H5N1

Malaysia confirms first (imported) case of Zika, launches measures to contain spread of virus

Thanks to Microbes & Infection for tweeting the link to this September 1 Reuters report: Malaysia confirms first case of Zika, launches measures to contain spread of virus. Excerpt:

Malaysia confirmed on Thursday its first case of Zika after a woman tested positive for the virus following a three-day visit to neighboring Singapore on August 19.  

The 58-year-old woman had showed signs of a rash and fever one week after returning from Singapore, according to Health Minister Subramaniam Sathasivam.  

"We are carrying out control measures against Aedes mosquitoes near the woman's home to prevent the spread of the virus," he said at a news conference on Thursday, adding that the virus was discovered in the woman's urine sample. 

Subramaniam initially said the woman's "child" had also tested positive for Zika in Singapore. He later clarified that the child was in fact an adult daughter who is working in Singapore and has not returned to Malaysia. 

Subramaniam said they have already intensified vector control activities in Taman Botani in Klang, where the infected woman's home is located, and urged residents to allow officers despatched to the area to enter their homes and carry out fogging and larvicidal spraying. 

Singapore announced the first locally contracted case of Zika late on Saturday, and the number of diagnosed infections has grown steadily this week.

WHO: Second meeting of the Emergency Committee under the International Health Regulations (2005) concerning yellow fever

A statement from WHO: Second meeting of the Emergency Committee under the International Health Regulations (2005) concerning yellow fever. Excerpt:

After discussion and consideration of the information provided, it was the view of the Committee that the current status of the yellow fever outbreaks in Angola and the Democratic Republic of the Congo does not constitute a Public Health Emergency of International Concern (PHEIC). 

However, despite the considerable progress made, the Committee concluded that the outbreak remains a serious public health event which warrants continued national action and international support. Furthermore, the imminent onset of the rainy season will intensify vector activity, thus raising subregional risks of yellow fever transmission. 

Members of the Committee offered technical advice on immediate actions for the consideration of WHO and Member States in the following areas: 

 For affected countries (Angola and DRC): 

• Further strengthening of surveillance and laboratory capacity, completion of mass vaccination, continuing risk communications, community mobilization, integrated vector control and case management measures. 

• There should be thorough documentation of the operational aspects of the fractional dose campaign and sharing of interim results on the study on duration of immunity; 

• Reinforcement of the need for yellow fever vaccination of all travellers, and especially migrant workers to and from areas with ongoing yellow fever virus activity. 

Other advice:  

• Strengthening of yellow fever vaccination as part of routine childhood immunization programmes where appropriate; 

• The intensification of surveillance and preparedness activities, including verification of yellow fever vaccination in travellers, risk communications and strengthening of systematic cross border collaboration in at-risk countries, particularly countries having land borders with the affected countries; 

• Further consideration should be given to a pre-emptive vaccination campaign in high-risk areas in the Republic of the Congo. 

• WHO and partners must continue efforts to ensure a carefully planned and maintained yellow fever vaccine stockpile. 

The Committee also emphasized the need to rapidly manage any new yellow fever cases, imported or locally acquired.

Zika virus and the Guillain–Barré syndrome: Case series from seven countries

Thanks to Greg Folkers for sending the link to this letter to NEJM: Zika Virus and the Guillain–Barré Syndrome — Case Series from Seven Countries. Excerpt:

Zika virus (ZIKV) disease had been described as a mild, self-limiting illness associated with fever, rash, joint pain, and conjunctivitis. However, during the outbreak in French Polynesia, 42 patients with ZIKV disease were found to have the Guillain–Barré syndrome, which represented a marked increase from the approximately 5 cases detected annually during the previous 4 years. A connection with the Guillain–Barré syndrome had previously been described in association with other flavivirus illnesses3 but not with ZIKV infection. 

From April 1, 2015, to March 31, 2016, a total of 164,237 confirmed and suspected cases of ZIKV disease and 1474 cases of the Guillain–Barré syndrome were reported in Bahia, Brazil; Colombia; the Dominican Republic; El Salvador; Honduras; Suriname; and Venezuela. To examine the temporal association between ZIKV disease and the Guillain–Barré syndrome, graphical and time-series analyses were applied to these two independent data sets, which were collected through official International Health Regulations channels or from ministry of health websites (see the Supplementary Appendix, available with the full text of this letter at NEJM.org). 

The data obtained from country reports contained no personally identifiable information and were collected as part of routine public health surveillance; therefore, the analysis was exempt from review by an ethics board. Differences between the observed and expected numbers of cases of the Guillain–Barré syndrome during the ZIKV transmission period, as well as differences in the incidence of the Guillain–Barré syndrome and ZIKV disease according to age and sex, were analyzed with the use of Poisson regression models (see the Supplementary Appendix). 

The analysis suggests that changes in the reported incidence of ZIKV disease during 2015 and early 2016 were closely associated with changes in the incidence of the Guillain–Barré syndrome. During the weeks of ZIKV transmission, there were significant increases in the incidence of the Guillain–Barré syndrome, as compared with the pre-ZIKV baseline incidence, in Bahia State (an increase of 172%), Colombia (211%), the Dominican Republic (150%), El Salvador (100%), Honduras (144%), Suriname (400%), and Venezuela (877%) (Table 1TABLE 1 Expected and Observed Numbers of Cases of the Guillain–Barré Syndrome. ). When the incidence of ZIKV disease increased, so did the incidence of the Guillain–Barré syndrome. 

In the six countries that also reported decreases in the incidence of ZIKV disease, the incidence of the Guillain–Barré syndrome also declined. When the seven epidemics of ZIKV disease are aligned according to week of peak incidence, the total number of cases of ZIKV disease and the Guillain–Barré syndrome are closely coincident (Figure 1B), although the period from acquiring infection to reporting disease is approximately 2 weeks longer for ZIKV than for the Guillain–Barré syndrome, a pattern that is especially visible in data from Colombia and Venezuela. Whether the 2-week difference can be explained in terms of incubation periods or reporting delays is not yet known. 

We explored the potential effect of dengue virus circulation on the incidence of the Guillain–Barré syndrome and found no link (see the Supplementary Appendix). In any event, we infer from these two series of cases, which were collected independently of each other, that ZIKV infection and the Guillain–Barré syndrome are strongly associated. Additional studies are needed to show that ZIKV infection is a cause of the Guillain–Barré syndrome.

India: 200 chikungunya cases reported in Gurgaon private hospitals

Via The Times of India: 200 chikungunya cases reported in pvt hospitals. Gurgaon is a city southwest of New Delhi. Excerpt:

Gurgaon: After two days of rain, five new dengue cases and over 200 chikungunya cases have been reported in the city's private and government hospitals. The official dengue figure now stands at 37, while the district health authority has confirmed only one chikungunya case so far. 

Though doctors in private hospitals have declared chikungunya as an epidemic, the health authority said the situation is under control. Patients, on the other hand, complained of lack of preparedness at Civil Hospital to deal with such cases after some of them were referred to Safdarjung Hospital in Delhi. 

According to the health authority, the five new dengue cases are from Sector 55, Sector 10, Jyoti Park, Wazirabad and Gurgaon Gaon. All the patients are in the age group of 28 to 55 years. Only government hospitals in the district can confirm dengue cases. 

Meanwhile. doctors in private hospitals in the city said they have witnessed over 200 cases with symptoms of chikungunya in the internal medicine out-patient ward in the past two days. And according to an estimate, the city has witnessed over 500 cases of Chikungunya in this season alone. 

"We have been witnessing 80% cases with symptoms of chikungunya. Cases are increasing with each passing day. Even though chikungunya very rarely leads to mortality, it has come up as an epidemic. People should take all precautionary measures to prevent mosquito breeding," said Dr Rajesh Kumar of Paras Hospital. 

However, Gurgaon's chief medical officer Dr Ramesh Dhankar said there is no need to panic as the mortality rate in chikungunya is very rare. 

"The major difference between dengue and chikungunya is that patients of chikungunya experience severe joint pain. We have adequate arrangements to treat such patients," he added.

Florida Health Zika update, August 31

Via Florida Health: Department of Health Daily Zika Update. Excerpt:

There are 13 new travel related cases today, five in Miami-Dade, two in Osceola, one in Broward, one in Lee, one in Orange, one in Seminole and two involving pregnant women. Please visit our website to see the full list of travel-related cases.  

There is one new non-travel related case today in Palm Beach County. The individual identified today experienced symptoms during the same time frame as the Palm Beach County case announced last week. The department has found no evidence of active transmission in the area. 

DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties and mosquito abatement and reduction activities are also taking place around the locations that are being investigated. DOH believes ongoing transmission is only taking place within the small identified areas in Wynwood and Miami Beach in Miami-Dade County, see maps below.

The numbers today: 569 travel-related Zika cases, 47 local cases, and 80 cases involving pregnant women.

As microcephaly rises in Haiti, doctors fear Zika is a sleeping giant

Thanks to Lucie Lecomte for the link to this report on NPR's Goats and Soda blog: As Microcephaly Rises In Haiti, Doctors Fear Zika Is A Sleeping Giant. Excerpt:

At the Mirebalais Hospital in Haiti's central plateau, Dr. Louise Ivers and Dr. Roman Jean-Louis are examining a baby girl who was born in early July with microcephaly, a smaller-than-normal skull often associated with Zika infections. 

The baby, named Chinashama, is dressed in a white smock adorned with small green flowers. It looks like a tiny bridesmaid's dress. Underneath that dress, however, it's unclear what physical and mental problems Chinashama is facing. 

Her legs cross unnaturally over her shins. Her mother, Chrisnette Sainvilus, says the baby cries a lot and has trouble passing stool. "Day and night she's crying," the mother of two says.  

Ivers lifts Chinashama's legs and tries to move them apart. "See, her legs are still crossed. The muscle development is not what we'd want to see," she says. "This baby definitely needs physical therapy." 

Chinashama is one of three babies born with microcephaly at the Mirebalais Hospital in July. The Haitian Ministry of Health says there have been 11 others born nationwide over the last two months with this usually rare birth defect. But only one has been officially confirmed as a result of the Zika virus. 

Haiti has all of the ingredients for widespread transmission of Zika. The mosquito that carries the virus flourishes in Haiti's tropical heat. As the outbreak wanes in Brazil and Colombia, the Caribbean is currently the epicenter of Zika transmission. Countries in the region are reporting high numbers of cases. Puerto Rico, for instance, has a population a third the size of Haiti and is reporting roughly 1,500 new cases of Zika each week. 

Yet as of August, Haiti had confirmed only five cases to the World Health Organization. 

Many people who get infected with Zika have mild symptoms or no symptoms at all. In Haiti, it can take all day for a patient to see a doctor, so most people don't come to health facilities unless they are extremely ill. But if they're pregnant and have Zika, the virus could still pose a threat to their fetus. 

Sainvilus, Chinashama's mother, says she doesn't remember having a fever or other signs of Zika during her pregnancy — although she thinks she had a bout of fever that she thought was chikungunya just before she got pregnant. 

But even if Sainvilus had gotten sick, it's highly unlikely that she would have been tested for Zika. For the last four months, a doctors' strike in Haiti has brought the public health care system to a standstill. The Mirebalais Hospital, which remained functioning, is a 5-hour bus drive from her home on the road that leads from Port-au-Prince to the Dominican Republic. 

Secondly, Haiti just doesn't have the infrastructure to do widespread Zika testing. The only place that can test for Zika is the national laboratory run by the Ministry of Health. They've been doing a limited number of tests which will only come back positive if the actual virus is still in the blood sample being tested. Zika clears from the blood fairly quickly, so unless you test while the person is still sick, it's going to come back negative. 

Other more complicated tests have to get sent out to Costa Rica, Trinidad and Tobago or the U.S. — and it can take months for a doctor to get those results if they get them at all. 

Ivers, from Partners in Health, a global health organization based in Boston, says she's quite anxious that Zika is spreading widely across Haiti — but it's not being detected. 

"We don't have a good idea of what's going on. Now that we've seen three babies born [with microcephaly] in the span of three weeks in our own facility, we are very concerned that it's being under-reported in other parts of the country," she says.

Did WHO report two Zika-related microcephaly cases in Guinea-Bissau—two weeks ago?

Thanks to the reader who read the details in WHO's Zika virus situation report for August 11, and found this quiet observation buried on page 2:

Two cases of microcephaly have been reported in the Western region of Gabu in Guinea-Bissau. The family members of the two children with microcephaly have not travelled outside Guinea-Bissau. The investigations regarding these two cases are ongoing. Trainings for regional health staff on the Zika case definition and other areas are planned to help ensure that cases are detected efficiently and effectively. 

 

Note that WHO doesn't say the microcephaly cases are Zika-related, and Guinea-Bissau is not listed in Table 3 of the same sitrep among the 15 countries having microcephaly cases even "potentially" associated with Zika.

 

But the paragraph is wedged in between two others on Zika in Guinea-Bissau, along with some very diplomatic discussion of what sounds like an abysmal lack of surveillance, lab testing, and leadership in dealing with Zika.

 

Predictably, Guinea-Bissau's web presence is almost nonexistent. The official government website has no links to ministries. WHO's country page offers some discouraging statistics. Its country office website does have a mention of WHO's Zika mission, dated August 4, in French. That story discusses the known Zika cases on Bubaque Island; the two microcephaly cases are in Gabú, in the east of the country, wedged in between Guinea and Senegal.

 

So your guess is as good as mine (likely better) as to whether the microcephaly cases really are Zika-related, or just turned up when the WHO mission asked about such cases.

 

I've also just checked the most recent WHO sitrep, from August 25, which reports lab tests on the four Zika cases are still pending—since July 1. What's more five microcephaly cases detected since April are under investigation as well.

 

And the thought occurs to me that if surveillance and testing are so weak in Guinea-Bissau, they're not likely much better in Guinea next door. So Zika (and perhaps microcephaly) could be more widespread than anyone realizes.

Indonesia mulls 'travel advisory' for Singapore over Zika outbreak

Via Channel NewsAsia: Indonesia mulls 'travel advisory' for Singapore over Zika outbreak. Excerpt:

JAKARTA: Indonesia is mulling a “travel advisory” for Singapore to guard against the spread of Zika.  

Singapore reported an outbreak of Zika over the weekend, with 82 locally transmitted cases so far, and a growing list of countries such as the US, South Korea, Australia have warned their citizens who are pregnant  or who are trying to get pregnant to avoid travel to Singapore in light of the virus.  

In a telephone conversation on Wednesday (Aug 31), Dr Oscar Primadi, spokesman for the Ministry of Health, said the advisory was not a "travel warning", and was aimed at alerting citizens of Indonesia to the severity of the conditions in Singapore. 

“This is not a ban. An advisory means advising people to be careful, especially pregnant women. This is our plan so far,” he said. “If it is not important, you don’t have to go there,” he added. 

Health Minister Nila Djuwita Moeloek echoed the advice, telling local media: "Those wanting to travel there could perhaps think about it. If the trip is in the interest of something important, then there is nothing to be done. But if possible, postpone the trip."  

According to Dr Oscar, the advisory was still under discussion, and could be issued in the coming days.  

Since Monday, more than 190 officials have reportedly been assigned to eight Indonesian ports with routes serving Singapore, including Batam, Bintan and Karimun, where thermal scanners have been introduced to check passengers upon their return from visits to the city-state.  

Three hospitals have also been assigned to handle infected patients in Riau province. Those showing signs of Zika or suffering from fever will be asked to provide a blood sample, and if they test positive for the Zika virus, they will be summoned by authorities.   

In a statement on the Health Ministry’s website, the director-general for Disease Prevention and Control Mohamad Subuh said every passenger that enters Indonesia from Singapore through the airport will also receive a health alert card. The card will contain information about Zika symptoms, and ask those who are showing them to immediately report to a health facility.

Anthrax in Siberia: Quarantine lifted

Via the Yamal-Nenets Autonomous Region government website: Quarantine lifted! The governor of Yamal has signed a decree on the abolition of restrictive measures in the Yamal region. Excerpt from the unedited Google translation:

Today, 31 August, the head of the Arctic region , Dmitry Kobylkin his order lifted quarantine on the territory of grazing reindeer in Yamal region. 

Recall, at the outbreak of anthrax on July 25 in one of the areas was introduced quarantine area, focus localization started and in the future - a large-scale work: in the aftermath of death of animals, to prevent the spread of the disease among the indigenous population and a healthy olenpogolovya.  

This week, Dmitry Kobylkin informed the government members about the actions taken and the results of the joint work. Today, the lifting of quarantine messages were sent to the federal center. 

At present, the territory continues rehabilitation activities. All tundra are traditional places of residence - in the net of the tundra zone, where the settling of new life in nomad camps, where imported products and necessities, daily necessities, medical kits, and more. Saved and disinfected wooden products, including sacred for many generations of indigenous people sledge, have already been transferred to heads of families. Funds have been allocated and developed options for the acquisition of deer affected tundra. 

The nomad camps are preparing for the new school year. In the Yamal region, as well as the Arctic tundra County, is collecting school children in boarding schools. Yarsalinskii school interenat, incidentally, is the largest in Russia, it is already taking children. The buildings are fully disinfected and meet the most stringent standards of sanitary inspections.  

Currently, the hospital is Salekhard 1 child. According to doctors, the girl is healthy, but will remain under supervision until they are healed traces of wounds on the skin. Parents waiting for discharge.  

Total on the morning of August 31 to the District vaccinated more than 14 thousand people from risk groups. 

Number of vaccinated animals is as follows: in the Yamal region - 180 352 heads, Taz - 94 424 Priuralsky - 55,543 heads, Nadym - 6205 goals, Krasnoselkupsky - 1754, in Shuryshkarsky - 20,023 heads, Purovsky area - 2 486 Total in the Yamalo-Nenets Autonomous Okrug vaccinated against anthrax 354,346 head of reindeer.

Thailand: Chiang Mai at risk from Zika virus

Via The Irrawaddy: Chiang Mai at Risk From Zika Virus. Excerpt:

The northern Thai city of Chiang Mai, whose metropolitan area contains almost a million people, is at risk from the Zika virus, according to provincial authorities.  

Chiang Mai-based City News reported that provincial governor Pawin Chamniprasart has designated a control zone for the Zika virus in the San Sai Luang District of Chiang Mai Province, in order to contain the spread, after several cases were identified in the district. 

Seven people have reportedly been infected so far in the province, which is also at risk of a dengue outbreak.