ECDC Zika/Microcephaly/GBS Rapid Risk Assessment - 2nd Update

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Three weeks after the first ECDC Rapid Risk Assessment On Zika Virus Epidemic we have a second update, and as we've come to expect from the ECDC, this 16 page document is both up to date, and feature-rich.

I've only included some small excerpts, so you'll want to download and reviewe the entire PDF. 

Rapid risk assessment: Zika virus disease epidemic: potential association with microcephaly and Guillain–Barré syndrome, Second update


08 Feb 2016
Available as PDF 
 
Abstract

​This document assesses the risks associated with the Zika virus epidemic currently affecting countries in the Americas. It assesses the association between Zika virus infection and congenital central nervous system malformations, including microcephaly, as well as the association between Zika virus infection and the Guillain–Barré syndrome (GBS).

Main conclusions and options for response 
 
Considering the continued rapid spread of Zika virus in the Americas and Caribbean, the growing evidence of an association between Zika virus infection during pregnancy and adverse pregnancy outcomes, the association between Zika virus infection and post-infectious Guillain–Barré syndrome (GBS), and the risk of establishment of local vector-borne transmission in Europe during the 2016 summer season, EU/EEA Member States are recommended to consider the following mitigation measures.

• Travellers visiting countries where Zika virus is currently being transmitted should be made aware of the ongoing outbreak of Zika virus infection. A list of countries and territories with documented autochthonous transmission during the past two months is maintained on the ECDC website (see also Table 1).

• Travellers visiting these countries should use personal preventive measures based on protection against mosquito bites indoors and outdoors, especially from sunrise to sunset when mosquitoes are most active in biting. Such measures include:

− using mosquito repellent in accordance with the instructions indicated on the product label. DEET-based repellent is not recommended for children under three months of age but pregnant women can use it.

− wearing long-sleeved shirts and long trousers, especially during the hours when the type of mosquito that carries the Zika virus (Aedes) is most active.

− sleeping or resting in screened or air-conditioned rooms, otherwise use mosquito nets, even during the day.

• Pregnant women and women who are planning to become pregnant, and who are intending travel to affected areas, should discuss their travel plans and evaluate the risk with their healthcare providers and consider postponing their travel.

• Travellers with immune disorders or severe chronic illnesses should consult their doctor or seek advice from a travel clinic before travelling, and be given advice on effective prevention measures.

• There is evidence that Zika virus can be transmitted sexually through semen, and there are indications that Zika virus can be present in semen for several weeks after a man has recovered from a Zika virus infection. Travellers to Zika-affected areas should be advised that the risk of sexual transmission from an infected man to another person can be reduced by using condoms.

• Travellers showing symptoms compatible with Zika virus disease within three weeks of return from an affected area are advised to contact their healthcare provider and mention their recent travel.

• Pregnant women that have travelled in areas with Zika virus transmission should mention their travel during antenatal visits in order to be assessed and monitored appropriate

• Male travellers returning from areas with local transmission of Zika virus should consider using a condom with a female partner at risk of getting pregnant or already pregnant:

− for 28 days after their return from an active Zika transmission area if they have not had any symptoms compatible with Zika virus infection;

− for 6 months following recovery from a laboratory-confirmed Zika virus infection.

This precautionary advice is based on limited evidence and will be revised as more information becomes available.

Information to healthcare providers

• Ensure that Zika virus-infected patients in areas with Aedes mosquitoes take measures to avoid getting bitten during the first week of illness (insecticide-treated bed nets, screened doors and windows as recommended by PAHO/WHO).

• Increase awareness among health professionals who provide prenatal care of the possible association between Zika virus and microcephaly and adapt prenatal monitoring in accordance with the exposure to the vector.

In addition, due to the unprecedented size of the Zika virus epidemic, health services and practitioners should be alert to the possible occurrence of neurological syndromes (GBS and other neurological syndromes such as meningitis, meningoencephalitis and myelitis according to WHO/PAHO) and potential disease complications not yet described in the scientific literature and atypical clinical presentation among specific populations (i.e. children, the elderly, immunocompromised individuals and those with sickle cell disease).

This document also includes more specific options for substances of human origin, surveillance and preparedness