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  • The Zika virus epidemic is spreading countries are

    2019-04-22

    The Zika virus epidemic is spreading: 63 countries are now reporting transmission, over 1500 cases of related microcephaly or CNS malformations have been confirmed this year, and knowledge on the disease is advancing slowly. Adding to the tension around Zika, at the epicentre of the outbreak, Brazil is bracing for a large-scale mass gathering: the . Conflicting opinions on the need to postpone or cancel the Games have been expressed, but during the 69th World Health Assembly last month, the : the Games will not significantly change the international spread of the virus and travellers can reduce their risk of contracting the disease by following simple prevention measures such as avoiding mosquito bites with repellents and adequate clothing, practising safe sex, staying in air-conditioned housing, and avoiding areas with poor water and sanitation. These recommendations are sound and reasonable. They also highlight the true nature of Zika: it is a disease of the poor and disenfranchised. The face of Zika is not often seen in the air-conditioned shopping malls of upscale Rio neighbourhoods or on the beaches of Ipanema. Rio has its fair share of cases, but so far the heaviest burden has been borne by the northeast region of Brazil, where poverty, poor infrastructure, and lack of access to health services are rampant, and the penetration of is high. A large proportion of the sorafenib tosylate in that region is of African descent—indeed, the face of Zika is often that of a darker-skinned person. And because most cases are asymptomatic, and the most dramatic signs of the disease appear through congenital Zika syndrome, the face of Zika is that of a woman or a small child. That is at least what we are able to outline, because in spite of the need for disaggregated epidemiological data to understand transmission patterns and evaluate interventions in vulnerable populations, there is no reliable count of Zika cases by sex and ethnicity. Last month, published on pregnancy management in the context of Zika virus infection. The guidance includes recommendations for preventing and managing infection in pregnant women. Vector control is emphasised, as well as personal protection such as clothing, bednets, repellents, and safe sex. Again these are sound recommendations, duly relayed by health authorities, but they certainly don\'t resonate in the poorest neighbourhoods of Brazil and other affected countries, where the availability, practicality, and affordability of protective items are doubtful and where safe sex is not always negotiable. When prevention fails, women of reproductive age or who are pregnant are faced with terrifying uncertainties, for lack of information, lack of access to basic services and diagnostic tests, and most importantly a blatant lack of choice.
    Cervical cancer is the fourth most common cancer in women globally, but remains the second most common cancer (after breast cancer) in many low-income and middle-income countries, and is still more common than breast cancer in sub-Saharan Africa. Most new cervical cancer cases (85%) and deaths (88%) occur in low-income and middle-income countries, where health systems are often fragmented or fragile, and where most have not yet implemented effective national cervical cancer screening programmes. Deaths from cervical cancer continue to be a largely preventable tragedy for more than 266 000 women and their families every year.
    In this issue of , Jay Berkley and colleagues in Kenya present the results of their outstanding clinical trial of antibiotic prophylaxis for children who recovered from complicated severe acute malnutrition (SAM). The high rates of mortality and nutritional relapse observed among children who recover from SAM have also been seen in children recovering from moderate acute malnutrition. These children may require a higher anthropometric threshold for recovery, which may serve as a marker of improved immune status and decreased susceptibility to infection.