Lo Spiegante (English): Valcler Rangel speaks to us about Zika

In the past several months we have often heard about the Zika virus, a virus which has been isolated for the first time in 1947 in a monkey from the Zika forest in Uganda.
Today, the virus is spreading in many countries, even in Europe, but has the most cases of infection in Brazil, where according to government estimates lives about 1.5 million contagiated people. In the last days the assessment of a link between Zika and microcephaly has been confirmed.

We, editors of “Lo Spiegone”, decided to get a professional explanation from someone who know more than us what is the Virus, especially from someone who live and face the emergency in Brazil, the epicenter of this spread of Zika.

Thanks to “Doctors without Borders” we got in touch with the Fundação Oswaldo Cruz (Fiocruz), an institution based in Rio de Janeiro which works for the Brazilian Ministry of Health , Brazil. Fiorcruz was founded in 1900 by the famous hygienist Oswaldo Cruz and today is the most important institution involved health and technology in Latin America and a world leading research centre on public health.

We spoke with Valcler Rangel, Vice-President of health promotion, environment and attention of Fundação Oswaldo Cruz (Fiocruz). Vancler Rangel coordinates Fiocruz’s cabinet dealing with Zika, more specifically on the axes of health surveillance and social mobilization: he doesn’t works much on the studies investigating the virus biology, but more on study areas involving society and healthcare.

1. How is the virus transmitted ?
   An important branch of research is to search for other ways of transmission, such as saliva, blood, urine and mother’s milk. We know that the vírus is active in many of these fluids but what we don’t know yet is whether it’s transmissible or not. We know kinds of mosquitoes. We also know that there are cases of sexual transmission, but we don’t know whether it is significant or not. We don’t know the viral load necessary to a transmission through semen to occur or through saliva.
2. How can people avoid being infected ? What to do in case of infection ?
   One should avoid taking antiinflammatories, because they aren’t recommended against chikungunya. A person can take drugs to minor pain, such as Parecetamol, and hydratate. But the most importante thing is seeing a doctor, to make clear whether it’s dengue, zika or chigunkunya. Considering these three, dengue is the most dangerous one, except in the case of pregnant women.
   When it comes to them, they also need to see a doctor as soon as possible.
   To avoid being bitten, people can use clothes with long-sleeves, use spray agains mosquitoes and also close the windows by the end of the afternoon, when it’s the time mosquitoes are out. Like all other sexually transmissible diseases, condoms are crucial.
   
3. What studies have been done on the disease ?
   Fiocruz has almost 300 studies being executed on zika right now. One of our first tasks is to study really well the virus biology. That means understanding what the virus is, what’s the relation between the virus and the vector, understanding what’s the relation between the virus and the sick person (that means the physiopathology of the disease), understanding the immunology of the disease (why some people become while others don’t), to understand the mechanisms that generate the congenital malformations (the great question about zika is that. It’s the first time we have a congenital disease that’s transmitted by a vector). To understand the physiology, the pathogeny, and the biology itself is extremely importante. We also have studies to understand how the disease develop; these studies, called the cohort studies, follow patients, including mothers and babies, during a long time, to understand why some people develop neurological alterations, and what these alterations are, because we know today that microcephaly is not the only problem that happens. These studies are being developed alongside with other institutes, in order to formulate protocols more adequate to the health of these people and also to colaborate to develop vacines and treatments. Because only by knowing better the biology of the disease we’ll be able to find a vacine and also, in a completely different line, a treatment, that is, how to treat the disease, which is not very simple. Generally, that’s it.
4. How are you treating infected people there?
   Another important dimension is to understand the social dimension of the disease. Some groups are interested in looking to these cohorts trying to understand it through anthropology and sociology. They try to understand what are the social dynamics behind it, to understand what are the social and anthropologic elements of the disease. These elements are various: some of them are related to sanitation and habitation.
   These studies are focused on two axes: health surveillance, where works controlling the vector, the projects related to vector control; three projects on this area could be highlighted: 
   1. the projects involving wolbacchia, a bacteria that’s introduced on aedes aegipty mosquitoes and that prevents them from transmitting dengue, chigungunya and zika; 
   2. the projects of dissemination units, where mosquitoes themselves are used as insecticide disseminators (EXPLAIN); 
   3. the projects about denguetech, a bioinsecticide developed through a partnership of Fiocruz and BR3. Right now this larvicide is passing through tests in order to prove it can be used in potable water, but it’s already in the Market.
   Regarding surveillance, we’re trying to make a group where we’ll work with states and cities in order to improve the surveillance of the system, the logistics for laboratorial diagnostics and the surveillance itself, that is, how is the dynamics of the disease on every territory (how territories are affected, which are the most vulnerable regions, etc.
5. Do you think that people are informed enough ?
   I think that people are not well informed enough yet. People are receiving a lot of information about the transmission and the mosquito, but that’s not enough. But zika is a broad issue and there are many doubts about it – right now, we have more questions than certainties. Even people who work with health are not well informed enough. We have made a course, for instance, alongside with Unasus (SUS’s Sistema Unificado de Saúde, Brazil’s public health system) and at the first week we go 50 thousand inscriptions. Many people want to understand it better. So we’re putting efforts to help people understand a broad range of subjects, to understand chikungunya, we’re also trying to capacitate them to zika, and we see a lot of disorientation amongst health professionals. With the population the disinformation is even higher.
6. What is the connection between the disease and microcephaly ?
   We know that there’s a Strong link between zika and microcephaly. Many researches, including various made by Fiocruz, but also by other institutions such as the Federal University of Rio, prove that the vírus has a tropism through the central neurological system and that it passes through the placentary barrier, and that it has a very destructive capacity on the brain, specially on the third trimester (although another research made by Fiocruz has shown that infection during other stages of pregnancy can also be destructive). What we don’t know is whether there are concurrent factores influencing zika and neurological damages, such as a previous infection.
   
7. What about international relationships? Is the international community helping you? What would you ask them for?
   Knowledge and technology sharing can help a lot when it comes to Zika. We’ve been working a lot with national health institutes such as NIH, from the USA, and also with institutes from the European Community, and also from other organizations from Latin America. The more we can share knowledge about the diseases and about how to control the vector – that exists in more than a 130 countries in the world –, the better our answers will be. It’s also critical for us to be able to use technology available in other countries. Today in Brazil we have very good human resources, and the act that many of the most importante articles and discoveris on zika so far have been written by Brazilians proves that. A group here at Fiocruz coordinated by Patricia Brasil, for instance, has studied 80 pregnant women and made a fantastic contribution. This work, nevertheless, was done in coordination with universities from other countries. There’s a lot of technology and knowledge that can be helpful, specially when it comes to vaccine development, which is one of the main collaborations we need. And also about treatments.
8. What perspectives are there? Do you think that this disease can be defeated ?
   The dynamics of infectious diseases is not predictable. Zika might disappear, to reduce until it’s not a public health problem anymore. But also the opposite may happen. Take the example of the Spanish flu: The first wave was brand, but the second one killed a huge amount of people. The third was also not that aggressive, and on the fourth wave, it killed nearly 40 million people.Right now we don’t work with the perspective that it will go down. We think that, because of the existence of the vector in Brazil, it will stay as a disease existent on the Brazilian territory. The changes on the patterns of will only occur if the vector indexes go down. If the rates of transmission are lower. 

We want to thank Andre Duchia De Magalhaes Costa for his great availability and for being our intermediary and translator from Portuguese into English.

Fiocruz: http://portal.fiocruz.br/en/content/home-inglês
Photos about Zika: http://www.fiocruzimagens.fiocruz.br/gallery.php?mode=gallery&id=71&page=1
Information about Zika: https://agencia.fiocruz.br/perguntas-e-respostas-virus-zika