Monsoon season has begun in India, and with it, health officials are bracing for an increase in mosquito-transmitted diseases like malaria, dengue and chikungunya. But concerns are circulating that Zika may join their ranks after three cases were recently confirmed – and allegedly concealed by officials – in the state of Gujarat.
On May 26, the World Health Organization (WHO) confirmed three cases of the potentially fatal virus in the city of Ahmedabad. In response, the Centers for Disease Control (CDC) upgraded India’s risk classification from category four – presence of the mosquito, but no known cases – to category two – area of ongoing transmission.
However, because the cases were detected back in November, January and February, some are accusing health officials of unethically withholding information from the public.
The virus, which can also be transmitted sexually, dominated headlines in 2015, when it was linked to Brazil’s sudden surge in microcephaly. Thousands of babies were born with brain damage and abnormally small heads, and the virus rapid spread through the Americas, Africa, Asia and the Pacific. But it did not make an appearance in India, where the last time the virus had been reported was in 1953.
In Nov. 2016, WHO finally declared that Zika would no longer be treated as a “public health emergency of international concern” but remained a “significant enduring public health challenge.”
That same month, a 34-year-old woman in Ahmedabad developed a low-grade fever after delivering a “clinically well” baby. She tested positive for Zika. Then, in January, a 22-year-old woman also tested positive in a routine laboratory surveillance, which used a blood sample taken during her 37th week of pregnancy. In February, a 64-year-old man with a fever was the third to test positive for the virus. None of the patients had travelled to Zika-affected countries.
But on March 17, junior health minister Anupriya Patel told parliament that “so far, only one case of laboratory-positive Zika virus has been detected as part of a routine laboratory surveillance in January 2017,” according to DNA. Two months later on May 15, India’s Ministry of Health and Family Welfare reported three cases to WHO.
According to DNA, a senior health official defended Patel’s statement, saying that at that time only one of the three cases had been confirmed even though the other two had been picked up.
“The two pregnant mothers … have delivered healthy babies, and the 64-year-old senior citizen has shown no complications so far,” the chief secretary of Gujarat J.N. Singh said after the WHO announcement, according to the Times of India.
Because there were no additional cases, he said, “The government consciously did not go public.” Some in the health community were not satisfied with that answer.
“This is unprecedented in India’s public health history. It is also disturbing and raises a lot of ethical issues,” Rajib Dasgupta, a professor of community medicine at Delhi’s Jawaharlal Nehru University, told BBC. “You have to take the community into confidence. You can do it without spreading panic. That is the job of a sound public health policy.”
But the CDC is not alarmed. The country’s response was prompt and robust, according to the agency: from the initial surveillance that discovered and reported the cases, to the way the cases were managed, task force appointed, guidelines distributed and joint monitoring efforts set up.
“I think that as a country, they have been absolutely on top of Zika,” Kayla Laserson, CDC’s Country Director in India, told Humanosphere. “There was a delay [in public reporting], but we are very hopeful that through global health security and our collaborative lab strengthening and disease surveillance efforts that a delay like that would be minimized. But we are not worried about the way the country responded in terms of the actual response to the identification.”
Laserson believes that the continued effort to strengthen India’s global health security framework served it well this time and will prepare it again for the possible rise in cases after the monsoon, because the Aedes aegypti mosquito that transmits chikungunya and dengue is the same one that transmits Zika.
“While we may find more Zika because of the monsoon, I think that the country is quite prepared to find it and then to respond to it.”