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West Africa, Ebola and the threat of Zika

Rapid testing for the Zika virus is a critical need in the recent Ebola-affected countries of Liberia, Sierra Leone and Guinea, says a Georgetown University professor, because of the recent Zika outbreak on nearby Cape Verde and the similarity in symptoms between Zika and early Ebola.

In his Health Security commentary published online yesterday, infectious disease specialist Daniel Lucey, MD, MPH, urges both surveillance for Zika and prospective studies to monitor for microcephaly and other neurologic disorders in West Africa, citing the close travel links with Cape Verde.

“The clinical presentation of ZIKV [Zika virus] infection, although extremely mild compared with typical Ebola virus disease, could cause initial confusion clinically because both can have fever, muscle and joint pain, red eyes, and rash,” writes Lucey. “If a patient with ZIKV infection were to raise initial concern about a potential Ebola virus infection, then a cascade of unnecessary medical, public health, societal, and political issues could be triggered.”

In February 2016, a World Health Organization risk assessment of the Zika virus in Africa placed Liberia, Sierra Leone and Guinea in either a high or moderate risk category. Lucey points out that critical information learned about Zika in the brief time since the report was issued warrants a change.

He proposes three additions: “(1) an explicit strong recommendation for prospective epidemiologic studies to monitor for microcephaly following every known ZIKV outbreak…. ; (2) explicit discussion of the potential confusion in initial differentiation of the clinical presentations of ZIKV infection and (mild) Ebola virus disease; and (3) making available rapid PCR testing for ZIKV as soon as possible in 2016, especially in Guinea, Sierra Leone, and Liberia, as well as Guinea-Bissau.”

Lucey, an adjunct professor of Medicine at Georgetown University School of Medicine and senior scholar with the O’Neill Institute for National and Global Health Law, spent several months in West Africa treating patients with Ebola in 2014.

“Bearing witness to the suffering caused by Ebola has led me to call for early action now for Zika and microcephaly in West Africa, as well as action against the panepidemic in the Americas,” Lucey says.