Indian government, despite reporting three laboratory-confirmed cases of Zika virus infection to World Health Organization, kept mum about the detection of Zika infection in India. Zika virus is known to cause microcephaly in children – a birth condition where a baby’s head is smaller than expected when compared to babies of the same sex and age, resulting in smaller brains that might not have developed properly. It is also linked to triggering neurological conditions in adults.

On May 26, the World Health Organisation in a release said that they received information from India about three cases – a 64-year-old man, a 34-year-old new mother and a 22-year-old year pregnant woman being detected of suffering from Zika infection. However, Indian government had sent the information to WHO on May 15. Between May 15 and May 26, no official circular or advisory was issued by the health department to local authorities or general public and private doctors.

Significantly, the first case was detected as far back as January 4 this year by National Institute of Virology, Pune. Some officials said that the health ministry was waiting to get further validation from WHO. The WHO release said:

“The routine laboratory surveillance detected a laboratory-confirmed case of Zika virus disease through RT-PCR test at B.J. Medical College, Ahmedabad, Gujarat. The etiology of this case has been further confirmed through a positive RT-PCR test and sequencing at the national reference laboratory, National Institute of Virology (NIV), Pune on 4 January 2017.”

It remains unclear as to why the health department took over four months to inform WHO about the first case. According to WHO, the Indian government gave them the information only on May 15 this year. Public health experts and activists said that the government should have “ideally informed the health authorities immediately after the confirmation was received.”

A senior official from Indian Council of Medical Research said that National Institute of Virology had infromed the Council upon confirmation of the first case in January itself. Immediately, the official said, the Council informed the health ministry, which was expected to inform WHO. However, the ministry, only informed WHO on May 15th, as is clear from the WHO release which brought the three cases to light.

Until May 27, late evening, the health department had not released any health advisory for its citizens and even local health authorities in Gujarat have not received any information from the ministry of health and family welfare. “We got to know about Zika cases in Ahmedabad after reading about it on the WHO website,” said Dr Vijay Kohli, entomologist, Ahmedabad Municipal Corporation.

The Indian government’s health department, has been testing the blood samples of patients who are suffering from acute fever for the presence of Zika virus. “Blood samples of patients, which did not show the presence of dengue and chikungunya virus, were screened for Zika virus,” said Dr Soumya Swaminathan, director general of the Indian Council of Medical Research.

The Indian Council of Medical Research has tested 34,233 human samples and 12,647 mosquito samples for the presence of Zika virus. They have not found the presence of Zika Virus in the mosquito samples tested by them.

It is still unclear why the health department take four months to inform WHO about the first case immediately. According to WHO, the Indian government gave them the information only on May 15 this year. Public health experts and activists said that the government should have “ideally informed the health authorities immediately after the confirmation was received.”

Bad management

Public health experts criticised the government’s lackadaisical attitude towards Zika Virus infection, which was declared as a public health emergency of international concern. Brazil reported most cases of microcephaly as a result of Zika infection. It was only this month that Brazil declared an end to the Zika emergency, according to a news report.

Despite the severity of the situation, the Indian government not only failed in informing its citizens but also local government authorities and doctors, who would have used the information to be more vigilant in treating people with symptoms, which arise in Zika infection. Kohli said that his office has decided to continue its efforts in mosquito control. “Both dengue and Zika are spread by the same mosquito (Aedes Aegypti). We have asked our teams to ensure that breeding sites, both indoors and outdoors are eradicated,” he said.

“The three cases of Zika virus must be addressed on a war-footing,” said Dr Edmond Fernandes, Founder, Center for Health and Development, a public health agency. “The government must have alerted all District Hospitals and integrated diseases surveillance programme units by now,” he said, adding: “The alert had to be raised by the health ministry immediately once they had confirmation about the cases was received.”

In fact, the Ahmedabad local corporation has no information about the cases and learnt about it from the WHO website like all other Indians did. Despite several attempts, senior health officials including Lav Agarwal, joint secretary, ministry of health and family welfare did not respond to’s queries. Agarwal said, he was travelling.

Sylvia Karpagam, a public health specialist, said that as soon as the laboratory confirmed the presence of Zika virus, the government should have taken all measures to prevent transmission, education of community, screening of pregnant women, upgrade lab testing facilities, provide consistent, timely and accurate information to all stakeholders, and co-ordinate community responses.

“The government has to balance to ensure that panic is not spread but sometimes they tend to downplay, which may one of the reasons why many outbreaks are not controlled,” said Karpagam. “There is a possibility that tourism will be affected but that should not stop the government from taking proactive steps for controlling, which includes educating the masses about precaution,” she added.

Further monitoring

Even when local governments were kept in dark, the central government authorities have come up with interventions to increase surveillance to pick any more cases of Zika in the community. The biggest fear in the minds of the medical community and health authorities is the possibility of Zika virus related increase in microcephaly cases. In Brazil, pregnant women suffering from Zika were found to be giving birth to children with congenital defects including microcephaly.

The government has set up surveillance at 50 hospitals in the country from where blood samples of children born with microcephaly will be sent for testing for Zika virus. “At present surveillance of microcephaly cases is already going on. We haven’t seen any unusual spike in the cases,” said Swaminathan. Testing children born with microcephaly should be the next step as “Zika has entered India,” she said.

Some senior health officials said that low transmission of Zika in India was discussed. And some authorities were aware of the situation but the general public and the private medical community and other local health governments were kept in the dark. “How will a doctor sitting in Gujarat suspect Zika, if he doesn’t know that Zika cases are being reported?” asked a senior doctor from a medical college in Mumbai. “All government medical colleges should have been informed. Until the WHO alert, we were all under the impression that Zika has not hit India.”