We are 30 days away from the start of the 2016 Summer Olympics in Rio de Janeiro, Brazil. The anticipation is building as we wait for the world’s elite athletes to compete against each other to bring glory and pride to their home countries.
Although we see beautiful photos and advertisements for the Olympics, as seen here, there’s a different reality taking place in Rio and the surrounding country.
We’ve mostly seen the good news about the sports facilities and qualifying athletes but we have hardly heard about the worst recession Brazil has had in decades that has now left the country broke, the precarious subway extension that could fail to open and cause severe traffic problems during the Olympics, the governmental turmoil and instability that includes presidential impeachment, or the recent police protests due to a lack of resources and wages, which raise security concerns for the Games.
Although we could continue to discuss these problems and their implications, this is a public health blog. As such, we will discuss the public health problem that persists in Brazil and could affect the thousands of visitors this August: the Zika virus.
The Zika virus was first identified in 1947 in the Zika Forest of Uganda. It resided in non-human primates, like the rhesus monkey, and it eventually spread throughout other African countries. The first cases of Zika virus in humans were reported as early as 1954. In the 1960s, Zika was confirmed in Asian countries like Malaysia. Until 2007, there were only 13 confirmed cases of Zika virus in humans from Africa and Asia.
In 2007, the virus spread to the Pacific Island of Yap State, which belongs to the Federated States of Micronesia. In all, there were 50 confirmed Zika cases on the island and over 100 were considered probable cases. Serological testing of the confirmed patients linked this particular strain of Zika to similar strains from Africa.
After a few more outbreaks in the Pacific islands, we learned about a sudden outbreak of Zika in Brazil in 2015. It’s thought that athletic events like the World Cup hosted by Brazil in 2014 or canoeing championships also hosted by Brazil in 2014 might have attracted visitors from Asian countries where Zika was already endemic.
These visitors, who may have been positive for the virus when they came to Brazil, might have spread the virus when mosquitoes landed on them to take in a blood meal. When mosquitoes suck up blood from these Zika-carrying visitors, the mosquitoes suck up Zika-infected blood. These mosquitoes are able to transmit the virus to Brazilian locals when they land on their exposed skin to take in the next blood meal. The locals can then infect other mosquitoes, which can infect other humans in other areas… the cycle would continue in this manner.
This is how viruses can become endemic in an area. By using mosquitoes, or arthropods, as vectors for carrying the disease, viruses like Zika can spread rapidly and effectively through a population. This is why Zika and others like it (i.e. dengue, West Nile Virus, and Chikungunya) are called arboviruses (arthropod-borne viruses).
The mosquitoes that commonly carry Zika are the same ones who also commonly carry Chikungunya and dengue. The Aedes aegyptii and Aedes albopictus mosquitoes are native to warm, tropical climates and can breed in nearly any surface that contains stagnant water (i.e. unused tires, tropical plants, rain gutters, trash cans, bird baths, etc.).
One way to help prevent mosquito reproduction is to regularly empty containers that collect water. People can also use insect repellent, screens on their windows, and nets over their beds to keep mosquitoes from biting.
It’s also worth mentioning that there is mounting evidence to suggest a potentially new route of Zika transmission: sex. There is much research to be done in this area, but studies have reported high viral loads in semen samples from men who have been infected with Zika.
Many Zika-positive cases are asymptomatic. However, symptomatic Zika is generally a self-limiting disease that causes fevers, rash, and joint pain. When it was confined to Asia and Africa, patients did not need hospitalization and deaths were rare. As the disease progressed through some of the Pacific Islands, hospitalization for Guillian-Barré Syndrome and other abnormalities were reported.
When Zika landed in Brazil, we became aware of microcephalic babies who were born from mothers infected with Zika. Microcephaly is a condition where the brain is underdeveloped, which results in a small head and could lead to long-lasting health and developmental problems.
In the meantime, Zika has spread like wildfire throughout Central and South America. On June 29th, 2016, WHO reported that over 67 countries and territories are currently experiencing an outbreak of mosquito-borne Zika virus.
As we reach the climax of this Zika epidemic in less than a month, we turn now to what the World Health Organization (WHO) and other organizations are doing to prevent the spread of Zika.
In order to implement WHO’s long-term Zika Strategic Response Plan, which is set to take effect July 2016 through December 2017, an estimated budget of $221 million US dollars is needed to effectively carry out the plan. It’s very involved, but it still seems to gloss over the fact that the Olympics are taking place in the epicenter of this epidemic.
So for the short-term response, we turn back to the Olympics to see what WHO and Brazil are doing to prepare for the Games in August.
The following is an excerpt from the International Health Regulations Emergency Committee from June 16, 2016, that considered all the evidence from the Zika outbreak in Brazil:
“The Committee reaffirmed its previous advice that there should be no general restrictions on travel and trade with countries, areas and/or territories with Zika virus transmission, including the cities in Brazil that will be hosting the Olympic and Paralympic Games.”
Although globalization and travel seem to be responsible for spreading Zika to the Western hemisphere and to this day continue to facilitate the transmission to other parts of the world, the Emergency Committee feels strongly that this should not prompt international trade or travel concerns. The Committee goes on to say:
Brazil should continue its work to intensify vector control measures in and around the cities and venues hosting Olympic and Paralympic Games events, make the nature and impact of those measures publicly available, enhance surveillance for Zika virus circulation and the mosquito vector in the cities hosting the events and publish that information in a timely manner, and ensure the availability of sufficient insect repellent and condoms for athletes and visitors.
Speaking of condoms, the International Olympic Committee stated will provide over 450,000 condoms to the 10,500 Olympian athletes. They even provided a breakdown of the distribution: 100,000 female condoms, 350,000 male condoms, and 175,000 packets of lube. If we just calculate the distribution to the 10,500 athletes, that’s about 10 female condoms, 33 male condoms, and 16 lube packets per person. These numbers are staggering in comparison to the mere 150,000 condoms usually given to athletes at the Olympic games (condom distribution started in the Barcelona Olympics in 1992 to prevent the spread of AIDS). Ironically, the São Paulo newspapers in Brazil denied that the increase in condoms is related in any way to the Zika virus. Whether this staggering condom influx promotes sexual behaviors to a risky level or just anticipates that athletes will have a really good time at the Olympic village with each other, we’ll let you draw the conclusions.
Regarding insect repellent, Brazil announced its partnership with Off! bug spray repellent two days ago. Off! will distribute about 115,000 bottles of repellent to athletes, staff, and volunteers. Visitors can have free samples at the events.
Some athletes aren’t convinced by the preventive measures Brazil and WHO are taking, despite WHO’s reassurance that there is little to no risk of contracting Zika during the Olympics. For example, pro-golfer Rory McIlroy and cyclist Tejay van Garderen both pulled out of the Olympics because of Zika concerns. Then again, these are people who would have participated in individual events. Athletes in team sports don’t have as much freedom to decide their participation, and many can’t afford missing out on a potential pay increase, publicity, and of course, the glory of the Olympics.
Zika is sinister and insidious in that it affects our offspring. It interferes with our reproduction – one of the most basic and natural human functions. Zika can literally incapacitate our children in the most severe and challenging ways. With no treatment or vaccines for the virus, we need to be extremely cognizant of the disease and how it can affect us.
A study by the National Institutes of Health (NIH) will observe pregnant women in Puerto Rico, Brazil, and other affected areas to more closely evaluate the health threats Zika can cause in mothers and their unborn babies. This kind of study is prospective, which means it will take quite a while as researchers monitor the entire pregnancy and the baby’s first few years outside the womb. They also want to observe the effects of the environment on gestation and the mother’s socio-economic status throughout pregnancy. Similarly, the Center for Disease Control & Prevention (CDC) is also running a study on 320 U.S women confirmed with Zika virus.
Until then, we watch and wait for the maelstrom that is the 2016 Summer Olympic Games in Rio de Janeiro, Brazil. We should be excited for the Olympics and we continue to hope nothing will go wrong. But we must realize we are sending athletes and encouraging civilians to step into a country where Zika is a national problem. We must remember Zika is listed as a public health emergency of international concern that garnered attention from everyone around the world. As much as we want to experience this global event in Rio, we need to be cautious about our health.
Researchers and governments are not taking this outbreak lightly, but it seems we have made an exception for one month for the world to gather and take its chance with Zika. So we do what we can, we wait, and we watch.