Everything is getting viral in India! Even social media flashed with breaking news on Communal riots, Mob lynching, Love jihads, JNU sedation charges, Kashmir stone palter, Cow meat-urine controversies, Money Laundering scam, Pinjratod and Me Too campaign. Yes, we are getting VIRAL. The Real Virus Outbreaks!!!!

In the last three years, India faced various viral epidemics in diverse geographical corner viz.the North India (Shimla, 2016) reported 15000 jaundice cases with 21 deaths due to Hepatitis E virus, due to the human negligence causing contamination of drinking water supply by the sewerage. A few weeks back, Nipah virus outbreak (May-July, 2018) rocked South India (Kerala: Kozhikode and Malappuram), where 19 confirmed cases with 17 deaths were reported. Commendable work was done by the virologist Prof.G Arun Kumar and his team, who identified and confined the spread of Nipah virus to Kerala only. This was the third Zika outbreak known to occur in India, although India experienced past two Nipah outbreaks in East India (West Bengal: 2001,2007). The major problem is that there is no vaccine for above three viral infections. Even the Kings of the Jungle (Lions in Gir sanctuary) was not spared by the viruses: Canine Distemper Virus (CDV) killed 23 Asiatic lions since September, in Gujarat’s Gir sanctuary with at least 21 more lions infected.

Now, we are facing the biggest outbreak of Zika virus in West India (Rajasthan: Jaipur), where so far (12/October/2018), 32 positive cases were reported including 3 pregnant women.  The focal point was identified as Jaipur’s Shastri Nagar with the first human case reported on 23 September 2018 and virus traces in Aedes aegypti mosquitoes on September 26, 2018.

Union Health Minister, Shri. J P Nadda assured the nation, “That everything is under control” and all the possible effective measure had been implemented from the Central Government.

Rapid Responses by the Indian Government

• A 7 member high-level team (By PMO: Health Ministry) in Jaipur to assist state government.
• A control room has been set up at the National Centre for Disease Control (NCDC) to undertake control and containment operations.
• So far 10,000 families, 168 pregnant women (3 positives for Zika virus) already screened for Zika virus (Health Ministry).
• All the suspected cases are being tested, 179 medical teams deployed working in six wards (around Shastrinagar).
• 26000 houses have intense surveyed and control measures like fogging, spraying and treating containers with chemicals already done and 29000 breeding grounds have been destroyed as a control measure.
• Even mosquito samples from the mosquito breeding areas were also examined and screened for Zika virus.
• Suspected state Bihar, for Zika virus transmission, has issued advisory for preventive measures and the family of Zika positive resident of Bihar is under surveillance to prevent another isolated infection inBihar.
• Sufficient medicines stockpiled up, viral research and diagnostic laboratories (VRDL) provided with diagnostic kits.
• State government ramping up efforts to raise awareness about the zika and how it can be prevented.

International Response:

• Designated India as Category: II indicating ongoing virus transmission (WHO classification on the prevalence of Zika virus)
• Pregnant travellers advised postponing their trips to Rajasthan (International Association for Medical Assistance to Travellers)

Cause and Effect

Zika virus was first identified in 1947 in Uganda and remains unknown until a large outbreak in 2007 in Micronesia was reported. Primarily known to transmit by Aedes aegypti mosquitoes (day biting) in addition to the recently identified sexual route of transmission. Zika virus mostly known to cause mild illness with symptoms like fever, rash, muscle and joint pain, headache which lasts for 2-7 days. The severe complications associated with Zika virus infection in pregnant women is brain abnormality in the babies in the womb, this defect is known as microcephaly (small heads). Also, a rare neurological disorder i.e. Guillain-Barre syndrome (GBS) causing paralysis in adults and children is attributed by Zika infection.

Treatment

Zika Virus has No treatment/cure or Vaccine. Patient advised to take rest and drink fluids. If fever persists, common medicine can be the option.

Antiviral Research: Drug Repurposing

To combat viral infection which has no antiviral drug or vaccine, the idea of drug repurposing suits well as per the requirement of epidemic situation. So far, three potential drugs were proposed by screening 6000 approved drugs and clinical trials candidates. Niclosamide (originally for tapeworm treatment) inhibits Zika replication whereas PHA-690509 interferes with gene expression. Third drug Emricasan inhibits programmed cell death and may protect brain cells of developing foetuses against viral damage. (Florida State University, Tallahassee, Emily Lee). Sofosbuvir (antiviral for HCV) can be used off-label for Zika, as suggested by Dr. Geiss (Colorado State University) and Dr. Muotri (University of California) as it targets viral DNA and blocked the ZIKA transmission from mother to baby (Trial in mice). Dr. Moutri also quoted the Chloroquine as a promising candidate; probably it may act by autophagy pathway.

Vaccine Research:

Zika virus accompanied with microcephaly and uncommon Guillain-Barre syndrome (GBS), raised the quest for vaccine research. Pharmaceutical giants GlaxoSmithKline (GSK), Sanofi and Inovio pharmaceuticals are working hard for the effective DNA-based vaccine for Zika. However, Walter Reed Army Institute of Research was working on the purified inactivated vaccine (ZPIV) with Sanofi, Moderna Therapeutics were developing modified mRNA vaccine and viral vector-based vaccine was also on the way as a candidate vaccine.

So, to combat any deadly viral infection, the best preparation is to have the right weapon, the drug/vaccine, as rightly said by Sir Louis Pasteur “I only wish I had invented the rabies vaccine before my dog, Old Yeller, got sick”.