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Journal of MPE Molecular Pathological Epidemiology Vol.1 No.1:6 2016

Dr. Vincent Icheku*
School of Health and Social Care, London South Bank University, UK

*Corresponding author: Vincent Icheku, School of Health and Social Care, London South Bank University, UK, Tel: +020 7815 8083; E-mail:Ichekuv@lsbu.ac.uk

Received date: Oct 03, 2016; Accepted date: Oct 25, 2016; Published Date: Oct 28, 2016
Copyright: © 2016 Icheku V.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Icheku V. A review of the evidence linking Zika virus to the developmental abnormalities that lead to microcephaly in view of recent cases
of birth defects in Africa. J Mol Pathol Epidemiol. 2016, 1:1.

Abstract

The World Health Organization (WHO) in May 2016 confirmed an outbreak of the Zika virus on the African island chain of Cape Verde, linking it to cases of the brain disease, microcephaly. This finding is of concern because Zika was first discovered in East Africa in 1947 with no known link to brain or birth disorders until the WHO reported findings. The question, therefore, is: if the Zika virus has been in Africa for 69 years, why wasn’t any association to microcephaly detected before the recent WHO findings in Brazil (see below) and Cape Verde? This study reviews the evidence linking Zika to microcephaly in view of recent cases of birth defects in Africa, with the aim of providing vital clues as to why there was no documented case of such birth defects in Africa, where the Zika virus originated.

The literature for this review was gathered through internet searches, including the websites of the European Centre for Disease Prevention and Control (ECDC), the United States Centre for Disease Control and Prevention (CDC), the World Health Organization (WHO) and Public Health England (PHE).

Materials from these sources were reviewed on the link between the Zika virus and microcephaly in relation to the recent cases of birth defects in Africa. Two possible explanations emerged from the review. The first explanation suggests that the phenomenon called herd immunity may have taken place in Africa. The Zika virus cannot infect the same person twice because it reaches a stage where there are too few people left to be infected for transmission to be sustained. The second explanation suggests that microcephaly linked to birth defects is caused by other conditions.

In conclusion, the findings of this review opens up the debate on the connection between the Zika virus and the birth defect attributed to mosquito-borne microcephaly, given that there is no documented case of birth defect in Africa 69 years after the discovery of the Zika virus. Large-scale research is recommended on the Zika virus and pregnancy in Africa for better understanding of the ecology and epidemiology of the virus in the continent.

Keywords: Aedes aegypti mosquito, Africa, birth defect, microcephaly, pregnancy, Zika virus.

Introduction

The Zika virus is a Flavivirus from the family Flaviviridae, which has emerged as a global mosquito-borne pathogen of growing public health concern. [1] The Aedes aegypti mosquito was implicated in a study by Boorman and Porterfield (1956) as the main vector transmitting the Zika virus. This finding was confirmed by a later experimental study that demonstrated the competence of the Aedes aegypti mosquito to transmit the Zika virus. [2] The Aedes aegypti mosquito is one of the two mosquitoes (Aedes aegypti and Aedes albopictus) that spread the dengue and chikungunya viruses. The virus is mostly transmitted to individuals through bites from infected Aedes aegypti mosquitos. The mosquito becomes infected when it feeds on a person already infected with the virus; it cannot be caught from merely coming into contact with the infected person. The symptoms of an infected person include fever, headache, myalgia, joint pains, maculopapular rash, eye pain, itching, arthralgia, muscle pain, and conjunctivitis or “red eye”. [1] [3]

Serological evidence and virus isolations have demonstrated widespread distribution of the Zika virus in Africa, the Indian subcontinent, Southeast Asia, Micronesia and French Polynesia, and most recently the American continent. For example, the latest Global Situation Report on Zika by WHO shows that 72 countries and territories have reported evidence of Zika virus transmission since 2007.The report further shows that since February 2016, 20 countries or territories have reported microcephaly potentially associated with Zika virus infection. Four of the 20 countries reported microcephalic babies born from mothers in countries with no endemic Zika virus transmission but who reported recent travel history to Zika-affected countries. [4] Thus, having considered the evidence presented at the fourth meeting of the WHO Emergency Committee on Zika held on 1 September 2016, the Committee agreed that, due to continuing geographic expansion and considerable gaps in understanding of the virus and its consequences, the Zika virus infection continues to be a Public Health Emergency of International Concern (WHO, 2016), as originally notified in February 2016. [5]

In May 2016, WHO tests confirmed 200 cases of Zika virus with 7,557 suspected cases in the African island chain of Cape Verde. [6] Cape Verde is an Atlantic archipelago that is about 350 miles (570km) west of Senegal and which has historic ties to Brazil. [7] The virus was first isolated in 1947 from a febrile sentinel rhesus monkey in the Zika forest in Uganda, where it got its name. [1] The forest at the time was the hub of scientific research in East Africa and, while carrying out tests on wild African monkeys in the Zika forest, scientists, whose research had been funded by the Rockefeller Foundation, unexpectedly discovered a previously unknown microorganism, which they later named Zika. [8]

According to CDC, Zika showed up in Brazil in 2014 with only 150 cases, which is a very small number for its population, compared to the outbreak in 2015. The outbreak in Brazil, beginning in May 2015, was unprecedented and is reported to have resulted in in more than 1 million cases, with 4,000 suspected cases of microcephaly, and 270 confirmed cases that health officials believe are linked to the Zika virus. [9] Microcephaly is a condition that makes a baby’s head smaller than expected when compared to other babies of the same sex and age. The babies often have smaller brains apparently lacking in normal development. Other complications of microcephaly include seizures, hearing loss, vision problems, intellectual disability such as decreased ability to learn and function in daily life, developmental delay such as problems with speech or other developmental milestones,  including sitting, standing and walking. These problems can range from mild to severe, are often life-long and, in some cases, can be life-threatening. [1]

One study shows that the association of Zika virus infection with pregnancy began during the outbreak of the disease in north-east Brazil in early 2015. The test carried out by the Brazilian Ministry of Health identified Zika virus RNA (ribonucleic acid) in the amniotic fluid of two women whose foetuses had been found by prenatal ultrasound to have microcephaly. [10] This finding prompted the Brazilian Ministry of Health to report on its website a possible association of microcephaly with Zika virus infection during pregnancy. Subsequently, the Pan American Health Organization (PAHO) reported the identification of Zika virus RNA by reverse transcription-polymerase chain reaction (RT-PCR) in in the tests on the two pregnant women, and the identification of Zika virus RNA from multiple body tissues, including the brain, of an infant with microcephaly who died in the immediate neonatal period. [11] The report of these findings prompted both the ECDC and CDC to publish reports concerning the possible association of microcephaly with the Zika virus outbreak. [12] The WHO Global Situation Report on Zika in 2016 reported that Zika virus infection during pregnancy causes microcephaly. [4]

In May 2016, the WHO tests confirmed two hundred cases of Zika virus with 7,557 suspected cases in the African island chain of Cape Verde. The Zika virus, linked in Brazil to the birth defect microcephaly, was first identified in the Ugandan Zika forest in 1947. Until this recent WHO finding, there was no documented evidence of Zika-associated microcephaly in any part of Africa, where the virus originated. [7] This once more raises the question as to what is the connection between Zika virus and microcephaly. In other words, is mosquito-borne infection actually the cause of the defects in babies born to Zika-virus-infected mothers?

Aim and objective

The aim of this study is to review the evidence linking Zika virus to the developmental abnormalities that lead to microcephaly in view of recent cases of birth defects in Africa. The objective is to provide vital clues as to why there was no documented case in Africa of such birth defects linked to the virus during the 69 years since its discovery in East Africa.

Method

The literature for this review was gathered through searches on Google Scholar and the Google search browser. The European Centre for Disease Prevention and Control (ECDC), United States Centre for Disease Control and Prevention (CDC), World Health Organization (WHO) and Public Health England (PHE) websites were also searched.

Result

The Zika virus, which has been linked in Brazil to the birth defect called microcephaly, was first identified in the Ugandan Zika forest in 1947. [1] Until the recent WHO finding in Cape Verde, there was no documented evidence of Zika-associated microcephaly in any part of Africa, the continent where the virus originated. [7] This once more raises the question as to what is the connection between Zika virus and microcephaly. The review found evidence suggesting that the phenomenon called herd immunity may have taken place in Africa. The Zika virus cannot infect the same person twice when it reaches a stage where there are too few people left to be infected for transmission to be sustained. [13] [14] [16] The review also found evidence suggesting that microcephaly linked to birth defects is caused by other conditions. [12] This suggestion re-opens the debate on the connection between the Zika virus found in pregnant women and the birth defects attributed to mosquito-borne microcephaly infections.

Discussion

Until this recent WHO’s finding, there was no documented evidence of Zika-associated microcephaly in any part of Africa where the virus originated. [7] The question, therefore, is: although the Zika virus has been in Africa for 69 years, why was no association to microcephaly detected before the recent WHO findings? Two possible explanations emerged from this review:

The first possible explanation is due to a phenomenon called herd immunity. According to Fine et al. (2011) the term herd immunity, referring to an entire population’s immunity, was  used to describe a naturally occurring phenomenon in the 1930s when it was observed that, after a large group of children had become immune to measles infection, new infections decreased in the short term. [13] In other words, herd immunity becomes a type of indirect protection from infectious disease, occurring when a significant percentage of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not immune and thus decreasing the number of new infections. [14]

As indicated above, the virus was discovered in the Zika forest in Uganda 69 years ago. It is common in Africa but it did not begin spreading widely in the Western Hemisphere until May 2015 when the outbreak occurred in Brazil. [15] Herd immunity may have been the reason why there was no scientific evidence linking microcephaly to the Zika virus earlier. The greater the proportion of individuals in the herd community who are immune to the virus, the lesser the probability that those who are not immune will come into contact with an infected individual. [13] It is not surprising therefore that a new study by scientists at Imperial College London predicted that “once the current epidemic is over, herd immunity will lead to a delay of at least a decade before large epidemics may recur” [16]

The second possible explanation opens up the debate on the connection between the Zika virus found in pregnant women and the birth defects attributed to mosquito-borne microcephaly. [17] [18] The WHO Global Situation Report on Zika virus in 2016 reported that Zika virus infection during pregnancy is a cause of microcephaly. The conclusion was based on a systematic review of the literature up to 30 May 2016. However, the findings, which emerge from a causality framework that WHO, developed in February 2016 to appraise the strengths and weaknesses of available evidence, identify gaps in research. [4]

The association between viral infections and pregnancy has long been recognized. For example, one study on viral infections and pregnancy shows that pregnant women suffer worse outcomes during viral epidemics and pandemics than the general population and non-pregnant women. A study explains that women go through an immunological transformation during pregnancy. Adverse pregnancy outcomes may result when the immune system required for promoting and supporting the pregnancy and growing foetus is compromised due to infection. [19]

In a review of literature, Icheku and Icheku (2016) found no conclusive evidence that Zika virus infection caused any of the abnormalities found in the babies with microcephaly. The study could also not find any conclusive scientific evidence of the full spectrum of outcomes that might be associated with Zika virus infection during pregnancy or the factors that might increase risk of the disease infection to the foetus. [1] However, a subsequent systematic review panel on Zika virus infection and neurological disorders found epidemiological studies, which suggested a marked increase in the risk of brain abnormalities in foetuses and new-borns when a woman acquires Zika virus infection during pregnancy. [20]

CDC recently reported that the causes of microcephaly in babies are mostly inconclusive. Some babies have microcephaly because of other abnormalities. Other causes of microcephaly, including severe microcephaly, can include exposures during pregnancy to certain infections such a s rubella, toxoplasmosis or cytomegalovirus; also to lack of nutrients or not getting enough food, exposure to harmful substances, such as alcohol, certain drugs, or toxic chemicals, and interruption of the blood supply to the baby’s brain during development. Finally, this calls for large-scale studies to produce conclusive evidence of other causes of abnormalities in babies born to mothers infected with Zika virus during pregnancy. [12]

Conclusion

The likelihood that herd immunity occurred may explain why the Zika virus has been in Africa for almost seven decades without any documented link to microcephaly. Herd immunity may have provided protection against the Zika virus in Africa when a significant percentage of the population has become immune to the disease, thereby providing a measure of protection for individuals who are not immune and thus decreasing the number of new infections. [14] In addition, the absence of large scale studies that produce robust scientific evidence linking microcephaly to other causes seem to offer additional clues as to why there had been no known cases of microcephaly in Africa. [12]

Finally, the findings of this review opens up the debate on the connection between the Zika virus and the birth defect attributed to mosquito-borne microcephaly, given that until recently, there is no documented case of birth defect in Africa where the virus originated. Large-scale research is recommended on the Zika virus and pregnancy in Africa for better understanding of the ecology and epidemiology of the virus in the continent.

References

[1]        Icheku, V. and Icheku, C.(2016) Exploration of Zika Virus Travel-related Transmission and a Review of Travel Advice to Minimise Health Risks to UK Travellers, Universal Journal of Public Health Vol. 4(4), pp. 203 – 211

 [2]          Cornet M, Robin Y, Adam C, Valade M, Calvo M.A. (1979) Transmission expérimentalecomparée du virus amaril et du virus Zika chez Aedes aegypti. Cah ORSTOM ser Ent med et Parasitol.;17:47–53.

[3]        CDC (2016), (1)Recognizing, Managing, and Reporting Zika Virus Infections in Travellers Returning from Central America, South America, the Caribbean, and Mexico, The Centers for Disease Control and Prevention,  Health Alert Network,  http://emergency.cdc.gov/han/han00385.asp

[4]          WHO (2016) Latest Global Situation Report on Zika:Zika virus, Microcephaly and Guillain-Barré syndrome, http://www.paho.org/hq/index.php?option=com_content&view=article&id=11669&Itemid=41716&lang=en

[5]        WHO (2016), WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain-Barré syndrome, http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/

[6]          WHO (2016), Zika situation report, https://www.google.co.uk/search?q=Zika+situation+report&oq=Zika+situation+report&aqs=chrome..69i57j69i60l3.406786j0j4&sourceid=chrome&ie=UTF-8

[7]        Davis, N (2016) Brazilian strain of Zika virus confirmed in Africa, says WHO, The Guardian, https://www.theguardian.com/world/2016/may/20/brazilian-strain-zika-virus-confirmed-in-africa-first-time-who

[8]          Byaruhanga, C. (2016), Zika virus: Inside Uganda’s forest where the disease originates, http://www.bbc.co.uk/news/world-africa-35431181(Online access, February 2016)

[9]          CDC2 (2016), Facts about Microcephaly, http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html

[10]      Campos G.S, Bandeira A.C, Sardi S.I. (2015) Zika virus outbreak, Bahia, Brazil.Emerg Infect Dis;21:1885–6.

[11]      PAHO (2015), Neurological syndrome, congenital malformations, and Zika virus infection: Implications for public health in the Americas—epidemiological alert. Washington DC: World Health Organization, Pan American Health Organization; http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32405&lang=en.

[12]      CDC (2016) Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015: Weekly / January 29, 2016 / 65(3);59–62, http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e2.htm

[13]      Fine, P.; Eames, K.; Heymann, D. L. (2011). “”Herd immunity”: A rough guide”. Clinical Infectious Diseases. 52 (7): 911–6. doi:10.1093/cid/cir007. PMID 21427399.

[14]      Hinman, A. R.; Orenstein, W. A.; Papania, M. J. (1 May 2004). “Evolution of measles elimination strategies in the United States”. The Journal of Infectious Diseases. 189 (Suppl 1): S17–22. doi:10.1086/377694. PMID 15106084.

[15]      McNEIL Jr.D. G, LOUIS, C. S and ST. FLEUR, N. (2016)Short Answers to Hard
Questions About Zika Virus, New York Times, http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0

[16]        Ferguson, N.M, Cucunuba, Z.M, Dorigatti, I, et al. (2016) Countering Zika in Latin America. Science, 22 Jul 2016: Vol. 353, Issue 6297, pp. 353-354

[17]      CDC (2016) Pregnancy, Centers for Disease Control and Preventionhttps://www.cdc.gov/zika/pregnancy/

[18]      CDC (2016), Transmission through mosquito bites, Centers for Disease Control and Preventionhttp://www.cdc.gov/zika/transmission/

[19]      Silasi M., Cardenas I., Kwon J.Y, Racicot K., Aldo P., Mor G. (2015) Viral infections during pregnancy, Am J Reprod Immunol;73:199–213.

[20]      WHO (2016) Zika causality statement, Update of WHO Statement published on 31 March 2016, http://www.who.int/emergencies/zika-virus/causality/en/

DOI: 10.13189/ujph.2016.040406
Universal Journal of Public Health 4(4): 203-211, 2016 207

Exploration of Zika Virus Travel-related Transmission and a Review of Travel Advice to Minimise Health Risks to UK Travellers

Vincent Icheku1,1* , Chinelo Icheku,2*

1*School of Health and Social Care, London South Bank University, UK
2*NHS Jenner Health Centre, UK

Copyright©2016 by authors, all rights reserved. Authors agree that this article remains permanently open access under the terms of the Creative Commons Attribution License 4.0 International License

Abstract The World Health Organization (WHO) on 1 February 2016 declared the Zika virus outbreak is a global public health emergency. Zika virus is thought to have led to more than 11,000 deaths and nearly 4,000 cases of microcephaly in Brazil since the start of the outbreak in May 2015. WHO predicted that, in 2016, as many as four million people may be infected with the virus. [1] Health experts have warned that the risk of transmitting Zika virus in the United Kingdom (UK) is very high because South America has become an increasingly popular tourist destination for UK travellers. [2] Given the declaration of Zika virus outbreak as a global public health emergency, this study explores Zika virus travel-related transmission and review current travel advice to minimise health risks to UK travellers. The evidence from our initial literature review showed that there is a paucity of research information on the recent Zika virus outbreak. Thus, the evidence used in this study was gathered from surveillance reports published by the European Centre for Disease Prevention and Control (ECDC), the United States Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Public Health England (PHE), Fitfortravel (NHS Scotland) and NHS Choices reports were reviewed for Zika virus outbreak alerts and travel advice. The study finds that Zika virus, which originated in East Africa, is now transmitted in South and North American countries and the Caribbean islands through travel and, to prevent the disease epidemic in the UK, health care professionals are required by PHE to offer advice to travellers to and from the Zika-affected countries. [3] As travel advice is likely to change as more information becomes available, we recommend that professionals supplying this service should be checking on the National Travel Health Network and Centre (NaTHNaC) website to stay abreast of the latest Zika virus updates.

Keywords Aedes-aegypti Mosquitoes, Asymptomatic, Microcephaly, Travel Advice, Zika Virus

1.Introduction
Global travel provides an avenue for exposing travellers to new cultures and ideas, thereby promoting a more global community. It also promotes global economy by encouraging spending and creating employment internationally. [4] For example, in 2014, 34.4 million travellers came to the UK and spent a record £21.8 billion. In the same year, 12.2 million UK residents travelled overseas and spent £6.7 billion compared to £9.2 billion in 2013. [5] As much as these statistics show that international travel is of immense value to the global economy, it has also been known to be a major means of transmitting diseases that pose risks to public health.

1.1. Travel Risk Theory
A large body of scholarly literature regarding travel risks has been developed; yet, there is no single widely accepted definition for risk. [6] [7] Risk is not a homogenous concept; it takes myriad of forms and is influenced by facts, perceptions, experience, social groups, culture, and personal judgments. [4] However, war and political instability; health concerns; natural disaster; crime and terrorism have been identified as the most critical travel risks’ factors. Given the social and economic significance of travel, the effects of the above factors can potentially be devastating for the nations concerned. [4] One study has shown that when perceptions of risk are high, intentions to travel are lower and risk perceptions considerably influence the intention to travel or pivotal to the travel-related decision-making process. [8] In other words, when potential traveller perceives a travel destination as very risky, the traveller may modify his or her intention to travel to the perceived risky destination. The travel risk factors have notably informed travel advice issued by UK Government travel health organisations. [9]204 Exploration of Zika Virus Travel-related Transmission and a Review of Travel Advice to Minimise Health Risks to UK travellers

1.2. Implication of Zika Virus Transmission on Travel Pattern
Studies have shown that travel pattern influences disease outbreaks and exacerbate international spread of infectious diseases. Studies have also shown that the number of international flights, travel routes, aviation network, countries of departure and countries of destination, number of passengers carried, and size of aircraft are important considerations for potential infectious disease outbreak and transmission. The evidence from the studies shows that travellers arriving with infectious disease could create an outbreak or spread the disease through contact with individuals and groups in the host country. [4] [10] [11]. A recent report by WHO (2016), which was cited by CDC (2016) shows that the first local transmission of Zika virus in the Western Hemisphere was reported in May 2015; with locally acquired cases identified in Brazil. The local transmission had been identified in at least 14 countries or territories in the Americas as of January 15, 2016. [12]Zika virus originated from Zika forest in Uganda where it got its name and was first isolated in 1947 from a febrile sentinel rhesus monkey found in the Zika forest. [13] According to Catherine Byaruhanga (2016), a BBC African reporter, Zika virus was discovered in the forest by Ugandan, American and European scientists. The forest was then the hub of scientific research in East Africa and while testing monkeys in the forest the scientists, whose research had been funded by the Rockefeller Foundation, accidentally came across a new microorganism, which they later named Zika. [14]
In Uganda where the virus was first discovered only two cases had been confirmed in the last seven decades. [15] We found this interesting but speculated that it may be due the lack of testing facilities for Zika virus especially in the rural areas with poor health facilities. For example, the Uganda Virus Research Institute is the only place in Uganda where Zika blood test can be carried out. [15] However, serological studies and isolation of the Zika virus strains have shown that the disease has a wide geographical distribution. [16] Since the 1960s, human cases of the Zika virus have been sporadically reported in Asia and Africa. The first large documented outbreak occurred in 2007 in Yap Island, Micronesia, in the North Pacific. [13] Marta Zaraska (2015) reporting for Washington post, Health and Sciences estimated that three-quarters out of 11,000 or so residents of the Yap Island older than 3 years, were infected by the Zika virus. The Island’s residents that were infected showed common symptoms, which resolved within few days and none of the residents, died and until 2007 when scientists knew only fourteen properly documented human cases of the disease. [16]
In 2013, Zika showed up again in in Tahiti and other parts of French Polynesia; infecting an estimated 28,000 people, equals to about 11 per cent of the population of the islands. By 2014, the virus showed up in several South Pacific islands such as New Caledonia, east of Australia and the Cook Islands. The disease popped up in the Easter Island and as the island is part of Chile, the arrival marks the first confirmed cases of the disease in the Americas. [16]
Zika showed up in Brazil in 2014 with only 150 cases, which is a very small number for its population. [12]The outbreak of the disease in May 2015 is unprecedented culminating in more than 1 million cases as well as 4,000 suspected cases of microcephaly, with 270 confirmed cases that health officials believe are linked to the Zika virus. [12] The Brazil Ministry of Health has since reported a remarkable increase in the number of babies born with microcephaly. However, it is not conclusive how the microcephaly cases are linked with Zika virus infection and what factors increase risk of the disease to the foetus. [12] [17] The former statement has been collaborated by the National Travel Health Network and Centre (NaTHNaC), the UK Department of Health’s travel advice branch, when it reported that scientists are currently investigating whether a causal relationship exists between exposure to Zika virus in pregnancy and microcephaly. [18]

1.3. Zika Virus Poses Health Risks for Travellers
The clinical characteristic of Zika virus infection include acute onset of fever, joint pain, maculopapular rash, eye pain, itching, arthralgia, headache, muscle pain, conjunctivitis or red eyes. [12] [19] To confirm Zika virus infection, performance of RT-PCR is required on serum specimens collected within the first week of illness. After onset of the virus infection, Immunoglobulin M and neutralizing antibody testing should be performed on specimens collected ≥4 days. However, the Zika virus IgM antibody assays can be positive due to antibodies against associated flavivirus such as dengue and yellow fever viruses. A virus-specific neutralization testing provides added specificity but might not discriminate between cross-reacting antibodies in people who have been previously infected with or vaccinated against the associated flavivirus. [12]
The Zika virus RNA has been identified in tissues from several infants with microcephaly and from foetal losses in women infected during pregnancy and the preliminary analysis of research carried out by Brazilian authorities following the current outbreak has established a relationship between an increase in cases of microcephaly in new-borns and Zika virus infections. [12] Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. The head circumference of babies with microcephaly is typically at or below 3 per cent on the growth curve. The babies often have smaller brains that might not have developed properly. Other microcephaly complications include seizures, hearing loss, vision problems; intellectual disability such as decreased ability to learn and function in daily life; developmental delay such as problems with speech or other developmental milestones like sitting, standing, and walking. These problems can range from mild to severe; often lifelong and in cases can be life-threatening. The numbers of new cases have been on the increase. Barchfield and Stobbe (2016) citing Brazil’s Health Ministry reported suspected cases of microcephaly linked to Zika in 270 of 700 of the 4,180 cases they have tested since October 2015. [20] [21]
The greatest risk of birth defect that results from microcephaly appears to be associated with Zika virus infection during the first trimester of pregnancy. [20] Microcephaly has also been known to be the result of genetic or environmental factors such as toxicity and radiation. Other causes of microcephaly can include exposures during pregnancy to infections such as rubella, toxoplasmosis, or cytomegalovirus; lack of nutrients or not getting enough food culminating in severe malnutrition and exposure to harmful substances such as alcohol, certain drugs, or toxic chemicals. [20] Yet, the recent coverage of Zika virus has focused mainly on the possibility that Zika virus infection can lead to microcephaly complication including birth defects. Much as it is difficult to predict at birth what problems a baby will have from microcephaly, most babies with microcephaly generally need close follow-up through regular check-ups with a healthcare provider who will monitor their growth and development. [20] [22]
The transmission from Zika virus infected pregnant mother to her baby during pregnancy or around the time of birth is still unknown. According to Pan American Health Organization (PAHO), research is on-going to determine how some mothers can pass the virus to their babies. [22] Thus, until research evidence is conclusive, pregnant women should attend regular prenatal check-ups and receive whatever tests their health care providers deem necessary at each stage of pregnancy.
However, there is growing evidence that people infected with Zika virus will have no symptoms or fall ill; one in five of the people infected with the disease become symptomatic. [12] In other words, four out of five people infected with the Zika virus become asymptomatic. As a consequence, 80 per cent of the people infected with the virus will not seek treatment and those who come down with symptoms will have no treatment as there is no vaccine or drug to treat the disease as yet. [23] This has public health implication as people who are asymptomatic and those who are in the incubation period of Zika virus could potentially donate infected blood or exchange contaminated body fluid, thereby, making human to human transmission possible. [24]
The current treatment is generally supportive endeavour that include rest, fluids in-take, and pain management involving the use of analgesics and antipyretics. Public health experts, however, advised that those infected with the virus must not be given Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). The abstention from the use of such drugs is to reduce the risk of haemorrhage. [12]
As allude earlier and supported by epidemiological study, Zika virus first emerged in Africa before spreading to Pacific Islands, Caribbean and now American countries. [14] [15] [19] The current outbreak in Brazil highlights the potential of the virus as an emerging pathogen. It is imperative, therefore, to explore how the disease is transmitted through travel.
One study demonstrated that Zika virus is transmitted to humans by mosquitoes, especially the Aedes aegypti species. [25] Aedes aegypti mosquito is one of the two mosquitoes (Aedes aegypti and Aedes albopictus) that spread dengue and chikungunya viruses. [26] The Zika virus is transmitted to an individual mostly through bites from an infected Aedes aegypti mosquito. The mosquito becomes infected when it feed on a person already infected with the virus and cannot be caught from coming into contact with the infected person. [27] In other words, the Zika virus natural transmission cycle involves Aedes aegypti mosquitoes, but sexual transmission has been suggested. [20] This probable sexual transmission took place after a patient who was infected with Zika virus in Senegal in 2008 returned to his home in Colorado, United States and experienced common symptoms of Zika virus infection with his wife. His wife had not travelled out of the United States during the previous year but had sexual intercourse with him a day after he returned home from Africa. [28]
The current spread of Zika virus in Caribbean Islands and the American countries constitutes a significant development in the epidemiology of this emerging vector-borne disease. [29] There is now enough compelling evidence to suggest that Zika virus spread from African to these countries through travel. For example, we alluded earlier that one person in Colorado became infected with the Zika virus after having sexual contact with her husband, who had returned from an African country where the virus is present [28] Although the man’ wife tested positive to Zika virus, no effort was made to check if the virus was in the man’s semen, which would be evidence of sexual transmission of Zika virus. [30] However, many people in the U.S state of Florida, Illinois, New Jersey, Texas, Arkansas and other several other states who recently travelled to countries where Zika virus is present have tested positive to the virus. This is in addition to the 20 confirmed cases of the virus in Puerto Rico and the U.S. Virgin Islands, bringing the total number of Zika virus in the United States to 51. [31] [32]

1.4. Rationale for Study
Since the start of the Zika virus outbreak in May 2015, five UK travellers have been diagnosed with the disease. This means that there is a real risk of increased Zika virus transmission in the UK through travel, yet there is an obvious absence of study on transmission through travel or measure of the effectiveness of current travel advice. [3] This study represents one of the first steps toward the exploration of travel-related Zika virus transmission and review of the nature of current travel advice to UK travellers.

1.5. Aim of Study
The aim of this study is to explore Zika virus travel-related transmission and carry out a review of current travel advice given to UK travellers aimed at minimising their health risks.
206 Exploration of Zika Virus Travel-related Transmission and a Review of Travel Advice to Minimise Health Risks to UK travellers

1.6. Objectives
To review surveillance reports and travel advice published by the European Centre for Disease Prevention and Control (ECDC), United States Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), Public Health England (PHE) and establish Zika virus epidemiological situation since the disease outbreak.
To review recent Zika virus outbreaks alerts and travel advice published by Public Health England (PHE), Fitfortravel, NHS Choices and any other UK travel organisations.To raise awareness of the issues pertinent to Zika virus travel-related transmission and thereby increase efforts towards enhancing travel safety.

2. Method
This study was conducted using the literature review research method. The overall goal of this method is to provide a full picture of Zika virus travel related transmission which can be concealed for the health care professional offering travel advice when only one piece of report is viewed on its own. The literature for this review was gathered through searches on the Google Scholar, Google Chrome, Scopus, Medical Literature Online (MEDLINE) and the ProMED data bases using the keywords Aedes- aegypti, dengue fever, yellow fever, microcephaly, vector, travel and Zika virus. Given that there is little or no research paper on the recent Zika virus outbreak, this study searched the following websites: European Centre for Disease Prevention and Control (ECDC), http://www.eurosurveillance.org/; United States Centers for Disease Control and Prevention (CDC), http://www.cdc.gov, and World Health Organisation (WHO), http://www.who.int/en/. The reports from these sources were reviewed for general information on the Zika epidemiological situation in the Pacific Islands, Caribbean, and the American countries. The Public Health England (PHE), http://www.gov.uk/government/organisations/public-health-england and Fitfortravel, http://www.fitfortravel.nhs.uk and NHS Choices, http://www.nhs.uk/pages/home.aspx websites were also searched for information on Zika virus outbreak alerts and travel advice for UK travellers.

3. Result
Some health experts’ view of the recent Zika virus outbreak is that it could trigger global outbreak. [1] Contrary to this view, we found that the disease outbreak in UK is unlikely. This is because the condition necessary for Aedes aegypti mosquitoes to breed is not fully present in the UK. [33] The Aedes aegypti mosquito that produces Zika virus survives year round in tropical and subtropical climates; extremely common in areas lacking in pipe borne water systems, and depend greatly on water storage containers to lay their eggs. [18] A study published in the medical journal The Lancet, by a public health researcher Simon Hales and colleagues found that the mosquito-borne disease transmission is climate sensitive for several reasons. The mosquitoes require standing water to breed, and a warm ambient temperature is critical to adult feeding behaviour and mortality, the rate of larval development, and speed of virus replication. They posited that if the climate is too cold, viral development is slowed down and the mosquitoes are unlikely to survive long enough to become infectious. [34] A group of researchers, on the other hand, working for the UN Intergovernmental Panel on Climate Change analysed several research studies and found that vector-borne diseases have been moving into more northern latitudes in response to global warming. [35] Given current global warming, these findings seem to reinforce the health experts’ view that present Zika virus outbreak could trigger global health threat. [33]
International travel is important for global cultural exchange and income generation. [4] Yet, we found clear evidence of well-established association between travels and the acquisition or transmission of infectious diseases. [10] We found that since the start of the Zika virus outbreak in May 2015, 5 UK travellers have been diagnosed with the disease and that between 2010 and 2014 for which data is available, an estimated 1.4 million UK citizens travelled to areas where Zika virus is prevalent. [3] The implication of this finding is that Aedes aegypti mosquito poses health risks to the thousands of UK resident who travel to Zika virus affected countries every year. There is also the likelihood of increase cases of the disease transmission in UK through travel. These potential risks may have prompted the UK Foreign Office to asked people who are travelling to countries where Zika virus is prevalent to seek travel advice. [36] The following themes emerged when we reviewed various travel advices published by the UK Government travel websites:
3.1. Advice for Those Concerned about Contracting the Zika Virus
The people whose travel is unavoidable to countries where Zika virus is prevalent, should be advised to take scrupulous insect bite avoidance measures, both during daytime and night time hours; especially during mid-morning and late afternoon to dusk, when the Aedes aegypti mosquito mosquitos are most active. [3] They should also be advised to use insect repellent that contains N, N-diethyl-meta-toluamide (DEET) on exposed skin. The repellent is considered safe to use even if they are pregnant and could be applied to skin after sunscreen is used. They should also include sleeping under a mosquito net and wearing loose clothing that covers the arms and legs. [37] [38]

3.2. Advice for Those Concerned about the Risks Zika Virus Poses in Pregnancy
The US Centers for Disease Control and Prevention position is that all pregnant women should be advised to refrain from travelling to countries affected by Zika virus. This is based on the inconclusive evidence suggesting a link between Zika virus infection with microcephaly and other neurological disorders. [39] The UK National Health Services current position is that women who are pregnant or planning to become pregnant should be advised to discuss their travel plans with appropriate health care professional. [37] All women who are pregnant or have plans to become pregnant during impending travel to areas where Zika virus is prevalent, should be strongly advised to seek pre-travel advice so that an informed decision can be made on whether or not to change the travel plans. Women who are not pregnant should be advised to consider using contraception during travel and for 28 days on their return to avoid an unplanned pregnancy occurring. [40] Women who are not pregnant should be advised to seek information on methods of contraception from their GP or community sexual health clinic professionals. [37]

3.3. Advice for Those Concerned about Visit to Zika Affected Area Whilst Pregnant
The current evidence, though not conclusive, suggests that pregnant women who contract the virus during pregnancy may have an increased risk of giving birth to a baby with microcephaly. [20] The people who are concerned about trying to get pregnant and have a history of travel to the Zika virus affected countries should be advised to see their GP or midwife and mention their travel history even if they are feeling well. They should also be advised to take folic acid supplements for 28 days before trying to get pregnant. The people who are experiencing Zika virus symptoms either during or within two weeks of returning home should be advised to wait at least six months after full recovery before attempting to get pregnant. If they are already feeling unwell, they should be advised to wait at least 28 days after they return home from Zika virus affected country before trying to get pregnant. [37]
Those concerned about visit to Zika affected area whilst pregnant should be advised to have an antenatal check promptly on return home, even if they are feeling well. They should also be advised to seek immediate medical attention if they are feeling unwell whilst travelling or on their return. [38] Individual who are concerned about visit to Zika affected area whilst pregnant should be advised to see their GP or midwife and mention their travel history; within two weeks of returning to the UK. The GP or the midwife should discuss the risk with them and arrange an ultrasound scan to monitor growth of their baby. The GP or midwife may also make referral to a specialist foetal medicine service for monitoring or order for blood test if Zika virus infection is suspected. [37] Referral should also be made to a maternal-foetal medicine or infectious disease specialist with expertise in pregnancy management. Those pregnant with laboratory evidence of Zika virus in serum or amniotic fluid should include serial ultrasounds to monitor foetal anatomy and growth every 3–4 weeks. [39] As there is no known antiviral treatment for the Zika virus, those infected with the disease should be advice to expect treatments that are meant to manage the symptoms and not cure.

3.4. Advice for Those Concerned about Sexual Transmission of Zika Virus
We could not find evidence of reported case of sexual transmission of Zika virus in UK. The finding is in line with Public Health England deposition that the risk of such transmission to the UK is very low. [3] [41] Much as sexual transmission of Zika virus in UK is thought to be low, Zika virus has been known to be present in semen up to two weeks after recovery from the virus infection. [42] The evidence may have prompted the British Medical Association (BMA) to recommend that male partner arriving from Zika affected area should be advised to use condom if their female partner is at risk of getting pregnant, or is already pregnant; for the following durations:
 For 28 days after his return from a Zika virus affected area if he has not had any symptoms compatible with Zika virus infection. The 28 days represents an estimated 14 days incubation period plus an estimated 14 days period of viraemia.
 For 6 months following recovery if a clinical illness is compatible with Zika virus infection or laboratory-confirmed Zika virus infection was reported. [43]
Lastly, in the absence of research knowledge to ascertain clearly how Zika virus is transmitted from mother to unborn child [1] and through sexual intercourse, [41] the UK health care professionals offering travel advices should be checking on the National Travel Health Network and Centre for Zika virus transmission updates. Until more is known, current advices are temporary and likely to change as research evidence and more information becomes available.

4. Discussion

We found that the World Health Organisation’s declaration of Zika virus as an important Public Health Emergency of International Concern (PHEIC) on 1st of February 2016 is mainly driven by two hypothesis:
First, is based on the evidence of growing support for another hypothesis that increase cases of microcephaly found in new born babies is linked to the on-going Zika virus outbreak. [1] However, we could not find any conclusive evidence that Zika virus infection caused any of the abnormalities found in the babies with microcephaly. We also could not find any conclusive scientific evidence of full spectrum of outcomes that might be associated with the Zika virus infection during pregnancy or the factors that might increase risk of the disease infection to the foetus. However, a study published in The Lancet Medical Journal and reported in the Daily Mail Online, suggests that the risk of microcephaly associated with Zika virus infection is relatively low, amounting to one per cent in comparison to other maternal infections. [44] Contrary to this view, the findings of a recent study on retrospective analysis of a large Zika virus outbreak in French Polynesia in 2013–14, which was also published by the Lancet, strongly support the current suspected link between infection with Zika virus during pregnancy and microcephaly. [45] The authors of the former study, however, noted that the link remains an important public health issue, because the risk of Zika virus infection is particularly high during the current outbreaks in Brazil. [44] Whilst, the authors of the later study emphasise the need for health authorities of affected countries to organise public health activities involving foetal monitoring, promote vector control, and provide evidence-driven information for pregnant women. [45]
The second hypothesis is based on the view that Zika virus outbreak constitutes a health risk to other countries through international spread. International travel provides an avenue for exposing travellers to new cultures and ideas; thereby promoting a more global community. It also promotes global economy by encouraging spending and creating employment internationally. [12] For example, in 2014, 34.4 million travellers came to the UK and spent a record £21.8 billion. In the same year, 12.2 million UK residents travelled overseas and spent £6.7 billion compared to £9.2 billion in 2013. [13] These statistics show that international travel is of immense value to the global economy, but yet has been known to be a major means of transmitting diseases that pose risks to public health. The SARS outbreak in 2003 and West African Ebola virus outbreak in 2014 exemplifies outbreaks associated to international travels. [4] [11]. Similarly, Zika virus that originated in Uganda in 1947 is now transmitted in at least 14 countries or territories in the Americas as at January 15, 2016. [12]
However, we could not establish the true extent of the Zika virus spread with certainty, since most of the affected countries have not been conducting appropriate surveillance. In the past, cases of the disease have been reported in Africa, Asia and the Pacific Islands. The current report has shown spread far beyond the affected areas where dozens of cases have been identified among travellers. [44] It has been reported recently in the media that airlines and cruise operators, hotels and tour operators serving Latin America and the Caribbean are facing growing concern among travellers spooked by the mosquito-borne Zika virus. [47] In addition, we found evidence of media reports, highlighting the possibility of Zika virus outbreak in UK through travel. For example, Dr Nick Beeching, a tropical medicine consultant at the Royal Liverpool Hospital was quoted by UK Daily Mail Online as saying that the risk of transmitting the disease in UK is so high because South America has become an increasingly popular tourist destination for UK travellers. [47] Similarly, Lizzie Dearden reporting for the UK Independent echoed health experts warning that Europe should be prepared for the virus to spread through the continent in the summer due to traveller returning from the Zika virus affected countries. [48]
We found these warnings as important public health issue and were taken seriously by UK and indeed European policy makers. [48] We also found that this is because of a well-established evidence of association between travels and the acquisition or transmission of infectious diseases. [10] For example, this review found 31 reported cases of travel-associated Zika virus in 11 states in the United States of America and the District of Columbia, from the period of outbreak in May 2015 to the present. [49] [50] In the UK, there are 5 cases of travellers diagnosed with the Zika virus since the start of the outbreak [3]
In response to the threat pose by the Zika virus, the Public Health England requires all healthcare professionals to consider Zika virus among the differential diagnoses of patients with fever returning from endemic areas. If a case of Zika virus is suspected, the healthcare professionals should take appropriate blood samples and send for testing together with a full travel and clinical history with relevant dates to the PHE Rare and Imported Pathogens Laboratory as early as possible. They should also be vigilant for any increase of neurological and autoimmune syndromes in both adults and children – or congenital malformations in new born infants where the cause is not otherwise evident in patients with a history of travel to Zika virus endemic areas. [51] The UK Foreign Office has asked UK travellers to and from Zika virus affected areas to seek travel advice from qualified healthcare professional. [36]
Finally, there are many unanswered questions when we examined the evidence of how Zika virus is transmitted through sexual intercourse. We review evidence from two studies, which found Zika virus RNA in semen and one study, which found replicable Zika virus particles in semen more than three weeks after the onset of Zika symptoms. We could not find any conclusive evidence when the studies were analysed that could explain whether or not the men infected with the Zika virus can transmit the disease to their sex partners. The limited evidence suggests that sexual transmission of Zika virus through semen is possible but that these events are rare. [29] Thus, the WHO recent announcement that it plans to fund research into Zika virus transmission is a welcome development. [1]

5. Limitation of Study

The aim of this study is only partially achieved because the reports that form the basis of the travel advices found and discussed in this study are not conclusive. For example, experts are yet to be fully convinced of the risks Zika virus transmission from pregnant woman to her unborn child and also transmission via sexual intercourse. [28] [38] [41] Further studies are therefore required to clarify the risks of Zika virus transmission during pregnancy and transmission through sexual intercourse. Until more is known, the only sensible advice is to avoid mosquitoes’ bite.
In addition, this study could not establish the true extent of the Zika virus transmission with certainty, since most of the affected countries have not been conducting appropriate surveillance. In other words, there are many countries where the Zika virus transmission is on-going but difficult to ascertain because there is no surveillance data. [48] This probably explains why the Public Health England and other public health organisations are updating their travel notices and surveillance reports as information becomes available. [43] [50] [52]. Thus, the current travel advices alluded earlier are momentary and likely to change as more information becomes available.
Finally, these limitations notwithstanding, this study has provided useful findings, given that there is so much we do not know about the Zika virus. We now have clear evidence that there is a real risk of Zika virus transmission in UK through travel. With the increase spreading of the disease in the holiday destination for many UK residents (Caribbean Islands and American countries), we can confidently make two predictions; first is that the number of the disease cases among travellers visiting or returning from the areas is likely to increase and second is that the disease transmission to UK through travel could increase in future due to global warming but the risk of full outbreak may be low.

6. Conclusions

The finding of this study shows that Zika virus is already transmitted in UK through travel and could spread in future due to global warming but the risk of full outbreak is low. [3]The study, on the other hand, could not find answers to many questions when it comes to how the Zika virus is transmitted sexually. [20] We could not also find conclusive evidence of the risks Zika virus transmission from a pregnant woman to her unborn child. We therefore support the view that studies should be planned to learn more about the risks of Zika virus transmission. [1] Until more is known, current travel advices are momentary and likely to change as more information becomes available. Thus, we recommend that healthcare professionals offering travel advice should be checking on the National Travel Health Network and Centre to stay abreast of the latest Zika virus updates.
Finally, additional research will be required to establish whether or not other mosquito species are involved in the current Zika virus outbreak. A recent study published by the medical journal, The Lancet warned that to assume that Aedes aegypti is the only mosquito involved in Zika virus transmission in areas where other mosquito species coexist is naive, and could be catastrophic if other species are found to have important roles in Zika virus transmission. Therefore, to minimise the drastic effects of Zika virus disease outbreaks, researchers working on vector pathogen interactions must attempt to find out whether or not other types of mosquitoes are involved in the virus transmission. [52]

7. Author’s contributions

VI is an academic who provided scholarship for the study and wrote most part of the script. CI is a nurse practitioner and wrote part of the script pertaining to travel advice. VI and CI read and critically revised the first draft as well as the subsequent drafts and jointly approved the final script.

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By:

Dr. Vincent Icheku 1,*, Dr. Nike Arowobusoye 2
1 School of health and social care, London South Bank University, UK
2 NHS Greenwich Public Health Lead, UK

Universal Journal of Public Health Vol. 3(2), pp. 97 – 102
DOI: 10.13189/ujph.2015.030207

ARTICLE INFO: http://www.hrpub.org/journals/article_info.php?aid=2433

DOWNLOADABLE FULL-TEXT: http://www.hrpub.org/download/20150301/UJPH7-17603551.pdf

Abstract:
Uptake of breast cancer screening is lowest in areas of London with many hard to reach communities. This report evaluates two interventions to improve uptake of breast cancer screening in the Royal London Borough of Greenwich with many hard to reach communities. The interventions involved splitting 2,004 women eligible for screening into two groups. Group 1 who were sent letter only invites has a target group (n=1,452) and eligible women screened were (n=878). Whilst, group 2 who were sent letter invites combined with Short Message service (SMS) reminder has a target group (n=552) and eligible women screened were (n=376). The result shows a significant difference in attendance rates between the two invitation methods. The screening uptake by the women who received invitation letter only had an attendance rate of 60 percent (table1). The screening uptake by the women who received invitation letter and SMS reminder was 68 percent (table 2). This amounts to 8 percent differential rate, which translates to an additional 44 women who were screened, as a direct result of receiving an SMS reminder. Applying the achieved result to the “Letter Only” group indicates that an additional 12 women would theoretically have been screened if the ‘Letter only’ invites were also sent with SMS reminder. An overall 2.54 percentage point increase in screening outcome was achieved when compared the uptake in the months of the project (July to Dec 2011) with the uptake in similar months in 2010. Finally, the results prove that intervention by letter invite combined with SMS reminder is the most effective method of improving uptake of breast cancer screening in the borough with many hard to reach communities.

KEYWORDS
Breast Cancer Screening, Hard-to-reach, Mammography, Short-Messaging-Service, SMS

Cite this paper
Vincent Icheku , Nike Arowobusoye (2015). Evaluation of a Service Intervention to Improve Uptake of Breast Cancer Screening in a London Borough with Many Hard to Reach Communities. Universal Journal of Public Health, 3 , 97 – 102. doi: 10.13189/ujph.2015.030207.

JOLT, the London South Bank University Journal of Learning and Teaching, 4th February, 2015

Link to full Paper:
https://ictserv1.lsbu.ac.uk/jolt/2015/02/siac-framework-for-ethical-analysis-a-tool-for-learning-and-teaching-ethics/

Copyright © 2014 London South Bank University

Dr. Vincent Icheku is a senior lecturer in the School of Health and Social Care, London South Bank University and a Senior Fellow of the Higher Education Academy with specialisms in public health, research methods, ethics and law. Ongoing research is on the cultural context of the Ebola outbreak in West Africa.

ABSTRACT

Background
Health and social care students facing practice placements for the first time frequently confront ethical dilemmas (Cohen et al., 2006 and Taboada, 2004). This view, which has been corroborated by our students’ feedback, has prompted this author to develop a simple ethical framework, named SIAC, an acronym for ‘Summarise, Identify, Apply, Consider. This paper presents the SIAC framework that has now gained wide acceptance as learning and teaching method in ethics.

Methods
A search was made for existing ethical frameworks, resulting in the observation of two things in common shared by three frameworks found – the elucidation of the ethical decision-making process and provision of a framework enabling professionals to resolve ethical dilemmas. With this emphasis on already qualified professionals, the suggested structures are not found to be suitable for preparing first year students to confront ethical dilemmas in their first practice placements.

Results
The SIAC framework resulted from a synthesis of the three frameworks but is unique in that it focuses on helping first year students, rather than those already qualified, to gain practical skills for dealing with ethical dilemmas. The SIAC framework was presented at the Higher Education Academy Ethics Special Interest conference for evaluation in 2010 and was generally endorsed. Subsequently, it gained wide acceptance and was published in the Higher Education Academy website and this author’s recent book.

Conclusions
Ethical frameworks provide professionals with a structure for resolving ethical dilemmas but they should also serve as effective learning and teaching tools. The SIAC framework is now widely used, moving health and social care students towards a more active-learning approach to ethics that, ultimately, is more effective and indeed enjoyable for both teachers and their adult learners. It is on record that SIAC application to learning and teaching of ethics increased our pass rates, leading to increased students’ satisfaction.

Universal Journal of Public Health Vol. 3(1), pp. 28 – 40
DOI: 10.13189/ujph.2015.030105

http://www.hrpub.org/journals/article_info.php?aid=2219

DOWNLOADABLE FULL TEXT: http://www.hrpub.org/download/20150101/UJPH5-17603190.pdf

Vincent Icheku *
London South Bank University, School of Health and Social Care, 103 Borough Road, London SE1 OAA

ABSTRACT

The recent Ebola Virus Disease (EVD) outbreak in West Africa is so far the largest and deadliest in recorded history. The rapid spread of the disease in the region and its potential for international spread prompted the World Health Organization to declare the outbreak a public health emergency of international concern. [1] This paper assesses the potential for the spread of the disease across international borders by returnee travelers and humanitarian health workers, given that the disease spreads through physical contact. The surveillance data published by both the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) were reviewed to identify the EVD epidemiological situation in West Africa from March 2014 to September 2014. The risk assessment data published by Public Health England (PHE) and CDC travel updates were reviewed to identify travel group(s) most at risk of transmitting EVD across international borders. Studies focusing on West African cultural practices were also reviewed to identify aspects that carry risk of EVD transmission. The study found that the risk of travelers transmitting EVD across international borders is low and would remain so on two conditions. First, all travelers must avoid direct physical contact with a sick or dead person or animal infected with EVD. Second, international humanitarian health workers in affected areas of West Africa who will eventually return to their home countries must work in safe environments with adequate protective equipment. The risk of travelers acquiring EVD is considered very low, yet there is serious concern that the disease may spread further within West Africa and across international borders. Local burial practices exacerbate the disease spread while poor working environments and inadequate supply of equipment increase risk of exposure to EVD of humanitarian workers. This researcher recommends addressing the issues through local awareness, pre-travel advice and capacity investment in the healthcare infrastructure in the EVD affected areas.

Anioma shines with pride once again in United Kingdom as one of the illustrious sons of Ibusa receives a National recognition and Award by the Higher Education Academy.

Dr. Vincent  Nwayobuije  Icheku has been awarded the “Senior Fellow of Higher Education” honour for his contribution to UK Higher (University) Education and reaching worldwide audience with his work.

Dr. Icheku hails from Umuwagwu village in Ibusa, Oshimili North Local Government area of Delta State and is currently a Senior Lecturer at the London South Bank University.

Vincent and I have been friends since 1983, when I met him at an ICDU meeting. Over the years, he has been bringing honours to Ibusa community in particular and Nigeria in general through his commitment to education and scholarly activities. He recently developed a framework for ethically analysis that was hailed by UK Higher Education Academy as innovative teaching and learning tool. Evidence abounds in literature, which shows that the framework enjoys world wide acceptance.

Dr. Icheku is a superb motivator and one of the most supportive persons, I have ever met. It was a great personal pride for me when the Ibusa Community Development Union (ICDU) UK and Ireland honoured him with an award for academic excellence in 2008 during my tenure as the President of the Union.

I join his family and well-wishers in celebrating yet another milestone achievement in his life. I also join them in thanking God for his gift of knowledge, love and kindness. I wish him more grease to his elbows!

Award’s celebration with Professor David Phoenix, the Vice Chancellor of London South Bank University

12 Years of a Slave was acted by Chiwetel Ejiofor, born in London to Nigerian parents. I watched the movie with my wife last week. The movie was set in the pre-Civil War United States, Solomon Northup (the actor), a free black man from upstate New York, is abducted and sold into slavery. Facing cruelty at the hands of a nasty slave owner, he struggles not only to stay alive, but to retain his dignity. In the twelfth year of his unforgettable odyssey, he met Canadian abolitionist by chance who started a chain of events that subsequently led to his freedom.

Most people, both white and black wept for the most part of the film. It became clear to me, on reflection after watching the movie that slavery was a taboo subject. In thirty years of work and travel outside the continent of African, I have not come across any white European or American who wants to talk openly about the fact that between 1500 and 1870, more than 11 million Africans were shipped across the Atlantic by European traders to work as slaves in the Americas under conditions of cruelty and to lead lives of hardship, unremitting labour, rape, degradation and violence.

The products of slave labour, which were in the form of cotton, sugar, coffee and tobacco were sent back to Europe and the profits derived from slavery trade helped fuel European economic development in the 18th and 19th centuries. The cost in terms of lives and human suffering of the slaves was enormous yet suppressed by those who profited from the trade.

Although slavery was abolished officially in Europe and America in 19th century, slavery still exists today. According to the International Labour Organisation (ILO) 20.9 million men, women and children around the world are in slavery. In the 21st century people are still sold like objects, forced to work for little or no pay and at the complete mercy of their employers, mistreatment and human right abuses of the voiceless and powerless in many developing countries. These forms of contemporary slavery may be different relative to trans-Atlantic slavery; it affects people of all ages, gender and races. It also comes in its trail with death and enormous suffering for those at the receiving end.

Slavery survived into the 21^st century because we talk about it metaphorically. I believe we should come to terms with our past by freely discussing the size and profitability of the slave trade, the people who engage in, and benefit from it, and its social and economic consequences. I also believe that there should be a closure to this darkest part of human history. To have a sensible closure, we must gain knowledge and understanding of what actually happened, make sense and learn the lesson of it and by so doing, prevent the mistakes of the past.

By Dr. Vincent Icheku, Senior Lecturer in the Faculty of Health and social care, London South Bank University, UK

Abstract

Promoting positive values through Ibusa youth education: paper presented at Ibusa Legacy Lecture organized by The National Association of Ibusa Students [NAIBS] on the 6th July 2013.

Dr. Vincent Icheku, Senior Lecturer in ethics and law, London South Bank University, United Kingdom

Introduction: The theme of this lecture is probably not new to you. You may have heard the same many times before. However, this lecture is unique in that it is informed by my own experience of growing up in Ibusa before and during the civil war, in Ibadan after the war and England where I now live and work as university lecturer.

My Teenage Years

I was a teenager living in Ibusa before and during the civil war. I survived the war with nothing and no place to live. Our house was destroyed and Ibusa was a war ravaged town with very limited opportunities for both old and young. Most teenagers at the time faced similar challenges. Our parents who also survived the war were poor and there were no jobs for them. Majority of us could not find schools as most of them were destroyed during the war. Yet, every Ibusa teenager that I knew had big dreams. In the midst of adversity, we all hoped that only the best would happen in our lives. It was a period in our lives when we looked forward to a bright tomorrow believing that nothing is impossible and that we must be successful. However, as we made the transition from teenager to adolescence, it dawned on us that life is more complicated than we thought. We began to understand ourselves, discover our potentials and able to discover our opportunities and threats. It was a turning point in our lives, a time to reinvent ourselves and reorient ourselves to succeed. Family and community played a big role in moulding our character.

Disappearance of traditional Ibusa values

In the traditional Ibusa community, the young people depended on personal relationships with family and the entire community for guidance in developing virtuous personality.

A virtuous person is used in this lecture to describe an individual who is rational and educated so that he or she follows the lead of reason to be of good character (Icheku, 2012).

The necessity of the young forming good character in order to become virtuous leads Ibusa families and community role models at the time to consider teaching, initiation and induction as crucial means of making the young successful adults. Unfortunately, the youths of today are not so lucky. The traditional elderly family members and community role models seem to have relinquished much of their responsibilities of guiding the young towards virtuous path.

Modernization and western influences had both helped to relegate traditional Ibusa values to the background. In other words, the traditional family system of teaching our young has lost ground rapidly; and the indigenous systems of educating our youths have by and large disappeared. Additionally, urbanization and current socioeconomic conditions in Ibusa have accentuated various kinds of challenges. These constitute impediment to the progress of Ibusa youths of today albeit limited educational and employment opportunities, increasing criminalities, gangs and occults membership. The challenges facing Ibusa youths today are in no doubt worse than our experience of growing up in the post war years. However, education has an important role to play in dealing with the root cause of the myriad of problems affecting Ibusa youths of today.

Aristotle (384 BC – 322 BC) a Greek philosopher wrote in Nicomachean Ethics that “Right education should make us take pleasure in what is good and be pained by what is bad.”

Aldous Leonard Huxley (1894 – 1963) an English writer stated that “Every man who knows how to read has it in his power to magnify himself, to multiply the ways, in which he exists, to make his life full, significant and interesting.”

Education as the only way forward

In my experience, education happens to be the only path that I know brings in its trail a positive change in any individual or community. It certainly has helped many in my generation that survived the civil war with nothing, except our hopes and dreams, to develop ourselves physically, mentally and socially.

Education is a benefactor of mankind; it creates virtuous human beings and essential to the healthy growth and development of a child’s personality. In other words, producing a virtuous human being out of undeveloped mind lays the importance of education. This is further discussed below:

Making career decisions

The importance of education manifests itself in the need to help youths experience successful transition to mature adult. As youth, you are like any other youth in the world that is in the stage of growing up and moulding your character. It is during this stage that you make career decisions and begin to pursue your goals in life. Education at this stage would help you define your career objectives, decide what you want and enable you to achieve what you desire in life. It would help you decide on the best career option, train to gain sets of skills that you could develop into subject expertise. Skills acquisition opens doors for new opportunities in different fields of human endeavour. You would be able to venture into new fields, explore new areas and pursue your interests and achieve fulfilling goals

Social and self-awareness

Education would provide you with the knowledge of contemporary and awareness of social, economic, political and environmental issues. It would expose you also to even the evils in your environment, the prejudices that shackle it and the superstitions that blind it, the deceitfulness of some of those with power and money. Education would provide you with the tools to navigate difficult situations or deal with them successfully. Sex education, for example, would expose you to the problems of prostitution, unprotected sex, teenage pregnancy and unwanted pregnancy. You would gain the knowledge of sexually transmitted diseases, abortions and other issues of growing concern for the youths of today.

Discernment of truth from falsehood

You would be more analytical and develop independent mind capable of discerning what truth is and what is false. You would no longer be fooled by some of those in power. Education would give you the ability to reject evil and empower you to take decisions and make choices, each time preferring right to wrong. You would have the courage to ask those with power and money to send their own children whenever they ask you to carry out criminal activity in exchange for money.

Epictetus (AD55-135), a Greek sage who was born into slavery and later became a philosopher, once said that it is only the educated that are free. This is true when you consider the fact that education releases us from the confines of our mind and forces us to think and question things. It makes us aware of our rights, grants us the power to be free and never to be enslaved, either by our own thoughts or that of others.

Furthermore, education would give you the courage to reflect on and accept the mistakes that you made, ability to make amend and learn from them. You would gain the ability to rise after every fall and turn every failure or misfortune into success.

Conclusion

The importance of education can never be over emphasized in that it goes beyond the concept of being literate and numerate. It is much deeper, incorporating individual’s way of life and thinking. In today’s world, education is synonymous with being a well-informed, thinking person and fit to succeed in the 21^st century. Thus, government at all levels should be proactive in terms of providing educational opportunities that will equip the youths with productive skills and critical thinking that will engender self-reliant. It is morally imperative that every child has opportunity to get a formal education in relative safety and adequate infrastructures.