The WASH-Zika connection
While the links between Zika and WASH are somewhat different to those between Zika and Ebola, commonalities remain:
- WASH is part of quality primary health care. Education and behavior change communication are core tasks of health care workers, while sustainable and affordable WASH access in homes, communities, schools, and other public places help prevent and control infection, whether from communicable illness or vector-borne.
-Approximately half of all health facilities in the developing world lack access to WASH on the premises, making health workers vulnerable to a range of illnesses, compromising the dignity and quality of care that can be provided, putting patients at risk of health facility-acquired infections, and taxing health systems overall. Closing this gap in quality services is of utmost importance for ensuring health systems are able to respond to outbreaks such as Zika.
- Public health emergency responses must take the long view. While preventing immediate morbidity and mortality must be a primary concern in an emergency, all emergency responses should include attention to building longer-term resilience to disease, stronger health systems, and stronger communities. This must also include blood safety measures.
In the case of Zika, limiting breeding grounds for mosquitoes, what’s known as vector control, is both the most effective way to control the virus and the most challenging. Because mosquitoes lay their eggs in standing water, whether clean or brackish, limiting even the smallest pools of water is paramount. This can include more simple responses, such as regularly changing and cleaning pet water bowls, or cleaning out roof gutters so water flows rather than pooling.
However, one of the most common sources of standing water in many areas of Latin America currently experiencing the Zika outbreak—which is associated microcephaly and other serious birth defects—is the buckets and cans used to store household water collected from a nearby water tap, lake or river.
Vector control recommendations from the US Center for Disease Control and the World Health Organization (WHO) include regularly emptying, scrubbing and discarding of items that may hold standing water.
However, in communities where water is difficult to come by and soap or other cleaning supplies may be beyond financial reach, these seemingly simple recommendations can carry enormous burden, and for many, may be simply impossible.
Policy and program recommendations:
As donor and national governments gather and direct resources to respond to Zika, including preventing its further spread, it is critical that efforts to control Zika not come at the expense of other human rights and basic needs. WaterAid makes the following recommendations to governments designing, monitoring and reassessing their response policies and programs:
Short term priorities
1. Provide immediate targeted funding for Zika vector control and transmission prevention efforts, including blood safety initiatives, in addition to supporting those for other infections spread by the Aedes mosquito, such as dengue. Ensure that all efforts to respond to mosquito-borne illness are complementary and making best use of all resources, in order to improve health outcomes for populations that may be affected by multiple infections or outbreaks by the same vector over the longer-term.
Ensure that recommendations for safe storage of household water and cleaning of containers, including rain collection tanks, are effectively and efficiently implemented for all, especially the most vulnerable people, without compromising the human right to sufficient water for multiple uses, such as drinking, cooking, cleaning, and watering kitchen gardens. Increase the availability of water for washing and soap to endemic communities and those at risk to ensure vector control measures, including regular cleaning of containers. Ensure that these measures are not undertaken in such a manner as to compromise ability to secure sufficient safe drinking water and hygiene supplies for personal use
2. Build safe water storage and hygiene behavior change messages into Zika education and awareness-raising campaigns.
3. Ensure that solid waste management in rural and urban settings is a component of all Zika response efforts.
4. Safeguard the provision of family planning counseling and supplies to prevent unintended pregnancies and potential sexual transmission of Zika as part of an overall response that emphasizes all areas of Zika prevention, not only vector control.
5. Consult with local, district, tribal and other government authorities and representatives in designing, implementing and evaluating Zika prevention and response plans.
Medium Term Priorities
1. Identify means by which to ensure provision of protected sources of safe drinking water to endemic communities that do not yet have access, including developing costed plans and collaborating with local organizations.
2. Prioritize the provision of primary health services, including family planning counseling and supplies, ante-natal care, and hygiene promotion; ensure all health facilities have piped safe drinking water, sanitation and hygiene supplies on premises.
3. Ensure sanitation, including non-sewered and sewered technologies and septic tanks, is prioritized as a core component of public health infrastructure in order to eliminate Aedes breeding and feeding sites as well as address numerous other negative health outcomes that may arise from poorly managed waste and unhygienic conditions.
Background
What is Zika Virus?
Zika virus disease is a mosquito-borne illness, spread by a species of mosquito called Aedes. Symptoms of Zika are flu-like and can include skin rash, conjunctivitis, muscle and joint pain, and headache. The incubation period of Zika is believed to be only a few days, and symptoms ordinarily resolve in a week or less. There is no vaccine currently available to prevent Zika, and no particular treatment is required short of providing relief for the flu-like symptoms of the virus.
Where is Zika a problem?
Zika was first identified in Uganda in 1947 in a local monkey population, as part of monitoring efforts of yellow fever. In 1952, it was first identified in humans in Uganda and Tanzania. Outbreaks of Zika have been recorded in Africa, Asia, the Pacific region and the Americas. Most recently, links to severe birth defects have increased awareness of what appears to be an accelerating outbreak of Zika in the Americas; it is anticipated that the virus will be seen in the United States this summer.
Zika prevention and its challenges
Zika is transmitted through the bite of an infected Aedes mosquito, a type of mosquito that is most active during the day, and also transmits dengue fever, chikungunya and yellow fever. Given its level of activity during the day, many traditional vector-control interventions, such as bednets, may not be effective against Zika. Additionally, one type of Aedes mosquito in particular, female Aedes Aegypti, gets its meals from numerous smaller bites rather than one large bite, meaning an infected mosquito may bite several people before obtaining a full meal, potentially creating clusters of Zika cases. Because of these complexities in vector control and bite prevention, the most straightforward way to prevent Zika is to avoid being bitten by any mosquitoes. Recommendations from CDC and WHO focus on using screens on windows and doors, sleeping under mosquito nets, wearing long-sleeved shirts and pants, treating clothing and skin with relevant insect repellant products, and limiting breeding grounds for the mosquitoes themselves, which tend to focus on pools of water in human-made domestic and household items rather than pools of water in the ground. This preference for breeding site is also in contrast to the species of mosquito that carries malaria, which prefers to lay its eggs in open natural water collections, again suggesting that traditional vector control methods focused on malaria—the most well-funded of the global efforts against mosquito-borne diseases—may not be wholly effective against Zika and other viruses spread by Aedes.
