Zika Virus - A Public Health Emergency of International Concern
The mosquito-borne Zika virus could infect an estimated 4 million people across the Americas this year, according to the WHO. The first local transmissions in South America were identified in May 2015, and since then cases have been reported in more than 20 countries in Latin America and the Caribbean.1
Concurrently, a rapid spike in the incidence of microcephaly in newborns has been observed in Brazil since the country’s outbreak of the Zika virus. Microcephaly is a devastating condition that means a baby is born with an abnormally small head because the brain has not developed properly. Babies born with it face a range of health and developmental problems.
By the end of January over 4,000 suspected cases of microcephaly had been reported in Brazil - more than 20 times the known average annual rate.2 According to the Centers for Disease Control and Prevention, microcephaly has ranged from 2 to 12 babies per 10,000 live births in the U.S.3 Brazil, where 8,000 new babies are born each day, would normally anticipate a few hundred cases each year.
However, not all recently reported cases of suspected microcephaly in Brazil are confirmed yet as being associated with the virus. Despite this, the circumstantial evidence and lack of effective vaccine has prompted the WHO to issue a rare global public health emergency declaration.
The main concern is for women who are, or might be, pregnant. It is thought microcephaly is a complication of intrauterine infection during the first trimester, meaning some women may not even be aware of their pregnancy at the point of infection. Countries have advised pregnant women against travel to affected areas.
In adults Zika’s brief symptoms include mild fever, skin rash and conjunctivitis. Most people don’t realise they are infected, making the virus difficult to track. There is a chance infection could cause patients to experience serious neurological complications, including meningitis, myelitis and Guillain-Barré syndrome.
Zika is primarily transmitted in bites from infected Aedes mosquitos. Sporadic outbreaks have occurred in the past where the insects are common: Africa, South Asia, Southeast Asia, Micronesia and Polynesia. Aedes mosquitos are also found in the Southern states of the U.S.
The same mosquito is a vector for Dengue, suggesting Zika could also spread in areas commonly affected by this virus, too, to parts of Australia, Southeast Asia, China, Sub-Saharan Africa and India.
The Aedes mosquito does not survive in northern countries, so local transmission within temperate climates is unlikely. However, people's travel from affected areas may explain reports of cases imported into Europe; perhaps their blood is freighted with the virus and insects are stowaways in their luggage. Blood transfusion is an obvious infection risk and there are questions about whether the virus is sexually transmitted.
In writing insurance in areas that are affected by the Zika virus and experiencing an abnormal rise in the incidence of microcephaly, it may be prudent to consider excluding benefits for congenital conditions in unborn children. After a full recovery from the virus, applicants for life insurance are not a risk unless there are indications of Guillain-Barré syndrome. Some Critical Illness products include partial or additional payments for Guillain-Barré syndrome, but where coverage is limited by definition to permanent conditions, there is no particular concern; infection with Zika is unlikely to cause long-term disability in adults.
- Pan American Health Organization / World Health Organization. Epidemiological Update: Neurological syndrome, congenital anomalies and Zika virus infection. 17 January, Washington, D.C.: PAHO/WHO; 2016