INTERVIEW – 600 experts met this week in Paris to take stock of the Zika virus. Dr Marie-Paule Kieny, Assistant Director-General of WHO participated.
France is at the heart of the fight against the Zika virus. For two days, more than 600 international experts attended a conference organized by the Institut Pasteur in Paris. Whether they come from South America – the epicenter of the current epidemic -, Asia or Europe, all came to take stock of the latest scientific knowledge concerning the virus and its vector, the mosquito. Aedes. Why Paris, when Brazil is the center of attention? No doubt because historically, the Institut Pasteur has been involved in research on emerging diseases through its Parisian foundation and its satellites around the world.
“It was natural for France to get involved in this theme,” said Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. She was in attendance throughout the science sessions. The opportunity for Why actor to come back to this unprecedented epidemic, and the means of control implemented by the World Health Organization (WHO) with its expertise.
Will the change of season favor the arrival of the virus on the European continent?
Dr Marie-Paule Kieny: It’s a possibility. Several epidemics have taken place outside Latin America, which is a sign that the virus can move. It is still too early to comment on its arrival in Europe, because the main vector which is theAedes aegypti is not present in Western Europe. But other insects can play a role. We know, for example, that mosquitoes of the Culex, present in Europe, may have Zika in their saliva. This does not mean that they are an efficient vector. We must therefore not panic and think that the virus is at our doorstep.
Who pays for the fight against the Zika virus and the mosquito Aedes ?
Dr Marie-Paule Kieny: Vector control campaigns are organized and paid for by the affected states. Brazil is a middle-income country but one that can afford it financially. We are not in the same conditions as for Ebola, where Guinea or Sierra Leone had no room for maneuver. For its part, the WHO is requesting funding to technically support the affected countries. The aim is to improve the effectiveness of campaigns by putting in place structures and methods that determine whether they work and how to improve them.
At present, are we looking for a treatment or a vaccine?
Dr Marie-Paule Kieny: At least 23 vaccine projects are at an initial level. At the end of 2016, a few should start to be evaluated in humans. We will have to wait a few more years before the registration of a vaccine that could be used in mass vaccination campaigns. There are two possibilities: a vaccine that would aim to eliminate an imminent threat, and would rather target women of childbearing age or pregnant, or a vaccine that would target children, in case the virus takes hold.
On the drug side, it is quite difficult to know how to attack the virus because it only remains in the blood for a few days. To find such a treatment, it would be necessary to detect infections very early and intervene immediately. But we must prepare because the situation in Central America can always get worse, and we do not know what will happen next year. It is also not known where the virus will migrate.
Have we underestimated this virus?
Dr Marie-Paule Kieny: Yes, we underestimated it but we do not yet know if it has evolved. There are now two subtypes of virus, African and Asian. It is not known whether this change altered its pathogenicity. Its neurological effects are now well described, but they were not described two years ago because the affected populations were too small. Microcephaly may have gone unnoticed, unlike what is currently happening in Brazil. We also did not understand the totality of the harmful effects induced by the infection. It seems that there are other neurological complications than microcephaly and Guillain-Barré syndromes.
How do you see the Olympic Games in Rio de Janeiro (Brazil) and Euro 2015 in France?
Dr Marie-Paule Kieny: Care must be taken, as with any mass movement. We advise pregnant women and their partners who travel to these areas to protect themselves against mosquitoes, and by using condoms. Without giving in to panic, we must have a responsible attitude and take all precautions for the most sensitive populations. The role of the WHO is to advise the organizing country and to issue global recommendations for the countries whose population will travel to Brazil, for the prevention and management of return.
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