Brazil struggles to contain damage of mosquito that transmits Zika virus

Dr. Sylvia Lordello of Saúde Criança speaks to a group of parents about Zika.

This was originally published by Global Health TV on March 31, 2016.

RIO DE JANEIRO, Brazil — A group of about 20 poor parents (mostly women) from the slums gathered this month in the offices of Saúde Criança (“child health” in Portuguese), a social enterprise that works with impoverished children and their families in a holistic way. After a meditation, they got down to the main point of the meeting — the Zika virus and how to avoid it.

These poor young mothers are prime candidates for Zika. Aedes aegypti, the mosquito that transmits Zika, will suck anyone’s blood — rich or poor. But they thrive in the densely populated favelas of Rio and other Brazilian cities where few people have screened windows and where even mosquito repellant may be a luxury. Many people have water cisterns on their roofs, usually not covered, which makes an ideal breeding ground for Aedes aegypti.

Dr. Sylvia Lordello, a medical doctor on staff at Saúde Criança, told the parents that prevention starts at home and reviewed a series of steps that could be taken to make their homes less hospitable to mosquitoes, such as covering their cisterns and not leaving water in the plates under house plants.

“If the whole country fights Zika, the mosquito cannot win,” Dr. Lordello told the parents. “Zika is not stronger than the country.”

That is the key message of the national campaign against Aedes aegypti: “A mosquito is not stronger than an entire country,” with the hashtag #ZIKAZERO. In a video on the #ZIKAZERO campaign website, you can see some of the strategies the government is promoting against Zika.

Aedes aegypti is, in fact, one of the most highly efficient disease machines ever created. It bites aggressively during the daytime, so bed nets are not effective against it. It often bites four or five people during one meal. Its bite is painless so people don’t always know it’s there, and so do not swat and kill it. It thrives in dense, urban environments. Aedes aegypti is the main vector not only for Zika but also dengue, Chikungunya and yellow fever (which was eradicated in urban Brazil years ago). All of this, and more, make it a formidable foe.

Brazil is the country most affected by Zika. It was diagnosed here in May 2015. The Brazilian Ministry of Health estimates that there were 0.4 to 1.3 million cases of Zika virus infection in 2015, mostly in the hot, poor northeast.

The symptoms of Zika are normally mild – much milder than dengue – and it might be considered a minor nuisance except that Zika is suspected of being linked to microcephaly, a condition in which babies are born with a smaller head and brain abnormalities. In adults, Zika has been associated with Guillain-Barré syndrome, that can result in paralysis and even death. These links are strongly suspected but have not been scientifically confirmed.

As of March 19, Brazil has reported a total of 6,671 cases of microcephaly and/or central nervous system malformation (not all caused by Zika), according to the World Health Organization (WHO). This is a huge increase from an average of 163 cases reported annually from 2001 to 2014. Of these, 907 have been confirmed for the Zika virus. Microcephaly has been detected throughout Brazil but the recent increase is concentrated in the Northeast.

The WHO said that it expects Brazil will have more than 2,500 babies born with microcephaly from Zika if current trends continue.

Brazilian federal and state governments and scientific agencies are mobilizing against the Zika virus, like the #ZIKAZERO campaign. The Lancet has urged this strategic plan for governmental action. Last week, Brazil’s National Development Bank announced it will provide $136.6 million to fight Aedes aegypti.

The military has been playing a major role. In February, 200,000 Brazilian soldiers were mobilized across the country to raise awareness about the the mosquito that spreads the Zika virus. The aim was to reach 3 million families in a single day, with soldiers visiting homes, parks and shopping malls in 350 cities.

Churches are also getting involved. The Brazilian Seventh Day Adventist Church is leading a national campaign to eradicate Zika. The church’s Zika Project started in February with a public awareness drive involving 200,000 students and hopes to expand to at least 600,000 members of the church.

Zika is raising issues about whether contraception and even abortion should play a role in helping prevent babies with microcephaly. This can be controversial given that many of the Zika countries are heavily Catholic.

Saúde Criança has always promoted family planning among the families in its program through regular condom distribution and lectures on family planning. And they believe this strategy is working because only seven out of the 600 women in their Rio de Janeiro program are pregnant at the present time, according to Cristiana Velloso, executive director of Saúde Criança.

This contraception might also help prevent cases of microcephaly.

“What we can do here is talk to our families about Zika, give them insect repellant (S.C. Johnson & Son, maker of Off! and Raid, just donated 25,000 bottles to Saúde Criança) and tell them how they can prevent Zika,” said Velloso. “We can’t do much more, and even the government can’t do much more.”