WHO Response to the PHEIC: Zika, Microcephaly, and Guillain- Barré Syndrome Member States Briefing. February 2016

Transcription

1 WHO Response to the PHEIC: Zika, Microcephaly, and Guillain- Barré Syndrome Member States Briefing February 2016

2 Zika Virus, microcephaly and Guillain-Barré activity and WHO response overview Zika Virus Guillain-Barre Microcephaly Overview 34 countries have reported autochthonous circulation of Zika virus; indirect evidence of local transmission in 6 additional countries Zika virus infection during pregnancy is strongly suspected to cause microcephaly, though not yet scientifically proven Zika geographical distribution has steadily increased from 1/2014 to 2/2016 with further spread to countries with the Aedes mosquito likely 7 countries have reported an increase in microcephaly or Guillain-Barré syndrome concomitantly with Zika virus WHO Response Emergency Committee convened 1/2/2016 and DG announced microcephaly and other neurologic disorders reported in Brazil to be a PHEIC Categorized as a Level 2 emergency and established an Incident Management System with central and regional structures WHO s Global Emergency Response Plan Strategic Objectives: Global prevention & control strategy launched by WHO with partners is based on surveillance, response activities, and research 1

3 Status of epidemiology: Zika Virus Countries and territories with autochthonous transmission of Zika virus, Reported autochthonous transmission WHO Regional Office AFRO AMRO/PAHO Country or territory Cape Verde Barbados, Bolivia, Brazil, Colombia, Costa Rica, Curaçao, Costa Rica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, United States Virgin Islands, Venezuela (Bolivarian Republic of) Indication of viral circulation SEARO WPRO AFRO SEARO WPRO Maldives, Thailand Tonga, Samoa, Solomon Islands, Vanuatu Gabon Indonesia, Thailand Cambodia, Fiji, Philippines, Malaysia 2

4 Status of Epidemiology: Microcephaly Country Microcephaly epidemiology In 10/2015, the Brazil Ministry of Health reported an increase in microcephaly cases Between 2001 and 2014, microcephaly cases averaged of 163 per year nationally, but as of 30/1/2016, 4,783 cases of microcephaly or CNS malformation have been reported (76 deaths) Brazil French Polynesia 1,113 of the 4,783 cases of microcephaly were investigated: 709 cases were discarded 17 were confirmed as Zika virus and 387 cases were compatible with congenital infection Of the 17 confirmed cases, 2 were miscarriages and the other 15 cases were live births Of the 76 reported deaths, Zika was identified in 5 cases, all from northeast Brazil Microcephaly cases in Brazil follow the same geography and timeline as Zika infections, but potential link needs more investigation French Polynesia: A review of births indicated an increase in CNS malformation in children between 3/2014 and 5/2015: 18 cases reported, 9 with microcephaly (typical average of 0 to 2 cases of per year) Other On 8/1/2016, CDC confirmed a baby born in Hawaii with microcephaly and evidence of past Zika virus infection. The mother likely acquired Zika in Brazil, 5/2015, infecting her newborn in utero 3

5 Goal Investigate and respond to the cluster of microcephaly and other neurological complications that could be linked to Zika virus infection, while increasing preventive measures, communicating risks and providing care to those affected. 4

6 Response Strategy SURVEILLENCE Provide up to date and accurate information on the Zika virus disease, neurological syndromes and congenital malformations RESPONSE Engage communities to communicate the risks associated with Zika virus disease and promote healthy behaviors, reduce anxiety, address stigma, dispel rumors and cultural misperceptions. Increase efforts to control the spread of the Aedes aegypti mosquito as well as access to personal protection measures. Provide guidance and mitigate the impact on pregnant women and those considering pregnancy, as well as families with children affected by Zika virus. RESEARCH Investigate the etiology of microcephaly, neurological syndromes and establish the possible consequences of Zika virus infection. Fast-track the research and development (R&D) of new products (e.g. rapid diagnostics, vaccines, therapeutics). 5

7 Application of response strategy Surveillance, laboratory testing, risk communications and community engagement Vector control and personal protection Management of microcephaly congenital malformations & neurologic syndromes Public health research to investigate associated risks Aedes + Zika + microcephaly and other neurological disorders Aedes + Zika Aedes Other countries 6

8 Urgent needs Overview of Needs and Requirements based on Global Strategy requests $53million for WHO and partner agencies WHO initial ask for urgent needs $25 million Development of global strategy and joint operations plan Establishment of incident management and coordination mechanisms Development of research agenda and field research activities Scaling up of operations in affected countries for community engagement, vector control, guidance and care for those affected Increased surveillance and global reporting, risk communication 7

9 Concept of Operations IHR Emergency Committee WHO Global Incident Management Team R&D Partners Global Coordination Mechanisms WHO Regional Incident Management Teams GOARN UN Agencies & NGOs WHO Technical Programmes Research Partners Regional Neoworks Regional Coordination Mechanisms National Incident Management Teams 1 WHO Country Incident Management Teams Country Coordination Mechanisms Member States & National Incident Management International Incident Management International Coordination Mechanisms 1 For countries with no WHO Country Team, National Incident Management will interface with WHO Regional Incident Management 8

10 Zika virus response technical challenges and WHO guidance Technical Challenge Establishing case definitions Laboratory Diagnosis Description Standardized case definition for Zika virus, Microcephaly, GBS, etc. Laboratory algorithms, confirmatory tests, national lab capacities, availability of reagents WHO Guidance WHO interim case definitions Validation/dissemination of laboratory testing algorithms. Tech support to national reference labs Management of infected pregnant women & infants Vector Control Travel and Trade Clinical management and monitoring (i) of pregnant women infected with Zika virus (ii) fetus and newborns with congenital malformation (microcephaly) Reduction of vector densities through community engagement and removal of breeding sites Aircraft/ship disinsection of Recommendations for international travel WHO statement on access to abortion in context of microcephaly. Development of technical guidance Technical guidance, mobilization of social science networks Technical guidance for international travel and transport agencies (ICAO, IMO, UNWTO) 9

11 Zika virus response technical challenges and WHO guidance Technical Challenge Communicating Sexual and Reproductive Health and Rights (SRHR) Guidance on Maternal, Newborn, and Child Health Activity Mapping and Coordination WHO guidance Communicate evidence-based SRHR messages to affected populations and recommend country responses Guidance on antenatal, intrapartum and postpartum care in the context of Zika virus infection and on management of infants with microcephaly Mapping research, monitoring, policy and program activities on SRHR and providing technical support for strengthening coordination of existing and future undertakings 10

12 Zika virus research and development R&D Activity Vaccine development Development of therapies Diagnostics Blood products Vector Control WHO progress to date Mapping of the current efforts to develop candidate vaccines Initiation of consultations to establish Target Product Profiles Strengthening of regulatory capacities Mapping of current landscape including anti-virals, host-directed therapeutics, immune products, and other therapeutic interventions Mapping of Diagnostics tests under development including PCR and serology Initiation of work to establish Target Product Profiles to guide developers Issuance of a call to submit candidate tests to WHO emergency listing procedure (EUAL) Preparation of guidance for blood banks on Zika testing Mapping the current landscape of novel approaches: biological and genetic Enablers Advancing the agenda on data and sample sharing 11

13 Zika virus research and development continued R&D Activity Facilities readiness Women s and health workers perceptions Persistence of Zika virus in bodily fluids WHO progress to date Assessment of facilities readiness to provide immediate access to contraception, safe abortion and post-abortion care (PAC) to women as part of the Zika emergency response Social science research on women s and health workers perceptions of pregnancy risk and consequent decisions making on contraceptive use, PAC and safe abortion to delay or avoid pregnancy in the context of Zika epidemic Cohort studies of women and men to determine presence and persistence of Zika virus in semen and other bodily fluids and association with pregnancy outcomes 12

14 Zika Performance Metrics on Transformative Changes to WHO Emergency Processes: ERF functions On Target Not on target but improved from previous Needs improvement ERF Function Transformative Change Performance Target Zika Performance Description Zika Performance Leadership Incident Manager identified and given agreed delegated responsibilities within 24 hours of grading; HC-certified WR (HC/WR) in all protracted crises Information Health situation analysis published within 72hrs for Acute events Coordination / Planning Standardized weekly SitRep published for all graded emergencies: single format for all emergencies Joint operations plan within 5 days for all acute, graded emergencies; updated 6 monthly in protracted. Core Services Initial disbursement of emergency funds of up to $500K USD within 24 hours Incident Manager (Ian Clark) identified within 24 hours of grading Sit rep published 5 days after grading Joint Operations plan to be completed by 10 days (near to final draft already reviewed extensively by partners) PAHO received $2.3M within 24 hours of request Non-roster staff and consultants recruited within 3 days and deployed within 5 days 1 N/A Operations Support & Logistics All staff and consultants fully operational (accommodation, office space, transport, computer, phone, connectivity) within 24hrs of arriving in-country N/A Minimum essential emergency supplies distributed to points of service within 72 hours Health Operations All essential health services provided to minimum standards, as per Sphere N/A 1 Includes acute event in protracted crisis situation 13

15 WHO and other materials available: WHO Strategic Response Framework and Joint Operations Plan: WHO has issued questions and answers on women in the context of microcephaly and Zika virus disease, in English and Portuguese: English version: Portuguese version: The most recent issue of the weekly Zika Situation Report was published on 12 February 2016: WHO has published a Zika Virus timeline, which summarizes the spread of Zika infection, country by country, from the earliest discovery in 1947 to the latest information as of 7 February The online, interactive timeline can be found at: Interim case definition for Zika virus: This is published and linked from the PED page and from the Microcephaly/Zika virus page. The WHO position for use of DDT for vector-borne diseases, including malaria is found here: International Civil Aviation Organization (ICAO) is coordinating with the World Health Organization on Zika response. ICAO aligns its air transport advice with that of WHO. ICAO news release: 14