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 Born in a poor neighborhood of Angola’s capital Luanda, the 10-month
old boy has microcephaly, a birth defect marked by a small head and
serious developmental problems. He still can’t sit upright and has
difficulty seeing and hearing.
“They don’t know what caused it,” Cula’s mother Marie Boa says,
sheltering under a blue umbrella from the summer rains. “The doctor
said it might have been caused by a mosquito, but I don’t know if
that’s true.” The 18-year-old does not know whether her first child
will ever walk or talk.
Cula is one of at least 72 babies born with microcephaly in Angola
between February 2017 and May 2018, suspected victims of an emerging
Zika outbreak. The cases have gone largely unreported, but an
internal World Health Organization report reviewed by Reuters
concluded in April that two cases of a potentially dangerous strain
of Zika confirmed in early 2017, along with the microcephaly cases
identified since then, provided "strong evidences" of a Zika-linked
microcephaly cluster in Angola.
(For a graphic on Angola's microcephaly cluster, see
https://tmsnrt.rs/2Ooz66X)
A lack of data and diagnostic testing along with a woefully
inadequate Angolan health system has made tracking the outbreak
difficult. But new findings from a research team in Portugal suggest
it is the first on the African mainland involving the Asian strain
of the disease.
It was the Asian strain that caused at least 3,762 cases of Zika-related
birth defects, including microcephaly, in Brazil since 2015, as well
as serious outbreaks in other Latin American countries. Doctors and
researchers now fear it could spread from Angola to other countries
on the African continent.
In an emailed response to questions, Angola’s ministry of health
said it had reports of 41 cases of Zika and 56 cases of microcephaly
since January 2017, when it began gathering data. It was not
immediately clear why the figures differed from the internal WHO
report.
A lack of testing capacity means many cases of microcephaly go
undetected, the ministry added, noting also that microcephaly has
many causes.
“Probably not all the cases of microcephaly can be attributed to
Zika,” the ministry said, listing a series of other potential causes
such as syphilis and rubella.
The Angolan outbreak comes at a time when world attention has moved
on from Zika, and most of the more than $1 billion in U.S. funding
allocated to fight the disease has been spent.
“We can’t let our attention down on this,” said Eve Lackritz, a
physician who leads WHO’s Zika task force. “We have to stay vigilant
and have a sustained response.”
Brazil’s epidemic prompted WHO to declare a global public health
emergency in February 2016 to investigate and ultimately identify
the virus as a cause of microcephaly and other birth defects.
Lackritz worries about a sense of complacency now that the crisis in
Latin America has waned.
“Our work is just starting,” she said in a telephone interview. “We
need continued attention and investment to make sure we protect
women and babies of the world.”
She said there is still a great need for better diagnostics, greater
lab capacity and programs to monitor birth defects.
Only one laboratory in Angola is currently testing for Zika,
according to the health ministry. In order to improve the speed and
accuracy of diagnoses, it said laboratories beyond the capital would
need to be given testing capacity.
ZIKA IN AFRICA
First discovered in Uganda's tropical Zika forest in 1947, Zika
circulated quietly for years, causing mild, flu-like symptoms in
parts of Africa and Asia. Over time, the virus diverged into two
genetically distinct lines – the African and the Asian lineages -
and neither was initially associated with large epidemics.
In late 2007, the Asian strain triggered the first large outbreak of
Zika in humans on the island of Yap in Micronesia, infecting 73
percent of residents over age 3. In 2013, an outbreak in French
Polynesia was the first linked to microcephaly.
The first lab-confirmed case of the Asian strain in Brazil was in
2015. By 2016 the virus, transmitted by the same mosquito that
carries dengue and Yellow fever, had spread to nearly all of the
states in Brazil, hitting hardest in the tropical Northeast. In its
wake, thousands of babies were born with small, misshapen heads.
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The African strain of Zika so far has not been linked to
microcephaly, which is why health officials are so concerned about
the Asian strain’s emergence in Angola, a Portuguese-speaking
country that serves as a major travel hub for the rest of Africa.
Some health officials are intrigued by the fact that the only
confirmed outbreaks of the Asian strain in Africa so far - in Angola
on the continent and in Cape Verde, an island nation off the coast
of Senegal - have been in countries that, like Brazil, are
Portuguese-speaking. They are probing whether travel ties between
Brazil and Portuguese-speaking African nations could have fostered
the spread.
In Angola, it has been difficult to directly link microcephaly cases
to Zika because of limited access to advanced testing that can
confirm the disease even after the acute phase passes.
Four medical professionals who have worked with Angola’s ministry of
health said there was also little political will to investigate a
Zika epidemic on the part of a government already dealing with
deadly malaria outbreaks, as well as cholera and the potential
threat of Ebola spreading from Democratic Republic of the Congo.
Speaking on condition of anonymity due to the sensitivity of the
matter, they added there was concern that an outbreak would require
the government to establish costly programs for babies with
microcephaly.
THE BABIES
In Brazil, the epicenter of the largest and most severe Zika
outbreak to date, the virus has now virtually disappeared. The high
rate of infections two years ago has left much of the population
immune, making it harder for the disease to spread.
"The saving grace, if there is any saving grace, is that we have
herd immunity," said Dr. Albert Ko, a tropical disease expert at
Yale University. It is not known whether immunity to the African
strain also confers immunity to the Asian strain.
Many families affected by the disease still struggle. Jackeline
Vieira de Souza, 28, who lives in the Brazilian state of Pernambuco,
describes a grueling daily routine for her son Daniel, born in 2015
with microcephaly: "My day to day is to wake up and take care of
him. Therapies and doctors."
Her hopes for Daniel are modest.
“I have no dream of seeing him walk, run," she said. "I only dream
that … at least he can eat better, breathe better.”
In Angola, the journey of such mothers is just beginning. There is
no public health program to help the children, who need regular
physical therapy and other care.
Families are often referred to The Center for Neurosurgery and
Treatment for Hydrocephaly in Luanda, even though the center lacks
funding to address the problem. Families are expected to pay for
consultations, costing between $7 and $21, which is far beyond the
means of many in a country where 30 percent of the population lives
on less than $1.90 per day.
“The majority come once and never come back,” said physiotherapist
Adelina Martins. “They don’t have the means to keep coming.”
On a recent Thursday, Luisa Alberto, 20, waited with her 3-month-old
baby to see a doctor with dozens of other mothers sitting in a
narrow corridor beneath a portrait of President João Lourenço.
The baby's father has refused to accept him, and Alberto is caring
for her first child alone while trying to finish school. The child
feeds but is developing slower than his peers.
“It's hard,” Alberto said. “He doesn't play like the other babies.”
(For a photo essay on Brazilan mothers of babies afflicted by Zika,
go to https://reut.rs/2RRMEWN)
(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and
Sue Horton)
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