CDC Updates Guidance - Adds Jamaica & Tonga To Zika List

Credit - http://www.cdc.gov/zika/geo/index.html

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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.  For the second time this week the CDC has added new destinations to their Zika Travel Alert:

• Jamaica
• Tonga

This brings to 27 the number of countries and territories in the Americas that have been affected - up from only two (Brazil & Columbia) in October - and 30 worldwide.

New in this update are guidelines to help prevent the sexual transmission of the virus to women who are pregnant or trying to be, an addition sparked by the second confirmed case of sexual transmission earlier this week:

Until we know more, if your male sexual partner has traveled to or lives in an area with active Zika virus transmission, you should abstain from sex or use condoms the right way every time you have vaginal, anal, and oral sex for the duration of the pregnancy. 

While likely a minor route of infection, other public health agencies have issued similar advice in recent days (see UK PHE Warns On Potential Sexual Transmission Of Zika).


As many countries are not yet testing for the virus, or are awaiting test results, this list of affected countries and territories should not be considered definitive.

CDC adds 2 destinations to interim travel guidance related to Zika virus

Media Statement

For Immediate Release: Wednesday, February 3, 2016Contact: 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:  Jamaica and Tonga.  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. Until we know more, if your male sexual partner has traveled to or lives in an area with active Zika virus transmission, you should abstain from sex or use condoms the right way every time you have vaginal, anal, and oral sex for the duration of the pregnancy. 

• 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.

  
  
  

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Macao Detects H7 In Poultry Market - Live Sales Halted 3 Days

Credit - http://portal.gov.mo/

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Macao, which is one of the most densely populated regions on earth, imports nearly all of its food - including live poultry - from neighboring Guangdong province.   Guangdong has, over the past four years, been the second most active province for H7N9 activity.

Today Macao authorities are reporting that environmental samples taken at a local live poultry market have tested positive for the H7 avian flu virus (full subtype not provided), and the culling of roughly 15,000 birds has been ordered. 

Today's revelation will no doubt attract the attention of Hong Kong's authorities, as they lie roughly 50 miles to the east, and also import thousands of live birds every week from the mainland.


First the official statement from the Macao government website, then a link to a Xinhua report.

Provisional Sha Li in street samples measure the H7 virus in Macao to suspend live poultry sales in three days

The year 2016-02-03

Municipal Affairs on February 3 near the evening confirmed the Provisional Sha Li head downtown one of the environmental samples taken from three birds, positive for the H7 subtype of bird flu virus. Avian influenza contingency plan is activated in real time of the SAR Government, decided to suspend the Macao sale of live poultry for three days, and slaughtered wholesale, and retail outlets for thorough cleansing and disinfection, and poultry workers health will also be on the market for medical monitoring.

Home Department temporary PEAR head downtown 158th stalls on the first floor (written) environmental samples of the H7 virus was detected and confirmed by the source supplying the chicken chickens from smart, CMAI has informed Mainland and common source investigations. Meanwhile, based on the public health and safety considerations, the Home Department will be tonight in the wholesale market over more than 15,000 live birds destroyed in full, and the Macao would from now on, stop the sale of live birds for three days. Under the breaking strain of avian influenza programme, check out suspected environmental sources of samples related to registration will be suspended for Macao, the source of the virus research, both sides confirmed so far for supplying other registration farm of live birds, environmental cleaning and disinfection in the wholesale market after three days of resumption.

In addition, the SAR Government on the wholesale market, and Macao three bird stalls in the markets a full range of cleaning and disinfection, and to the Macao poultry workers and related staff issued health guidelines. As environment sample in the check out H7 type avian influenza virus of market stalls, Health Council has will the stalls of male tenant people and the two name respectively for a male a female of employees set for close contact who, Health Council are arrangements three people to ren Earl integrated hospital accept check and the isolation medical observation, they will will was isolation observation ten days, during regularly accept check H7N9 virus, about detection results will immediately foreign announced.

The other hand, the Health Bureau called on February 3 on a temporary water markets and the stalls are hot sewing thread if you have any questions please call the Board of health infectious diseases 2870 0800 to schedule assessments and other measures. If there are symptoms such as fever, cough, sore throat, and immediately put on a mask and not to travel by public transport, ren Earl, summoned an ambulance to General Hospital Emergency Department for treatment.

 

 

H7 bird flu virus detected in Macao market

MACAO, Feb. 3 (Xinhua) -- An H7 avian flu virus was detected in samples of poultry sold in Macao's street market, officials from Macao's Civic and Municipal Affairs Bureau (IACM) and the Health Bureau (SSM) said Wednesday.

Authorities confirmed that the 15,000 live chickens were imported from Guangdong province and all the poultry in the wholesale market had been culled.

The government decided to temporarily suspend live poultry sales for three days, an IACM official said.

Local authorities also ordered all poultry stalls in Macao's market streets to clean and disinfect.

Macao's IACM has asked relevant departments of the mainland to trace the source of the virus together.

The health bureau said it was placing employees who were in contact with the poultry under medical observation.

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WHO: Statement Urging European Nations Prevent Zika's Spread

Aedes Albupictus - Credit ECDC VBORNET

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In 2007 Chikungunya arrived, albeit briefly, to the province of Ravenna (in the northeast of Italy) carried in by a traveler who had recently returned from India (see  It's A Smaller World After All).  Before the outbreak ended, roughly 300 people were infected.

This was a huge wake up call for Europe, as it demonstrated how easily an exotic tropical arbovirus could be imported, and transmit in a region normally thought immune to such things.

 
Since then, we’ve seen a procession of studies suggesting that Europe is increasingly at risk for many of these vector borne diseases to spread. In 2010 the journal Eurosurveillance devoted an entire issue to The Threat Of Vector Borne Diseases.
 

In 2011, in ECDC: Local Malaria Acquisition In Greece we saw more reasons for concern with the return of a scourge that had – due to diligent mosquito control measures over the past 50 years – been all but eliminated across Europe.

In 2012 we looked at series of initiatives that looked at the likelihood that vectorborne diseases like Dengue, Chikungunya, Malaria, and yes . . . Zika . . . might find a suitable environment in Europe.

ECDC: Status & Importance Of Invasive Mosquito Breeds In Europe

ECDC: Climatic Suitability For Dengue Transmission in Europe

ECDC: Mapping Disease Vectors

While southern Europe has always been slightly vulnerable to mosquito-borne diseases, in October of 2014, in WHO: Locally Acquired Chikungunya In France, we saw another example of autochthonous transmission of a formerly tropical disease, this time in a Central European nation. 

The ECDC, via VBORNET, maintains an updated set of mosquito vector maps for Europe, which can be accessed here, showing those areas where various species of mosquitoes may be found.

For Zika, the current concern is over Aedes Aegypti, and potentially Aedes Albopictus.   Research is ongoing into other possible mosquito vectors.

In light of the potential for some European mosquito species to vector the Zika Virus, today the World Health Organization has released the following statement urging European nations prepare to deal with the threat. 

WHO urges European countries to prevent Zika virus disease spread now

Statement by Dr Zsuzsanna Jakab, WHO Regional Director for Europe

The WHO Director-General has declared that the recent cluster of microcephaly and neurological disorders in Latin America and the Caribbean constitutes a public health emergency of international concern and requires a united response.  She has defined it an "extraordinary event" and a public health threat to other parts of the world, on the basis of a strong suspicion of a causal link between this cluster of disorders and Zika virus disease, as agreed by the experts on the International Health Regulations Emergency Committee. 

The combination of broad geographical distribution of mosquito species that can transmit the virus, the absence of immunity against the virus throughout the world and lack of both a vaccine and rapid, reliable diagnostic tests raises concerns that Zika virus disease will spread globally.

Recommendations to European countries 

Every European country in which Aedes mosquitos are present can be at risk for the spread of Zika virus disease. A number of travellers infected with Zika have entered Europe, but the disease has not been transmitted further, as the mosquito is still inactive. With the onset of spring and summer, the risk that Zika virus will spread increases.

Now is the time for countries to prepare themselves to reduce the risk to their populations. As there is no vaccine or treatment for Zika virus disease, we must protect the European Region by stopping the disease at its source. I urge European countries to act early in a coordinated way to:

• control the mosquitoes, including community engagement in eliminating mosquito breeding sites and planning for insecticide spraying and killing of larvae in case of outbreaks; 
• inform people at risk, especially pregnant women, about preventing mosquito bites;
• enhance surveillance and ensure laboratory detection of Zika virus disease and its neurological complications; and
• step up research to understand Zika virus disease and develop diagnostic tests and vaccines. 

We at WHO stand ready to support countries in the European Region in preventing the spread of Zika virus disease, where requested. This will include: 

• providing guidance on integrated vector control strategies;
• facilitating shipment of samples to WHO reference laboratories or delivering diagnostic tools for local testing; and
• advising on risk communication.

No restrictions on travel or trade

On the basis of the available evidence, WHO does not recommend travel or trade restrictions related to Zika virus disease. As a precautionary measure, national governments may issue travel recommendations to their own populations after assessing the available evidence and local risk factors.

People travelling to high-risk areas should protect themselves from mosquito bites by using repellents, wearing light-coloured, long-sleeved shirts and trousers and ensuring that rooms are fitted with screens to prevent mosquitoes from entering. As Aedes mosquitoes bite during the day, these measures should be applied all day long. 

Women who are pregnant or planning to become pregnant should take extra care to protect themselves from mosquito bites. They might also consult their local health authorities if they are travelling to an area with ongoing Zika virus transmission.

Health authorities are advised to collaborate with the transport sector to ensure disinsection of aircraft arriving from affected areas.

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Saudi MOH Reports 1 Primary MERS Case In Taif

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Although Zika's spread and Brazil's microcephaly outbreak are dominating the media's attention there remain many other important emerging infectious disease stories worth following.   MERS-CoV, while not making a lot of headlines, is one of them.

Today the Saudi MOH reports another primary case they are attributing to camel contact, this time a 78 year old male from Taif.   This is the 9th reported case of 2016.

We've seen a steady parade of camel-related infections over the past month, but so far, no signs of any large nosocomial outbreaks which in the past have often followed the community cases.

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Brazilian MOH Microcephaly Summary Report - Week 4

Credit - Brazil MOH

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The Brazilian MOH has published their latest weekly surveillance report on suspected and confirmed microcephalic births, adding more than 600 suspected cases over the past week.  This represents the largest one-week increase in suspected cases we've seen to date.  

The net-under-investigation number only increases by 212 over last week since another 134 confirmed cases and 247 discarded cases were deducted from this week's total. 

So far, of those cases fully investigated, roughly 1/3rd have been confirmed (404 of 1113) as microcephalic. While the true number of microcephalic births in Brazil prior to 2015 remains a subject of debate (see Pondering The Great Zika Unknowns), this nonetheless appears to be a substantial increase. 


Follow the link below for the full report, including a breakdown by Brazil's regions and Federative units.

Registration Date: 02/02/2016 19:02:18 changed in the 02/02/2016 the 19:02:18

REPORT CARD

Health investigates 3,670 suspected cases of microcephaly in the country

They are being investigated all cases of microcephaly and other disorders of the central nervous system, including the possible relationship with the Zika virus and other congenital infections

The Ministry of Health and the states investigating 3,670 suspected cases of microcephaly across the country. This represents 76.7% of reported cases. The new report released on Wednesday (2) points out, too, that 404 cases have had microcephaly confirmation and / or other disorders of the central nervous system, and 17 with respect to the Zika virus. Other 709 reported cases have been discarded. In all, 4,783 suspected cases of microcephaly were registered by 30 January.

The new figures show rise in cases already classified as confirmed and discarded in the last week, compared to previous weeks. The growth of the investigated and classified cases was 52%, with respect to the report on 23 January. Were 732 last week, moving to the current 1,113.

In total, 76 deaths were reported by microcephaly and / or alteration of the central nervous system after delivery (stillbirth) or during pregnancy (miscarriage). Of these, 15 were investigated and confirmed to microcephaly and / or alteration of the central nervous system, and five had identification Zika virus in fetal tissue. Another 56 are still under investigation and five have already been discarded.

It should be noted that the Ministry of Health is investigating all cases of microcephaly and other disorders of the central nervous system, informed by the states and the possible relationship with the Zika virus and other congenital infections. The microcephaly can be caused by various infectious agents beyond Zika, such as syphilis, toxoplasmosis, Other Infectious Agents, Rubella, Cytomegalovirus and Herpes Viral.

According to the report, the 404 confirmed cases since the beginning of the investigation on 22 October last year - were recorded in 156 municipalities in nine Brazilian states: Alagoas, Bahia, Ceará, Paraíba, Pernambuco, Piauí, Rio Grande do Norte , Rio de Janeiro and Rio Grande do Sul. The Northeast region has 98% of the municipalities with confirmed cases, and Pernambuco continues with the highest number of municipalities with confirmed cases (56), followed by the states of Rio Grande do Norte (31) , Paraíba (24), Bahia (23), Alagoas (10), Piauí (6), Ceará (3), Rio de Janeiro (2) and Rio Grande do Sul (1).

So far, they are with indigenous circulation of Zika virus 22 units of the federation. They are: Goiás, Minas Gerais, Federal District, Mato Grosso do Sul, Roraima, Amazonas, Para, Rondonia, Mato Grosso, Tocantins, Maranhao, Piaui, Ceara, Rio Grande do Norte, Paraiba, Pernambuco, Alagoas, Bahia, Espírito Santo , Rio de Janeiro, Sao Paulo and Parana.

Guidance- The Ministry of Health advises pregnant women to adopt measures to reduce the presence of the Aedes aegypti mosquito, with the elimination of breeding sites, and protect themselves from mosquito exposure, keeping doors and windows closed or screened, wear pants and shirt Sleeve and use repellents allowed for pregnant women.

ZIKA - The Ministry of Health will announce in the coming weeks the compulsory notification of cases identified as infection Zika virus in Brazil. Currently, the Unified Health System (SUS) does not count the number of cases of infections Zika. Currently, the monitoring is done by the sentinel surveillance system to monitor the circulation of the virus and provide support for measures to prevent the disease.

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Dallas, Texas: DCHHS Confirms Locally Acquired Sexually Transmitted Zika Infection

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Although the evidence for sexual transmission of the Zika virus has been limited (see  EID Journal dispatches on Probable Non–Vector-borne Transmission of Zika Virus, Colorado, USA & Potential Sexual Transmission of Zika Virus), we've started to see warnings over the possibilities from health agencies (see UK PHE Warns On Potential Sexual Transmission Of Zika).

Today, we appear to have additional confirmation, with the following statement released this afternoon from Dallas County Health and Human Services (DCHHS). 

 I expect we'll hear a lot more about this case in the hours and days ahead.

FOR IMMEDIATE RELEASE

DCHHS Reports First Zika Virus Case in Dallas County Acquired Through Sexual Transmission

DALLAS (Feb. 2, 2016) – Dallas County Health and Human Services (DCHHS) has received confirmation from the Centers for Disease Control and Prevention (CDC) of the first Zika virus case acquired through sexual transmission in Dallas County in 2016. The patient was infected with the virus after having sexual contact with an ill individual who returned from a country where Zika virus is present. For medical confidentiality and personal privacy reasons, DCHHS does not provide additional identifying information.

“Now that we know Zika virus can be transmitted through sex, this increases our awareness campaign in educating the public about protecting themselves and others,” said Zachary Thompson, DCHHS director. “Next to abstinence, condoms are the best prevention method against any sexually-transmitted infections.” 

Zika virus is transmitted to people by mosquitoes and through sexual activity. The most common symptoms of Zika virus are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting several days to a week.

DCHHS advises individuals with symptoms to see a healthcare provider if they have visited an area where Zika virus is present or had sexual contact with a person who traveled to an area where Zika virus is present. There is no specific medication available to treat Zika virus and there is not a vaccine. The best way to avoid Zika virus is to avoid mosquito bites and to avoid sexual contact with a person who has Zika virus.

“Education and awareness is crucial in preventing Zika virus,” said Dr. Christopher Perkins, DCHHS medical director/health authority. “Patients are highly encouraged to follow prevention recommendations to avoid transmitting and spreading Zika virus.”

DCHHS recommends the following to avoid Zika virus:

           

Use the 4Ds to reduce the chance of being bitten by a mosquito.

• DEET All Day, Every Day: Whenever you’re outside, use insect repellents that contain DEET or other EPA approved repellents and follow instructions.
•  DRESS: Wear long, loose, and light-colored clothing outside.
•  DRAIN: Remove all standing water in and around your home.
•  DUSK & DAWN: Limit outdoor activities during dusk and dawn hours when mosquitoes are most active.

Travelers can protect themselves by doing the following:

Choose a hotel or lodging with air conditioning or screens on windows or doors.

Sleep under a mosquito bed net if you are outside or in a room that is not well-screened

Sexual partners can protect each other by using condoms to prevent spreading sexually-transmitted infections.

There are currently no reports of Zika virus being locally-transmitted by mosquitoes in Dallas County. However, imported cases make local spread by mosquitoes possible because the mosquitoes that can transmit the virus are found locally. DCHHS advises recent travelers with Zika virus symptoms as well as individuals diagnosed with Zika virus protect themselves from further mosquito bites.

For more information on Chikungunya, Dengue and Zika viruses, go to the DCHHS website. ###

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WHO MERS-CoV Update - Saudi Arabia

Credit FAO

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In January, after a very quiet couple of months on the MERS front, we saw a spate of MERS cases reported out of Saudi Arabia all involving camel contact (see here and here), several involving Camels That Tested Positive For MERS-CoV In A Jeddah Market.

Today the World Health Organization has posted an update on five of these recent cases, including two asymptomatic cases, and one who is listed as being a relative of closes contacts to a camel. 

While the vast majority of people have been exposed to MERS from other infected humans, infected camels appear responsible for sporadically `seeding' the virus into the human population, where it tends to transmit in health care settings particularly well.


Finding ways to curb this camel-to-human transmission is viewed as the most effective way to keep MERS in check.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
2 February 2016 

Between 22 and 27 January 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 5 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Details of the cases

• A 47-year-old male from Al-Kharj city developed symptoms on 24 January and, on 26 January, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 27 January. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
• A 21-year-old, non-national male from Alkumrah city was identified through contact tracing while asymptomatic. The patient, who has no comorbidities, tested positive for MERS-CoV on 23 January. Currently, he is still asymptomatic and in home isolation. The patient has a history of contact with MERS-CoV positive camels. He has no history of exposure to other known risk factors in the 14 days prior to detection.
• A 45-year-old, non-national male from Alkumrah city was identified through contact tracing while asymptomatic. The patient, who has no comorbidities, tested positive for MERS-CoV on 23 January. Currently, he is still asymptomatic and in home isolation. The patient has a history of contact with MERS-CoV positive camels. He has no history of exposure to other known risk factors in the 14 days prior to detection.
• An 85-year-old male from Muthnab city developed symptoms on 11 January and, on 19 January, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 21 January. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of contact with his relatives who have a history of contact with camels. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
• A 58-year-old male from Jeddah city developed symptoms on 12 January and, on 19 January, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 21 January. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

Contact tracing of household and healthcare contacts is ongoing for these cases.

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