Microcephaly and Zika Epidemiological situation and Management

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1 Microcephaly and Zika Epidemiological situation and Management ECONOMIC AND SOCIAL COUNCIL Briefing on the Zika Virus ECOSOC Chamber, UN Headquarters, New York Cláudio Maierovitch Director Department of Communicable Disease Surveillance Secretariat of Health Surveillance Brasília, february 2015

2 HISTORY REPORT TO IHR-OPAS/OMS ABOUT ZIKA, GUILLAIN-BARRÉ E MICROCEPHALY Around 29 reports to IHR: March, 12, 2015 First report about exanthematous syndrome May, 02, 2015 Report about Zika virus circulation June, 26, 2015 Guillain-Barre information October, 23, 2015 Microcephaly information reported to PAHO October, 30, 2015 OMS starts sharing data with Brazil November, 12, 2015 Health Emergency Declaration November, 18, 2015 Communication from ESPIN to WHO November, 27, 2015 Communication of identification of zika virus in 2 deaths November, 29, 2015 Association between zika and microcephaly Week updates on microcephaly since october 22nd to WHO and other requesting countries.

3 HISTORY NOV- APR/2015 APR/2015 EW 17 MAY/2015 AUG/2015 EW 31 OCT/2015 EW 41 OCT/2015 EW 42 OCT/2015 EW 43 NOV/2015 EW 45 April/2015 Northeast region reporting exanthemat ous syndrome 30/04 detection of Zika virus Camaçari/B A May/2015 First cases of Guillain Barre August/2015 First microcephaly cases Changes in epidemiologic al profile 22/10 Pernambuco reports cases to Ministry of Healh 26/10 Start investigations 12/11 Statement of emergency NOV/2015 EW 45 NOV/2015 EW 47 DEC/2015 EW 49 DEC/2015 EW 50 JAN/2016 EW 02 JAN/2016 EW 03 17/11 First national guidelines for microcephaly (33 cm); Zika virus confirmation in amniotic fluid in pregnant PB - Fiocruz 28/11 Relation confirmed between microcephaly and Zika virus - IEC/SVS 09/12 Disclosure of the Protocol of Microcephalysurveillance version 1 changes in CP alteration to 32 cm and others* 14/12 Disclosure of the Microcephaly Protocol Health care 12/01 National guidelines for early stimulation in babies with microcephaly ; CDC: identifcation of 4 zika virus cases 20/01 Confirmed the passage of the zika virus placental barrier; Protocol of Microcephalysurveillance version 1,3 *EW epidemiological week

4 WHO INTERNACIONAL EMERGENCY February 1st 2016: WHO declared a Public Health Emergency of International Concern due to zika epidemic and microcephaly association Recognition of transparency and efficiency on information sharing through the International Health Regulations (IHR/WHO)

5 RELATION BETWEEN MICRCEPHALY AND ZIKA VIRUS An increase of exanthematous syndrome before microcephaly occurrence in Northeast of Brazil Mothers of Microcephaly cases reporting rash during pregnancy Positive zikavirus in amniotic fluid, tissues and blood sample 5

6 MICROCEPHALY SURVAILLANCE Newborn with microcephaly Suggestive miscarriage of congenital infection Stillbirth with microcephaly and / or malformation suggestive of congenital infection Fetus with microcephaly and / or compromised central nervous system, suggesting congenital infection 6

7 SURVAILLANCE AND HEALTH CARE Report Microcephaly Follow up Microcephaly with delay in intellectual development, motor and neurological disorders Investigated causes Suggestive microcephaly of congenital infection Diseases and etiological agents Z-STORCH: Zika vírus, syphilis, toxoplasmosis, other viruses (Chikungunya, Dengue, HIV, etc.), Rubella, Cytomegalovirus and Herpes virus 7

8 Microcephaly protocols Surveillance: compulsory notification Care: care to pregnant women and babies with microcephaly Guidelines for early stimulation on children with microcephaly until three years age

9 REPORTED CASES OF MICROCEPHALY OR MALFORMATION OF THE NERVOUS CENTRAL SYSTEM, BRAZIL AND REGION, UNTIL EW 05/2016 Regions Reported cases of microcephaly and/or malformation of nervous central system, suggestive of congenital infection in fetuses, abortions, stillbirths or live births (A) In investigation (B) Investigated and confirmed (C) Investigated and discarded Total cases reported (A+B+C) Brazil Northeast Southeast North Midwest South Source: Ministry of Health and State Secretariats of Health 9

10 ESPACIAL DISTRIBUTION OF MUNICIPALITIES WITH CONFIRMED CASES OF MICROCEPHALY, BRAZIL, UNTIL EW 05/2016 Legend Municipalities with confirmed cases States with confirmed cases States without confirmed cases Total number of municipalities with confirmed cases: 175 Source: Ministry of Health and State Secretariats of Health (last update: 06/02/2016). 10

11 Estratégias de Comunicação -

12 Research and Development Iniciatives of vaccines against zika virus supported by the Ministry of Health Produção final INSTITUTO EVANDRO BIO MANGUINHOS CHAGAS BIOMANGUINHOS INSTITUTO BUTANTÃ INSTITUTO BUTANTÃ Partnerships Desenvolvimento 1. UNIVERSITY INSTITUTO EVANDRO OF TEXAS CHAGAS MEDICAL (IEC/SVS/MS) BRANCH + UNIVERSIDADE DO TEXAS MEDICAL BRANCH 2. GlaxoSmithKline 1. GlaxoSmithKline 1. NATIONAL INSTITUTES OF OF HEALTH DOS OF ESTADOS USA( VACCINE UNIDOS AGAINST (VACINA DENGUE) CONTRA DENGUE) 2. USP (UNIV. SÃO PAULO) FINANCING brazilian government: Brazilian Development Bank (BNDS) Ministry of Development, Industry and Foreign Trade (MDIC); Financing Agency for Studies and Projects (FINEP) Ministry of Science, Technology and Innovation (MCTI) Secretariat of Science, Technology and Strategic Inputs (SCTIE/MS)

13 NATIONAL COORDINATION AND CONTROL ROOM AGAINST AEDES AND ITS CONSEQUENCES (SNCC) Goals: SC PR ES CE DF Intensify the campaign against the mosquito from December 2015 to June 2016; RR AM MT TO Inspect all households and public and private urban facilities by the end of February 2016 through a taskforce with participation of agent of endemics, community health agents, armies, civil defense, brigades (of firemen) and military forces; MS RO RN PE MG MA Conduct monthly visits until February and bimonthly visits, starting from March to June 2016 through the taskforce. RS GO PB AC Reduce the rate of infestation by Aedes to less than 1% in all municipalities. AP SE RJ PI BA AL SP

14 Brazilian Estrategy on zika: in accordange with PAHO/WHO estrategy Detecting rapid detection of the virus, its complications, monitoring and report to WHO the evolution of the epidemic Researche s Evidencies Preventing Reduction of risk by eliminating the vector and reducing the chances of transmission. #ZIKAZERO Responding The response includes preparation of health services, clinical guidelines, communication of risk and research and development

15 Source: Sinan, *dados atualizados em 29/12/2015. Epi week of first symptoms Notified Dengue Cases by Epidemiological weeks 2013, 2014 e 2015, Brazil Number of cases

16 Notified cases by month, Rio de Janeiro State, January Janeiro Fevereiro February Marco Mars Abril April Maio May Junho June Julho July August Agosto Setembro September Outubro October Novembro November Dezembro December

17 25000 Notified cases of dengue by month, city of Rio de Janeiro, January February Mars April May June July August September October November December

18 Secretariat of Health Surveillance Disque Notifica

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