Update on Zika virus. Dr Razitasham Safii CMPH department, FPSK,UNIMAS

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1 Update on Zika virus Dr Razitasham Safii CMPH department, FPSK,UNIMAS CMPH Public health seminar

2 Contents Epidemiology of Zika Historical perspecmve CDC classificamon Current situamon for Zika virus Why Malaysian should be worried? CMPH Public health seminar

3 EPIDEMIOLOGY OF ZIKA CMPH Public health seminar

4 What is Zika? Zika virus belongs to the genus Flavivirus of the family Flaviviridae laboratory studies ; Zika is neurotropic, meaning that it preferenmally affects brain cells. CMPH Public health seminar

5 How is zika transmived? Primarily through infected Aedes mosquito (Ae. aegyp2 and Ae. albopictus). 22 July 2016 : Brazil.Fiocruz InsMtute Pernambuco; detected Zika virus in Culex quinquefasciatus collected in houses. Further evidence is needed, to know to what extent Culex is able to transmit the virus to people. CMPH Public health seminar

6 How is zika transmived? 2008 ; first documented case of sexual transmission CDC.MMWR Zika Reports Male-to-Male Sexual Transmission of Zika Virus Texas, January 2016 hvps:// CMPH Public health seminar

7 How is zika transmived? 2014 ; Transplacental transmission or during delivery. 31 March 2014; blood transfusion. 17 November 2015; Brazil reports detection of Zika virus in amniotic fluid. CMPH Public health seminar

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9 Zika symptoms 80% asymptomamc or only mild symptoms. Most common symptoms: fever, rash, joint pain, or red eyes. Other common symptoms: muscle pain and headache. Symptoms can last for several days to a week. Death - very rare Once infected confers protecmon against future infecmons. CMPH Public health seminar

10 Other clinical presentamons 17 July 2015; Brazil reported 49 cases Guillain-Barre syndrome. 11 November 2015 ; Brazil declares a national public health emergency as cases of suspected microcephaly continue to increase. CMPH Public health seminar

11 Other clinical presentamons A case report. The Lancet,3 March year-old girl who developed acute myelitis,positive for Zika. CMPH Public health seminar

12 Lab confirmamon 2012 : Researchers identify 2 distinct lineages of the virus, African and Asian CMPH Public health seminar

13 HISTORICAL PERSPECTIVE CMPH Public health seminar

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16 The first outbreaks 2007 ; first outbreak on Yap Island in the Federated States of Micronesia. EsMmated 5,000 people were infected (> 70% of the island s populamon) no one was hospitalized and no one died. The outbreak was brief, lasmng just three months. At that Mme, researchers speculated that a new virus strain, with greater fitness and epidemic potenmal, had likely emerged Credit: United States Air Force A United States Air Force service man interviews a family on Yap island in Micronesia as part of the investigation of an outbreak of the rare Zika virus. CMPH Public health seminar

17 The French polynesia outbreaks ,: an esmmated 30,000 infecmons. During and aper the outbreak, the virus spread to an addimonal seven island namons, though the outbreaks were much smaller. No deaths were reported As the outbreak evolved, doctors began seeing usually rare neurological complicamons, including 42 cases of Guillain-Barré syndrome. CMPH Public health seminar

18 The virus reaches Brazil The outbreak in Brazil also carried a high risk of exported cases, with around 10 million travellers deparmng each year for internamonal desmnamons. Zika was first confirmed in Brazil in may of 2015, GM Mosquitoes May Be Responsible For Zika Virus Outbreak Explosive outbreak throughout LaMn America and the Caribbean. Within a year, the virus had been detected in nearly every country or territory infested with Aedes aegyp2. Two factors favoured explosive spread: the lack of populamon immunity and the behaviour of the mosquito. CMPH Public health seminar

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20 10 March 2016 The United States reports 2 GBS cases with confirmed Zika virus infection. The first case, an elderly man with a recent history of travel to El Salvador, died from sudden subarachnoid haemorrhage caused by a ruptured aneurysm. The second case, a male resident of Haiti in his 30s, was diagnosed after he travelled to the US for treatment. He recovered fully after 5 days of treatment in hospital. 26 March 2016 Chile notifies WHO/PAHO of a confirmed case of sexually transmitted Zika virus. This is the first case acquired in continental Chilean territory where Aedesmosquitoes are not present. CMPH Public health seminar

21 WHO acmon PHEIC Announced in February May 2015; WHO / PAHO release an epidemiological alert 8 March 2016 : WHO updates its travel recommendations to pregnant women. CMPH Public health seminar

22 WHO acmon Projected Zika Virus ImportaMon and Subsequent Ongoing Transmission aper Travel to the 2016 Olympic and Paralympic Games Country-Specific Assessment, July Cancelling or changing the location of the 2016 Olympics would not significantly alter the international spread of Zika virus. volumes/65/wr/mm6528e1.htm? s_cid=mm6528e1_w CMPH Public health seminar

23 26 August 2016 WHO publishes updated interim guidance on the assessment and management of Guillain- Barré syndrome in the context of Zika virus infection. Mid- August 2016 Brazil and a few other countries are scaling up new vector control tools approved by WHO, such as Wolbachia infected Aedes mosquitoes, genetically modified mosquitoes and traps for surveillance. CMPH Public health seminar

24 A dramakc new profile for a harmless old disease In mid-july 2015, Brazil informed WHO of an increase of neurological disorders, including Guillain-Barré syndrome, mainly from the northeastern state of Bahia, an early epicentre of Zika virus transmission The same findings was reported in other countries with large outbreaks, including Colombia, Dominican Republic, El Salvador, Honduras, Suriname, and Venezuela. In most of these countries, the syndrome was detected about three months aper virus circulamon was confirmed. A link with Zika was strongly suspected. End of October 2015, when Brazil informed WHO that 54 cases of microcephaly among newborns had been detected since August. CMPH Public health seminar

25 Lessons learnt from Brazil outbreak Poor coping capacity comes from the complacency aper the spectacularly successful mosquito control campaigns in the 1940s and 1950s. During the 1960s, with yellow fever vanquished, funding for mosquito control dried up, control programmes were largely dismantled, and entomologists vanished. The response to the infecmous disease threat shiped from building basic public health infrastructures and capacimes for prevenmon as the first line of defence to the use of surveillance to pick up early signals of an outbreak and then mount an emergency response. CMPH Public health seminar

26 CDC CLASSIFICATION CMPH Public health seminar

27 CDC Country ClassificaMon Technical Guidance Aim: To protect travelers appropriate travel recommendamons. These recommendamons are based on: historical or current presence of Zika in the country. Based on this assessment areas are classified as epidemic or endemic. CMPH Public health seminar

28 CDC Country ClassificaMon Technical Guidance Epidemic: countries are currently experiencing outbreaks of Zika, These countries are considered epidemic : the mosquito that carries Zika virus is present, Zika has not been reported in the past, and Very livle, if any, of the populamon is likely to be immune. CMPH Public health seminar

29 Zika Virus Makes CDC Consider A Travel Warning For Pregnant Women Source: Centers for Disease Control and Prevention, Pan American Health Organization Credit: Alyson Hurt/NPR CMPH Public health seminar

30 CDC Country ClassificaMon Technical Guidance Endemic: These countries have reported cases of Zika in the past and may occasionally report new cases. A large number of local residents are likely to be immune, so cases may occur but not in numbers to be considered an outbreak. The risk to travelers is likely much lower,travel nomces will not be posted CMPH Public health seminar

31 Countries that have not reported Zika transmission in the past ClassificaMon according to the likelihood that they could experience an epidemic. ClassificaMon is based on: Presence of Aedes aegyp2 or Aedes albopictus mosquitoes Presence of outbreaks of dengue. High risk for a Zika epidemic : presence of Aedes aegyp2 or Aedes albopictus and history of widespread, recurrent dengue outbreaks. CMPH Public health seminar

32 Countries that have not reported Zika transmission in the past low risk for a Zika epidemic : Countries that have Aedes aegyp2 or Aedes albopictus mosquitoes without a history of widespread, recurrent dengue outbreaks. No risk : Countries that do not have the Aedes aegyp2 or Aedes albopictus mosquitoes.these countries may smll have people who get infected while traveling to a Zika affected area, through sexual transmission, through blood transfusion, or through laboratory exposure. Re-classification of country status : Countries may be re-classified in response to new human and mosquito surveillance data, as well as advancements in the understanding of Zika virus disease and transmission. CMPH Public health seminar

33 Global Aedes aegypti predicted distribution. The map depicts the probability of occurrence (blue=none, red=highest occurrence). CMPH Public health seminar

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35 CURRENT SITUATION CMPH Public health seminar

36 Countries & Territories with AcMve Zika Virus Transmission hvps://

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38 Zika situakon report 5 May 2016 Mosquito-borne transmission: 44 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulamon, and with ongoing transmission by mosquitoes. 13 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission. Four countries or territories have reported an outbreak since 2015 that is now over: Cook Islands, French Polynesia, ISLA DE PASCUA Chile and YAP (Federated States of Micronesia). CMPH Public health seminar

39 Zika infecmons acquired by travellers to countries without recognized virus circulamon Year Country in which infeckon acquired 2016 Philippines United States 2015 Indonesia Australia 2015 Maldives Finland 2014 Thailand Japan 2014 Malaysian Borneo Germany 2014 Thailand Canada 2013 Thailand Germany 2013 Indonesia Australia 2008 Senegal USA Country to which infeckon imported CMPH Public health seminar

40 WHY SHOULD WE WORRIED? CMPH Public health seminar

41 Why Malaysian should be Malaysia is high risk AsymptomaMc No drugs to treat prepared? Disease reported in neighbouring countries Thailand (2012) Indonesia (Jambi province in Sumatera Island) Singapore (2016) CMPH Public health seminar

42 Same mosquitoes CMPH Public health seminar

43 SEA situakon Viet Nam nomfies WHO of two laboratory-confirmed cases of Zika virus infecmon. These are the first locally acquired cases of Zika in that country. Thai health officials confirmed two cases of microcephaly, linked to the Zika virus. CMPH Public health seminar

44 THANK YOU CMPH Public health seminar