Thailand Reports `1st' Domestic Case Of Zika

UPDATED (see bottom)

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Thailand is one of several Southeast Asian nations where Zika has been suspected to be circulating, but due to the background noise from Dengue and Chikungunya, and a lack of Zika-specific testing, it has never been proven.

At least, not until today. 

First a report from AFP, then I'll be back with more.

Thailand confirms first domestic case of Zika virus

AFP News 2 February 2016

A man has contracted the Zika virus in Thailand, officials said Tuesday, as a global alert intensifies over the mosquito-borne infection blamed for a surge in serious birth defects in South America.

Authorities said the 22-year-old Thai man is likely to have caught the same strain of the virus that has caused panic in countries such as Brazil and Colombia.

(Continue . . .)

The Zika status of countries like Vietnam, Laos, Cambodia, and even China are suspect because the testing routinely done for dengue can show positive results for Zika as well.  

As more specific PCR testing for Zika becomes widely available it is likely the list of countries where autochthonous transmission takes place will rise considerably. 

One clue that Zika might have been in Thailand prior to today's report came from a 2014 case report from the American Journal of Tropical Medicine and Hygiene that described a Canadian tourist who returned from Thailand and was subsequently diagnosed with Zika. 

First Case of Zika Virus Infection in a Returning Canadian Traveler

Kevin Fonseca,^* Bonnie Meatherall, Danielle Zarra, Michael Drebot, Judy MacDonald, Kanti Pabbaraju, Sallene Wong, Patricia Webster, Robbin Lindsay, and Raymond Tellier

Abstract

A woman who recently traveled to Thailand came to a local emergency department with a fever and papular rash. She was tested for measles, malaria, and dengue. Positive finding for IgM antibody against dengue and a failure to seroconvert for IgG against dengue for multiple blood samples suggested an alternate flavivirus etiology. Amplification of a conserved region of the non-structural protein 5 gene of the genus Flavivirus yielded a polymerase chain reaction product with a matching sequence of 99% identity with Zika virus. A urine sample and a nasopharygeal swab specimen obtained for the measles investigation were also positive for this virus by reverse transcription polymerase chain reaction. Subsequently, the urine sample yielded a Zika virus isolate in cell culture. This case report describes a number of novel clinical and laboratory findings, the first documentation of this virus in Canada, and the second documentation from this region in Thailand.

Since arboviruses are best transported over long distances by viremic humans on holiday, popular tourist destinations like Brazil, Thailand, and the Islands of the Caribbean - which all feature abundant mosquito vectors - seem to be natural hot spots for Zika and CHKV.

A notion that, as a Floridian, already has me stocking up on DEET for the summer ahead.


Update: 

Although the media reports are calling this the first domestic case of Zika in Thailand, I was alerted by Gert van der Hoek of Flutrackers to a recent study (also in Am J Trop Med Hyg)  where 7 Zika cases were confirmed in Thailand between 2012-2014. 

Detection of Zika Virus Infection in Thailand, 2012–2014

Rome Buathong, Laura Hermann,^* Butsaya Thaisomboonsuk, Wiriya Rutvisuttinunt, Chonticha Klungthong, Piyawan Chinnawirotpisan, Wudtichai Manasatienkij, Ananda Nisalak, Stefan Fernandez, In-Kyu Yoon, Passakorn Akrasewi, and Tanarak Plipat

Abstract

Zika virus (ZIKV) is an emerging mosquito-borne pathogen with reported cases in Africa, Asia, and large outbreaks in the Pacific. No autochthonous ZIKV infections have been confirmed in Thailand. However, there have been several cases reported in travelers returning from Thailand.

Here we report seven cases of acute ZIKV infection in Thai residents across the country confirmed by molecular or serological testing including sequence data. These endemic cases, combined with previous reports in travelers, provide evidence that ZIKV is widespread throughout Thailand.

 

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Updating Russia's Flu Outbreak

http://www.influenza.spb.ru

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North America's flu season has been slow in getting started, but yesterday's unexpected CDC HAN Advisory on Severe Influenza reminds us there is plenty of flu season left , and that seasonal flu is always unpredictable.

As mentioned last week, unlike North America (see An Update On The Russian Influenza Epi Report), Eastern Europe and Russia have been reporting heavy flu activity for several weeks, with A(H1N1)pdm09 being the dominant strain.  

The hyperbolic nature of local media reports makes it difficult to gauge the true impact of this year's epidemic, but it appears that thousands of schools across Russia have been closed due to this outbreak.  A sampling of (translated) headlines includes:

The flu epidemic in Russia: in quarantine closed 9,000 schools

Quarantine in schools Saratov extended until February 8

In the Saratov region 415 schools are closed for quarantine

Igor Molchanov: "School of Saratov have to close for a week"  

The official information we are getting comes from the  WHO National Influenza Centre Of Russia.  These reports tend to lag a week or two behind current events, but their Epi Week 4 Influenza Epidemic report summarizes:

Influenza and ARI morbidity data. Influenza activity increased significantly on the week 04.2016. The nationwide ILI & ARI morbidity level (91.9 per 10 000 of population) exceeded the national baseline by 32.2%.

Etiology of ILI & ARI morbidity. The overall proportion of respiratory samples positive for influenza in traditional surveillance system was estimated as 33.6%. Influenza A(H1N1)pdm09 dominated (91.9% of influenza cases). Influenza A(H3N2) and B cases registered sporadically. Percent of positive ARI cases of non-influenza etiology (PIV, adeno- and RSV) was estimated as 19.6% of investigated patients by IFA and 7.3% by PCR.

In sentinel surveillance system clinical samples from 68 SARI and 60 ILI/ARI patients were investigated by rRT-PCR. 21 (30.8%) influenza A(H1N1)pdm09 cases among SARI patients and 10 (16.7%) influenza A(H1N1)pdm09 cases among ILI/ARI patients were detected.

Antigenic characterization. Totally 84 influenza A(H1N1)pdm09 and 2 influenza A(H3N2) viruses were characterizated antigenically in HI in two NICs of Russia since the beginning of the season. 43 (51.2%) influenza A(H1N1)pdm09 strains were related closely to influenza A/California/07/09 virus, 41 (48.8%) influenza A(H1N1)pdm09 viruses had decreased up to 1/8 - 1/16 titers in interaction with antiserum to this virus. Two A(H3N2) strains were similar to influenza A/Hong-Kong/4801/2014 virus, with antiserum to influenza A/Switzerland/9715293/2013 they reacted up to 1/4 - 1/8 of homological titer.

Genetic characterization. 11 investigated influenza A(H1N1)pdm09 virus strains were A/South Africa/3626/2013-like. All viruses bear clade 6B specific mutations in HA (S84N, S162+N and I216T) and formed new genetic group according to phylogenetic analysis. One A(H1N1)pdm09 sequence obtained directly from autopsy sample showed the presence of additional mutation D222G in HA1.

 

The A(H1N1)pdm09 virus has remained remarkably stable since it emerged 7 years ago, but the antigenic and genetic characterizations above describe three interesting attributes: 

1. Nearly half of the samples tested (and the majority since January 1st) show reduced titers against the current vaccine strain.
2. Most of the samples tested since January 1st fall into the emerging 6B subclade  defined by HA1 amino acid substitutions S162N and I216T (see  Influenza virus characterisation, Summary Europe, December 2015).
3. One sequence obtained from an autopsy showed the D222G mutation which has been linked to enhanced virulence

The H1N1 vaccine strain used today is essentially the same one as was developed in 2009, while we've seen the H3N2 vaccine strain replaced numerous times over the past 7 years.

It is inevitable that through the process of antigenic drift, the H1N1 strain will eventually acquire enough genetic changes to require an updated vaccine virus.

But for that to happen, a biologically `fit', antigenically drifted virus must outperform the old virus and become dominant.  And right now, it is too soon to know if these reduced titer viruses will fit that bill.

It is, however, something to watch.

 
The D222G (or D225G in influenza H3 numbering) mutation mentioned above is not new. We saw it described as early as the summer of 2009, but it really came to prominence in the fall of that year when scientists in Norway linked it to deeper lung infections and greater virulence.

This relatively rare amino acid substitution at position 222 (225 using H3 Numbering) from aspartic acid (D) to glycine (G) allows the virus to bind to receptors found deeper in the lungs, and is linked to the development of more severe pneumonia.

In 2013, in EuroSurveillance: Revisiting The D222G Mutation In A/H1N1pdm09, we saw a study that suggested this mutation may actually degrade H1N1's transmissibility, and that most of the time this variant comes about through a spontaneous mutation in the host after the host has been infected. 

D222G's rarity, showing up in only 1%-2% of isolates tested, has kept this mutation from being a major public health concern (Cite).

But another study that appeared last year in the EID Journal (see  Severity of Influenza A(H1N1) Illness and Emergence of D225G Variant, 2013–14 Influenza Season, Florida, USA) cautioned:

Abstract

Despite a regional decline in influenza A(H1N1)pdm09 virus infections during 2013–14, cases at a Florida hospital were more severe than those during 2009–10. Examined strains had a hemagglutinin polymorphism associated with enhanced binding to lower respiratory tract receptors. Genetic changes in this virus must be monitored to predict the effect of future pandemic viruses.

This is all very interesting from virological standpoint, but its significance beyond Russia's current outbreak remains unclear. New influenza clades, subclades and variants continually emerge, and most fail to thrive, or are quickly overrun by other, more successful strains.   

We'll have to wait to see if these clade 6B mutations are winners or losers in influenza's evolutionary lottery.

But with the selection of next fall's seasonal flu vaccine components only a few weeks away, influenza scientists are undoubtedly taking a hard look at the recent rise of clade 6B H1N1 viruses as they try to devine influenza's future.

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CDC Adds 4 Destinations To Zika Travel Alert

Credit CDC Map & Data

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The list of countries where the Zika virus is currently reported to be transmitting increases every couple of days, and seems likely to do so for some time.  Overnight the CDC added 4 more destinations to their Zika Travel Alert:

• American Samoa
• Costa Rica
• Curacao
• Nicaragua

This brings to 26 the number of countries and territories in the Americas that have been affected - up from only two (Brazil & Columbia) in October - and 29 worldwide.  Many countries are not yet testing for the virus, or are awaiting test results, and so this list should not be considered definitive.

CDC adds 4 destinations to interim travel guidance related to Zika virus

 

Media Statement

For Immediate Release: Monday, February 1, 2016

Contact: Media Relations,
(404) 639-3286

CDC is working with other public health officials to monitor for ongoing Zika virus‎ transmission. Today, CDC added the following destinations to the Zika virus travel alerts:  American Samoa, Costa Rica, Curacao, and Nicaragua.   

CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. For a full list of affected countries/regions: http://www.cdc.gov/zika/geo/index.html. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time.

As more information becomes available, CDC travel alerts will be updated. Travelers to areas where cases of Zika virus infection have been recently confirmed are at risk of being infected with the Zika virus. Mosquitoes that spread Zika are aggressive daytime biters, prefer to bite people, and live indoors and outdoors near people. There is no vaccine or medicine available for Zika virus. The best way to avoid Zika virus infection is to prevent mosquito bites.

Some travelers to areas with ongoing Zika virus transmission will become infected while traveling but will not become sick until they return home. Some people who are infected do not have any symptoms. Symptoms include fever, rash, joint pain, and red eyes. Other commonly reported symptoms include muscle pain and headache. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. Travelers to these areas should monitor for symptoms or illness upon return. If they become ill, they should tell their healthcare professional where they have traveled and when.

Until more is known, CDC continues to recommend that pregnant women and women trying to become pregnant take the following precautions:

• Pregnant women should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare professional first and strictly follow steps to avoid mosquito bites during the trip.
• Women trying to become pregnant should consult with their healthcare professional before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip. 

Guillain-Barré syndrome (GBS) has been reported in patients with probable Zika virus infection in French Polynesia and Brazil. Because we do not know if Zika virus infection causes GBS, research efforts are underway to examine if there is a potential link between Zika and GBS.

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WHO Statements On Today's IHR Committee Decision To Declare a PHEIC

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The World Health Organization has posted two statements on today's decision to declare the clusters of microcephaly tentatively linked to the Zika virus a Public Health Emergency Of International Concern (PHEIC).


First, the committee's decision:

WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

WHO statement
1 February 2016

The first meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurologic disorders in some areas affected by Zika virus was held by teleconference on 1 February 2016, from 13:10 to 16:55 Central European Time.

The WHO Secretariat briefed the Committee on the clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have been temporally associated with Zika virus transmission in some settings. The Committee was provided with additional data on the current understanding of the history of Zika virus, its spread, clinical presentation and epidemiology. 

The following States Parties provided information on a potential association between microcephaly and/or neurological disorders and Zika virus disease: Brazil, France, United States of America, and El Salvador.

The Committee advised that the recent cluster of microcephaly cases and other neurologic disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC). 

The Committee provided the following advice to the Director-General for her consideration to address the PHEIC (clusters of microcephaly and neurologic disorders) and their possible association with Zika virus, in accordance with IHR (2005).

Microcephaly and neurologic disorders

• Surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk of such transmission.
• Research into the etiology of new clusters of microcephaly and neurologic disorders should be intensified to determine whether there is a causative link to Zika virus and/or other factors or co-factors.

As these clusters have occurred in areas newly infected with Zika virus, and in keeping with good public health practice and the absence of another explanation for these clusters, the Committee highlights the importance of aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of childbearing age.

As a precautionary measure, the Committee made the following additional recommendations:

Zika virus transmission

• Surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas.
• The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures.
• Risk communications should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures.
• Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus.
• Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.
• Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies.

Longer-term measures

• Appropriate research and development efforts should be intensified for Zika virus vaccines, therapeutics and diagnostics.
• In areas of known Zika virus transmission health services should be prepared for potential increases in neurological syndromes and/or congenital malformations.

Travel measures

• There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission.
• Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.
• Standard WHO recommendations regarding disinsection of aircraft and airports should be implemented.

Data sharing

• National authorities should ensure the rapid and timely reporting and sharing of information of public health importance relevant to this PHEIC.
• Clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with WHO to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Based on this advice the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

WHO Director-General Margaret Chan's statement on the IHR Emergency Committee's decision follows:

WHO Director-General summarizes the outcome of the Emergency Committee on Zika

WHO statement on the first meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
 
1 February 2016 

I convened an Emergency Committee, under the International Health Regulations, to gather advice on the severity of the health threat associated with the continuing spread of Zika virus disease in Latin America and the Caribbean. The Committee met today by teleconference.

In assessing the level of threat, the 18 experts and advisers looked in particular at the strong association, in time and place, between infection with the Zika virus and a rise in detected cases of congenital malformations and neurological complications. 

The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better. 

The experts also considered patterns of recent spread and the broad geographical distribution of mosquito species that can transmit the virus. 

The lack of vaccines and rapid and reliable diagnostic tests, and the absence of population immunity in newly affected countries were cited as further causes for concern.

After a review of the evidence, the Committee advised that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes an “extraordinary event” and a public health threat to other parts of the world. 

In their view, a coordinated international response is needed to minimize the threat in affected countries and reduce the risk of further international spread.

Members of the Committee agreed that the situation meets the conditions for a Public Health Emergency of International Concern.

I have accepted this advice.
 
I am now declaring that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern.
 
A coordinated international response is needed to improve surveillance, the detection of infections, congenital malformations, and neurological complications, to intensify the control of mosquito populations, and to expedite the development of diagnostic tests and vaccines to protect people at risk, especially during pregnancy.
 
The Committee found no public health justification for restrictions on travel or trade to prevent the spread of Zika virus.

At present, the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals, especially pregnant women.

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WHO: Zika Virus & Microcephaly Constitute A PHEIC (Public Health Emergency)

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Although a causal link between the Zika virus and the apparent spike in microcephaly in Brazil has yet to be established the World Health Organization has decided the recent surge in microcephalic births is reason enough to declare a PHEIC (Public Health Emergency Of International Concern).

By itself, the Zika Virus would not be considered a public health emergency, according to panel chair David Heymann, as it is normally a mild virus.  

But when you add in the clusters of microcephaly in French Polynesia and Brazil - and reports of increased Guillain-Barré syndrome (GBS) - all concurrent with the arrival of Zika, the overall picture warrants today's emergency declaration.


Statements from Director-General Margaret Chan and panel Chair David Heymann - along with transcripts from the press conference - should be available shortly.  I'll update this post when they become available.

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CDC HAN Advisory: Severe Influenza Illness Reported

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North American seasonal flu activity has been pretty slow this winter, but in recent weeks we've seen some signs that it is beginning to increase (see Friday's FluView Report). Other parts of the world haven't been as lucky, and some areas are getting hammered pretty hard (see An Update On The Russian Influenza Epi Report) .


Apparently the CDC is beginning to get reports of serious flu activity, as the following excerpt from today's HAN Advisory explains:

CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported. Some of these patients reportedly tested negative for influenza by RIDT; their influenza diagnosis was made later with molecular assays.

The failure of RIDT (rapid flu tests) to detect the H1N1 virus isn't all that unusual, as their sensitivity rates often hover around 50% (see CDC: Updated RIDT Guidance - When `No’ Doesn’t Always Mean No).  A spike in younger adults in intensive care is a concern.


All of which has prompted the release of the following Health Advisory for caregivers.

Flu Season Begins: Severe Influenza Illness Reported

This is an official

CDC HEALTH ADVISORY

Distributed via the CDC Health Alert Network
Monday, February 01, 2016, 08:50 EST (8:50 AM EST)
CDCHAN-00387

Flu Season Begins: Severe Influenza Illness ReportedCDC urges rapid antiviral treatment of very ill and high risk suspect influenza patients without waiting for testing

Summary

Influenza activity is increasing across the country and CDC has received reports of severe influenza illness. Clinicians are reminded to treat suspected influenza in high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results. Early antiviral treatment works best, but treatment may offer benefit when started up to 4-5 days after symptom onset in hospitalized patients. Early antiviral treatment can reduce influenza morbidity and mortality.

Since October 2015, CDC has detected co-circulation of influenza A(H3N2), A(H1N1)pdm09, and influenza B viruses. However, H1N1pdm09 viruses have predominated in recent weeks. CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported. Some of these patients reportedly tested negative for influenza by RIDT; their influenza diagnosis was made later with molecular assays.

Most of these patients were reportedly unvaccinated. H1N1pdm09 virus infection in the past has caused severe illness in some children and young- and middle-aged adults. Clinicians should continue efforts to vaccinate patients this season for as long as influenza viruses are circulating, and promptly start antiviral treatment of severely ill and high-risk patients if influenza is suspected or confirmed.

Recommendations

1. Clinicians should encourage all patients who have not yet received an influenza vaccine this season to be vaccinated against influenza. This recommendation is for patients 6 months of age and older. There are several influenza vaccine options for the 2015-2016 influenza season (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm ), and all available vaccine formulations this season contain A(H3N2), A(H1N1)pdm09, and B virus strains. CDC does not recommend one influenza vaccine formulation over another.
2. Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications (see list below) to seek care promptly to determine if treatment with influenza antiviral medications is warranted.
3. Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza. Clinicians using RIDTs to inform treatment decisions should use caution in interpreting negative RIDT results. These tests, defined here as rapid antigen detection tests using immunoassays or immunofluorescence assays, have a high potential for false negative results. Antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative by RIDT; initiation of empiric antiviral therapy, if warranted, should not be delayed.
4. CDC guidelines for influenza antiviral use during 2015-16 season are the same as during prior seasons (see http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm ).
5. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. Clinical benefit is greatest when antiviral treatment is administered early. However, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients and in some outpatients when started after 48 hours of illness onset, as indicated by clinical and observational studies.
6. Treatment with an appropriate neuraminidase inhibitor antiviral drugs (oral oseltamivir, inhaled zanamivir, or intravenous peramivir) is recommended as early as possible for any patient with confirmed or suspected influenza who
   1. is hospitalized;
   2. has severe, complicated, or progressive illness; or
   3. is at higher risk for influenza complications. This list includes:
      1. children aged younger than 2 years;
      2. adults aged 65 years and older;
      3. persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
      4. persons with immunosuppression, including that caused by medications or by HIV infection;
      5. women who are pregnant or postpartum (within 2 weeks after delivery);
      6. persons aged younger than 19 years who are receiving long-term aspirin therapy;
      7. American Indians/Alaska Natives;
      8. persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
      9. residents of nursing homes and other chronic-care facilities.
7. Antiviral treatment can also be considered for suspected or confirmed influenza in previously healthy, symptomatic outpatients not at high risk on the basis of clinical judgment, especially if treatment can be initiated within 48 hours of illness onset.
8. Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for outpatients.
9. While influenza vaccination is the best way to prevent influenza, a history of influenza vaccination does not rule out influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza. Vaccination status should not impede the initiation of prompt antiviral treatment.  

(Continue . . .)

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Hong Kong Screening Blood Donors For Potential Zika Exposure

Credit WHO/O. O’Hanlon

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One of the concerns with the Zika virus - particularly since testing is still difficult - is how to protect the blood supply from possible contamination.  Last week CDC's Principal Deputy Director Anne Schuchat, M.D., during a press conference, indicated that our own FDA is looking at the issue of blood supply, donors, and travelers.

Today Hong Kong's Hospital Authority has announced that starting tomorrow, their Blood Transfusion Service (BTS) will screen donors for recent travel to areas which are currently affected by the Zika virus, and blood donations will be deferred for at least 28 days from their departure date.

This is the same sort of screening process widely used to protect the blood supply from other mosquito-borne pathogens, including malaria and West Nile Virus.

Screening of blood donors to prevent Zika virus
 
The following is issued on behalf of the Hospital Authority:

The spokesperson for Hong Kong Red Cross Blood Transfusion Service (BTS) today (February 1) announced that with effect from tomorrow (February 2), anyone who has resided in or visited any countries which are affected by Zika virus (which include Barbados, Bolivia, Brazil, Cape Verde, Columbia, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, the US Virgin Islands and Venezuela) will be screened under the new screening guidelines and deferred for blood donation in BTS donor centres for at least 28 days from the date he/she departed from the affected country. The incubation period for Zika virus is typically between three and 12 days. The BTS will closely follow the latest information on the virus outbreak as announced by the World Health Organization so as to revise blood donation screening policies.

The spokesperson added that the screening decision has been made as a precautionary measure by the Hospital Authority (BTS) Expert Panel on Blood and Blood Products Safety, and was endorsed by the Blood Transfusion Service Governing Committee. In fact, donors are currently temporarily deferred for blood donation if they have travelled to part of the countries or territories as mentioned in the past 12 months for the prevention of malaria, which is also an infection transmitted by mosquitoes.

The current blood donor screening policy includes enquiring about the travel history of prospective donors in the past 12 months. If a person has visited a malaria high-risk region in the last 12 months, or visited the West Nile virus prevalent regions in North America in the last 28 days, blood donation deferral will apply. The spokesperson also stressed that the objective of the deferral policy is to ensure blood safety, while blood supply would not be affected.


Ends/Monday, February 1, 2016
Issued at HKT 19:37

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