Zika's Impact On Belize: Understanding The Numbers

Belize has a history of Zika virus transmission, with the country being declared endemic in certain regions, particularly on the island of Caye Caulker. However, there is currently no evidence of an ongoing Zika outbreak, and the number of reported/suspected cases of Zika in 2017 peaked at around 165 cases, with 45 of these being confirmed.

The Zika virus is transmitted by the female Aedes aegypti and Aedes albopictus mosquitoes

Both Aedes aegypti and Aedes albopictus pose significant challenges for mosquito control efforts. They are active during the daytime, which requires different control strategies compared to nighttime-biting mosquito species. Additionally, their eggs are highly resilient and can survive for extended periods, even when dried out. These factors contribute to the difficulty in preventing the spread of the Zika virus in affected areas.

The Zika virus is a significant health concern, especially for pregnant women, as it can be transmitted from a pregnant woman to her fetus. The virus is associated with neurological complications such as Guillain-Barré syndrome and microcephaly in infants born to infected mothers. While most cases of Zika infection are asymptomatic, some individuals may experience mild fever, headache, muscle and joint pain, nausea, vomiting, and a skin rash.

To protect against the Zika virus, it is crucial to take meticulous measures to prevent mosquito bites, especially during the daytime when Aedes aegypti and Aedes albopictus mosquitoes are most active. This includes using insect repellents, wearing protective clothing, and eliminating standing water sources where mosquitoes can breed. For pregnant women or those considering pregnancy, it is recommended to consult a healthcare practitioner before travelling to areas with a risk of Zika transmission.

The Zika virus can also be transmitted from a pregnant woman to her foetus

While there is no evidence of an ongoing Zika Virus outbreak in Belize, the country has a history of Zika Virus transmission. The Zika Virus is primarily transmitted by infected daytime-biting female Aedes aegypti and Aedes albopictus mosquitoes. However, it is important to note that the Zika Virus can also be transmitted from a pregnant woman to her foetus, which can have severe consequences.

The Zika Virus can be transmitted from a pregnant woman to her foetus during pregnancy, known as congenital transmission, or around the time of birth, referred to as perinatal transmission. Congenital transmission occurs when a pregnant person is infected with the Zika Virus before delivery, allowing the virus to pass to the foetus. Perinatal transmission happens when a pregnant person is infected within approximately two weeks of delivery, resulting in the virus passing to the infant at or around birth.

The consequences of Zika Virus transmission from mother to foetus can be severe and may lead to congenital Zika syndrome (CZS) in the infant. CZS encompasses a range of developmental problems and birth defects, including microcephaly (a smaller than normal head size), severe brain defects, eye defects, hearing loss, limb contractures, high muscle tone, and problems with joint and limb movement. Studies indicate that around 5-10% of babies born to people infected with the Zika Virus during pregnancy will suffer from birth defects related to the infection. The risk of congenital malformations is highest during the first trimester but can also occur during the second and third trimesters.

In addition to congenital malformations, Zika Virus infection during pregnancy can also increase the likelihood of other adverse pregnancy outcomes. These include miscarriage, stillbirth, preterm delivery, small for gestational age, and low birth weight. Furthermore, infants born without apparent effects from Zika Virus infection may subsequently exhibit slowed head and brain growth (postnatal microcephaly) or experience developmental delays or epilepsy.

Due to the potential risks associated with Zika Virus infection during pregnancy, it is recommended that pregnant travellers seek counselling from a travel medicine specialist and carefully consider the hazards associated with travelling to areas where the Zika Virus is present. Preventative measures, such as mosquito bite precautions and safe sexual practices, are crucial to minimising the risk of Zika Virus transmission.

The Zika virus is associated with neurological complications such as Guillain-Barré syndrome and microcephaly in infants

Guillain-Barré syndrome is an acute, immune-mediated polyneuropathy affecting mainly the peripheral nerves and often following a prior infection. Several reports have described a probable, temporal association between the exponential increase in the number of GBS cases and Zika virus infection in areas of recent Zika virus outbreaks. The Zika virus has also been suggested to trigger other severe neurologic complications in adults, including meningoencephalitis, transverse myelitis, and acute disseminated encephalomyelitis.

Meningoencephalitis is a well-known and common presentation of Japanese encephalitis and West Nile virus infections, but it is, surprisingly, a relatively rare complication involving other flaviviruses, including the Zika virus. The patients affected with meningoencephalitis present clinically with progressive somnolence, seizures, and focal deficits, and in rare cases, their condition may evolve into deep coma or brain death.

Acute transverse myelitis can also be identified as diffuse lesions with varying sizes that may affect any portion of the spinal cord. Contrast enhancement may be seen in acute lesions. The spinal cord may be enlarged due to edema.

Microcephaly is the most severe outcome of infants who develop Zika virus-induced microcephaly. Infants who develop Zika virus-induced microcephaly show recurrent seizures, and severely compromised neuropsychomotor development is frequently reported. Several alterations were described after brain tomography of babies congenitally exposed to Zika virus, including widespread calcifications, cerebral atrophy, brainstem and cerebellar hypoplasia, as well as ventriculomegaly.

The Zika virus is present in Mexico, Central America, South America, the Caribbean, tropical areas of Southeast Asia, Oceania, and parts of Africa

The Zika virus is a global threat and a major public health issue in Latin America and the Caribbean. The virus has also been observed in other regions, including Southeast Asia, Africa, Mexico, Central America, South America, and Oceania.

Southeast Asia

Zika virus infections in humans have been observed in Southeast Asia, where arboviral diseases are very common. The first report of Zika in the region was in 1981 in Indonesia. Since then, there have been several reports of travellers contracting the virus in Indonesia, including one interesting case of a traveller who may have contracted the virus from a macaque monkey bite. Singapore, as the smallest country in the region, has also seen the potential for Zika transmission, although no human cases have been reported. No information is available for Brunei and Timor-Leste, while other countries in the region, such as Myanmar, Laos, and Vietnam, have not published any reports on Zika infections.

Cambodia, Thailand, and Malaysia have all seen Zika infections, with the first report in Thailand in 2014. There have also been cases of travellers returning from Thailand and Malaysia with Zika infections. The Philippines, an island country close to the Yap Islands, where a major Zika outbreak occurred, has also confirmed Zika infections.

Africa

Zika was first discovered in Uganda in 1947, circulating between primates and mosquitoes. From the 1960s to the 1980s, the African lineage of the virus caused sporadic infections in several African countries, with mild symptoms such as low fever.

Mexico, Central America, and South America

Mexico and several countries in Central and South America have reported Zika infections. These include Belize, Brazil, Colombia, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Peru, and Venezuela.

Oceania

Zika infections have been observed in travellers returning from Oceania, specifically the Yap Islands in Micronesia, where a major outbreak occurred.

The Belize Ministry of Health (MoH) runs a large vector control program to protect citizens and visitors from mosquito-borne illnesses

The Belize Ministry of Health and Wellness (MoH) runs a large vector control program to protect citizens and visitors from mosquito-borne illnesses, such as Zika. While there is no evidence of an ongoing Zika outbreak in Belize, the country has a history of Zika virus transmission. The Zika virus is primarily transmitted by infected female Aedes aegypti and Aedes albopictus mosquitoes, which are typically active from dawn to dusk.

The MoH is committed to providing quality, affordable, and comprehensive health services to promote equal health and well-being for all. In line with this mission, the ministry has been carrying out major projects to upgrade health facilities across the country, bringing modern infrastructure improvements.

In addition to its own efforts, the MoH collaborates with various organizations to strengthen the country's health system. For example, through the European Union-funded Health Sector Support Programme, the ministry facilitated a two-day stakeholder consultation workshop on Belize's Essential Public Health Functions (EPHFs). This workshop brought together stakeholders from various government ministries and departments to identify gaps and develop an action plan to address priority gaps in the health sector.

The MoH also collaborates with the University of Notre Dame's Belize Vector and Ecology Center (BVEC), which serves as a research platform for investigating ecological, animal, and public health concerns in Belize. The BVEC works closely with the MoH, providing assistance in identifying pain points and needs, particularly in the area of vector control and public health.

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