Zika and microcephaly; Zika as a sexually transmitted infection; Zika as a human rights issue

Nearly nine months after Zika was declared a global health emergency, the virus has infected at least 650,000 people in Latin America and the Caribbean, including tens of thousands of pregnant women.However, two different sorts of unexpected information have emerged from studies. In Brazil, a study in 16,208 neonates born between Jan 2012 and Dec 2015, in 21 maternity centres in Paraíba, the epicentre of the epidemic, found that 2% of the total (316) fulfilled all three accepted criteria for microcephaly and that the prevalence fluctuated over time. However, the numbers fulfilling any one of these criteria were much higher. These numbers are also much higher than the 6.4 per 10,000 live births reported in Paraíba by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.Secondly, the epidemic has not produced the wave of fetal anomalies in other countries that first emerged in Brazil. Data indicate that 75% of the babies with neurological damage that causes microcephaly are clustered in Paraíba. Although Zika has spread this year to more than 50 nations and territories across the Western Hemisphere, UN data show just 142 cases of congenital birth defects linked to Zika outside Brazil so far. Thus, Zika may not be the only cause.However, Zika is continuing to spread across Central America, South America, and the Caribbean, and although most people are likely think about long sleeves, mosquito netting, and insect repellent, as well as the potential for vaccines against the disease, all the evidence says we should also be treating Zika as a sexually transmitted infection, including the new guidelines on Zika recently released by the US Centers for Disease Control and Prevention (CDC).Zika is unique in that it is transmitted through both sex and mosquitoes, which makes it hard to determine just how much of an effect sexual transmission is having on the spread of the disease. But as with HIV, it would be better to talk about prevention (especially condoms) rather than wait for a vaccine to be developed, even if the possibility of a vaccine exists.Anis – Institute of Bioethics in Brazil recently filed before the Brazilian Supreme Court an application for amicus curiae to be admitted in their submission to the court (ADI 5581 case), which addresses rights violated in the context of the Zika epidemic in Brazil. One of the demands of ADI 5581 concerns the right of pregnant women infected with Zika and experiencing mental suffering to choose to terminate the pregnancy, in order to protect their mental health.The submission was written by independent special procedures mandate holders of the United Nations Human Rights Council. It reiterates the human rights obligations which States have in relation to abortion services, including in the context of the Zika epidemic. The submission aims to assist the Court by detailing the circumstances in which denial of abortion services may amount to torture and/or cruel, inhuman and degrading treatment. Specifically, the mental suffering that women and girls may face when they wish to terminate their pregnancy, including in the context of Zika, but do not have legal access to service, can be severe, and can meet the threshold of torture and/or cruel, inhuman and degrading treatment. This can be further exacerbated for certain women and girls in a particularly vulnerable situation, including as a result of their age, disability status, or circumstances under which they became pregnant. It is signed by the Special Rapporteur on torture and cruel, inhuman and degrading treatment or punishment, Mr. Juan Mendez; Special Rapporteur on violence against women, its causes and consequences, Ms. Dubravka Simonovic; Working Group on discrimination against women in law and practice, Ms. Alda Facio, Chair, and Ms. Emna Aouij, Ms. Kamala Chandrakirana, Ms. Frances Raday, Ms. Eleonora Zielinska; Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Mr. Dainius Puras; and Special Rapporteur on the rights of persons with disabilities, Ms. Catalina Devandas Aguilar.SOURCES: Rewire, by Martha Kempner, 15 November 2016 ; Washington Post, by Dom Phillips, Nick Miroff, 25 October 2016 ; Bulletin of World Health Organization, by Juliana Sousa Soares de Araújo, Cláudio Teixeira Regis, Renata Grigório Silva Gomes, et al. 2016;94(11):835-40 ; Press statement, Anis – Institute of Bioethics