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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CDC COCA Call On Zika Virus - Webcast & Audio Online

Credit CDC

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Last week the CDC held a COCA Call on the Zika Virus that was not well publicized in advance, and so many clinicians were unable to attend the live broadcast. Over the weekend they've posted the audio, transcript, and even a video of the web cast on their website - along with ancillary materials - which you can now access. 

Primarily of interest to clinicians and health care providers, COCA (Clinician Outreach Communication Activity) calls are designed to ensure that practitioners have up-to-date information for their practices. 

The details of this latest presentation are presented below.

Zika Virus — What Clinicians Need to Know

= Free Continuing Education

Date:Tuesday, January 26, 2016   

Presenter(s)

Ingrid Rabe, MBChB, MMed
Medical Epidemiologist
Division of Vector-Borne Diseases
Centers for Disease Control and Prevention

Dana Meaney-Delman, MD, MPH, FACOG
Medical Officer
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Cynthia A. Moore, MD, PhD
Director
Division of Birth Defects and Developmental Disabilities
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention

Overview

Zika virus is a mosquito-borne flavivirus transmitted primarily by Aedes aegypti mosquitoes and an estimated 80% of persons infected with Zika virus are asymptomatic. Symptomatic disease is generally mild, with symptoms of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis that typically last from several days to one week. Sporadic cases and outbreaks of Zika virus disease have occurred in countries in Africa and Southeast Asia. In 2015, the first local Zika virus transmission in the Americas was reported in Brazil and local transmission has now been in several countries or territories in the Americas. In the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported and Zika virus infections have been confirmed in some infants with microcephaly. However, it is not known how many of the microcephaly cases are associated with Zika virus infection. Travelers to areas with ongoing outbreaks are at risk of becoming infected and spreading the virus to new areas, including the continental United States. During this COCA Call, participants will learn about the epidemiology and clinical manifestation of Zika virus disease and how early recognition and reporting of suspected cases can mitigate the risk of local transmission.

Objectives

At the conclusion of the session, the participant will be able to accomplish the following:

• Describe the epidemiology, clinical manifestations, management, and prevention of Zika virus disease
• Discuss diagnostic testing for Zika virus infection and interpretation of test results
• Articulate the importance of early recognition and reporting of cases
• State the recommendations for pregnant women and possible Zika virus exposure
• Discuss evaluation of infants with microcephaly and the relationship of Zika and microcephaly

Call Materials

• Slides:View Now
• Transcript:Read Now
• Audio:Listen Now
• Webcast:Watch Now

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Saudi MOH Announces A New MERS Case In Riyadh

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The Saudi MOH has announced  a new MERS case, this time in the capital of Riyadh involving a 43 year old expatriate male. This is the 8th case reported in 2016, and so far the authorities have not identified a known risk exposure.

While camel (or camel product) exposure has figured prominently in most of the recently reported community acquired cases, over the past 3 years the vast majority of these primary cases have unidentified risk exposures.


Last November, in EID Journal: Risk Factors For Primary MERS-CoV Infection, Saudi Arabia, we finally saw a small case-control study come out of KSA that found 33% of their subjects reported camel contact in the 14 days prior to falling ill vs. 15% in the control group.

While statistically significant, this obviously leaves a good many primary cases for whom camel contact does not appear to be a factor.

The authors of this study acknowledged these non-camel related cases, and wrote:

 
Other potential explanations of MERS-CoV illness in primary case-patients who did not have direct contact with dromedaries include unrecognized community exposure to patients with mild or subclinical MERS-CoV infection or exposure to other sources of primary MERS-CoV infection not ascertained in our study. 

A recent nationwide serosurvey from Saudi Arabia estimated that >44,000 persons might be seropositive for MERS-CoV and might be the source of infection to patients with confirmed primary MERS-CoV illness but with no dromedary exposure (8).

For more on the possibility of there being some limited `stealth’ transmission of the virus in the community see The Community Transmission Mystery and WHO Guidance On The Management Of Asymptomatic MERS Cases.

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RESEP BATAGOR BANDUNG TAHU BAKSO IKAN GORENG

RESEP BATAGOR BANDUNG

Batagor adalah bakso tahu goreng, merupakan jajanan Bandung populer yang biasa disajikan bersama lumuran saus kacang sebagai khas bumbu batagor (batagor kering) atau disiram dengan kuah (batagor kuah). Resep batagor Bandung akan terasa lebih enak dan spesial gurih dengan ikan tenggiri sebagai bahan batagor yang dicampur dengan tepung kanji. Selain batagor tahu, terdapat juga batagor pangsit yang menggunakan kulit pangsit untuk variasi penyajiannya.

Persiapan Bahan Bumbu Batagor

Cara membuat batagor ikan tenggiri beserta bumbu kacang (sambal kacang) dapat diolah dengan mudah dan sederhana di rumah.

• 600 gram daging ikan tenggiri dihaluskan
• 400 gram tepung kanji/tapioka (sagu tani)
• 2 butir telur ayam
• 2 batang daun bawang diiris kecil-kecil
• 1,5 sdt lada/merica butir dihaluskan
• 8 butir bawang putih dihaluskan
• 1,5 sdt garam

Kombinasi jumlah tahu dan pangsit bisa sesuaikan selera :

• 11 buah tahu putih dibelah dua diagonal/bentuk segitiga
• 60 buah kulit pangsit
• minyak goreng secukupnya

Cara Membuat Batagor Bandung Ikan Tenggiri

1. Campurkan daging ikan tenggiri halus dengan semua bahan lainnya, gunakan sarung tangan plastik lalu uleni hingga merata dan kalis.
2. Tiap-tiap potongan tahu, korek sedikit tengahnya dan beri adonan ikan tadi. Sedangkan untuk setiap kulit pangsit, tuang 1 sendok teh adonan ikan lalu rekatkan menjadi bentuk bunga.
3. Panaskan minyak goreng yang banyak, kemudian goreng hingga matang dan berwarna kuning keemasan. Angkat dan tiriskan lalu sajikan dengan bumbu kacang.

Persiapan Bahan Bumbu Saus/sambal Kacang

• 200 gram kacang tanah
• 4 butir bawang merah
• 2 siung bawang putih
• 2 cm kencur
• 30 gram gula merah
• 50 ml air asam jawa
• 500 ml air
• 10 buah cabe merah keriting
• 1/2 sdt garam
• minyak goreng seperlunya

Cara Membuat Saus Kacang

1. Goreng kacang tanah hingga matang, angkat dan tiriskan dari minyak kemudian haluskan. Haluskan juga bawang merah, bawang putih, kencur dan cabe merah keriting.
2. Panaskan sedikit minyak dan tumis bumbu halus tadi hingga harum. Tuangkan air, masukkan kacang halus serta aduk rata. Masukkan juga gula merah, air asam jawa dan garam, lalu aduk rata dan masak hingga mendidih serta mengental.

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