the mosquito populations and breeding places.

The Zika virus and the Ebola virus are two different viruses. The average fatality rate from the Ebola virus disease is very high with around 50 percent while the Zika virus infection is usually mild, the main problem being the risk of causing birth defects, especially microcephaly in the baby if the woman get infected during pregnancy.

It is winter in Bhutan and there are no mosquitoes in most parts of Bhutan. Are we still at risk?

The Aedes mosquito is present in the southern part of the country even in winter. In addition, the mosquito and the virus can be imported from another country.

The Zika virus has been around for decades, so why the sudden increase in cases?

The Zika virus was first isolated in 1947. However, in May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. The outbreak in Brazil led to reports of pregnant women giving birth to babies with birth defects and poor pregnancy outcomes.

Bhutan has witnessed a significant drop in vector-borne diseases like dengue and malaria. Is Bhutan still at risk?

Bhutan has made significant progress in prevention and control of vector-borne diseases through effective surveillance systems and the involvement of communities to mosquitos in their areas.  We are still at risk if we are not controlling the mosquito population, if we do not strengthen border surveillance and engage in cross-border collaboration.


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