UPDATE ON ZIKA VIRUS OUTBREAK TONGA Issued 24thMarch 2016

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1 MINISTRY OF HEALTH TONGA P.O. Box 59 Nuku alofa, TONGA Telephone: ( 676) (676 )23200 Fax: (676) UPDATE ON ZIKA VIRUS OUTBREAK TONGA Issued 24thMarch 2016 This update report on Zika virus outbreak in Tonga covered Epi- week 12 which is up to the 20 th March The total number of zika virus infected persons (both confirmed and suspected) collected from different sources both local and overseas was The attack incidence for the Epi week 12 was 57. 1a: Current Surveillance Update In this report, Tonga continues to witness the ongoing decline in the incidence ofzika virus infection as shown in Figure 1 and Table 1. Interesting to find that there was significant number of cases seen in the report from Vava u compared to that of Tongatapu and Eua. This finding poses the possibility of either Vava u is starting or in the peak of its outbreak or is it that the reporting-data is more complete. These challenges need to be followed up closely in weeks to come. Out of the 15 samples sent to ESR for PCR, 6 came back positive for zika virus, and these were all pregnant women. All these positive pregnant women had been contacted and are currently in the list for ongoing surveillance and close follow up by the Obstetric team, headed by the Obstetrician in charge, DrMa aketupou, and the Charge Nurse of ANC, SMW TainaPalaki. Page 1

2 Figure 1: Weekly Incidence of Zika virus infected cases (both suspected and confirmed), 1 st January- 20 th March, Zika Outbreak in Tonga as of March 20 th No. of cases F M Comment: Based on the fact that Tonga is still on outbreak category, the case definition for suspected zika virus infection is counted as zika infection until they are tested and confirmed to be either positive or negative. Page 2

3 Table 1: Weekly Incidence of AFR* Cases (Suspected Zika Cases), 1 st January- 20 th March, 2016 Reporting weeks Tongatapu (Vaiola: OPD & AC) Zika Outbreak in Tonga as of March 20 th 2016 Health Centres Vava'u 'Eua Ha'apai (7) Australia (DOH) Total Sub-Total In weeks 11 and 12 there were 22 suspected Zika cases reported in pregnant women. From the 1 st January 2016, Vaiola Antenatal Clinic (ANC) has reported a total of 41 cases of suspected Zika in pregnant women. Of those, 6 cases have been confirmed by PCR by the ESR laboratory (NZ) in women who presented to ANC during the months of January and February 2016, and who were in their first trimester. Table 2: Cumulative number of confirmed cases of zika virus infection among Tonga residents and travellers from Tonga during this period of declared Outbreak status. Source of information Number of cases (category) Laboratory (MOH) 2 (non-pregnant) 6 (pregnant) IHR National Focal Point NZMOH 45 (returning travellers from Tonga noncategorized)) Australia 6 (returning (sourced: travellers from Tonga non- categorized) Total Total 59 Note: 20blood specimens from pregnant mothers were sent last Wednesday (16 th March) and results are pending. This makes it a total of 77 requests so far, and 8 had come back positive. Page 3

4 1bSummary update on activities implemented as part of the response to Zika outbreak to date: The awareness campaign is ongoing in terms of TV and radio programs, Fact sheets and IEC materials being distributed nationally, as well as Zikaposters displayed at the airport. The national clean-up programin Tongatapu was delayed due to bad weather conditions, and the current scheduled programs are in Table 3 below. Table 3: The lasting clean up schedules for Tongatapu District Date Areas/villages VaheHihifolotoloto 10 th -24 th March Puke Sia atoutai, Fatai, Matafonua, Lakepa, Nukunuku, Vaotu u, Houma, Ha akame, Ha alalo, Utulau, Mataaliku, Lomaiviti, Kahoua, Matangiake, Liahona, Matahau VaheHihifo 29 March- 1 st April 2016 Te ekiu, Masilamea, Fahefa, Ha a utu, Kala au, Fo ui, Ha avakatolo, Kolovai, Ahau, Kanokupolu, Ha atafu The Vector control campaignis now focusing mainly on the homes of pregnant mothers. These identified pregnant mothers are sourced from lists from ANC, Vaiola Hospital and Private clinics as shown in Table 4 below. Table 4: Homes of pregnant mothers in Tongatapu and outer islands Names of District/villages Total numbers Number already delivered * Kolofo ou District 11 1 Havelu 9 3 VaheLapaha Tatakamotonga Fua amotu 32 6 Hihifo 16 2 Sub-total for Tongatapu Vava u 35 - Eua 18 - Total * No birth complications or congenital abnormalities have been reported for those who have already delivered. Page 4

5 The Environmental Health Section of the Ministry of Health takes lead role in ensuring that homes of identified pregnant mothers are visited, briefed on the scheduled spraying activity, and implement at a later date. It was through these visits that some pregnant mothers were found to have already delivered as in the above table (Table 4). MsSelaFa u, Head of Environmental Section, at work with her team in the planning, coordinating and implementing zika related activities. Pregnant women are priority sub-group in the MOH response plan for the zika outbreak as indicated from various strategies/activities planned to be implemented as immediate/short, medium and long term strategies. Surveillance systems set up to continue screening of symptomatic pregnant women, especially now that WHO, SPC, NZMOH are assisting in funding the testing. WHO offered to fund serology tests at the Institute for Clinical and Medical Research (ICPMR), Australia. In short, the discussion between DrsMa aketupou (Obstetrician in-charge), SeiniKupu (CDOP, Public Health) and Sean Tobin (WHO consultant) had set the platform where various surveillance activities will be coordinated. This screening and lab-based surveillance activity focuses on: o Continue screening of all symptomatic pregnant women, especially those in their first trimester, by sending blood specimens for PCR (ESR, Wellington, New Zealand), and if negative, then re-send for serology in Australia. o Identify a cohort of asymptomatic pregnant womenwho were in their first trimester during the height of the outbreak and request blood samples for serology testing in Australia. o Ultrasound scans are offered for all symptomatic as well as asymptomatic pregnant ladies on a routine basis. Ongoing surveillance, including lab based and syndromic. These include AFR, those with severe diseases as well as those with underlying medical conditionsbutthe clinician is responsible for requesting or not to be screened. Page 5

6 Acknowledgement: The Hon Minister of Health and his Ministry wish to acknowledge with heartfelt appreciation the ongoing kind assistance and support of our various working, development and donor partners as well as the people of Tonga in the great and timely response and control of Zika virus outbreak in Tonga. Malo aupito Page 6