Zika in India

A university project caught India’s fourth Zika case – not the government’s surveillance programme

The Manipal laboratory that detected the case tested 20,000 patient samples for Zika. Less than 1,000 came from the government’s surveillance programme.

India’s fourth reported case of infection by the Zika virus, detected in early July in Tamil Nadu, was picked up first by a public health project conducted by Manipal University and then passed on to the national surveillance programme for communicable diseases. If not for Manipal University’s project on fever diagnosis, the case might have gone unreported.

The Manipal Centre for Virus Research launched a project called the Hospital Based Acute Febrile Illness Surveillance in India in 2013. The aim of the project is to characterise the infectious causes of Acute Febrile Illness or AFI among patients in district and sub-district hospitals and in primary health centres across India, by identifying pathogens including the malaria parasite and bacterial, viral and other causes of fevers.

The project operates in 13 districts across 12 states – Karnataka, Kerala, Goa, Tamil Nadu, Assam, Tripura, Odisha, Jharkhand, Gujarat, Punjab, Uttar Pradesh and Bihar – from where samples of fever patients are collected at any of 27 designated sentinel hospitals, which may be district hospitals or primary health centres. Private doctors can also send in samples of their patients who have tested negative for dengue and chikungunya. The samples are sent to the Manipal Centre for Virus Research to be testing.

One of the project sites happens to be the primary health centre in N Puttur village in Krishnagiri, where the blood samples of India’s fourth Zika patient were first collected.

The 27-year-old man went to the primary health centre with fever and redness in his eyes. He also complained of pain behind his eyes, a headache and joint pains. These symptoms are indicative of both dengue and chikungunya and his blood and urine samples were tested for antibodies for both illnesses.

When the tests did not show dengue or chikungunya infections, the team at the Manipal Centre for Virus Research ran a real-time polymerase chain reaction test for Zika. Dr G Arunkumar, professor and head of the department of virus research, was not expecting to find the Zika virus in the samples. His team has tested about 20,000 samples of fever patients till then, all of which were negative.

However, the N Puttur resident’s test results on July 1 showed the presence of the Zika virus. The research team quickly reconfirmed the results. “We took the samples again on July 2,” said Arunkumar. “This time the blood showed the presence of the virus. The urine did not have the virus.”

The laboratory immediately alerted the Indian Council of Medical Research, the union health ministry and the Tamil Nadu government. Another set of the man’s samples were sent to the National Institute of Virology. On July 5, the institute also confirmed that the man had Zika.

The purpose of Manipal’s AFI project is to provide early and accurate diagnosis and treatment of fever-related illnesses even to people in remote parts of the country who do not have easy access to laboratory testing.

Therefore, the question that this case of Zika detection throws up is whether there are Zika cases in areas where the AFI project is not operating that are also being missed by the national surveillance programme for communicable diseases.

Cases getting missed?

Senior health officials agreed that if this patient had belonged to another district where the AFI project was not operating, his blood and urine samples may not have been tested for Zika.

Along with the AFI project, the Manipal Centre for Virus Research is also one of 25 laboratories associated with the Indian Council of Medical Research, the apex agency leading the national surveillance programme.

The national surveillance programme for communicable diseases coordinates testing of samples of fever patients for dengue and chikungunya. If these initial tests are negative, then the samples are tested for Zika. Twenty five laboratories across the country have been equipped to test for Zika. Government and private hospitals have been notified that they can send patient samples to these laboratories to be checked for Zika.

There is no active case finding and health workers are not looking for possible infections within communities. The 25 laboratories mostly end up testing samples of those patients who are admitted at hospitals that they are attached to.

“Most of the labs are located in medical colleges and they receive samples from there for testing,” said Arunkumar, who said that most of the samples that the Manipal Centre for Virus Research tests come from cities. The only samples that they get from rural areas come in as part of the AFI project.

“Less than 1,000 samples came from the [national] surveillance,” he added.

At the same time, not all the 25 laboratories linked with the national surveillance programme have started testing for Zika. “We are waiting for some reagents and other materials to begin testing,” said an official at the Haffkine Institute in Mumbai. The Central Research Institute at Kausali also confirmed to Scroll.in that it had not started testing patient samples for Zika.

However, Dr AC Dhariwal, director of the National Centre for Disease Control said that the system is robust. “Every laboratory is given a region from where they can get and test samples,” he said.

Meanwhile, the real burden of Zika in India remains unknown.

“We are trying to ensure a geographic coverage so that all states are covered,” said Dr Soumya Swaminathan, director general of Indian Council of Medical Research, about the national surveillance programme. “There are more labs in Tamil Nadu and Karnataka. About 50% of 40,000 samples tested for Zika were tested at Manipal.”

Of the 40,000 samples tested only 10% have come from private hospitals, even though most people in India go to private hospitals first for treatment, suggesting that many ever cases being treating at private facilities are not being tested for Zika. There is an even smaller chance, then, that Zika infections that are not showing up as fever are being detected.

“We are testing samples of those with fever and the detection is best if done within first week of symptoms,” said Swaminathan. “About 80% of Zika infected individuals will have no symptoms. It is not possible to screen thousands of asymptomatic people.

Unknown neurological conditions?

Apart from actively looking for Zika cases, the surveillance programme is also conducting tests to check how similar the Zika virus strain found in India is to the strain that caused Zika infections in Brazil through 2015 and 2016. The World Health Organisation declared Zika a Public Health Emergency of International Concern after several reports of women infected with Zika giving birth to babies with microcephaly, a condition in which the brain is small and underdeveloped.

The four Zika cases reported so far in India have all been caused by the Asian strain of the Zika virus, the same strain that caused the Zika outbreak in Brazil. But, the Indian Council of Medical Research is looking closer.

“Even a smaller mutation may make the virus less or more neurotopic,” said Swaminathan, referring to the virus’s ability to attack the nervous system.

Meanwhile, the health ministry has identified 50 hospitals, both government and private and mostly in cities, where all newborns will be screened for Zika infections. The blood samples collected from infants within one week of their birth or their umbilical cord blood will be tested.

“It is not just microcephaly, newer evidence is coming up every day about various neurological conditions [associated with Zika] which can cause developmental delays,” said Swaminathan.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

How sustainable farming practices can secure India's food for the future

India is home to 15% of the world’s undernourished population.

Food security is a pressing problem in India and in the world. According to the Food and Agriculture Organization of the UN (FAO), it is estimated that over 190 million people go hungry every day in the country.

Evidence for India’s food challenge can be found in the fact that the yield per hectare of rice, one of India’s principal crops, is 2177 kgs per hectare, lagging behind countries such as China and Brazil that have yield rates of 4263 kgs/hectare and 3265 kgs/hectare respectively. The cereal yield per hectare in the country is also 2,981 kgs per hectare, lagging far behind countries such as China, Japan and the US.

The slow growth of agricultural production in India can be attributed to an inefficient rural transport system, lack of awareness about the treatment of crops, limited access to modern farming technology and the shrinking agricultural land due to urbanization. Add to that, an irregular monsoon and the fact that 63% of agricultural land is dependent on rainfall further increase the difficulties we face.

Despite these odds, there is huge potential for India to increase its agricultural productivity to meet the food requirements of its growing population.

The good news is that experience in India and other countries shows that the adoption of sustainable farming practices can increase both productivity and reduce ecological harm.

Sustainable agriculture techniques enable higher resource efficiency – they help produce greater agricultural output while using lesser land, water and energy, ensuring profitability for the farmer. These essentially include methods that, among other things, protect and enhance the crops and the soil, improve water absorption and use efficient seed treatments. While Indian farmers have traditionally followed these principles, new technology now makes them more effective.

For example, for soil enhancement, certified biodegradable mulch films are now available. A mulch film is a layer of protective material applied to soil to conserve moisture and fertility. Most mulch films used in agriculture today are made of polyethylene (PE), which has the unwanted overhead of disposal. It is a labour intensive and time-consuming process to remove the PE mulch film after usage. If not done, it affects soil quality and hence, crop yield. An independently certified biodegradable mulch film, on the other hand, is directly absorbed by the microorganisms in the soil. It conserves the soil properties, eliminates soil contamination, and saves the labor cost that comes with PE mulch films.

The other perpetual challenge for India’s farms is the availability of water. Many food crops like rice and sugarcane have a high-water requirement. In a country like India, where majority of the agricultural land is rain-fed, low rainfall years can wreak havoc for crops and cause a slew of other problems - a surge in crop prices and a reduction in access to essential food items. Again, Indian farmers have long experience in water conservation that can now be enhanced through technology.

Seeds can now be treated with enhancements that help them improve their root systems. This leads to more efficient water absorption.

In addition to soil and water management, the third big factor, better seed treatment, can also significantly improve crop health and boost productivity. These solutions include application of fungicides and insecticides that protect the seed from unwanted fungi and parasites that can damage crops or hinder growth, and increase productivity.

While sustainable agriculture through soil, water and seed management can increase crop yields, an efficient warehousing and distribution system is also necessary to ensure that the output reaches the consumers. According to a study by CIPHET, Indian government’s harvest-research body, up to 67 million tons of food get wasted every year — a quantity equivalent to that consumed by the entire state of Bihar in a year. Perishables, such as fruits and vegetables, end up rotting in store houses or during transportation due to pests, erratic weather and the lack of modern storage facilities. In fact, simply bringing down food wastage and increasing the efficiency in distribution alone can significantly help improve food security. Innovations such as special tarpaulins, that keep perishables cool during transit, and more efficient insulation solutions can reduce rotting and reduce energy usage in cold storage.

Thus, all three aspects — production, storage, and distribution — need to be optimized if India is to feed its ever-growing population.

One company working to drive increased sustainability down the entire agriculture value chain is BASF. For example, the company offers cutting edge seed treatments that protect crops from disease and provide plant health benefits such as enhanced vitality and better tolerance for stress and cold. In addition, BASF has developed a biodegradable mulch film from its ecovio® bioplastic that is certified compostable – meaning farmers can reap the benefits of better soil without risk of contamination or increased labor costs. These and more of the company’s innovations are helping farmers in India achieve higher and more sustainable yields.

Of course, products are only one part of the solution. The company also recognizes the importance of training farmers in sustainable farming practices and in the safe use of its products. To this end, BASF engaged in a widespread farmer outreach program called Samruddhi from 2007 to 2014. Their ‘Suraksha Hamesha’ (safety always) program reached over 23,000 farmers and 4,000 spray men across India in 2016 alone. In addition to training, the company also offers a ‘Sanrakshan® Kit’ to farmers that includes personal protection tools and equipment. All these efforts serve to spread awareness about the sustainable and responsible use of crop protection products – ensuring that farmers stay safe while producing good quality food.

Interested in learning more about BASF’s work in sustainable agriculture? See here.

This article was produced by the Scroll marketing team on behalf of BASF and not by the Scroll editorial team.