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Running head: ZIKA VIRUS
Zika Virus
Tracey Wilson
Abstract
There are many viruses know to infect humans and new ones are discovered each year. Zika
virus, though not a new virus, has resurfaced in the past one to two years and is leaving its mark,
neurological disorder. Many factors contribute to virus outbreaks as these things do not just
issues all play a role. Health organizations have made recommendations to protect us from
further spread and a vaccine is being worked on. It is hoped that the world will listen and work
Introduction
Viruses are biological agents that need a host to replicate. They are so small that they can
only be seen under a microscope. There are 219 viruses that are known to be able to infect
humans and about three to four new species are still being found each year (Woolhouse, Scott,
Hudson, Howey, Chase-Tapping, 2012). Some virus names we are familiar with such as
measles, mumps, and chickenpox. Other viruses are hard to say such as dengue and
chikungunya; then there are ones that strike us with fear like HIV/AIDS, Ebola and now Zika
virus.
Zika is not a new virus. According to the World Health Organization (2016), it was first
identified in Zika Forest, Uganda in 1947. Researchers from the Rockefeller Foundation were
studying yellow fever using monkeys and upon analysis of their blood, something new was
discovered. It was new in 1947, but had likely been present and undetected for ages (Quammen,
2016). No major outbreaks occurred until 2007; on the island of Yap and then again in 2013-14
in French Polynesia and some other islands in the Pacific. It was in 2015 that Brazil confirmed
Zika virus circulating in the country and began to see an increase in microcephaly among
The question arises as to how a virus found in monkeys is now found in humans in many
parts of the world and the answer is a small one. The virus is spread primarily through the bite of
an infected Aedes mosquito, Aedes aegypti, also called the yellow fever mosquito and Aedes
albopictus, also known as the Asian tiger mosquito (Quammen, 2016). To narrow it down
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further, only female mosquitoes bite people as they need blood to lay eggs. These mosquitoes
breed in stagnant, standing pools of water and usually bite in the daytime (McNeil, Saint Louis &
St. Fleur, 2016). Other forms of transmission can be through sexual contact and through blood
Most people who are bitten do not even know that they have been infected as they do not
develop symptoms. If someone does become ill, symptoms include fever, rash, joint pains,
muscle pains, headache and blood-shot eyes (Vittor, 2016). No deaths have been reported and
the symptoms are like a number of bug bites or minor illnesses such as a cold or flu. If the
aforementioned symptoms were all we had to worry about, the virus would never have been
looked at twice.
Zika has been linked to an increase in cases of microcephaly, so those particularly at risk are
pregnant women or women who may become pregnant (CDC, 2017). Microcephaly is a nervous
system disorder in which babies are born with unusually small heads. As with any disorder,
there are various forms ranging from mild to severe. Zika virus appears to cause a severe form
of microcephaly where the brain stops growing, is small and smooth, lacking the normal
indentations otherwise known as gyri and sulci. These children may also be blind and/or deaf as
the long nerves connecting the eyes and ears to the brain are damaged. Constant seizures and
permanently rigid limbs can also occur (McNeil et al., 2016). This is a rare disorder usually
occurring in 1 in 5,000 to 1 in 10,000 births. Brazil had a total of 3,530 suspected microcephaly
cases by January 2016. Widespread transmission of Zika virus was recognized in Brazil in late
2014, and in October 2015, an increase in the number of microcephaly cases were reported
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Viruses do not necessarily choose a certain population to affect. Many factors come
together to set the stage for an outbreak. Unfortunately, the low and middle income countries are
usually the ones hardest hit as there is not enough money available to help with prevention or
education. Vittor (2016) explains it well using the Swiss cheese model. Swiss cheese has holes
of varying sizes and shapes, the problem occurs when the holes align.
The first factor is a fertile environment for the mosquitoes. As countries are becoming
more industrialized and life is transitioning more toward cities, we need to improve sanitation.
These mosquitoes breed in standing pools of water, be it big or small. The reservoir could be as
large as a pond to as small as a bottle cap (Vittor, 2016). Many low-income countries have fast
growing cities and populations with trash piling up such as old tires, barrels, buckets, pots and
empty cups which collect water. These should be emptied and disposed of. Environment and
climates are also changing. Our world is getting warmer and this increases the areas where the
The second layer features the mosquito. Just as people move up and out, so do the bugs.
With the growth of cities, poor sanitation, warmer climates, advanced transportation, frequent
flyer miles and efforts to eradicate mosquitoes starting and stopping due to money and politics,
the mosquito vector is expanding its territory. As new living conditions are discovered, the
mosquito finds new sources of food; unsuspecting people never exposed to the virus it carries
which brings us to the third layer, susceptible hosts. By crossing the Pacific into South America,
the virus can now circulate for a long time as well have no immunity.
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The final layer is introduction of the virus. This is a hard thing to prove, but it is thought
that the increase and ease of air travel is to blame (Vittor, 2016). When all of this is stacked
Because of what has been reported and seen, the World Health Organization issued
recommendations for protection and prevention, the biggest having to do with sexual
transmission of the virus. For areas with active transmission of Zika virus, WHO (2016)
recommends sexually active men and women have counseling and receive information about the
risks of sexual transmission of Zika virus. In addition, contraceptive methods should be offered
so choices can be made about becoming pregnant and those who are pregnant need to practice
safer sex by correctly using condoms or abstaining from sex for the entire pregnancy. For areas
where there is no active transmission of Zika virus, but individuals are returning from areas
where there was transmission, WHO again recommends safer sex or abstinence for six months
for men and women. Protection recommendations include wearing protective clothing such as
long sleeves and covering up as much as possible; using insect repellents containing DEET,
IR3535 or icaridin; utilizing physical barriers such as screens in windows, closing doors and
These recommendations seem reasonable and do-able for individuals in high income
countries where money is available as well as education, freedom of choice and equality. This is
not the case in low and middle income countries, especially Brazil. Brazil is a large country in
Latin America. Within this nation, there are many groups of people. They are indigenous
people, Africans brought over as slaves and European settlers. All these people have their own
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cultural beliefs and values. Religion is a big part of ones culture. The Roman Catholic Church
has a great deal of influence over the people of Brazil (Howells & Pieters, 2016). Throughout
the Churchs history, their stance on contraception and abortion has been one of condemnation.
Abortion is considered murder in the eyes of the Church as well as the law. The Churchs
influence flows over to the schools as well. There is very little sex education, if any at all
(Howells & Pieters, 2016). This has a large impact on the spread of Zika virus as we already
know it can be transmitted sexually. No matter how much information is given out and certain
practices suggested, if it goes against the Church, the law of the land and ones cultural beliefs it
will fall upon deaf ears. To affect change in health behaviors, we look at various models or
theories and this instance may warrant an ecological perspective. Skolnik (2016, pg. 151) tells
institutional, community and public policy. With the information gathered by the WHO and the
CDC, an educational plan can be established. Howells & Pieters (2016) tell us Zikas rise has
prompted an ethical reconsideration by the Catholic Church. Looking at what this virus can do,
Pope Francis has even hinted that the Church would allow birth control to prevent pregnancy in
the areas affected. Members of the health organizations need to meet and work closely with the
local officials and churches so education can be delivered to the community on the importance of
sex education and the use of condoms that will help keep people healthy, prevent spread of
disease and pregnancies resulting in babies suffering from microcephaly. Individuals hear what
is going on and what can be done. They talk with family and friends. Institutions such as
schools and churches buy into the program, condone the actions needed. Education is then
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implemented in the communities with the Catholic Churchs blessing alleviating peoples fear of
displeasing God. Governments and leaders help to change policies and laws.
As mentioned, the WHO and the CDC have issued recommendations for protection.
Governments and humanitarian groups need to help implement change to protect populations.
The United Nations established a list of 17 Sustainable Development Goals or SDGs. The
emergence of Zika virus highlights the importance of three. SDG 3 wants to ensure healthy
lives and promote well-being for all at all ages (Beyond 2015, n.d). Governments need to
consider spraying insecticides to kill the mosquitoes which would also help with other mosquito-
borne viruses. In past decades, there were mosquito eradication campaigns in Latin America and
in recent years mosquito control programs in North Carolina. These programs worked well and
when the mosquito population decreased so did the efforts causing a resurgence in mosquitoes
once again. This needs to be implemented again; however, this costs money that some countries
simply do not have (Sifferlin, 2016). Perhaps with the help of outside agencies and aid,
governments could purchase nets to help if eradication programs are too expense.
Education is important as the WHO and CDC are recommending decreased travel for
women considering pregnancy and safer sex or abstinence for at least six months or the duration
of pregnancy. For those living in the countries with Zika virus, this can prove to be a daunting
task. Access to healthcare where contraception may be available and money to purchase
condoms may not be a high priority. In addition, the standing of women in many cultures and
countries of this world is not strong. They are uneducated, poor and have no voice. In this
instance, we need to look at SDG 5 which is to achieve gender equality and empower all women
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and girls (Beyond 2015, n.d). When women are given a voice, and are educated, they will be able
to achieve great things and control over their body is a start. SDG 6 talks about clean water and
sanitation for all. Educating people on removal of bulk trash, debris and emptying standing
Clinical Interventions
When any virus presents itself, and causes an outbreak, we want to ease the suffering and
pain seeking testing and treatment. Right now, there are no commercial diagnostic tests for
Zika, so unless youre pregnant or a traveler with symptoms, your doctor may not test
you (Sifferlin, 2016). Pregnant women are the exception and should be tested if they have
traveled to any of the 44 countries where Zika has spread. In addition, there are no approved
drugs or vaccines for Zika. This is not to say that vaccine development is not under way.
Sifferlin (2016) states that scientists with the National Institute of Health (NIH) are working with
a vaccine initially made for West Nile virus and hope to launch a safety trial for it. Bharat
Biotech, an Indian firm working on a vaccine, has shown 100% efficacy against mortality and
disease in animal studies. Mice were given two doses of the vaccine on days 0 and 21 and
protection against Zika virus was seen 7 days after the second installment (Prasad, 2017).
Until the time that a vaccine is perfected and mass produced, counseling and education is
the key to success in decreasing spread of Zika virus. Most of the topics have been mentioned
such as safe sex or delay in having children and continued interventions such as insecticides to
eradicate the mosquitoes and prevent relapse in population growth. I will also add that education
and empowerment for women to allow freedom of choice as well as improved nutritional status
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which can off-set neural tube defects and other disorders of the nervous system in fetuses is very
important. Finally, we may need to decrease travel as our ability to travel to far-off places allows
us to see many things, but also to become exposed to conditions and viruses we are not prepared
for.
Conclusion
organizations. Think about where we are traveling and know what risks are present. Talk with
your doctor about protection. As nurses, we need to educate the public to be more aware of their
surroundings and do not allow breeding grounds to form for mosquitoes. Sign up to go on a
mission trip to help low income countries and truly see what they must face each day. If you
cannot give your time, there are various humanitarian groups who always accept donations. We
have our job cut out for us, as what was once viewed as a large world, now seems quite small.
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References
development-goals-sdgs
Centers for Disease Control and Prevention. (2017). Zika Virus. Retrieved from
https://www.cdc.gov/zika/
McNeil, D., Saint Louis, C., & St. Fleur, N. (2016, July 29). Short Answers to Hard Questions
About Zika Virus. The New York Times. Retrieved from https://nyti.ms/2jRss62
Prasad, R., (2017, April 17). Indian firms Zika virus vaccine 100% efficient in animal
firms-zika-virus-vaccine-100-efficient-in-animal-trials/article18081782.ece
Quammen, D. (2016, January 18). Why Zika Is This Years Scary Virus. National Geographic
defects-brian-damage-history-science/
Sifferlin, A. (2016, May 4). 10 Zika Facts You Need to Know Now. Time Health. Retrieved
from http://time.com/4318624/zika-virus-and-birth-defects-what-you-need-to-know/
Skolnik, R. (2016). Global Health 101 (3rd ed.). Burlington, MA: Jones & Bartlett Learning
Vittor, A. (2016, January 17). Explainer: where did Zika virus come from and why is it a
https://the conversation.com/explainer-where-did-zika-virus-come-from-and-why-is-it-a-
problem-in-brazil-53425
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Woolhouse, M., Scott, F., Hudson, Z., Howey, R., Chase-Topping, M., (2012, October 19)
Human viruses: discovery and emergence Philos Trans R Soc Lond B Biol Sci. 2012 Oct
World Health Organization. (2016, September 6). Zika Virus. Retrieved from
www.who.int/mediacentre/factsheets/zika/en/