Why did Centre take late action despite signs of Zika's presence?

It was September 16, 2016. I was working on an article on the mystery fever that was haunting Delhi and other parts of India. The official version was that the cases of fever were due to chikungunya virus, dengue virus and an unknown pathogen.

Symptoms like high fever, joint pains and rashes, and in many cases redness of eyes, were reported. These are classic symptoms of chikungunya and dengue. And these are symptoms of an infection of Zika virus. And it could well be Zika virus as the whole world was reporting cases.

The virus is spread by Aedes aegypti mosquito, the same mosquito that carries dengue and chikungunya and is present in abundance in the country. There is research to show that the three viruses that cause dengue, chikungunya and Zika can coexist in patients. They can then be picked up by the mosquito and transmitted together to the next person. India is quite susceptible to import of diseases by Indians and several models suggest that India is vulnerable to the import and spread of the Zika virus. Our neighbour, Bangladesh, already reported the disease in April. The Centre, too, sent out an advisory to airports to test incoming passengers for the presence of virus.

Zika virus was linked positively to microcephaly in children born to women affected with the virus. Researchers have even predicted a global epidemic of microcephaly. For India, this could have huge repercussions. However, we are certainly not ready to take care of these children.

But there was silence on this possibility in the media. Was I panicking unnecessarily?

The government had already started testing blood samples for the presence of the Zika virus after an advisory by the World Health Organization. A newspaper report in The Telegraph did say that none of the blood samples and mosquitoes sampled by the National Institute of Virology (NIV), Pune, showed the presence of the virus. But it did not mention how many of these samples are from the current epidemic. Things could have easily changed since the last sample was collected. We called the Indian Council of Medical Research (ICMR) to find out. We were told that the samples were negative for Zika. Our story fell flat due to lack of evidence.

But the ICMR had also suggested that we find out more from the director of the NIV. Just to be sure, we sent an email questionnaire.

Here’s the response we got from D T Mourya, Director, National Institute of Virology, Pune on the questions relevant to what was on our mind. Other questions pertained to vector control.

1) What do we know about the cause of the current cases of fever?

There is no "mystery fever". Undifferentiated fever is a seasonal event and nothing new and can be due to various factors.  We have observed cases of both chikungunya and dengue positivity in samples referred to NIV.

2) I understand that NIV is studying the possibility of entry of Zika virus in India. What do the results show?

Samples collected during the early period of illness and those which test negative for Dengue and Chikungunya IgM (Immunoglobulin M) are submitted for a molecular test, the multiplex real time RT-PCR assay which can detect DENV (dengue virus), CHIKV (chikungunya virus) and ZIKAV (Zika virus) RNA (genetic material) at the same time.  Several samples have tested positive for CHIKV, few for DENV but none for ZIKAV. NIV has tested around 300 samples for Zika virus, none were positive.

3) Have recent samples from the current outbreak been tested? Please provide some data on this.

From June to September 15, 2016, there have been 702 dengue cases and 998 chikungunya cases detected at NIV after testing 3,560 referred samples.

I found the answer to the third question unsatisfactory as it did not mention when these samples had been referred and sent follow-up queries. After these remained unanswered, I called up Atanu Basu who was marked in the email reply I had received from the director. Basu is a scientist at NIV and he said that they were testing recent samples for Zika and these were negative. 

We decided that it would not be prudent to create a panic. This would have been devastating for pregnant women in the country. Instead, we carried a story on vector control.

But now, the confirmed cases of Zika virus prove true what we had believed then. One of the cases that have been reported positive now was from November 2016. The blood sample had been collected during an Acute Febrile Illness surveillance. That was the time when the whole world was talking about Zika, we should have taken note and tested this patient for the presence of the virus immediately.

Maybe, the authorities also did not want to create a panic. But they could have easily confirmed through tests. Their failure left thousands of people vulnerable to infection. Microcephaly is no joke for the affected children or their parents.

Health India