Functional Dependence and Nutritional Status

1 Vol 1(2) (2016) 1-3 | jchs-medicine.uitm. edu.my | eISSN 0127-984X The Olympics and Paralympic games bring joy to millions of people worldwide. This year it was held in Rio de Janeiro, Brazil amidst the Zika virus epidemic. On 1 February 2016, six months leading to the Olympics, the excitement was dampened by the World Health Organization declaration of the unprecedented vector-borne Zika virus (ZIKV) infection as a public health emergency of international concern [1]. At that point in time, people in Malaysia also felt the heat but had the consolation that the epidemic occurred across the Atlantic on the other side of the world. On 27 August 2016, Singapore reported the first local confirmed case of ZIKV infection in the city-state [2]. It was only a matter of time that Malaysia reported its first confirmed case of ZIKV infection on 2 September 2016 [3]. A 58-year old woman from Klang, Selangor was diagnosed as the first ZIKV case, who had earlier visited her daughter in Singapore who was infected by the ZIKV. As of 22 September 2016, the number of confirmed ZIKV cases in Malaysia has mounted to six with both Polynesia and Micronesia strains [4]. The occurrence of the disease in our continent brings to light how rapidly globalization and free movement of population across geographical borders can accelerate the arbovirus threat across the globe. The ZIKV is spread through the bite of infected female Aedes mosquitoes and evidence has shown it can also spread via sexual and blood transmission [5]. Most of the cases are asymptomatic or subclinical while the symptomatic cases are selflimiting. Other manifestations include neurological (Guillain-Barré syndrome and meningoencephalitis) and autoimmune (thrombocytopenic purpura and leukopenia) complications. More alarming is the association of the virus with infants born with microcephaly as a result of pregnant mothers infected with ZIKV with the risk of microcephaly ranges between 1-13% [6, 7], though the direct causal relationship is still under investigation. In line with the international response, Malaysia has intensified the surveillance and management activities to control its ZIKV epidemic. These include clinical surveillance, laboratory surveillance, microcephaly and Guillain-Barre Syndrome case detection as well as preparedness and response at all ports of entry [8]. The public health delivery system in Malaysia has improved tremendously over the years following lessons learned from the emerging and re-emerging infectious diseases that affected the country over the recent years. Apart from those commendable measures; in light of this ZIKV outbreak, there are looming questions even though may appear elementary are nevertheless pertinent which the healthcare fraternity should address. Where do we go from here? What more do we need to know and do to help us manage and control this outbreak more efficiently and effectively? These questions would certainly pose a challenge to our public health especially when this arbovirus shares the same transmission vector with dengue and chikungunya i.e., Aedes mosquito where the authorities in Malaysia are still struggling to achieve a satisfactory control level in the country. What shall we do? We need a paradigm shift. We need to look at the re-emergence of ZIKV in a bigger perspective and manage it accordingly. Thus, instead of reacting merely to the notified ZIKV cases, we need to start strategizing how the transmission dynamics of the arbovirus family can be altered; this possibly means to look out of the box for the solutions. The conventional measures for prevention and control should also be complemented with two other elements Zika on Board