Dry drains will reduce the numbers of mosquitoes breeding, but now the Aedes aegypti mosquito is going underground to breed underground in available water and flying to feed. Credit: Zadie Neufville/IPS

By Zadie Neufville
KINGSTON, Jamaica, Apr 18 2017 (IPS)

There were surprised gasps when University of the West Indies (UWI) Professor John Agard told journalists at an Intergovernmental Panel on Climate Change (IPCC) meeting in late November 2016 that mosquitoes were not only living longer, but were “breeding in septic tanks underground”.

For many, it explained why months of fogging at the height of Zika and Chikungunya outbreaks had done little to reduce mosquito populations in their various countries. The revelation also made it clear that climate change would force scientists and environmental health professionals to spend more time studying new breeding cycles and finding new control techniques for vector insects.“Globally, we predict that over 2.17 billion people live in areas that are environmentally suitable for ZIKV transmission." --Dr. Moritz Kraemar

Jump to March 31, 2017 when the UWI and the government of Jamaica opened the new Mosquito Control and Research Unit at the Mona Campus in Kingston, to investigate new ways to manage and eradicate mosquitoes. Its existence is an acknowledgement that the region is looking for improved management and control strategies.

Agard was reporting on a study by the late Dave Chadee, a co-author on the IPCC Fifth Assessment Report and UWI professor. The study examined evolutionary changes in the life cycle of the Aedes aegypti mosquito, which spreads the yellow and dengue fevers as well as the chikungunya and Zika viruses.

“We found out that in higher temperatures, the mosquito’s breeding cycle shortens. They go through more cycles during the season and they produce more offspring. The mosquitoes, however, are a little smaller,” Agard told journalists.

Even more worrisome were Chadee’s findings on the longevity of the “evolved” mosquitoes – 100 days instead of the 30 days they were previously thought to survive. The study also found that mosquitoes that survived longer than 90 days could produce eggs and offspring that were born transmitters, raising new concerns.

Alarming as these findings were, they were only the latest on the evolutionary strategies of vector insect populations in the Caribbean. A study published in February 2016 revealed that the triatomino (or vinchuca), the vector insects for Chagas disease, were breeding twice a year instead of only in the rainy season. And before that in 2011, Barbadian Environmental officers found mosquitoes breeding in junction boxes underground.

Sebastian Gourbiere, the researcher who led the Chagas study, pointed to the need for regional governments to re-examine their vector control methods if they are to effectively fight these diseases.

“The practical limitations that the dual threat poses outweigh the capabilities of local vector teams,” he said in response to questions about the control of Chagas disease.

Caribbean scientists and governments had already been warned. The IPCC’s AR 5 (2013) acknowledged the sensitivity of human health to shifts in weather patterns and other aspects of the changing climate.

“Until mid-century climate change will act mainly by exacerbating health problems that already exist. New conditions may emerge under climate change, and existing diseases may extend their range into areas that are presently unaffected,” the report said.

Gourbiere agrees with Agard and other regional researchers that there is need for solutions that are primarily focused on vector controls: eradication and effective controls of the Aedes aegypti could also eliminate the diseases they spread.

The failure of the newest vector control strategies also forced health professionals to revisit the old, but proven techniques developed with the guidance of researchers like Chadee, whose work on dengue and yellow fever, malaria and most recently the Zika virus had helped to guide the development of mosquito control, surveillance and control strategies in the Caribbean.

And while Zika brought with it several other serious complications like microcephaly, which affects babies born to women infected by the virus, and Guillain Barré Syndrome, the threats also exposed more serious concerns. The rapid spread of the viruses opened the eyes of regional governments to the challenges of emerging diseases and of epidemics like ebola and H1N1.

But it was the World Health Organisation (WHO) that raised concerns about the status and possible effects of the Neglected Tropical Diseases (NTDs) – a group of communicable diseases including the Zika virus – which affect more than a billion people in 149 countries each year but for which there are no treatments.

NTDs include Dengue, Chic-V and Chagas Disease and until the last outbreak in 2014 that killed more than 6,000 people, Ebola was among them. In the previous 26 outbreaks between 1976 and 2013, only 1,716 people in sub-Saharan African nations were infected, WHO data showed.

Now the Caribbean is changing its approach to the study and control of vector insects. So while there are no widespread infections of Chagas disease, UWI is preparing to begin its own studies on the triatomino and the disease it transmits.

An addition to UWI’s Task Force formed just over a year ago to “aggressively eliminate” breeding sites for the Aedes aegypti mosquito, the Mosquito Unit is expected to build on Professor Chadee’s groundbreaking research.

“From dealing with the consequences of Chikungunya, Dengue and Zika on our population to managing the potentially harmful effects of newly discovered viruses, the benefits of establishing a unit like this will produce significant rewards in the protection of national and regional health,” UWI Mona Professor Archibald McDonald said at the launch.

Zika had been infecting thousands of people in Asia and Africa for decades before it made its devastating appearance in Brazil and other parts of Latin America and the Caribbean. Zika also made its way to the US and several European nations in 2016, before being confirmed in Thailand on Sept 30.

Not surprising, as in its 3rd AR, and most recently in the 5th AR the IPCC projected increases in threats to human health, particularly in lower income populations of mainly tropical and sub-tropical countries. Those findings are also supported by more recent independent studies including Mapping global environmental suitability for Zika virus, published by the University of Oxford (UK) in February 2016.

By combining climate data, mosquito prevalence and the socio-economic makeup of each region, researchers found the likelihood of the Zika virus gaining a foothold worldwide to be “extremely high”. The team led by Moritz Kraemer also concluded that Zika alone could infect more than a third of the world’s population.

The findings noted that shifts in the breeding patterns of the Aedes family of mosquitos allowed it to take advantage of newly ‘favourable conditions’ resulting from climate change. The environmentally suitable areas now stretch from the Caribbean to areas of South America; large portions of the United States to sizeable areas of sub-Saharan Africa; more than two million square miles of India “from its northwest regions through to Bangladesh and Myanmar”; the Indochina region, southeast China and Indonesia and includes roughly 250,000 square miles of Australia.

“Globally, we predict that over 2.17 billion people live in areas that are environmentally suitable for ZIKV transmission,” Dr. Kraemar said.

The Aedes aegypti mosquitoes’ efficiency at spreading diseases in urban areas and population densities are believed to be the main factors driving the rapid spread of the Zika virus. Other studies have found the Zika virus in 19 species of the Aedes family, with the Asian Tiger Mosquito (Aedes albopictus) – which has now spread its range to Europe –  likely another efficient vector.

Back in the Caribbean, Chadee’s findings on the adaptation of the Aedes aegypti mosquito from clean water breeders to breeding in available waters is expected to drive the development of regional strategies that are better suited to the evolving environment of a changing climate.

“Abortion shouldn’t be a crime” reads a sign held in one of the numerous demonstrations held in Brazil to demand the legalisation of abortion. Credit: Courtesy of Distintas Latitudes

By Mario Osava
RIO DE JANEIRO, Feb 8 2016 (IPS)

The Zika virus epidemic and a rise in the number of cases of microcephaly in newborns have revived the debate on legalising abortion in Brazil. However, the timing is difficult as conservative and religious groups are growing in strength, especially in parliament.

“We are issuing a call to society to hold a rational, generous debate towards a review of the law that criminalises abortion,” lawyer Silvia Pimentel told IPS.

Pimentel, one of the 23 independent experts who oversee compliance with the United Nations Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), defends the right to abortion in cases of “severe and irreversible birth defects”.

In Brazil, a 1940 law makes abortion illegal with two exceptions: when it is necessary to save the mother’s life or if the pregnancy is the result of rape.

A third exception, in cases of anencephalic fetuses -which have no brain – was legalised in 2012 as the result of a Supreme Court ruling based on the fact that they cannot survive outside the womb.

“This is different – microcephaly is not like anencephaly, in terms of surviving outside the womb; for the anencephalic fetus, the uterus serves as an intensive care unit; many even die before they are born,” said Clair Castilhos, executive secretary of the National Feminist Network for Health and Sexual and Reproductive Rights.

Microcephalic children, who are born with abnormally small heads, often have some degree of mental retardation, but they can survive.

“In these cases, we should discuss a woman’s right to decide whether to continue with the pregnancy, once she and her partner have been informed that their child could be born with serious difficulties,” said Castilhos, a pharmacist and biochemist who specialises in public health.

If the Supreme Court rules in favour of the right to abortion in cases of microcephaly, as women’s rights activists are seeking, “it would be a fourth exception,” she said.

“Although it wouldn’t be what we’re working for, which is the right for all women to decide whether to continue with a pregnancy, in any circumstances, rather than have an abortion as a ‘permissible crime’ in some cases,” she said in an interview with IPS.

But the approval of this “fourth exception” is unlikely.

Those opposed to making abortion legal, led by religious groups, argue that it violates the most basic of human rights, the right to life. They even protested the decriminalisation of abortion in cases of anencephalic fetuses, arguing that life begins at conception.

In their campaign over the social networks, they are now arguing that abortion of microcephalic fetuses amounts to “eugenics” or selective breeding, and compare those who defend the right to abortion in these cases to Nazis.

But Débora Diniz, a researcher at the Anis Bioethics Institute and the University of Brasilia, has argued in interviews and opinion pieces that eugenics occurs when the state intervenes in decision-making in an authoritarian manner, exercising control over women’s pregnancies, and not when the idea is for women to be free to make their own family planning decisions.

The Bom Jardim neighbourhood in Fortaleza, one of the big cities in Northeast Brazil, the region hit hardest by the Zika virus. The lack of sanitation and huge garbage dumps on the banks of rivers and stagnant water in containers everywhere offer ideal breeding grounds for the Aedes aegypti mosquito, which transmits Zika virus, dengue fever and the chikungunya virus. Credit: Mario Osava/IPS

Diniz forms part of a group of legal experts, feminists and other activists who plan to turn to the Supreme Court for a ruling on abortion in the case of microcephaly, in a repeat of the process they followed in the case of anencephaly, which began in 2004 and finally led to a verdict in 2012.

On Feb. 5, U.N. high commissioner for human rights Zeid Ra’ad Al Hussein urged Latin American governments to boost access to “reproductive health services,” including emergency contraception and abortion, given the spread of Zika virus in several countries of the region.

Between October – when the outbreak of microcephaly was identified as possibly linked to the Zika virus – and Jan. 30, there were 404 proven cases of microcephaly in newborns in Brazil. Another 3,670 cases are still being studied.

There have also been 76 infant deaths due to small brain size or central nervous system problems since October, but only five cases were confirmed as Zika-related while 56 are still under investigation.

Seventeen children were born with brain malformations proven to be linked to a mother’s infection with the Zika virus during pregnancy.

Zika virus, like dengue fever and the chikungunya virus, are spread by the bite of an infected Aedes aegypti mosquito.

The main symptoms of Zika virus disease are a low fever, an itchy skin rash, joint pain, and red, inflamed eyes. The symptoms, which are generally mild, last from three to seven days, and most people don’t even know they have had the disease, which makes it difficult to assess the actual number of cases.

The government does not even have estimates of the number of victims of the epidemic, and only recently gave instructions for mandatory reporting of the disease.

There were 1,649,008 cases of dengue registered by the Health Ministry in 2015, with 863 deaths, 82.5 percent more than in 2014. This virus is more widespread and more lethal, but it does not seem to have caused such alarm among Brazilians as Zika virus.

Microcephaly, which is only a threat in the case of pregnant women, has had a much bigger public impact.

Its link to Zika was established by Brazilian researchers.

The World Health Organisation (WHO) said a causal relationship between the virus and microcephaly has not yet been fully established.

Nevertheless, on Feb. 1 it declared the Zika virus and its suspected link to birth defects an international public health emergency.

In Brazil, only when unborn babies began to be affected was a decision reached to combat the spread of the Aedes aegypti mosquito. In late January, the government launched a campaign that mobilised 220,000 military troops and thousands of health ministry and other public employees, as well as the public at large.

Brazil will have “a generation of people who have been impaired” if the mosquito is not eliminated, said Health Minister Marcelo Castro, who has been criticised for making contradictory statements about the epidemic.

But a leading national voice on bioethics, Volnei Garrafa, complained to IPS that the government wants to hold society responsible for fighing the Aedes aegypti mosquito, without assuming its own responsibility for the lack of adequate sanitation and the “garbage and stagnant water everywhere,” which generate perfect breeding grounds for the mosquito.

He said that in the renewed debate on the right to abortion, it would be important to have a bioethics council, such as the ones that operate in Europe and in a few countries of Latin America, where abortion remains illegal except in Cuba, Uruguay and Mexico City, or under extremely limited circumstances (fetal malformation, rape, risk to the mother’s life) in most other countries.

Garrafa said that with the current composition of the national Congress, where evangelical and Catholic groups have a strong influence, the approval of measures moving – even gradually – in the direction of the legalisation of abortion is nearly impossible.

“Congress is no longer ‘national’, it is an inquisition tribunal, where religious beliefs prevail,” said Castilhos.

Proposals in parliament, rather than being aimed at easing abortion law, seek to restrict the right to legal abortion in cases of rape, creating humiliating requirements for the victims that make it practically impossible for them to obtain an abortion.

“The Supreme Court has been forced to fill the legislative vacuum, at the risk of eroding democracy through the mixing up of the branches of the state, with the judiciary legislating instead of parliament,” said Garrafa.

In the past few decades, the Supreme Court has handed down rulings on complex issues such as biosafety and stem cell research, where experts in jointly evaluating biological and ethical questions would help overcome or mitigate controversies, said Garrafa, the founder of several Brazilian and Latin American bioethics institutions.

In the current political context, the Supreme Court represents the hope for progress on sexual and reproductive rights, Pimentel, Castilhos and Garrafa all told IPS.

Against this backdrop, the outbreak of microcephaly is traumatic, but it also represents an opportunity for debate on abortion and the need for universal access to sanitation, they added.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

In the country’s capital, Brazilian President Dilma Rousseff oversees one of the military operations against the Aedes Aegypti mosquito carried out at a national level in the last few days to curb the spread of the Zika virus. Credit: Roberto Stuckert Filho/PR

By Mario Osava
RIO DE JANEIRO, Feb 2 2016 (IPS)

Brazil is deploying 220,000 troops to wage war against the Zika virus, in response to the alarm caused by the birth of thousands of children with abnormally small heads. But eradicating the Aedes aegypti mosquito requires battles on many fronts, including science and the pharmaceutical industry.

The Zika virus, transmitted by the Aedes aegypti mosquito, like dengue and Chikungunya fever, is blamed for the current epidemic of microcephaly, which has frightened people in Brazil and could hurt attendance at the Aug. 5-21 Olympic Games in Rio de Janeiro.

It has also revived the debate on the right to abortion in Brazil, where the practice is illegal except in cases of pregnancy resulting from rape, or when the mother’s life is in danger.

“Immediate measures to provide assistance to the mothers of newborns with microcephaly are indispensable,” said Silvia Camurça, a sociologist who heads SOS Body – Feminist Institute for Democracy. “Almost all of them are poor, and they are completely overwhelmed by this new burden, with no help in the household.

“Imagine a mother with more than one child, without a husband,” she told IPS. “Childcare centres are not prepared to receive children with microcephaly, who are now numerous and whose numbers will grow even more, with the children to be born in the next few months. It’s a desperate situation. Public assistance for these families is urgently needed.”

An increase in the number of unsafe back-alley abortions, which put women’s lives in danger, “is very likely, since many women know that there are no public policies to support them, and the situation is aggravated by the economic crisis and high unemployment,” said Camurça.

Pernambuco, the Northeast Brazilian state where her non-governmental organisation is based, has the highest number of suspected or confirmed cases of microcephaly, a rare birth defect.

As of Jan. 23, the Health Ministry had registered 1,373 suspected cases in the state, of which 138 have been confirmed, 110 were ruled out, and 1,125 are still being examined.

A total of 270 cases of microcephaly have been confirmed in Brazil and 3,448 suspected cases still need to be investigated. There have also been 68 infant deaths due to congenital malformations since October, 12 of which were confirmed as Zika-related and five of which were not, while the rest are still under investigation.

The main symptoms of Zika virus disease are a low fever, an itchy skin rash, joint pain, and red, inflamed eyes. The symptoms, which are generally mild, last from three to seven days, and most people don’t even know they have had the disease.

Brazil is at the centre of the debate on the virus because it is experiencing the largest-known outbreak of the disease, and because the link between the Zika virus and microcephaly was identified by the Professor Joaquim Amorim Neto Research Institute (IPESQ) in the city of Campina Grande in the Northeast – the poorest region of Brazil and the hardest-hit by this and other mosquito-borne diseases.

Explosive spread

On Monday Feb. 1, the World Health Organisation declared the Zika virus and its suspected link to birth defects an international public health emergency.

The WHO said the rise in the disease in the Americas is “explosive”, and predicted up to 1.5 million cases in Brazil and between three and four million cases in the Americas this year.

Spraying against the Aedes aegypti mosquito, which transmits the Zika virus and other diseases, has been stepped up in cities around Brazil. Credit: Cristina Rochol/PMPA

Although WHO Director General Margaret Chan said “A causal relationship between Zika virus and birth malformations and neurological syndromes has not yet been established,” in Brazil there are no doubts that the Aedes aegypti is the transmitter of the new national tragedy.

The government has mobilised the army, navy and air force against the epidemic, and is trying to mobilise the local population as well as state employees who make door-to-door visits as part of their job, such as electric and water utility meter readers.

The aim is to eliminate mosquito breeding grounds – any water-holding containers (tin cans, plastic jugs, or used tires) lying around the country’s 49.2 million households.

Mosquito repellent has been distributed to pregnant women. “But there are already shortages of repellent, and the ones that are safe for pregnant women are more expensive,” and less affordable for poor women, said Camurça.

The activist said another big problem is the lack of information and knowledge about epidemics. In Pernambuco, dengue fever – also transmitted by the Aedes aegypti mosquito – was under control, according to health officials, “but all of a sudden we’re the champions of Zika,” a contradiction that has yet to be explained, she complained.

The first confirmed case of Zika virus in Brazil came to light in April 2015, after which the disease began to spread like wildfire. It is now present in 23 countries of the Americas, according to the WHO.

Epidemiologists say the statistics available on diseases transmitted by the Aedes aegypti are insufficient because reporting the diseases was not mandatory, which led to under-reporting.

Now microcephaly, but not its causes, are reported, and the lack of reliable statistics from the past, and on related infections, make it more difficult to obtain clear data.

Microcephaly has a number of other causes, such as syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes and different infections.

Science is, however, another battlefront that could be decisive in this medium to long-term war. The hope is that efforts to develop a vaccine will be successful, at least to prevent the Zika virus’s most severe effect: microcephaly in unborn infants.

Research forges ahead

The Health Ministry’s Secretariat of Science, Technology and Strategic Inputs has played a key role in research on the Zika virus, encouraging studies in Brazil’s leading health research centres.

The head of the Secretariat, epidemiologist Eduardo Costa, believes Brazil could develop a vaccine, “despite the bureaucratic hurdles to the import of biological material and other inputs necessary to research, delaying it and driving up the costs.”

“It’s Brazil’s responsibility to produce a vaccine, and it’s something we owe Africa,” he told IPS.

Progress has been made in specialised centres, such as the Butantan Institute in the southern city of São Paulo, which is working on a vaccine that offers 80 percent protection against the four strains of dengue and could extend to the Zika virus. “Clinical tests are needed,” which are costly and take time, Costa said.

The Evandro Chagas Institute, of the northern Amazon state of Pará, is also making progress towards a medication that mitigates the effects of the Zika virus. And a University of São Paulo laboratory is researching possibilities offered by genetic engineering.

These Brazilian research centres have ties to universities or pharmaceutical companies abroad, and the resulting medications could be wholly produced in Brazil, in Bio-Manguinhos, the technical scientific unit that produces and develops immunobiologicals for the Oswaldo Cruz Foundation (Fiocruz), a leading Health Ministry research centre, said Costa.

Other technologies being tested in Brazil are aimed at curbing the breeding of the Aedes aegypti. One example is the Wolbachia bacterium, which can stop the dengue virus from replicating in its mosquito host. Fiocruz is releasing mosquitos with the bacterium in a Rio de Janeiro neighbourhood to infect other Aedes aegypti mosquitos.

Another initiative involves the release of genetically modified male mosquitos which produce offspring that die before they are old enough to start reproducing. Other studies have involved an insect growth regulator, pyriproxyfen, which disrupts the growth and reproduction of mosquitos.

In addition, new tests are needed to diagnose women with the Zika virus. The tests currently available must be carried out in the few days that the infection is active.

“A post-infection test is needed, to identify the lingering antibodies and offer more information about what the virus does,” Costa said.

Brazil eradicated the Aedes aegypti mosquito in 1954, in a campaign against yellow fever, the disease it spread back then, Costa pointed out. But the mosquito returned in intermittent outbreaks in the following decades, when it began to transmit dengue.

Now eradicating the mosquito is impossible, even for 220,000 soldiers, with the expanded repertoir of viruses it transmits, and today’s much more populous cities, with limited sanitation, endless amounts of garbage and containers of all kinds strewn everywhere. But technology and social mobilisation could at least help curb the mosquito population.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes