Zika Virus Update Wednesday, 25 May 2016 10:00 11:00 PRESENTED BY: Dr. Michael Braida
Zika Virus Outbreak Author - Disclosure Canadian medical doctor living and working in UK and Germany Medical Director at MedAire Farnborough UK Intensive Care Specialist plus 17 years HEMS in Munich Germany Regional Medical Director at International SOS supporting the Oil and Gas Industry 2
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Aviation and Global Outbreaks
Zika Virus where did it start? 1947 Routine yellow fever monitoring in the Zika Forest in Uganda blood taken from rhesus monkeys Zika virus 1948 Virus isolated from Aedes africanus captured in the Zika forest 1952 First human cases in Uganda and Tanzania 5
Zika Virus Chronology - I Sources: enter sources here 6
Zika Virus Chronology - II Sources: enter sources here 7
Zika Virus Chronology - III Sources: enter sources here 8
What is Zika Virus disease? Zika virus disease is an emerging mosquito-borne illness. Spreads via mosquito bites to non-human primates and humans Prior to this outbreak, limited studies. Present in tropical areas of Africa, Asia, South America and Caribbean Islands No specific treatment, and no vaccine are available A lot more research is underway
Zika Virus Symptoms Mostly mild. One in five will get symptoms about two to seven days after the mosquito bite. Similar to dengue, chikungunya, malaria. Common symptoms include: Fever Rash Muscle and joint pain Conjunctivitis (red eye) Headache Most people recover in about a week.
Zika Virus Complications Growing evidence, but not clear if Zika alone is responsible. Appears to be associated with Brain malformations in the babies of women who were infected while pregnant, including microcephaly (small head circumference and brain damage) Poor outcomes in pregnancy such as miscarriage or still birth Guillain-Barré syndrome - muscular weakness which can be mild or severe, leading to respiratory failure Several affected nations have advised women to delay pregnancy
How does Zika Virus spread? Via Aedes mosquitoes (the same mosquito spreads dengue, chikungunya and yellow fever). Life cycle 1½ to 3 weeks! These mosquitoes mostly bite during the day - inside and outside. Other types of transmission Sexual from males to female appears to be more than previously suspected. Unknown how long virus persists in semen (detected at 62 days post illness) From mother to newborn around time of delivery or possibly during pregnancy Blood transfusion Perhaps through infected monkey bite (rare)
Zika Virus Diagnostics and Treatment Diagnosis: Suspected based on symptoms and history of exposure (e.g. travel). Specialised blood tests are needed to confirm the diagnosis. Treatment No specific treatment is available. Treatment is mainly supportive and includes rest, plenty of water. If using medicine to relieve fever and pain, AVOID aspirin / nonsteroidal anti-inflammatories (such as ibuprofen) unless dengue has been excluded, as these medicines can make bleeding worse.
Diagnostics http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/patient-case-management/publishingimages/zika-virus-laboratory-diagnosis-large.jpg
Should I travel to a Zika region? An individual risk assessment Some authorities are advising pregnant women to consider postponing travel, especially to areas with increasing or widespread transmission. US CDC travel notice applies to >20 countries, other authorities identify other locations Some authorities advise women to delay getting pregnant for at least 28 days after travel to a Zika-affected area due to the risk of birth defects
Travel Advice Monitor the information, which is changing If travelling to an affected area, prevent infection by reducing your chance of getting mosquito bites Pregnant women - consult your doctor for an individual risk assessment. Consider avoiding travel to affected areas. If travel must proceed, prevent mosquito bites. In addition to the infectious risks consider the standard of available healthcare, and obstetric and neonatal specialist support.
Returning Travellers Monitor your health for two to three weeks If symptoms develop, seek medical care, and advise your doctor of your travel history Some authorities are advising women to delay pregnancy for 28 days, and men to use condoms (for at least 28 days up to 6 months)
Research in the Scientific Community
Indoor bite prevention Use insecticide sprays or vaporisers: Spray bedrooms before going to sleep. Plug-in electric vaporisers release insecticide. Install insect screens on doors and windows: The mesh size should be less than 1.5mm. If possible use air conditioning: It may reduce the chance you will be bitten Use an insecticide-treated bed net: Make sure the net does not have any tears. Tuck the ends in under the mattress, or make sure it reaches the floor. Use it if resting / sleeping during the daytime (and also at night).
Outdoor bite prevention Wear clothing that covers most of the body (long sleeves and long pants). Wear socks and shoes. Consider treating clothing with an insecticide if you are very likely to be exposed to mosquitoes Be aware of peak exposure times. Avoid mosquito breeding areas (stagnant or still water). Use an effective insect repellent: Such as one containing DEET, Picaridin, PMD, or IR3535. Reapply after swimming or excessive sweating. Coils: Release pyrethroids which repel mosquitoes. Use outdoors only.
What does NOT repel mosquitoes Sound-producing vibrating buzzers UV Blue light electric zappers Herbal preparations Vitamins Citronella candles / burners
Zika virus prevention Prevent mosquito breeding sites: Aedes mosquitoes like stagnant water found in man-made containers around homes and urban areas. Make sure any containers you have outdoors don t collect standing water. Turn buckets and watering cans upside down when not in use. Don t place dishes of water under pot plants. Clean up and dispose of fallen leaves regularly. Clear any stagnant water in air conditioning units and gutters.
(Un)usual mosquito breeding sites Tree hole Air-con tray Plant axil BBQ pit Canvas sheet Discarded receptacle
Zika Virus Aviation Sources: http://www.capsca.org/ http://www.who.int/ihr/ports_airports/zika-aircraft-disinsection/en/ 24
Pre-flight A pre-flight aerosol containing an insecticide with rapid action and limited residual action is applied by ground staff to the flight deck, passenger cabin including toilet areas, open overhead and side-wall lockers, coat lockers and crew rest areas. The spray is applied before the passengers board the aircraft but not more than 1 h before the doors are closed. A 2% permethrin cis:trans (25:75) formulation is currently recommended t½ up to 2 weeks Preflight spraying is followed by a further in-flight spray, i.e. top-of-descent as the aircraft starts its descent to the arrival airport.
Blocks Away Spraying is carried out by crew members when the passengers are on board, after closure of the cabin door and before the flight takes off. The air-conditioning system should be switched off during cabin spraying. The flight deck is sprayed before the pilot boards (when no passengers are on board). The doors of overhead luggage racks should be closed only after spraying has been completed. An aerosol containing 2% D-phenothrin is currently recommended by WHO t½ 38 to 72 minutes Cargo holds should also be disinsected
Top of descent Carried out as the aircraft starts its descent to the arrival airport. 2% D-phenothrin is currently recommended by WHO for this purpose and is applied with the air recirculation system set at from high to normal flow.
Residual The internal surfaces of the passenger cabin and cargo hold, excluding food preparation areas, are sprayed with a compression sprayer that has a constant flow valve and flat fan nozzle according to WHO specifications Permethrin 25:75 (cis:trans) emulsifiable concentrate is currently recommended by WHO Air-conditioning packs should be run for at least 1 h before the crew and passengers embark to clear the air of the volatile components Residual disinsection is a professional service! https://www.transportation.gov/office-policy/aviation-policy/aircraft-disinsection-requirements
Crystal Ball What May Lie Ahead? Expect Zika to spread to all countries in the Americas (except Canada and continental Chile) More exported cases, imported cases will be detected. Outbreaks may occur in places with the mosquito vector Expect outbreak to lessen in South America with onset of winter Expect outbreaks in the USA this summer southern states, and other African and Asian countries at-risk too Progress with diagnostics Vaccine may be years away?
Thank You