Zika (5)

Earlier this year I visited Brazil’s official website. It was infested with mosquitoes. They crawled in from the corners and buzzed around the web content. My first thought was “it’s a hack”, but as I moved my mouse a swatter appeared. I clicked over a mosquito and a blood-red banner popped up reading "Just killing a mosquito is not good enough. We cannot let it be born, and that depends on all of us."

It wasn’t a game or a hack. It was a smart effort by Brazil’s government to raise awareness about the Zika. The banner had links to Brazil’s Health Ministry page. It told how Brazil had mobilised 220,000 members of the armed forces and 300,000 government agents to deal with Zika. They would distribute information about the virus and carry large signs that read "Get out, Zika." Musicians played samba along the famous Ipanema Beach.

"A mosquito is not stronger than the whole country," the page said.

Jamaica is fighting Zika too. It’s using reggae music. "We Nuh Want Zik V!" sings Dr Michael Abrahams. He is a gynecologist, obstetrician, comedian, poet.

Dr Abrahams' music advises Jamaicans to dispose of sources of stagnant water and use mosquito repellent. He says he’s ”urging all Jamaicans, for 2016, to resolve to do all that we can to fight the Zika virus and increase public awareness about it. Armed with our knowledge of ZIKV, and being amply warned, we must play our part in preparing our country for what appears to be the inevitable." Jamaica recommends that women postpone pregnancy.

CNN has a post on approaches used in Brazil and Jamaica. eHNA looks forward to sharing African countries’ imaginative ways of communicating about Zika. Let us know what your country is doing.

The World Health Organization (WHO) is building an arsenal of digital tools to support patients and healthcare workers. It already has an e-pocketbook app for children and recently released an mHealth checklist for the reporting of mobile health studies. Their latest mobile app supports healthcare workers in their fight against Zika, a fast-spreading virus that the WHO has declared a global public health emergency. The Zika app is a medical app for physicians and health professionals to reference for the latest information about Zika, says an article in iMedicalApps

The virus is an emerging mosquito-borne illness that was first discovered in the 1940’s. It is spread via the bite of the Aedes mosquito, though we now know the virus can also be spread via blood and semen. 

Although outbreaks in the past in Africa and Pacific countries had noted microcephaly, the current outbreak that started in French Polynesia and Brazil has brought the proposed microcephaly link to the forefront. The WHO predicts that over 2,500 babies in Brazil will be born with microcephaly attributed to Zika.

The virus has spread rapidly throughout the Americas. The Centers for Disease Control ahs reported says there are now cases in over 40 countries and territories. Zika’s also now reached Africa’s shores as numerous cases in Cape Verde, off Western Africa, has been reported in eHNA. 

Currently there are very few medical apps on Zika, which is why the WHO Zika app is a welcome addition. The Zika medical app has three main modules: general information, health care workers, and news. Each one has many sub topics, ranging from symptoms to transmission to prevention. The healthcare worker section contains all of WHO’s technical guidance, ranging from birth defect surveillance training to prevention through sexual transmission. The medical app contains numerous WHO graphics, PDF’s and videos along with the most current Zika news. 

It’s a crucial tool for healthcare workers. The app’s free, available in English, French, Spanish and Portuguese and provides detailed content on the Zika virus. Its life-saving information and news section will ensure healthcare workers are familiar with the latest developments and spread of the virus, allowing healthcare providers and policy makers to track its spread and make better informed decisions. It’s essential for Africa’s health systems.

Zika’s not new to Africa. WHO’s Zika virus factsheet says “Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania.” 

It maybe that Zika’s taken a step up. The Centers for Disease Control and Prevention (CDC) says “Local mosquito transmission of Zika virus infection (Zika) has been reported in Cape Verde. Local mosquito transmission means that mosquitoes in the area are infected with Zika virus and are spreading it to people.” It’s issued a travel warning.

Almost 0.5m people live in Cape Verde, off Western Africa. The BBC says about 7,000 people, 1.4% of the population, are suspected of being affected, including 180 pregnant women. An epidemic can be defined on a smaller incidence than this if a disease’s spread is rapid, such as within a fortnight. 

While many people infected with Zika don’t become ill, people who do usually have mild illness with symptoms that last for several days to a week. In this setting, the effect of unborn babies is a bigger concern. Whether Zika in Cape Verde matches this is somewhat academic. Its seemingly sudden incidence in an African country seems more concerning. 

An eHNA post set out the roles of eHealth in dealing with Zika. Now’s the time to invest in them.

WHO describes Zika as an “emerging mosquito-borne virus” first identified in Uganda in 1947. It now seems to be taking hold with serious implications. NPR has a post about an initiative in Brazil to combat it using an existing telehealth service.

It was originally designed as a telehealth programme for paediatric cardiology. Now, specialist doctors in Brazil’s state of Paraiba on the North-East coast are using it to help infants with possible Zika-related birth problems, such as microcephally, a congenital condition of an abnormally small head associated with incomplete brain development.

One of Brazil’s big challenges in dealing with Zika is logistics. Dispersed communities, weak infrastructure and unequal healthcare access combine to make it difficult for parents to seek the help they need.

Dr Sandra Mattos, a paediatric cardiologist, designed the telehealth service, and uses it to assess her patients through her laptop. It’s part of her Heart Network of 22 regional hospitals with over 100 doctors involved. Her telehealth initiative can deal with congenital heart defects and brain defects too.

She can access hospital rooms across Paraiba and see the status of patients and decide if actions needed. It extends into communities too. Three echo taxis deliver specialised equipment to facilities in three remote rural communities and provide links to specialists in regional hospitals.

Local health workers are trained to operate the equipment, and specialist doctors are on hand to review the data. It supports decisions about which babies need to be seen in person and which ones don't. Two benefits are better access for patients and avoiding over-full clinics in the regional hospitals. 

Can Africa’s health systems use their existing telehealth services in the same way to fight Zika? If they can’t, Paraiba demonstrates the opportunities to develop and use new telehealth programmes.

With lingering concerns about Ebola, what should Africa do about Zika? While it’s less damaging than Ebola, its effects on some population groups, such as pregnant women and their babies, are very serious. 

WHO is supporting countries to control Zika virus disease with seven activities

  1. Define and prioritise research into Zika virus disease by convening experts and partners
  2. Enhance surveillance of Zika virus and potential complications
  3. Strengthen capacity in risk communication to help countries meet their commitments under the International Health Regulations
  4. Provide training on clinical management, diagnosis and vector control including through a number of WHO Collaborating Centres
  5. Strengthen the capacity of laboratories to detect the virus
  6. Support health authorities to implement vector control strategies aimed at reducing Aedes mosquito populations such as providing larvicide to treat standing water sites that can’t be treated in other ways, such as cleaning, emptying, and covering them
  7. Prepare recommendations for clinical care and follow-up of people with Zika virus, in collaboration with experts and other health agencies. 

WHO’s factsheet sets out the diagnosis, prevention and treatment arrangements for Zika. Diagnosis by serology can be difficult because the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever. sharecare, a website, describes why people and countries should pay attention to Zika and act to avoid it.

While it may not be at epidemic proportions in parts of Africa, can eHealth be deployed to help? Some of the eHealth lessons from Ebola seem relevant. With no vaccine available for Zika prevention, eHealth services for vaccination and immunisation won’t be needed initially, and maybe for some time. eHealth initiatives could include:

  • Data collection, data bases and registries, and analytical tools for surveillance
  • Risk communication plans using mHealth seem a valuable initiative
  • Mapping Aedes populations and behaviour
  • Supporting laboratory testing and results reporting can help too
  • Clinical Decision Support (CDS) for treatments and follow-ups offer a way to achieve consistency across numerous locations and easy updates.

All these have value for health and healthcare, so eHealth initiatives for Zika should be pursued in this context. They can help to spread affordability challenges, and more importantly, avoid the inefficiencies of paper trails. However, this latter goal relies on good eHealth.