CAA Meeting COMMUNICABLE DISEASE CONTROL 20 July 2016
Middle East respiratory syndrome coronavirus (MERS-CoV) Globally, since September 2012, WHO has been notified of 1,782 laboratory-confirmed cases of infection with MERS-CoV, including at least 634 related deaths. 2
MERS-CoV: WHO risk assessment MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. Human-to-human transmission has occurred mainly in health care settings. WHO expects additional cases of infection from Middle East, and cases will continue to be exported to other countries by individuals who might acquire the infection from animals or animal products (e.g. dromedaries) or human source (e.g. health care setting). 4
WHO Advice People with diabetes, renal failure, chronic lung disease, and immunocompromised persons considered high risk of severe disease. These people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. Food hygiene practices should be observed. Avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked. WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice. 5
Mers-CoV Action Plan Objectives Coordinate timely interventions to reduce the risk of onset of pandemic Ensure that mechanisms exist so that imminent potential human health threats can be recognised and dealt with Early detection and reporting of human-to-human transmission of MERS - CoV and identification of risk factors Prevent nosocomial transmission and laboratory infection Heighten awareness among health care providers regarding isolated cases or clusters Contain or reduce human-to-human virus transmission Limit morbidity and mortality associated with current human infections Increase readiness for possible pandemic development Communicate transparently and coherently with the public regarding outbreak progression and management Ensure rapid sharing of appropriate information among health authorities, other government departments and partners 6
Lassa Fever Nigeria Between Aug 2015 and 17 May 2016, WHO notified of 273 cases, incl. 149 deaths. Of these, 165 cases and 89 deaths have been confirmed through laboratory testing (CFR: 53.9%). Since August 2015, 10 HCWs have been infected, of which 2 have died. Of these 10 cases, 4 were nosocomial infections. As of 17 May 2016, 8 states are currently reporting Lassa fever cases, deaths and/or following of contacts for the maximum 21- day incubation period. 248 contacts are being followed up in the country. 15 previously affected states have completed the 42-day period following last known possible transmission. 7
Lassa: WHO Risk Assessment Overall, the Lassa fever outbreak shows a declining trend. Considering the seasonal peaks in previous years, improvements in community and HCW awareness, preparedness and general response activities, the risk of a larger-scale outbreak is low. Close monitoring, active case search, contact tracing, laboratory support and disease awareness (both in community in general and specific training for health care workers) should continue. 8
WHO Advice Diagnosis of Lassa fever should be considered in febrile patients returning from areas where Lassa fever is endemic. HCWs seeing a patient suspected to have Lassa fever should immediately contact local and national experts for advice and to arrange for laboratory testing. WHO does not recommend any travel or trade restriction to Nigeria based on the current information available. 9
Yellow Fever 10
Yellow Fever: Angola Yellow fever outbreak was detected in Luanda, Angola late in December 2015. First cases were confirmed by NICD on 19 Jan 2016 & by Institut Pasteur Dakar on 20 Jan. Subsequently, a rapid increase in the number of cases has been observed. As of 8 July 2016, 3625 suspected cases have been reported, of which 876 are confirmed. The total number of reported deaths is 357 Suspected cases have been reported in all 18 provinces and confirmed cases have been reported in 16 of 18 provinces and 80 of 125 reporting districts. Mass reactive vaccination campaigns first began in Luanda and have now expanded to cover most of the other affected parts of Angola. Despite extensive vaccination efforts circulation of the virus persists. 11
Yellow Fever: DRC As of 11 July, suspected cases is 1798, with 68 confirmed cases and 85 reported deaths. Surveillance efforts have increased and vaccination campaigns have centred on affected health zones in Kinshasa and Kongo Central. 12
Risk of spread 2 additional countries have reported confirmed cases imported from Angola: Kenya (2 cases) & China (11 cases). These cases highlight the risk of international spread through non-immunised travellers. 7 countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) are currently reporting YF outbreaks or sporadic cases not linked to the Angolan outbreak. 13
Risk Assessment Outbreak in Angola of high concern due to: Persistent local transmission despite approx 15 million vaccinations. Local transmission has been reported in 12 highly populated provinces including Luanda. Continued extension of the outbreak to new provinces and new districts. High risk of spread to neighbouring countries. As the borders are porous with substantial crossborder social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present; In DRC, the outbreak has spread to 3 provinces. Given the limited availability of vaccines, the large Angolan community in Kinshasa, the porous border between Angola and DRC, and the presence and the activity of the vector Aedes in the country, the outbreak might extend to other provinces. The virus in Angola and DRC is largely concentrated in main cities; however, there is a high risk of spread and local transmission to other provinces in both countries. In addition, the risk is high for potential spread to bordering countries, especially those classified as low-risk (i.e. Namibia, Zambia) and where the population, travelers and foreign workers are not vaccinated for yellow fever. 14
Risk Assessment cont Some African countries (Chad, Ghana, Guinea, Republic of Congo and Uganda) and some countries in South America (Brazil, Colombia and Peru) have reported cases of yellow fever in 2016. These events are not related to the Angolan outbreak, but there remains a need for vaccines in those countries, which poses additional strain on the limited global yellow fever vaccine stockpile. 15
Actions Taken YF is a priority notifiable medical conditions - immediate verbal report on clinical suspicion within 24 hours RSA has a small risk of yellow fever disease introduction as the mosquito vector occurs with a limited distribution to northern Limpopo and Northern KwaZulu-Natal Ongoing actions a. Screening/monitoring for travelers with fever b. YF vaccine certificate or certified exemption verification c. Provision of updated informational to travelers going to YF risk countries YF vaccine - provided at port health, public and private travel clinics Vaccine protection from 10 years to lifetime ii. Removing/addition of YF at-risk countries list Testing for YF is available at the NHLS labs and private labs. Other websites of reference for SA http://www.nicd.ac.za/?page=search&id=8&q=yellow+fever&x=0&y=0 http://www.who.int/topics/yellow_fever/en/ http://www.health.gov.za/index.php/diseases 16
Human infection with avian influenza A(H7N9) virus China 17
Since 2003, a total of 851 laboratory-confirmed cases of human infection with avian influenza A(H5N1) virus, including 450 deaths, have been reported to WHO from 16 countries. A total of 781 laboratory-confirmed cases of human infection with avian influenza A(H7N9) viruses, including at least 313 deaths, have been reported to WHO 18
Human infection with avian influenza A(H7N9) virus China Public health response The Chinese Government has taken the following surveillance and control measures: strengthening outbreak surveillance and situation analysis; reinforcing all efforts on medical treatment; and conducting risk communication with the public and dissemination of information. 19
WHO risk assessment Most human cases are exposed to the A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, further human cases can be expected. Although small clusters of human cases with A(H7N9) viruses have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore, community level spread of this virus is considered unlikely for the time being. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and/or its transmission behaviour to humans as it may have a serious public health impact. 20
WHO advice WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should wash hands often & follow good food safety practices. WHO does not advise special screening at PoE s, nor does it currently recommend any travel or trade restrictions. A diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern. WHO encourages countries to continue strengthening surveillance, including for severe acute respiratory infections (SARI) and to carefully review unusual patterns & ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions. 21
Zika Virus 22
Zika Virus As of 13 July 2016, 65 countries & territories have reported evidence of mosquito-borne Zika virus transmission since 2007 (62 of these have reported evidence of mosquito-borne Zika virus transmission since 2015): 48 countries and territories with a first reported outbreak from 2015 onwards. 4 countries are classified as having possible endemic transmission or have reported evidence of local mosquito-borne Zika infections in 2016. 13 countries and territories have reported evidence of local mosquitoborne Zika infections in or before 2015, but without documentation of cases in 2016, or with outbreak terminated. 23
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Global spread of Zika virus, 2013-2016
Risk assessment Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high. At this stage, based on the evidence available, there is no overall decline in the outbreak. 26
Risk assessment: Olympics On 13 July 2016, the U.S. CDC released a risk assessment for Zika virus spread related to travel to Olympics. Assessment concluded that international spread of Zika related to the Games would not significantly alter spread, but that 4 countries were at special risk, because residents of those countries did not have substantial travel to Zika affected countries, outside of potential exposure at the Olympics: Eritrea, Djibouti, Chad, and Yemen. 27
Actions taken by DOH Joint stakeholder meetings were held with CDC Directorate, Port Health, US-CDC, NICD Zika pamphlet was finalized and placed on DOH website. Port Health is facilitating printing of pamphlet and banner. Action plan was updated. Info was shared with MNORT & stakeholders Finalized pamphlet will be circulated to Atletics-SA, the Olympics Committee, SASTM and travel agents once printed. 28
Coordination: Coordination EPR activities in the country is led by the Multisectoral National Outbreak Response Team (MNORT) at national level as well as provincial outbreak response teams (PORT) at provincial level. Existing structures that are handling Ebola preparedness and response are adapted to include Zika virus. A national action plan for preparedness and response has been developed. The major elements of the action plan include: ORTs at provincial and district levels are alerted. ORTs at provincial and district levels have been trained on EPR. Interim guidelines developed updated as new information emerges. The National Operation Centre (NATHOC) is handling queries from the public. The Emergency Operations Centre (EOC) is on standby and will be active in the event of an outbreak in the country. 29
Early detection: Enhanced surveillance: Port Health: Ports of entry temperature screening for travellers arriving from countries reporting local transmission At Health facilities: guidelines with case definition and laboratory testing protocol was developed and distributed Algorithm for risk assessment was developed to increase awareness regarding pregnant women with travel history to affected countries reporting confirmed ZVD 30
Communication: Risk communication has been initiated to raise public awareness on signs and symptoms of ZVD, preventive measures, where to seek health care if symptoms develop etc. Information is available on the Department of Health Website and will be updated as new information becomes available. Media briefings have been conducted by the NICD. 31
Preventive measures: Vector control at airports and community level: Ensured appropriate disinsection of aircrafts using Standard WHO recommendations regarding disinsection of aircraft and airports Elimination of mosquito breeding sites is emphasized and will be enhanced Protection measures from mosquito bites are being enhanced through public communication; a travel advice and fact sheet is in circulation. 32
Work in progress: Although Zika virus(zikv) was discovered in 1947, it remains relatively unknown for decades since it affected mainly monkeys and occasionally caused a mild disease in humans residing across a narrow equatorial belt in Africa and Asia and was self limiting. The emergence of the implicated highly pathogenic strain in South America raised the urgency to learn more about the disease as well as preventive and treatment measures such as vaccines and drugs. The following measures are in progress to enhance prevention and control of Zika virus: Environmental studies to learn more about the nature of the vector (Aedes aegypti) Pathogenicity of the virus in humans Diagnosis and treatment of cases including pregnant women 33
Thank you 34