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Skip to 0 minutes and 12 seconds So microcephaly can have a wide and varying impact. So what will happen is that the child’s brain will not develop in the normal way; they are likely to have big intellectual impairments, and they will have difficulties learning and so on. But it can also be broader than that so some of the children also have difficulties with walking and moving and other kinds of functions. Microcephaly can also affect other organs. So there is some suggestion that the children have difficulties with seeing as well and all of that will become clearer as the kids become a bit older.

Skip to 0 minutes and 44 seconds And all of that means that they will likely have more difficulties doing a range of different things so in having friends and social interactions and talking in schools and attending school so that will impact later down their lives whether or not they can have jobs and so on. There’s also going to be a big impact on their families, the families who look after these children, both in terms of practically the amount of time that they will have to spend looking after children, but also emotional impact. Microcephaly was detected in Brazil for the first time– a big increase in microcephaly– and the suggestion was done very soon that it was a consequence of congenital infection, i.e.

Skip to 1 minute and 26 seconds the microcephaly was a manifestation of congenital Zika syndrome one of the manifestations. But microcephaly was easy to identify and that was used for surveillance, and it started with a few doctors noticing small increases– I had two babies with microcephaly in a month I only have one a year normally– and they start talking the neurologists receiving the cases reported to the Department of Health, they reported to the Ministry of Health, who then called a meeting. And by that time it was clear there was a big increase in microcephaly.

Skip to 2 minutes and 5 seconds How to take it from there it was a new disease, and there were hypotheses in how to investigate, so the first steps were to define what was going to be notifiable. So they set up a special notification system, and it was babies with microcephaly in utero or at birth. But they also notified pregnant women with a rash, which was a very sensible thing to do because it allowed monitoring the occurrence of the epidemic. They also set up notifications for Guillain-Barré. And then the question was how to identify causality how do we know that this is really congenital Zika syndrome? There was a lot against it there’s never been a flavivirus or a mosquito transmitted virus causing congenital infection.

Skip to 2 minutes and 56 seconds That was new, so we have to go beyond that it never happened before, therefore that’s not it, and it’s in fact the last time there was an epidemic of congenital infections were rubella and to a certain degree cytomegalovirus, but it’s never been anything like this. Who declares causality? So some interesting aspects one is the Brazilian government decided there was a causal link between Zika and microcephaly in November. But the rest of the world was more reticent and were looking for for more evidence and then of course the evidence it was both laboratory findings and a very strong evidence is the finding of microcephaly in countries that had an epidemic of Zika but haven’t at the time detected.

Skip to 3 minutes and 49 seconds So when Brazil said we think it’s microcephaly is caused by Zika, Then the question was why wasn’t any microcephaly in the French Polynesia where there was a big outbreak? And then they went back and looked and found; and I think that’s a beautiful example of proposing a hypothesis and testing the hypothesis. So I think that was very strong evidence– for me that was the evidence that clinched it and I think what’s interesting is how the degree of certainty was changing during the process. So when the public health emergency was declared they said there’s a strong suggestion, there is no proof of causality, but we cannot find any other hypothesis so let’s take public health actions based on that.

Skip to 4 minutes and 35 seconds And as evidence was slowly accumulating, you can look at every situation report from WHO how their language was changing slightly becoming more and more

Skip to 4 minutes and 48 seconds convinced of the strength of the evidence and then the last sentence said there is a scientific consensus that the link is causal. So I think that’s a that’s a very interesting process to look at. The impact of microcephaly on the children and their families will probably be quite big and that will have a wider impact on the community and society in general. So those children have rights, they have the right to attend school they have the right to healthcare they have the right to be involved in the job market and so on. So communities and society will have to adapt to welcome them and be able to include them in those activities.

Skip to 5 minutes and 31 seconds Those children are likely to have quite big healthcare needs and so they will that will impact on the health services which will also have kind of costs attached to that. The families may have to adapt their lives because of the baby that they have so they may have to take time out of the job or work in a different way so that they can look after their baby as childs grow up and there might be adaptations needed there. And an overall economic cost that comes from these babies.

Skip to 6 minutes and 3 seconds A lot of the Zika focus and attention has been on prevention of Zika, on how to try and diagnose Zika, how to stop the mosquitoes and so on and that’s very important, but at the same time attention needs to shift towards the needs of the babies and their families born to Zika infected mothers and attention needs to be given there to work out how to best meet those needs which may also require more research and attention. And just providing physiotherapy, which is often what is being done at the moment, will not really meet the needs of those children and their families. More will need to be done.

Microcephaly and congenital Zika syndrome

The tragic link between Zika virus and cases of microcephaly in newborns has now been confirmed, while a range of other birth defects are being explored and collectively termed as congenital Zika syndrome. Here Dr Hannah Kuper and Professor Laura Rodrigues, who works with the Microcephaly Epidemic Research Group (MERG) in Brazil, reflect on what a case of microcephaly can mean for babies and their families, in addition to how the links between Zika and microcephaly in the recent outbreak were initially recognised, investigated, and later agreed upon by world organisations.

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