Editorial

Cadu Rolim/Fotoarena/Corbis

Zika virus: a new global threat for 2016

See Online/Correspondence http://dx.doi.org/10.1016/ S0140-6736(16)00003-9 and http://dx.doi.org/10.1016/ S0140-6736(16)00006-4 See Online/Newsdesk The Lancet Infect Dis published online Dec 23, http://dx.doi.org/10.1016/ S1473-3099(15)00548-4 For more on Zika epidemiology see Correspondence Lancet 2015; 386: 243–44 For more on protecting global health security see Comment Lancet 2014; 383: 764–66

Concerns about the threat posed to global health security by Zika virus are escalating, with new outbreaks reported in Central and South America. Locally transmitted (autochthonous) cases of Zika have now been detected in Colombia, El Salvador, Guatemala, Mexico, Paraguay, Puerto Rico, and Venezuela. The first five autochthonous cases detected in Suriname are reported in Correspondence online, with complete coding of the Zika virus sequence for one patient, and envelope protein coding sequences for three others. Phylogenetic analyses show that the Suriname strains belong to the Asian genotype, and are closely related to the strain that was circulating in French Polynesia in 2013. Last month, the Ministry of Health in Brazil reported a twentyfold annual increase in cases of newborn babies with microcephaly in the northeastern region of the country. The ocular findings (funduscopic changes in the macular region) in three of these babies with microcephaly are described in a second Correspondence published online. A causal link between Zika virus in the

mother and microcephaly in the newborn baby has yet to be firmly established, but is a worrying possibility. Other congenital neurological anomalies and an increased frequency of Guillain-Barré syndrome linked to Zika virus have also been reported. Zika virus is an emerging mosquito-borne arbovirus that was first isolated from a rhesus monkey in Uganda in 1947, and caused sporadic human infections in some African and Asian countries, with usually mild symptoms of fever, rash, and arthralgia. In 2007, it caused an epidemic on Yap Island in the Federated States of Micronesia, then spread to many countries in Oceania, before arriving in the Americas in 2014–15, probably via Easter Island. With an estimated 440 000–1 300 000 cases currently in Brazil alone, Zika virus could be following in the footsteps of dengue and chikungunya, which are also transmitted by the Aedes aegypti mosquito. Given that an outbreak anywhere is potentially a threat everywhere, now is the time to step up all efforts to prevent, detect, and respond to Zika virus. „ The Lancet

Harish Tyagi/epa/Corbis

India’s air pollution: a new government and global plan

For the report by India’s Ministry of Health and Family Welfare see http://apps.who.int/ gb/ebwha/pdf_files/EB138/ B138_17-en.pdf For WHO’s ambient air pollution database see http:// www.who.int/entity/ quantifying_ehimpacts/ national/countryprofile/aap_ pm_database_may2014. xls?ua=1 For the draft road map see http://apps.who.int/gb/ebwha/ pdf_files/EB138/B138_17-en.pdf

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In 2015, India’s Ministry of Health and Family Welfare reported that if no action is taken the ambient concentration of fine particulate matter (PM₂·₅) from transport sources in the country is expected to double by 2030. According to WHO’s 2014 database for ambient (outdoor) air pollution, India’s capital Delhi was the most polluted city of more than 1600 cities in the world. Delhi had a yearly mean PM₂·₅ concentration of 153 μg/m³—much higher than WHO’s air quality guideline of 10 μg/m³. Emissions from vehicles are the main cause of the pollution in the capital. Early this month, the Indian Government, in its first attempt to address air pollution in the capital, will publish a federal plan to target non-vehicular emissions, including the burning of construction dust, refuse, and tyres in Delhi and surrounding states. Additionally, the transport ministry is planning to tackle vehicular emissions by banning commercial vehicles that are more than 15 years old from India’s roads. Beijing, like Delhi, is overpopulated and has chronic air pollution (yearly mean PM₂·₅ 56 μg/m³). During the

Olympic Games in 2008 and on other important occasions, and on days with an orange alert (the second highest level) for air pollution, Beijing has applied an odd–even rule for licence plates to order cars off the road. For the first 15 days of January, Delhi will try a similar regulation to reduce the number of private cars on the road. Worldwide, in 2012, 3·7 million deaths were attributable to ambient air pollution and 4·3 million to household air pollution. A draft road map to mitigate the global adverse health effects of air pollution was drawn up in November, 2015, and will be discussed at WHO’s Executive Board meeting at the end of January, 2016. The revised and elaborated road map will be presented at the World Health Assembly in May. It has four categories: expansion of the knowledge base; monitoring and reporting of health trends associated with air pollution and its sources; global leadership and coordination; and building capacity in the health sector to analyse and influence policy and decisionmaking processes for joint action on air pollution and health. Hopefully, starting this year, this road map will help to clear the air. „ The Lancet www.thelancet.com Vol 387 January 9, 2016

India's air pollution: a new government and global plan.

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