Zika in Africa: Rare birth defect on the rise in Angola

LUANDA/CHICAGO: Emiliano Cula starts to cry as his tiny fingers, curled into a tight fist, are stretched by a physical therapist to stimulate motor control.

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.

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.

“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.

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.

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.

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.

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.”

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.”