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Emiliano is one of 72 babies born from February 2017 to May 2018 with microcephaly in Angola, alleged victims of the Zika epidemic. Cases have been virtually unreported, but an internal report from the World Health Organization, reviewed by Reuters, concluded in April that two cases of a potentially dangerous strain of Zika confirmed early 2017, as well as the cases of microcephaly identified since, provided strong evidence of a Zika microcephaly related to Angola.
The lack of data and diagnostic tests as well as the totally inadequate health system in Angola made the monitoring of the epidemic difficult. But new findings from a research team in Portugal suggest that it is the first on the African continent involving the Asian strain of the disease.
It is the Asian strain that has caused at least 3,762 cases of Zika-related birth defects in Brazil, including microcephaly, since 2015, as well as serious outbreaks in other Latin American countries. Doctors and researchers now fear that this disease will spread from Angola to other African countries.
"We can not let our attention on that. We must remain vigilant and have a sustained response. "
In an e-mail response to queries, the Angolan Ministry of Health has reported 41 cases of zika and 56 cases of microcephaly since January 2017, when it began collecting data. The reason the figures differ from those in the WHO internal report is not immediately clear.
A lack of screening capacity means that many cases of microcephaly are not detected, the ministry added, noting that microcephaly has many causes, including syphilis and rubella.
The Angolan epidemic comes at a time when the world's attention is no longer at the center of Zika, and most of the more than $ 1 billion in US funding devoted to combating illness was spent.
"We can not give up our attention," said Dr. Eve Lackritz, doctor who heads the WHO Zika virus working group. "We must remain vigilant and have a sustained response."
The epidemic in Brazil prompted WHO to declare a global public health emergency in February 2016 to investigate and identify the virus as a cause of microcephaly and other congenital anomalies. Lackritz worries about a sense of complacency now that the crisis in Latin America has faded.
"Our work is just beginning," she said in a phone interview. "We need continued attention and investment to protect the world's women and babies."
She added that there was still a need to improve diagnoses, increase the capacity of laboratories and set up congenital anomaly surveillance programs.
According to the Ministry of Health, only one Angolan laboratory is currently testing the Zika virus. To improve the speed and accuracy of diagnostics, labs beyond the capital city should be equipped with testing capability.
Zika in Africa
Discovered for the first time in the Zika rainforest in Uganda in 1947, Zika was traveling quietly for years, causing mild flul like symptoms in parts of Africa and Asia. . Over time, the virus has diverged into two genetically distinct lineages – the African and Asian lineages – and none were initially associated with major epidemics.
At the end of 2007, the Asian strain caused the first major outbreak of Zika in humans on the island of Yap in Micronesia, infecting 73% of people over the age of 3 years. In 2013, an epidemic in French Polynesia was the first linked to microcephaly.
The first case of Asian strain in Brazil was confirmed in laboratory in 2015. In 2016, the virus, transmitted by the same mosquito carrying dengue fever and yellow fever, had spread in almost all states of Brazil. , hitting the tropics harder. to North-east. In its wake, thousands of babies are born with small malformed heads.
The African strain of Zika has not so far been linked to microcephaly. That's why health officials are so concerned about the emergence of the Asian strain in Angola, a Portuguese-speaking country that is a major hub of tourism in the rest of Africa.
Some health officials are intrigued by the fact that the only confirmed outbreaks of Asian strain in Africa so far – in Angola on the mainland and Cape Verde, an island nation off the coast of Senegal – have products in countries like Brazil: are Portuguese speaking. They study whether the travel links between Brazil and Portuguese-speaking African countries could have promoted the spread.
In Angola, it has been difficult to link microcephaly cases directly to Zika because of limited access to advanced tests to confirm the disease even after the acute phase.
Four health professionals who worked with the Angolan Ministry of Health said that there was also not much political will to investigate a zika epidemic caused by a government already struggling with deadly outbreaks of malaria, as well as against cholera and the potential threat of spread of Ebola from the Democratic Republic of Congo. Speaking under the guise of anonymity because of the sensitivity of the issue, they added that it was feared that an epidemic would force the government to put in place place expensive programs for babies with microcephaly.
Babies
In Brazil, the epicenter of Zika's largest and most serious epidemic so far, the virus has virtually disappeared. The high rate of infections two years ago left a large part of the population immunized, making the spread of the disease more difficult.
"The salvation, if it exists, is that we benefit from herd immunity," said Dr. Albert Ko, a tropical disease specialist at Yale University. It is not known whether immunity against the African strain also confers immunity against the Asian strain.
Many families affected by the disease are still struggling. Jaqueline Vieira de Souza, 28, lives in the Brazilian state of Pernambuco. She describes a stressful daily life for her son Daniel, born in 2015 with microcephaly: "My life is to wake up and take care of him." Therapies and doctors.
His hopes for Daniel are modest.
"I have no dreams of seeing him walk, run," she said. "I only dream that … at least he can eat better, breathe better."
In Angola, the journey of such mothers is just beginning. There is no public health program to help children, who need regular physical therapy and other care.
Families are often referred to Luanda's Center for Neurosurgery and Hydrocephalus, although the center lacks funds to address this problem. Families are expected to pay for consultations costing between $ 7 and $ 21, far beyond the means of many in a country where 30% of the population lives on less than $ 1.90 a day.
"The majority comes once and never comes back," said physiotherapist Adelina Martins. "They can not afford to keep coming."
Recently Thursday, Luisa Alberto, 20, was waiting with her 3 month old baby to see a doctor with dozens of other mothers sitting in a narrow hallway under the portrait of President João Lourenço.
The baby's father refused to accept him and Alberto alone takes care of his first child while trying to finish his studies. The child feeds but grows more slowly than his peers.
"It's difficult," Alberto said. "He does not play like other babies."
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