Papu Gujjar, a resident of Bapunagar, a sprawling slum in Ahmedabad, is not surprised that the local authorities did not inform them about the presence of the Zika virus in their neighbourhood.

“They don’t count us as humans,” he said. “They never come to our houses, not even when we complain about the poor sanitation.”

Six lakh people, mostly daily wage workers and their families, live in the squalid streets of Bapunagar, tightly-packed with squat houses. On Sunday, its residents discovered through newspapers and television that all three confirmed cases of Zika virus infections in India have been reported from their neighbourhood. Later, Gujarat health department clarified that two of the three cases were from Bapunagar, while the third was from Gopalnagar, another locality in Ahmedabad.

Zika is a viral infection that is transmitted mainly by mosquitoes. In 2015, it led to a public health emergency in Brazil, when thousands of babies were born with abnormally small heads, a condition called microcephaly that was traced to the Zika virus.

India has been screening for Zika since July 2016 through more than 50 laboratories.

In November, the laboratory in BJ Medical College of Ahmedabad detected the Zika virus in the sample of a 34-year-old woman who developed a low-grade fever after delivering her child. The result was re-confirmed as positive by the National Institute of Virology in Pune on January 4. The Minister of State for Health, Anupriya Patel, while responding to a question in Parliament in March, referred to this case. But local authorities in Gujarat say they were not informed about it.

“We learnt that Gujarat has three cases of Zika just like all of you found out,” said Mukesh Kumar, the municipal commissioner of Ahmedabad, in a press conference on Sunday. The news flooded the media on Friday, after the World Health Organisation reported the cases on its website.

Kumar said when he asked Gujarat’s health department, he was told all three cases – a 34-year-old woman, a 64-year-old man, a 22-year-old pregnant woman – did not have any history of travel to a foreign country. This means that they got the infection locally.

Kumar insisted that he did not have any further information on the three cases. On the question of whether the three had been informed of their samples testing positive for Zika, he said he did not know. “I can only answer as far as the role of the corporation is concerned in vector control,” he added.

By vector control, he was referring to preventive measures like fumigation to control the spread of mosquitoes. The Aedes aegypti mosquito is the primary carrier of the Zika virus, although the disease can also be sexually transmitted.

Ahmedabad Mayor Gautam Shah. (Photo:Priyanka Vora)
Ahmedabad Mayor Gautam Shah. (Photo:Priyanka Vora)

Controlling the spread of Zika

The municipal officials in Ahmedabad said even though they did not know of the Zika virus cases, they had carried out extensive vector control to limit mosquitoes in Bapunagar.

Residents, however, deny this.

Ramila Patni, 35, said municipal workers had come to her house with a liquid they wanted to add to her water tank. Patni said she did not allow them as she does not trust them. “We don’t know what they are pouring in our water,” she said.

The lack of trust has further deepened after the residents discovered they were kept in the dark about the Zika cases.

“How can the government not tell people that there is a new disease which is infecting people in the neighbourhood they live?” asked JD Patel, the corporator of Bapunagar area who is a member of the Congress, the main opposition party of Gujarat.

“They have lied to our faces by not telling us about Zika cases,” said Patel. “I won’t be surprised if there are 10 other cases which the government is hiding from us.”

A common theory in Ahmedabad is that the state government did not disclose information about the Zika case detected in January because the Vibrant Gujarat Summit, a conference for investors, was being held in Gandhinagar, the adjoining capital city, that month. The mayor of Ahmedabad, Gautam Shah, a member of the Bharatiya Janata Party, however, denied this, saying there was “nothing political” in the lack of disclosure. He said he did not know about the cases himself.

JD Patel, corporator of Bapunagar area where three cases of Zika have been detected. (Photo: Priyanka Vora)
JD Patel, corporator of Bapunagar area where three cases of Zika have been detected. (Photo: Priyanka Vora)

Stepping up surveillance

After he heard about the three Zika cases, Patel said he made inquiries with several residents of Bapunagar who said that no officials had visited the area to try to detect fever cases in the community.

While no official statement has been made by the Ministry of Health and Family Welfare, Shankar Chaudhary, Gujarat’s health minister, said on Sunday that the government has taken all action in accordance with the guidelines of the WHO after the Zika cases were detected. The government has told the World Health Organisation that the Integrated Disease Surveillance Programme is tracking for the clustering of acute febrile illness, or the rapid and sudden onset of fever and other symptoms, in the community.

Dr Soumya Swaminathan, director-general of Indian Council of Medical Research, said that after the cases were tested positive, surveillance was stepped up in Ahmedabad. “Three months after that there were no positives for Zika,” she said. “That is why we did not feel the need for a public announcement.”

Dr Bhavin Joshi, additional medical officer of the Ahmedabad Municipal Corporation said the Indian Council of Medical Research did not inform them about the “real” purpose of the sudden surveillance, which was carried out in January and February by his staff. “We were told that the surveillance is being carried out as a national exercise to control malaria,” he said. “There was no mention of Zika virus or cases to us.”

But Patni and her neighbours said that over the last four months, not once has a health worker visited their homes to screen for fever cases. “If we get fever, we go to a local doctor,” Patni said. Most people go to doctors practicing Ayurveda and Homeopathy, which are common in the neighbourhood.

Concerns for pregnant women

Dr Hiren Shah, a MBBS doctor practicing in Bapunagar, said that 30% of the patients he sees suffer from viral fever, which could be the result of dengue, chikungunya, malaria. “The treatment for dengue, chikungunya, as well as Zika, is the same,” he said. “Hence, there could be patients who perhaps were having Zika but got treated on their own because the disease is self-limiting in adults.”

Shah expressed concern that two of the three cases were of pregnant women. The disease can be dangerous for the foetus who may suffer from congenital defects like microcephaly. “Now that we know that Zika is present in India, if a pregnant woman comes to us with symptoms, we will monitor the foetus also,” said Shah.

Among the residents of Bapunagar, there is some anger, but mostly resignation. Pratap Marwari said the government has not cared to improve the living condition in the slum. Why would it care after Zika virus had been discovered?

Alleys in Bapunagar area are stinking with garbage. Poor sanitation encourages mosquitoes to breed. (Photo: Priyanka Vora)
Alleys in Bapunagar area are stinking with garbage. Poor sanitation encourages mosquitoes to breed. (Photo: Priyanka Vora)

This reporting project has been made possible partly by funding from New Venture Fund for Communications.

Corrections and clarifications: An earlier version of the story said all three cases of Zika viral infections were reported from Bapunagar. This was based on information shared by municipal officials. However, state health officials later said that only two of the three cases were from Bapunagar. The story has been updated to reflect the change.