Zika virus - the glamour of a new illness, the practical abandonment of the mothers and new evidence on uncertain causality.

Abstract

To appraise the impact of the Zika virus epidemics, we need to understand the challenges to reproductive justice posed by this new disease in a context of structural inequities. In August 2014, an outbreak of an illness with a flat pinkish rash, joint pain, bloodshot eyes, fever and headaches started in Natal, Northeast Brazil. Testing ruled out dengue and other potential causes. By March 2015, the illness had appeared in three different states, and in May 2015, researchers found that it was an outbreak of the Zika virus, transmitted by the same mosquito that is the vector for dengue and chikungunya viruses, the Aedes aegypti. Zika infection was previously associated with neurological complications, such as Guillian-Barré syndrome (GBS) in a few cases, but up to that moment, was generally thought as a relatively benign illness, a type of a “soft dengue”. By September 2015, medical providers in the States of Paraíba and Pernambuco reported increased cases of microcephaly and cerebral calcifications. Other illnesses were ruled out, and the tests for Zika virus were positive in the amniotic fluid of affected pregnant women in mid-November. In the following months, thousands of suspected cases of microcephaly and other neurological malformations emerged in Brazil, creating a global concern on this new public health and reproductive threat. In February 2016, looking in particular at the strong association, in time and place, between a rise in detected cases of congenital malformations, neurological complications and infection with the Zika virus, the World Health Organization considered that the situation met the conditions for a Public Health Emergency of International Concern. The scientific interest in this new public health emergency led to an explosion of publications on the biological, epidemiological and clinical aspects, and on establishing the causality links between the virus and the congenital syndrome. In April 2016, a WHO report noted that “microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection” were reported in Brazil (1046 cases), Cape Verde (2 cases), Colombia (7 cases), French Polynesia (8 cases), Martinique (3 cases) and Panama (1 case). There were two additional cases, linked to a stay in Brazil. The series of neurological harms associated with the Zika virus was called congenital Zika syndrome (CZS). Although Zika virus has spread throughout Brazil, Latin America and other regions, the concentration of high rates of microcephaly has been reported only in the Northeast of Brazil, and basically in poorer areas. By mid-2016, evidence suggested that Zika can cause microcephaly, but the clustering pattern hints that other environmental, socio-economic or biological factors could be at play. Cases were concentrated in areas where there is little or no sanitation, with open sewage, and without a regular supply of clean drinking water (leading to the need to store water, a potential breeder for the mosquitoes). The environmental exposure to the Aedes also leads to an additional vulnerability to reproductive harms, as pregnant women are in contact with a superimposition of other infections (dengue and chikungunya, as the PERSPECTIVE