THE WORLD Health Organisation (WHO) has reported the first three “laboratory-confirmed cases of Zika virus disease” in India — all from Bapunagar area of Ahmedabad. While the latest case is of a pregnant woman who tested positive in January this year, the first sample dates back to February last year.
“On May 15, 2017, the Ministry of Health and Family Welfare, Government of India, reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area, Ahmedabad district, Gujarat,” says the WHO report dated May 26.
“These are old cases. They were confirmed in January. We shared the information with WHO then, and WHO has now decided to go public. These are not fresh cases,” said a Union health ministry official.
When contacted, Dr D T Mourya, Director, National Institute of Virology (NIV), Pune, said the virus was first WHO confirms first three cases of Zika virus in India, all from Gujarat confirmed in one sample from Ahmedabad on January 4 this year, and two other cases were confirmed in the second week of January.
Speaking to The Sunday Express, J P Gupta, Commissioner of Health, Gujarat, said all three patients were now “Zika-free”, “leading normal lives” and “not under any medication”.
“The routine laboratory surveillance detected a laboratory-confirmed case of Zika virus disease through RT-PCR test at B J Medical College (BJMC), Ahmedabad, Gujarat. The etiology of this case has been further confirmed through a positive RT-PCR test and sequencing at the national reference laboratory, National Institute of Virology (NIV), Pune on January 4, 2017… Two additional cases have then been identified through the Acute Febrile Illness (AFI) and the Antenatal Clinic (ANC) surveillance,” says the WHO report.
Listing the cases, the report says:
* “During the AFI surveillance between February 10-16, 2016, a total of 93 blood samples were collected at BJMC, Ahmedabad. One sample from a 64-year-old male presenting with febrile illness of 8 days’ duration (negative for dengue infection) was found to be positive for Zika virus… This is the first Zika-positive case reported through AFI surveillance at BJMC, Ahmedabad.”
* “A 34-year-old female delivered a clinically well baby at BJMC on November 9, 2016. During her hospital stay, she developed a low-grade fever after delivery. No history of fever during pregnancy and no history of travel for the past three months was reported. A sample from the patient was referred to the Viral Research & Diagnostic Laboratory (VRDL) at the BJMC for dengue testing and thereafter found to be positive for Zika virus. She was discharged after one week. The sample was re-confirmed as Zika virus positive by RT-PCR and sequencing at NIV, Pune.”
* “During the Antenatal Clinic (ANC) surveillance between January 6-12, 2017, a total of 111 blood samples were collected at BJMC. One sample from a 22-year-old pregnant female in her 37th week of pregnancy has tested positive for Zika virus disease.”
Gujarat Health Commissioner Gupta said the surveillance on all three patients has been lifted. “They can reinfect people within six weeks of acquiring the virus. After that, they are ‘Zika-free’,” he said, adding that the woman who was pregnant and her child were both normal, and there was “no sign of any problem in the child”.
“We identified the cases during a random survey. The samples of more than 50,000 families in Bapunagar were taken… We are waiting for the Centre’s advisory on whether the cases were indigenous or acquired from outside,” said Gupta.
“We are continuing to collect samples, but none have tested positive so far. The virus is not dangerous, except for pregnant women… We are monitoring fever cases… There is nothing to worry about, Zika is not fatal,” he said.
Asked about the protocol regarding the announcement of Zika virus cases, he said: “We got to know about the final Zika results from the Centre. They tell us what to do. It is not the other way round.”
“There is a protocol and we have followed it. We have made sure that after the cases were confirmed, we did the required fogging, sprayed medicines as per WHO rules, monitored people for fever, ensured active surveillance in the area where positive cases were detected and passive surveillance in other areas,” said Gupta.
“NIV has developed reagents which have been distributed to all the ICMR labs for testing Zika virus. We have trained personnel in these labs on how the tests should be conducted,” said Dr Mourya.
Confirming that these are the first cases of “Zika virus infections in the country”, Dr Soumya Swaminathan, Director General, Indian Council of Medical Research (ICMR), said the ministry had submitted a written reply about the detection of the virus in the Budget Session of Parliament.
“There is a low level of transmission of the Zika virus, and picking up these three cases indicates a strong surveillance network. All state entomological laboratories have been told to collect mosquito samples and send them to six ICMR-designated laboratories… At 40 other laboratories, samples from people with fever, especially pregnant women, are being tested. So far, we have tested 40,000 such samples and ruled out Zika virus,” said Dr Swaminathan.
“We have stepped up vector control measures. People should not panic as it is not life-threatening. However antenatal surveillance is being stepped up, as Zika virus infection during pregnancy is one of the causes of congenital brain abnormalities including microcephaly. We are also expanding research by testing babies with microcephaly to rule out Zika virus. Several medical colleges will be identified as testing sites,” said Dr Swaminathan.
According to the WHO report, “an Inter-Ministerial Task Force has been set up under the Chairmanship of Secretary (Health and Family Welfare) together with Secretary (Bio-Technology) and Secretary (Department of Health Research)… In addition to NIV Pune, and National Centre for Disease Control in Delhi, 25 laboratories have also been strengthened by ICMR for laboratory diagnosis. In addition, three entomological laboratories are conducting Zika virus testing on mosquito samples.”
The report says that the “ICMR tested 34,233 human samples and 12,647 mosquito samples for the presence of Zika virus. Among those, close to 500 mosquitoes samples were collected from Bapunagar area, Ahmedabad, and were found negative for Zika.”
The WHO report mentions that the “Rashtriya Bal Swasthya Karyakram (RBSK) is monitoring microcephaly from 55 sentinel sites. As of now, no increase in number of cases or clustering of microcephaly has been reported from these centres.”
“This report is important as it describes the first cases of Zika virus infections and provides evidence on the circulation of the virus in India. These findings suggest low level transmission of Zika virus and new cases may occur in the future,” says the report, adding that “WHO does not recommend any travel or trade restriction to India based on the current information available.”
Meanwhile international airports and ports have displayed information for travellers on Zika virus, while the National Centre for Disease Control and the National Vector Borne Disease Control Programme are monitoring vector control measures.