THE ZIKA VIRUS III - THE WORLD HEALTH ORGANIZATION AND THE CENTRE FOR DISEASE CONTROL
This is the last Brief in a three part series dealing with the Zika Virus. It discusses what the World Health Organization (WHO) and Centre for Disease Control (CDC) is currently doing in order to cope with the Zika epidemic.
Introduction
The WHO and CDC have increased the measures that they are taking to deal with Zika. The WHO releases regular situational reports and the CDC has released an interim response plan.
The WHO situational reports
Each week the WHO issues a situational report. The report sets out new notifications of mosquito-borne and person-to-person transmission of the Zika virus, and of associated diseases. It contains operational updates from WHO regional offices, and it reports key research findings. The report of 8 September 2016 contains the following information:
1. It was noted that Malaysia had reported a locally acquired mosquito-borne Zika infection in the last week, a new development for that country.
2. The WHO Regional Office for the Americas has conducted workshops on clinical management of neurological complications in Barbados. A technical mission to Brazil for laboratory assessment and strengthening of Zika diagnostic capacity of State laboratories was completed in August. WHO facilitated two meetings in Panama with regards to the updating of the strategic plan for vector surveillance and control. In Columbia and El Salvador there were Mosquito Awareness Week programmes. In Haiti there were three train-the-trainer workshops on epidemiological surveillance of Zika and its complications in August. WHO has provided technical support to the Brazilian Ministry of Health to ensure that the Summer Paralympic Games are as safe as possible.
3. An analysis of the Zika virus cases in Singapore indicates that the virus belongs to the Asian lineage, evolving from the South East Asian strain and is likely to have surfaced in South-East Asia first.
4. There have also been meetings conducted by the Emergency Committee looking into the Zika virus and its infection and associated congenital and other neurological disorders which continue to be a public health emergency of international concern. WHO has also been able to establish that the Zika virus infection in pregnant women is the cause of the congenital brain abnormalities including microcephaly and that the Zika virus can trigger the Guillain-Barre’ Syndrome. WHO issued a revised guideline on the prevention of sexual transmission which was published on 6 September 2016.
The CDC response
The CDC has developed a 10 step programme for infected areas to implement.
Step 1: Vector surveillance and control.
This consists of identifying vectors[1] in areas where the Zika virus is present, surveying their incidence and developing and implementing plans for their control, especially in areas where the Aedes mosquito is found. This step also involves educating communities on self-protection.
Step 2: Public Health Surveillance and Epidemiological Investigation
The goals are to ensure that adequate diagnosis and reporting of the Zika virus cases occurs, and to monitor epidemiologic trends in transmission, distribution and severity.
The activities are to determine if systems and procedures are in place to identify confirmed Zika cases. This can be done by considering looking at:
- Symptomatic infection
- Problems in pregnant women
- Reproductive or congenital outcomes including microcephaly
- Guillain-Barré syndrome
- Infections as a result of blood transfusions
- Infections transmitted sexually
Step 3: Laboratory testing and support services
The goal is to ensure that state and territorial departments have the support needed to adequately test specimens from suspected Zika cases.
This entails determining which laboratories in a particular place are capable of conducting molecular tests or antibody tests for the Zika virus infection, to put in place mechanisms for testing, and training health care providers about submitting specimens.
Stage 4: Prevention of Sexually Transmitted Zika virus Infections
The goal is to focus on reducing the risk of sexually transmitting the Zika virus by providing guidance to the public regarding the risks.
The actionable steps are to educate the public as well as health care providers as to the risks of sexual transmission of the Zika virus as well as to promote the following of the guidelines for prevention and transmission as issued by the CDC.
Step 5: Prevention of Blood transfusion- transmitted Zika Virus Infections
The goal is to reduce the transmission of the Zika virus through blood transfusions in areas with an outbreak of Zika. The actionable steps here are to co-ordinate with surveillance partners in order to investigate when the Zika virus may have infected blood products or transfusions in local blood centres and transfusing health care facilities, and to introduce testing of blood products for the Zika virus.
Step 6: Maternal and Child Health Surveillance and Response
The goal is to ensure that infection during pregnancy is prevented as well as to ensure that expectant mothers who are suspected of having contracted the Zika virus are monitored.
The actionable steps are to ensure that a state-level pregnancy reporting system is in place to actively monitor expectant mothers who are suspected of having contracted the Zika virus, and to introduce programmes dealing with training, counselling and advice to pregnant mothers and health care workers dealing with the pregnant mothers.
Step 7: Rapid Birth Defects monitoring and follow ups
The goal is to ensure rapid detection of microcephaly and other birth defects and to plan for adequate services for these children and families.
Step 8: Travel Health News
The goal under this step is to ensure that travellers who go to areas which are infected with the Zika virus receive the appropriate information regarding risks and preventative measures.
Step 9: Clinician outreach and communication
The goal is to keep healthcare practitioners updated as to the risks, recognition, diagnosis, reporting, clinical management and outcomes as well as prevention of the Zika virus infections.
The actionable measures would be to have reviews and update guidelines on the Zika virus as well as identify the most appropriate and functional channels to share information with healthcare providers.
Step 10: Risk communication / community education
The goal is to inform the public about Zika and related birth defects or illnesses, especially microcephaly and other harmful effects to women and their foetuses.
The actionable steps here are to develop communication messages with key partners and stakeholders and to identify local vendors who can assist in information dissemination on the Zika virus.
Conclusion
Monitoring, vector control, information and advice are all helpful. Even so, the Zika virus will continue to spread, and a vaccine is needed. It will take several years before the action of the virus is fully understood, potential vaccines developed and clinical trials completed.
Arvitha Doodnath
Legal Researcher
arvitha@hsf.org.za