Zika virus: is Lebanon at risk?


On February 1, 2016, the World Health Organization’s public health emergency committee declared the spread of the emerging infectious disease caused by the Zika virus a public health emergency of international concern.

Since the confirmation by the Pan American Health Organization (PAHO) of the first case of Zika infection in May 2015 in Brazil, the disease spread dramatically.

The number of new cases emerging worldwide is growing at an alarming rate. However, the cases declared so far in the U.S. and more recently in Germany, Denmark and the UK (and other European countries) were not locally transmitted, but contracted in countries where the virus in present, particularly in Latin America.

In Lebanon no case has been reported so far. And, in the Middle East only one case has been declared in Israel.

However, because of the presence in the Middle East (including Lebanon) of the mosquito Aedes aegypti/tiger-mosquito – the type of mosquito that could spread of the virus – the WHO (and the Lebanese Ministry of Health) recommend taking the appropriate preventive measures, including reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. To this end, it would be useful to avoid having standing water around homes because it can become a breeding ground for mosquitoes, spray pesticides, use insect-repellent lotions; In addition, and although the WHO is not recommending travel restrictions yet, pregnant women or women planning to become pregnant should carefully consider whether or not to travel to countries where the Zika virus is present.

Sporadic cases have also been reported among travelers to Thailand, Cambodia, Indonesia and the Pacific islands, and in May 2015, the first case was diagnosed in Brazil. Experts assume that Zika will continue to spread rapidly, possibly developing new methods of transmission.

Possible reasons behind the epidemic:

  1. Overpopulation and inadequate housing, unavailability of clean water and poor waste management (the refugee crisis in Lebanon and the region could be an amplifying factor).
  2. Poor control of the mosquito (vector) spread (absence of windows and door screens, lack of use of insect repellents, stagnant waters, accumulation of waste, bad waste management…)
  3. Global warming.
  4. Global mobility, particularly to endemic/epidemic regions
  5. Genetically Modified Mosquitoes (GMM) (and sterile-male) which has been released  mid-2012 in the countries affected today by the epidemic,  by the British biotech company Oxitec, in order to reduce the mosquitoes population
  6. Virus mutation

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A lot remains to be known about the Zika virus outbreak and disease. In the meantime, since a Zika infection is an emergency health issue, and in the absence of vaccine (according to the WHO it could take 18 months to start large-scale clinical trials of potential preventative shots), precaution and prevention are mandatory. Increasing mobility, whether for business, leisure or even people fleeing conflicts, can contribute to the spread of the virus in countries where the mosquito is present but not necessarily yet infected. An organized team work between health authorities, healthcare providers aiming to educate citizens, institutions (including schools, universities), travelers etc. about infectious diseases in general. Healthcare providers are encouraged to report suspected cases to the Ministry of Health. It is also worth to note that previous Lebanese experiences in dealing with epidemic outbreaks (Ebola, MERS etc.) were a success.

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Zika is a viral infectious disease caused by the transmission of the Zika virus from infected individuals to healthy ones, through mosquito bites, the Aedes aegyptei (Aedes species).

Other ways of transmission:

  1. Sexual contact: the virus has been lately isolated in semen and the first case diagnosed in USA (Texas), was sexually transmitted from a man who came back from a trip to South America, to his partner.
  2. Blood: by transfusion from infected individual
  3. From mother to child:
  • During pregnancy: the transmission of the virus from mother to fetus is possible; It is suspected to cause microcephaly among newborns. According to the WHO, the link between the Zika virus and two neurological disorders, microcephaly and Guillain-Barre syndrome, could be confirmed within weeks. 
  • Near the time of delivery: the transmission of the virus from an infected mother to her newborn is possible but rare.
  • So far, breastfeeding has not been incriminated in the transmission of the virus from the mother to the newborn. But, with the spread of the epidemic, experts prefer to be vigilant as to the emergence of new methods of transmission.

Three to twelve days after being infected, the patient may experience the following clinical manifestations:

  1. No symptoms
  • Frequent, in 4/5 of the patients (80% of infected cases).
  • In this case, prevention is difficult. The patient, unaware of having the virus in his blood, will not take necessary precaution to protect others.
  1. Mild to moderate symptoms:
  • In 1/5 patient (20% of infected cases).
  • Symptoms are usually self-limiting after 4 to 7 days (the virus may sometimes stay longer in the blood).
  • The most common symptoms: fever, conjunctivitis (red eyes), headache, muscle and joint pains, skin rash.
  1. Complications are rare:
  • Among pregnant women (Birth defects/microcephaly)
  • Guillain-Barré Syndrome (GBS)
  • Death (Very rare)