Three Zika cases are found in India after random tests.

Three cases of the mosquito-borne Zika virus have been confirmed in the western Indian state of Gujarat, the World Health Organization has said, adding that efforts should be made to strengthen surveillance. The cases, which included a 34 year old woman who had just given birth and a pregnant 22 year old, were detected during random testing from November 2016 to February this year in Gujarat’s capital city, Ahmedabad. None of the patients had travelled outside India, and both women delivered healthy babies without birth defects. Although only three cases were confirmed, the government has come under attack for not informing the public and local authorities immediately after they were detected. Instead, the Ministry of Health and Family Welfare officially reported the cases on 15 May, months after they had been confirmed. Gujarat’s chief secretary, J N Singh, told local media that the government “consciously did not go public with the cases,” as the number of cases did not rise. Rajib Dasgupta, professor of community medicine at Delhi’s Jawaharlal Nehru University, said that the decision to withhold information from local authorities “violated a basic tenet of surveillance and risk communication.” Meanwhile, WHO said that the cases “suggest low level transmission of Zika virus” and that “new cases may occur in the future,” adding that, because of the risk of sexual transmission, health programmes should advise women and men on safer sexual practices, in line with the agency’s guidance released last year. Laura Rodrigues, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, UK, told The BMJ that there had “almost certainly” been more cases in India that had not been identified for various reasons, such as not recording any clinical symptoms. “What we don’t know is if there’s ongoing transmission or not,” she said. “It’s difficult to know if this was just the beginning. But the fact that no new cases have been identified is mildly reassuring.” Despite the UK’s large Indian community, many of whom travel to and from India, Rodrigues agreed with WHO’s advice not to regard the country as having a high transmission zone yet. The Indian Council of Medical Research has tested more than 34 000 people and almost 13 000 mosquitoes for the presence of Zika virus.