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WHO: Zika Virus Disease – India (14 October 2021)

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  • WHO: Zika Virus Disease – India (14 October 2021)


    Zika Virus Disease – India
    14 October 2021

    On 8 July 2021, a Zika virus (ZIKV) infection was laboratory-confirmed in a resident of Kerala state, south-west India. This represents the first Zika virus disease case ever reported from Kerala. ZIKV viral RNA was detected through RT-PCR testing at the National Institute of Virology (NIV) Pune, in a blood sample collected from the patient, a 24-year-old pregnant woman in her third trimester of pregnancy resident in Trivandrum district. On 28 June 2021, she was admitted to a private hospital with arbovirus like symptoms of fever, headache and general rash. Laboratory results were negative for dengue virus (DENV) and chikungunya virus (CHIKV). The woman delivered on 7 July, she was reportedly in good health and there were no apparent birth defects in the new-born. In the 3 months before delivery, she had resided in Trivandrum district not having traveled during that period. Among her close contacts, her mother reported having fever and similar symptoms one week before ZIKV confirmation in her daughter.
    Retrospective testing was conducted among 19 hospital staff and patients at the same private hospital who had previously presented with fever, myalgia, arthralgia and petechial lesions in May 2021. Blood samples collected from these 19 ZIKV suspected cases were sent to NIV Pune, and on 10 July the laboratory results confirmed that 13 of the 19 samples tested positive for ZIKV by RT-PCR, indicating cryptic transmission of ZIKV in Kerala state since May 2021.
    During the period from 8 to 26 July 2021, 590 blood samples were collected in Kerala state through active case finding and passive surveillance. Of them, 70 (11.9%) tested positive for ZIKV by RT-PCR at NIV Pune, including four additional pregnant women. All these cases were from Trivandrum district, except two cases reported from Ernakulam and Kottayam districts, who both had recent travel history to Trivandrum district.
    On 31 July 2021, Maharashtra state also reported its first Zika laboratory-confirmed case from Belsar, a village of 3500 inhabitants located in Purandar Taluka administrative unit, Pune district. The case, a 50-year-old women, tested positive for both ZIKV (by RT-PCR and sero-neutralization) and CHIKV (by RT- PCR and IgM ELISA) at NIV Pune. Fifty-one additional samples from ZIKV suspected cases were collected from Belsar village, of them 40 tested negative for ZIKV and 11 are still pending for results.
    So far, no cases of microcephaly and/or Guillain-Barre syndrome (GBS) have been linked with this outbreak.

    Public health response

    The Kerala Health department, along with local self-government health departments has implemented the following response activities:
    • On 8 July 2021, the State of Kerala issued guidelines on enhanced surveillance for ZIKV disease and sent guidance to all 14 districts.
    • Information, Education and Communication activities pertaining to ZIKV disease have been strengthened immediately throughout the State. Sensitization activities across the State for both health care workers and the general public are ongoing.
    • All ultrasound scanning centers have been directed to report incidences of microcephaly during regular antenatal scans to the Reproductive and Child Health Officer.
    • Currently, four laboratories (National Institute of Virology Alappuzha, Medical College laboratories of Trivandrum, Thrissur and Kozhikode) in Kerala state are equipped to perform RT-PCR testing for ZIKV infection. The State is also planning to start testing in another public health laboratory in Trivandrum district. So far, the State has received 2100 RT-PCR kits from NIV Pune to detect Zika cases, which have been distributed to the four laboratories mentioned above.
    • Measures to ensure strict deferral of blood donors with a history of fever in the previous two weeks, have been undertaken.
    • A central team visited the Trivandrum district and collected samples of mosquitoes and larvae from the residential area of the cases and sent them for testing at the Vector Control Research centre, Kottayam field station in Kerala state. The results are pending.
    • The State Health Minister has conducted multiple rounds of reviews, and all the districts have been alerted to carry out active surveillance, mosquito control and information, education, and communication activities related to control of ZIKV.
    • In Trivandrum district, which has been declared as having a cluster of ZIKV disease cases, intensified vector control activities have been conducted for a week including; extensive fogging, spraying, use of larvicides, source reduction and sanitization of the surrounding areas. Additionally, field teams visited each household to conduct active case finding, ensure elimination of mosquito breeding sites, and sensitize the community to preventive mosquito control measures and identification of ZIKV disease symptoms to seek timely medical assistance.
    • WHO was requested to support the country’s updates on standard operating procedures and guidelines for: syndromic and case-based surveillance; laboratory surveillance; vector surveillance; enhanced surveillance among antenatal women; microcephaly surveillance; surveillance of Acute Flaccid Paralysis (AFP) and GBS.

    WHO risk assessment

    ZIKV can cause large epidemics with a substantial demand on the public health system including surveillance, case management, and laboratory capacity to differentiate ZIKV disease from illness due to co-circulating mosquito-borne viruses like dengue and chikungunya. Although 60-80% of the Zika virus infected cases are asymptomatic or only have mild symptoms, ZIKV can cause microcephaly, congenital Zika syndrome (CZS) and GBS. Moreover, although ZIKV is primarily transmitted by Aedes species mosquitoes, it can also be transmitted from mother to foetus during pregnancy, through sexual contact, transfusion of blood and blood products, and organ transplantation.

    In India, ZIKV disease cases/infections have been detected in Gujarat, Madhya Pradesh and Rajasthan states in 2018 (South-East Asian lineage), but no ZIKV-associated microcephaly has been reported. Although this event is not unexpected, given the wide distribution of the primary mosquito vector, Aedes aegypti, and competent vector, Aedes albopictus, in Kerala and Maharashtra states, this is unusual as it is the first time that ZIKV disease cases have been confirmed in these states.

    The overall risk is considered low at the regional level and global level, while at the national level (Kerala and Maharashtra States) is currently assessed as moderate, given that:
    1. The actual ZIKV transmission might be higher due to the undetermined population immunity in the two affected states and the asymptomatic clinical presentation in most of the ZIKV infections;
    2. The primary vector Aedes aegypti, and competent vector Aedes albopictus, are established in the area, often in high densities, and the ecological conditions are favourable for ZIKV transmission and potential endemicity;
    3. The current evidence suggests that the main source of infection is due to vector-borne transmission; however, epidemiological and entomological investigations are ongoing and the outbreak magnitude might change;
    4. Although appropriate control measures have been implemented, and travel is currently limited under COVID-19 pandemic conditions, further spread of the disease cannot be excluded through asymptomatic and mildly symptomatic infected persons;
    5. The ongoing monsoon season could increase the vector density and the likelihood of further transmission via mosquitos;
    6. Kerala is a tourist destination with frequent travel to and from other areas of the country and other countries; however, there are current travel restrictions because of the COVID-19 pandemic.
    7. The exportation within India and to other states and countries cannot be ruled out due the presence of competent vector (Ae. aegypti) in other states where mosquitos can become infected by biting infected returning travellers leading to potential further spread of the disease.
    8. The region as a whole remains at risk for ZIKV transmission because of the presence of competent vectors, often in high densities and vector control activities might have been interrupted in other countries because of the pandemic...

  • #2

    Almost 100 Zika Virus Cases Reported In Northern India
    By Dr Alfredo Carpineti
    10 Nov 2021, 10:11

    At least 98 people, including 17 children, have tested positive for the Zika virus in the Indian City of Kanpur in the Northern state of Uttar Pradesh. The surge in cases is concerning, reminiscent of the Zika epidemic that affected Brazil and other South American countries in late 2015...


    • #3

      Latest update: Two cases of Zika virus have been reported in Lucknow after Kanpur
      By APN Live
      November 12, 2021

      The Zika virus has spread beyond Kanpur, with two cases detected in Lucknow, Uttar Pradesh’s state capital. More than 16 cases of mosquito-borne disease, were reported from Kanpur on Wednesday, November 10, 2021...


      • #4

        UP's Kanpur reports 123 Zika virus cases so far, active cases at 96
        The first Zika case in Kanpur was detected on October 23 when an Indian Air Force (IAF) warrant officer tested positive for the Zika virus. The number of cases has increased over the past few weeks.
        | Written by Meenakshi Ray

        Uttar Pradesh's Kanpur has reported 123 cases of Zika virus so far and out of which 96 are active, a senior official has said.

        "One case of Zika virus was reported in Kannauj and three in Lucknow. We are taking necessary steps and doing contact tracing,” additional chief secretary (health) Amit Mohan Prasad said, according to news agency ANI...


        • #5

          India's most populous state struggles with Zika virus spread
          by Anadolu Agency
          NEW DELHI Nov 22, 2021 - 1:23 pm GMT+3

          Uttar Pradesh, India's most populous north-central state, which is already grappling with a large number of dengue fever cases, now faces the additional challenge of combating the Zika virus.

          The Zika virus spreads through the bite of an infected mosquito belonging to the Aedes genus. While the infection is not fatal, it can cause serious neurologic complications, according to physicians.

          Ved Vrat Singh, director-general of medical and health services in Uttar Pradesh, told Anadolu Agency (AA) that the situation is now under control, and the government is doing everything possible to prevent further spread.

          "A total of 143 Zika virus infections have been confirmed, with one or two new instances still being reported, which is a first in Uttar Pradesh state," he said, adding: "We have done extensive testing recently as well, and things are generally under control."

          According to India's National Vector-Borne Disease Control Program, the country saw a total of 123,106 dengue cases from January to October this year, with Uttar Pradesh having the highest number of cases at 21,687.

          Singh acknowledges that there are more dengue cases this year but says that the two diseases are being combated at the same time. "The situation is under control," he asserted...


          • #6
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            • #7

              231 cases of Zika reported from 3 states, no deaths recorded: Govt informs Rajya Sabha
              By PTI | Nov 30, 2021, 08:26 PM IST (Updated)

              A total of 231 cases of Zika virus were reported from the states of Uttar Pradesh, Kerala and Maharashtra this year, the Rajya Sabha was informed on Tuesday. No deaths were recorded from these three states, Union Minister of State for Health Bharati Pravin Pawar said in a written reply...


              • #8
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