1018 GMT March 22, 2019
Born in a poor neighborhood of Angola’s capital Luanda, the 10-month old boy has microcephaly, a birth defect marked by a small head and serious developmental problems. He still can’t sit upright and has difficulty seeing and hearing, Reuters reported.
“They don’t know what caused it,” Cula’s mother Marie Boa said, sheltering under a blue umbrella from the summer rains.
“The doctor said it might have been caused by a mosquito, but I don’t know if that’s true.”
The 18-year-old does not know whether her first child will ever walk or talk.
Cula is one of at least 72 babies born with microcephaly in Angola between February 2017 and May 2018, suspected victims of an emerging Zika outbreak. The cases have gone largely unreported, but an internal World Health Organization report reviewed by Reuters concluded in April that two cases of a potentially dangerous strain of Zika confirmed in early 2017, along with the microcephaly cases identified since then, provided ‘strong evidences’ of a Zika-linked microcephaly cluster in Angola.
A lack of data and diagnostic testing along with a woefully inadequate Angolan health system has made tracking the outbreak difficult. But new findings from a research team in Portugal suggest it is the first on the African mainland involving the Asian strain of the disease.
It was the Asian strain that caused at least 3,762 cases of Zika-related birth defects, including microcephaly, in Brazil since 2015, as well as serious outbreaks in other Latin American countries. Doctors and researchers now fear it could spread from Angola to other countries on the African continent.
In an emailed response to questions, Angola’s ministry of health said it had reports of 41 cases of Zika and 56 cases of microcephaly since January 2017, when it began gathering data. It was not immediately clear why the figures differed from the internal WHO report.
A lack of testing capacity means many cases of microcephaly go undetected, the ministry added, noting also that microcephaly has many causes.
“Probably not all the cases of microcephaly can be attributed to Zika,” the ministry said, listing a series of other potential causes such as syphilis and rubella.
The Angolan outbreak comes at a time when world attention has moved on from Zika, and most of the more than $1 billion in US funding allocated to fight the disease has been spent.
“We can’t let our attention down on this,” said Eve Lackritz, a physician who leads WHO’s Zika task force.
“We have to stay vigilant and have a sustained response.”
Brazil’s epidemic prompted WHO to declare a global public health emergency in February 2016 to investigate and ultimately identify the virus as a cause of microcephaly and other birth defects. Lackritz worries about a sense of complacency now that the crisis in Latin America has waned.
“Our work is just starting,” she said in a telephone interview.
“We need continued attention and investment to make sure we protect women and babies of the world.”
Ten month old Emiliano Cula, who has microcephaly, receives physiotherapy to try and stimulate control over his muscles in Luanda, Angola, September 6, 2018. She said there is still a great need for better diagnostics, greater lab capacity and programs to monitor birth defects.
Only one laboratory in Angola is currently testing for Zika, according to the health ministry. In order to improve the speed and accuracy of diagnoses, it said laboratories beyond the capital would need to be given testing capacity.
Zika in Africa
First discovered in Uganda’s tropical Zika forest in 1947, Zika circulated quietly for years, causing mild, flu-like symptoms in parts of Africa and Asia. Over time, the virus diverged into two genetically distinct lines — the African and the Asian lineages — and neither was initially associated with large epidemics.
In late 2007, the Asian strain triggered the first large outbreak of Zika in humans on the island of Yap in Micronesia, infecting 73 percent of residents over age 3. In 2013, an outbreak in French Polynesia was the first linked to microcephaly.
The first lab-confirmed case of the Asian strain in Brazil was in 2015. By 2016 the virus, transmitted by the same mosquito that carries dengue and Yellow fever, had spread to nearly all of the states in Brazil, hitting hardest in the tropical Northeast. In its wake, thousands of babies were born with small, misshapen heads.
The African strain of Zika so far has not been linked to microcephaly, which is why health officials are so concerned about the Asian strain’s emergence in Angola, a Portuguese-speaking country that serves as a major travel hub for the rest of Africa.
Some health officials are intrigued by the fact that the only confirmed outbreaks of the Asian strain in Africa so far — in Angola on the continent and in Cape Verde, an island nation off the coast of Senegal — have been in countries that, like Brazil, are Portuguese-speaking. They are probing whether travel ties between Brazil and Portuguese-speaking African nations could have fostered the spread.