ZIKA PH Divn

Directorate of Health Services

Zica map 6 2 2016

•AFRO Cape Verde

•AMRO/PAHO Barbados, Bolivia, Brazil, Colombia, Curaçao,

Costa Rica, Dominican Republic, Ecuador, El Salvador, French Guiana,

Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica,

Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint

Martin, Suriname, United States Virgin Islands, Venezuela (Bolivarian

Republic of)

•SEARO Maldives

•WPRO Fiji, Tonga, Samoa, Solomon Islands, Vanuatu

•Indication of viral circulation AFRO Gabon

•SEARO Indonesia, Thailand

•WPRO Cambodia, Philippines, Malaysia

Countries and territories Zika virus, 2007 – 2016

Zika countries 2 2 2016 list likely to change with time. check periodically.

• Brazil,

• Barbados,

• Bolivia,

• Columbia,

• Dominican Republic

• Equador,

• El Salvador,

• French Guyana

• Guadeloupe,.

• Guatemala,

• Guyana,

• Haiti,

• Honduras,

• Martinique,

• Mexico,

• Panama,

• Paraguay,

• Puerto Rico,

• St Martin,

• Suriname,

• Virgin Island

• Venezuela.

ZIKA

• Viral disease,due to Zika virus, an RNA virus.

• Transmission* --aedes mosquito bite. , ?sexual, ?blood – *1st week of infection, max transmission

• WHO has reported 22 +countries and territories in americas

• Associations

• Microcephaly

• Guillain barre syndrome

ZIKA

• Potential for further international spread

– Wide geographical distribution of aedes

– Lack of immunity among population in newly

affected areas

– High volume of international travel.

• As of now, the disease has not been reported

in India

– But Aedes aegypti is widely prevalent in india.

Clinical….

• Symptomatic-20%

• Asymptomatics - 80%

• Mild symptoms - fever, rash, conjunctivitis, body ache, joint pains.

• Suspect case---patients reporting with acute onset of fever, maculo-papular rash and arthralgia, + travel to areas with ongoing transmission during the two weeks preceding the onset of illness.

• Fatalities are rare.

• There is no vaccine or drug available to prevent/ treat Zika virus disease at present.

Pregnancy ,

Zika,&

Microcephaly

• Linkage between microcephaly and Zika inf

• Other causes also preexist

• Incidence has gone up, Causal relationship

still under scrutiny

• Once a female infected

any future consequences?-

NO

World Health Organization

has declared Zika virus disease

Public Health Emergency of International Concern

(PHEIC)

on 1st February, 2016.

GoI-MoHFW

GoI-MoHFW

• Guidelines released 2 2 2016

– Zika

– Aedes mgmt

– http://www.mohfw.nic.in/

Actions

• 1.Enhanced Surveillance

• 2.Risk Communication

• 3.Vector Control

• 4.Travel Advisory

• 5.Non-Governmental Organizations

• 6.Co-ordination with International Agencies

• 7.Research

• 8.Monitoring

Actions

• 1.Enhanced Surveillance

• 1.1. Community based Surveillance

• 1.2 International Airports/ Ports

• 1.3 Rapid Response Teams

• 1.4 Laboratory Diagnosis

1.1. Community based Surveillance

• ∙IDSP

– clustering of acute febrile illness

– seek primary case, if any, among those who

travelled to areas with ongoing transmission in the

2 weeks preceding the onset of illness.

– clustering of microcephaly ,Gullian Barre

Syndrome.

• MCH Division (NHM) -field units –

– clustering of cases of microcephaly

1.2 International Airports/ Ports

• Billboards/ signage -- information to travelers on zika

virus disease --to report to custom authorities if they are

returning from affected countries and suffering from

febrile illness.

• ∙APHO / PHO---

– Quarantine / isolation facility in identified Airports

– Aircraft disinsection

– Monitor vector control (with NVBDCP assistance)

in airport premises and in the defined perimeter.

1.3 Rapid Response Teams

• RRTs activated at Central and State

surveillance units. –(epidemiologist / public health specialist,

microbiologist and a medical / paediatric specialist and other experts

(entomologist etc) -- travel at short notice to investigate suspected

outbreak.

• National Centre for Disease Control (NCDC),

Delhi --agency for investigation of outbreak in

any part of the country.

1.4 Laboratory Diagnosis

• ∙NCDC, Delhi and NIV, Pune,

• diagnosis of Zika virus disease in acute febrile stage.

• Ten additional laboratories to be strengthened

by ICMR

• RT- PCR –the standard test. (not

commercially available)

• Serological tests are not recommended.

Sample testing protocol

• 5 ml blood

• Standard triple packing with cold chain

• Requisition sheet to be attached securely outside box. (NCDC test requisition format has been mailed to districts)

• Address to Outbreak Monitoring Cell , Zoonosis Division, National Centre for Disease Control, 22-Sham Nath Marg, Delhi – 110054.

• Contact SNO -ZICA,(9946123995) by phone to inform and liaison with Delhi

• Email of the request to NCDC to be be sent on: nicdzoonosis@yahoo.com. Phone: 01123981607

2. Risk Communication

• Create increased awareness among clinicians including obstetricians, paediatricians and neurologists about

• Enhanced vigilance to take note of travel history to the affected countries in the preceding two weeks.

• Public ---to be reassured that there is no cause for undue concern.

• The Central/ State Government ==all necessary steps to address this infection.

3. Vector Control • Enhanced integrated vector management.

• The measures undertaken for control of dengue further

augmented.

• Personal protection,

• Biological and chemical control at household,

community and institutional levels.

• Kerala, Tamil Nadu to ensure extra vigil.

4.Travel Advisory- reg affected countries

• ∙Non-essential travel --defer/ cancel.

• ∙Pregnant women or women who are trying to

become pregnant -- defer/ cancel travel

• ∙All travelers --strictly follow individual protective

measures, especially during day time– – mosquito repellant cream, electronic mosquito repellants, use of bed

nets, and dress that appropriately covers most of the body parts).

• co-morbid conditions (diabetes, hypertension,

chronic respiratory illness, Immune disorders etc--

advice from the nearest health facility, prior to

travel

4.Travel Advisory

• Travelers having febrile illness within two weeks of return from an affected country should report to the nearest health facility.

• Pregnant women who have travelled to areas with Zika virus transmission should mention about their travel during ante-natal visits in order to be assessed and monitored appropriately

5. Non-Governmental Organizations role

• Collaboration with NGOs--- Indian / State

Medical Associations, Professional bodies etc -

-sensitize clinicians both in Government and

private sector

• Based on available evidence, World Health

Organization is not recommending any travel

or trade restrictions.

• 6.Co-ordination with International Agencies

• - NCDC

• 7.Research

• - ICMR

• 8.Monitoring

• - Joint Monitoring group under DGHS

Action Kerala

• Convergence and coordination meetings

• SSU-State Control Room-DSU linkage

• Media management

• Airport and Seaport dists-

– assitance to APHO/PHO, local perimeter vector mgmt , DSOs to establish laiason with APHO for transport

• All Dist –

– Vector control, isol facility for suspect, home isol advisory

– Sample transport chain by Air--- back to full readiness– Rehearsal, laiason with DSO of MPM, Ekm, Tvm

– Triple pack materials, sample collection facility OK?

Keep looking sharp…….Thank you Dr Amar Fettle SNO