ENDING THE EPIDEMIC

Colombia 2017 | HEALTH & EDUCATION | FOCUS: ZIKA VIRUS

The Zika virus posed a special threat to the 26 million Colombians living in 900 municipalities below 2,200m. Nevertheless, due to proper surveillance, international cooperation, and an immediate government response, Colombia was the first country in the Americas to announce the end of the Zika epidemic.

According to the Colombian National Health Institute (INS), the Zika virus reached nearly 100,000 reported cases in Colombia in 2015-2016. Although these numbers made it the second highest after Brazil, it was much less than the 450,000-600,000 expected cases. While 18% of these cases included pregnant women, 0.5% resulted in neurological syndromes, mostly being Guillain-Barré Syndrome (GBS), and 0.3% in cranial malformation in babies.

Although Zika's progression in Colombia was fast, it caused no deaths. Other countries, such as Brazil, were not as lucky and were caught off guard by the outbreak. The main driver of Colombia's relative success in combating Zika was a comprehensive monitoring effort put in place by the time the first infections were confirmed in October 2015. Parallel to this effort, Colombian health officials published detailed weekly bulletins that reported the number of infections and their location, as well as statistics on Zika-related complications, including microcephaly and GBS.

Colombia's success was also guided by international support and collaboration, especially from US health officials. The US-Colombian partnership on health outlined in Plan Colombia's successor, the recently announced Peace Colombia, was especially successful. Through Peace Colombia, the US collaborates with Colombia to research infectious diseases and figure out the best way to address them. The effectiveness of this partnership has already been demonstrated by the Center for Disease Control and Prevention's (CDC) work with Colombia's INS in setting up the Zika surveillance system. This allowed them to track the spread of the disease and its impact on pregnant women and children so health officials could know exactly what they were up against.
The CDC also worked closely with Colombian doctors to identify Zika's risks through “enhanced surveillance" programs in three cities—Cucuta, Barranquilla, and Cali—where researchers monitored fetal development in infected mothers and continue to track babies' growth for at least a year after birth. Cali and the surrounding department of Valle del Cauca reported nearly 25,000 Zika infections, more than any other territory in Colombia. But as of July 2016 there had not been a single case of microcephaly linked to the virus. The Ministry of Health also decided during this time to stop recommending that women living in high-risk areas postpone their pregnancies, and allowed them to travel throughout the country without any restrictions.
However, when World Health Organization (WHO) official Bruce Aylward was asked why the microcephaly numbers in Colombia are so much lower than in Brazil, he told reporters that the country is only counting “live births," indicating that many Colombian women with Zika are miscarrying or seeking to interrupt their pregnancies. Martha Lucía Ospina, Director of the INS, backed this by stating that miscarriages due to Zika increased 8% in Colombia.

According to the WHO, a dozen laboratories and public agencies around the world are working on a vaccine, but it could take years to commercialize due to the virus' massive global presence and capability to be transmitted sexually, often asymptomatically. On the other hand, Zika can only be acquired once, and group immunity is normally developed among populations, which makes it easier to control.

Nevertheless, Ospina led a group of Colombian researchers in writing the most rigorous and detailed analysis on the evolution and expansion of the Zika virus, which was later published on the New England Journal of Medicine's online portal. This study will help governments around the world understand how the Zika virus behaves and evolves, as well as assist health authorities in promoting campaigns oriented at reducing the risk of all transmitted diseases such as Zika, dengue, yellow fever, and chikunguña.