Aylin Angulo

HPS 405

February 27, 2018

Infectious Diseases and Vaccinations

In 1947, the Zika Virus (ZIKV) was first accidentally isolated from a monkey with yellow

fever in Uganda (Gubler et al, 2017). Afterwards, mice were inoculated with ZIKV and after ten

days of exposure mice remained asymptomatic(Gubler et al, 2017). Unlike other vector borne

disease, mice that were inoculated with ZIKV had no signs or symptoms of disease (Gubler et al,

2017). In 1962, the first confirmed human Zika virus infection occurred (Gubler et al, 2017).

During this time, it was very difficult to differentiate due to similarity of other vector-borne

diseases such as yellow fever, dengue, and many others (Gubler et al, 2017). In 1966, ZIKV was

then isolated from mosquitos in Malaysia specifically in Aedes aegypti (Gubler et al, 2017).

Serosurveys were conducted from 1950 to 1970 and suggested that Zika virus was transmitted

throughout Africa and Asia (Gubler et al, 2017).

The first confirmed outbreak of ZIKV occurred in Yap State, Western Pacific from 2013 to

2014, where it presented Dengue-like symptoms, but some patients were asymptomatic which

raised questions to the associated virus (Gubler et al, 2017). The next outbreak of Zika virus was

during 2013 in French Polynesia, which is when the association between Guillain-Barre

Syndrome (GBS) and ZIKV was discovered (Gubler et al, 2017). GBS can lead to paralysis due

to the immune system attacking certain parts of the peripheral nervous system (Hughes, 2012).

ZIKV began gaining attention in 2015, when it emerged in Brazil and confirmations of it causing

microcephaly were validated (Gubler et al, 2017). In the past ten years, ZIKV has affected over
80 countries and approximately thirty-one countries have reported higher rates of microcephaly

and other central nervous system (CNS) issues associated with the Zika virus (Gubler et al,

2017).

One of the most distinguishing characteristics of the Zika virus is its ability to rapidly mutate

its genome. This is caused by its ribonucleic acid(RNA)- dependent RNA polymerase (Gubler et

al, 2017). It is estimated that after each genome replication there is approximately one mutation

(Gubler et al, 2017). This quick adaptive feature contributes to the transmission of Zika through

majority of the planet (Gubler et al, 2017). Its ability to quickly adapt could have contributed to

it spread in different climates which include temperatures and pressure changes (Gubler et al,

2017).

The amount of genetic and behavioral risk factors for Zika are very minimal, but there are

various environmental risk factors identified. Inhabitants of tropical areas are at higher risk since

ZIKV is a vector borne disease primarily transmitted using the help of Aedes aegypti (Paixão et

al, 2016). A link between heavy rainfall and ZIKV outbreaks has been associated due to the

presence of stagnant water (Fuller et al, 2017). Currently, the focus of prevention has been on

pregnant women or future mothers due to the ZIKV being able to cross the placenta and affecting

the fetus during development (Paixão et al, 2016).

The effects of the zika virus and initiatives can be interpreted through the socioecological

model. On the intrapersonal level, we can see how a child’s life is affected by the presence of

microcephaly, a side effect of ZIKV, whether it is creating learning difficulties or decreasing

interactions with peers. This can later lead to stress due to the problems listed above. Using the

intrapersonal level, the child can receive additional resources especially during the course of

their studies. On the interpersonal level, the effect of having a child with microcephaly can be
seen within the parents whether it is the added stress of having to take their child to multiple

doctor’s appointments or the financial burden of medical bills. Certain initiatives may help

educate parents and family members on what microcephaly is and how it affects their child. On a

community level, disseminating information about the side effects of ZIKV such as

microcephaly and Guillain-Barre Syndrome. On an organizational level, creating effective school

programs for children with neurological disabilities that still have an inclusive component would

help individuals who may be suffering from the side effects of ZIKV. On a policy level, creating

new research initiatives on how to reduce susceptibility to vector-borne diseases such as Zika.

The prevention of Zika transmission can also be incorporated into the socioecological model.

On the intrapersonal level, individuals can be informed about wearing insect repellents and

staying actively up to date of risk areas. On an interpersonal level, women planning to become

pregnant should be tested to see if they have been exposed to ZIKV. This may reduce the level of

children being born with microcephaly or other neurological complications. On a community

level, stagnant water that may attract mosquitos should be removed as soon as possible. On an

organizational level, field trap barrier systems that reduce the number of mosquitos should be

implemented into schools, workplaces, and other places where large numbers of community

members meet. On a policy level, legislation should be created that will help minimize costs of

repellent, bed nets, and other equipment that deters mosquito bites.

A successful intervention that not only decreases Zika, but also other vector borne diseases

such as dengue and chikungunya diseases is the use of field trap barrier system (Akhoundi et al,

2018). The study targeted Aedes aegypti and Aedes albopictus mosquitos, but it also eliminated

other mosquitos present (Akhoundi et al, 2018). A field trap barrier system uses target specific

attractants which later kills them. The study was conducted from July 2016 to September 2016
and included 800 houses in France (Akhoundi et al, 2018). The trap barrier system being utilized

was BioBelt Anti-Moustiques (Akhoundi et al, 2018). The intervention was successful at

reducing the biting rate of mosquitos in houses with trap barrier systems (Akhoundi et al, 2018).

It also reduced the biting rates in nearby houses due to the spillover effect (Akhoundi et al,

2018). This intervention was based on the community level of the socioecological due to creating

an effect within a certain section of a city (Akhoundi et al, 2018).

An unsuccessful intervention is the use of insecticide treated school uniforms. The

intervention primarily focused on the organizational level of the socioecological model since it

was based out of local schools. At the beginning of the intervention, the insecticide treated

uniforms where highly effective, but after a couple washes the insecticide began to dilute

(Kittayapong et al, 2017). The insecticide used is called Permethrin which was not expected to

wash out when the study design was created (Kittayapong et al, 2017). After twenty washes, the

effectiveness of the insecticide was well below 20%. After seventy washes, the permethrin had

zero effect on neighboring mosquitos (Kittayapong et al, 2017). Another complication of the

study is that researchers do not know the long-term effect Permethrin may have on individuals

(Kittayapong et al, 2017). This study cannot be directly translated to intervening the effects of

zika since the effects of ZIKV are mostly affecting pregnant women.

Both of these interventions were not specifically geared towards prevention of ZIKV, but

they did target the main vectors which are Aedes aegypti and Aedes albopictus (Gubler et al,

2017). At the end of both interventions, they did include a brief discussion of the effect it may

have on ZIKV. Since the effects of Zika are fairly new, there are very few interventions which is

why vector-targeted interventions are being used rather than virus-targeted.

 The effects of ZIKV have already been seen in the past ten years, but what can be expected

from this actively mutating virus? Zika virus has been silently transmitting through certain

geographical regions, but now it is affecting hosts by creating neurological complications such as

GBS and microcephaly. ZIKV is a public health issue due to globalization, an actively mutating

genome, and the effect it might have on infants.

 References

Akhoundi, M., Jourdain, F., Chandre, F., Delaunay, P., & Roiz, D. (2018). Effectiveness of a

field trap barrier system for controlling Aedes albopictus: a “removal trapping” strategy.

Parasites & Vectors, 11(1), 101.

Gubler, D. J., Vasilakis, N., & Musso, D. (2017). History and emergence of Zika virus. The

Journal of infectious diseases, 216(suppl_10), S860-S867.

Fuller, T., Calvet, G. A., Estevam, C. G., Brasil, P., Angelo, J. R., Smith, T. B., & Di Filippis, A.

M. B. (2017). Environmental and Climatic Risk Factors for Zika and Chikungunya Virus

Infections in Rio de Janeiro, Brazil, 2015–2016. (Vol. 4, No. Suppl 1, p. S56). Oxford

University Press.

Kittayapong, P., Olanratmanee, P., Maskhao, P., Byass, P., Logan, J., Tozan, Y., ... & Wilder-

Smith, A. (2017). Mitigating diseases transmitted by Aedes mosquitoes: a cluster-

randomised trial of permethrin-impregnated school uniforms. PLoS neglected tropical

diseases, 11(1).

Hughes, R. A. (2012). Guillain-Barré Syndrome. Springer Science & Business Media.

Paixão, E. S., Barreto, F., da Glória Teixeira, M., da Conceição N. Costa, M., & Rodrigues, L. C.

(2016). History, epidemiology, and clinical manifestations of Zika: a systematic review.

American journal of public health, 106(4), 606-612.