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Running head: ZIKA VIRUS

Health Impact Framework/Research Paper

Zika Virus

Delaware Technical Community College

NUR 310 Global Health

Tracey Wilson

April 30, 2017



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,

particularly in Brazil. This is evidenced by a significant increase in microcephaly cases, a rare

neurological disorder. Many factors contribute to virus outbreaks as these things do not just

happen. Changing environment, climate change, urbanization, overcrowding and sanitation

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

together to truly promote healthy lives and well-being for all.



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


Origins, Transmission, Effects and Complications

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

newborns and reports of Guillain-Barre syndrome (World Health Organization, 2016).

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

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

transfusion which is being investigated (WHO, 2016).

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.

Serious complications have come up as mentioned previously, particularly in Brazil.

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

leading to the 2016 total (CDC, 2016).

Socioeconomic factors Leading to an Outbreak

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

mosquitoes can thrive.

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.

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

together and the holes are in alignment, an outbreak is sure to occur.

Changing the Context to Make Individuals Default Decisions Healthy

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

windows and sleeping with mosquito nets (WHO, 2016).

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

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

us health behaviors occur at several levels. They include individual, interpersonal,

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

implemented in the communities with the Catholic Churchs blessing alleviating peoples fear of

displeasing God. Governments and leaders help to change policies and laws.

Long-Lasting Protective Interventions

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

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

containers will reduce the possible breeding grounds for mosquitoes.

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).

Counseling and Education

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

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



In conclusion, the best thing we can do is follow recommendations issued by health

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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