WHO statement on the second meeting of the International Health Regulations (2005) (IHR(2005)) Emergency Committee on Zika virus and observed increase

[sharon sanders]

From: WorldHealthOrganizationNews@who.int
To: undisclosed-recipients@null, null@null
Subject: WHO statement on the second meeting of the International Health Regulations (2005) (IHR(2005)) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
Date: Mar 8, 2016 1:00 PM

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[TD]WHO statement on the second meeting of the International Health Regulations (2005) (IHR(2005)) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations


8 March 2016


The second 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 neurological disorders in some areas affected by Zika virus was held by teleconference on 8 March 2016, from 13:00 to 16:45 Central European Time.
The WHO Secretariat briefed the Committee on action in implementing the Temporary Recommendations issued by the Director-General on 1 February 2016, and on clusters of microcephaly and Guillain-Barr? Syndrome (GBS) that have had a temporal association with Zika virus transmission. The Committee was provided with additional data from observational, comparative and experimental studies on the possible causal association between Zika virus infection, microcephaly and GBS.
The following States Parties provided information on microcephaly, GBS and other neurological disorders occurring in the presence of Zika virus transmission: Brazil, Cabo Verde, Colombia, France, and the United States of America.
The Committee noted the new information from States Parties and academic institutions in terms of case reports, case series, 1 case control study (GBS) and 1 cohort study (microcephaly) on congenital abnormalities and neurologic disease in the presence of Zika virus infection. It reinforced the need for further work to generate additional evidence on this association and to understand any inconsistencies in data from countries. The Committee advised that the clusters of microcephaly cases and other neurological disorders continue to constitute a Public Health Emergency of International Concern (PHEIC), and that there is increasing evidence that there is a causal relationship with Zika virus.
The Committee provided the following advice to the Director-General for her consideration to address the PHEIC, in accordance with IHR (2005).

Microcephaly, other neurological disorders and Zika virus

• Research into the relationship between new clusters of microcephaly, other neurological disorders, including GBS, and Zika virus, should be intensified,
• Particular attention should be given to generating additional data on the genetic sequences and clinical effect of different Zika virus strains, studying the neuropathology of microcephaly, conducting additional case-control and cohort studies in other and more recently infected settings, and developing animal models for experimental studies,
• Research on the natural history of Zika virus infection should be expedited, including on the rates of asymptomatic infection, the implications of asymptomatic infection, particularly with respect to pregnancy, and the persistence of virus excretion,
• Retrospective and prospective studies of the rates of microcephaly and other neurological disorders should be conducted in other areas known to have had Zika virus transmission but where such clusters were not observed,
• Research should continue to explore the possibility of other causative factors or co-factors for the observed clusters of microcephaly and other neurological disorders,
• To facilitate this research and ensure the most rapid results:
  • surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk,
  • work should begin on the development of a potential case definition for ?congenital Zika infection?,
  • clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with the World Health Organization to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Surveillance

• Surveillance for and notification of Zika virus infection should be enhanced with the dissemination of standard case definitions and diagnostics to areas of transmission and at-risk areas; newly infected areas should undertake the vector control measures outlined below.

Vector Control

• Vector surveillance, including the determination of mosquito vector species and their sensitivity to insecticides, should be enhanced to strengthen risk assessments and vector control measures,
• Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus,
• Countries should strengthen vector control measures in the long term and the Director-General of WHO should explore the use of IHR mechanisms, and consider bringing this to a forthcoming World Health Assembly, as means to better engage countries on this issue.

Risk Communications

• 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,
• These measures should be based on an appropriate assessment of public perception, knowledge and information; the impact of risk communication measures should be rigorously evaluated to guide their adaptation and improve their impact,

• 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,

• Information on the risk of sexual transmission, and measures to reduce that risk, should be available to people living in and returning from areas of reported Zika virus transmission.

Clinical Care

• 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,
• 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 general restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission,
• Pregnant women should be advised not travel to areas of ongoing Zika virus outbreaks; pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks should ensure safe sexual practices or abstain from sex for the duration of their pregnancy,
• Travellers to areas with Zika virus outbreaks should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites and, upon return, should take appropriate measures, including safe sex, to reduce the risk of onward transmission,
• The World Health Organization should regularly update its guidance on travel with evolving information on the nature and duration of risks associated with Zika virus infection,
• Standard WHO recommendations regarding vector control at airports should be implemented in keeping with the IHR (2005). Countries should consider the disinsection of aircraft.

Research & Product Development

• The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures, and especially the management of pregnancy,
• Research, development and evaluation of novel vector control measures should be pursued with particular urgency,
• Research and development efforts should also be intensified for Zika virus vaccines and therapeutics in the medium term.

Based on this advice the Director-General declared the continuation of the Public Health Emergency of International Concern (PHEIC). 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.[/TD]
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[sharon sanders]

[h=1]WHO Director-General addresses media after Zika Emergency Committee[/h] Statement by WHO Director-General Dr Margaret Chan
8 March 2016

Ladies and gentlemen,
Since this emergency committee on Zika virus first met on 1 February, substantial new clinical and epidemiological research has strengthened the association between Zika infection and the occurrence of fetal malformations and neurological disorders.
In addition, the geographical distribution of the disease is wider. The risk group is broader. And the modes of transmission now include sexual intercourse as well as mosquito bites.
Local transmission has now been reported in 31 countries and territories in Latin America and the Caribbean.
In this region, cases of dengue, which is carried by the same mosquito species as Zika, typically increase during the rainy season, which lasts from January to May. We can expect to see more cases and further geographical spread.
Imported cases of Zika have been reported from every region in the world.
Concerning the link with fetal malformations, the virus has been detected in amniotic fluid. Evidence shows it can cross the placental barrier and infect the fetus. We can now conclude that Zika virus is neurotropic, preferentially affecting tissues in the brain and brain stem of the developing fetus.
Zika has been detected in the blood, brain tissue, and cerebrospinal fluid of foetuses following miscarriage, stillbirth, or termination of pregnancy.
Microcephaly is now only one of several documented birth abnormalities associated with Zika infection during pregnancy. Grave outcomes include fetal death, placental insufficiency, fetal growth retardation, and injury to the central nervous system.
To date, microcephaly has been documented in only two countries: French Polynesia and Brazil. However, intense surveillance for fetal abnormalities is currently under way in countries, like Colombia, where the outbreaks started later than in Brazil.
Nine countries are now reporting an increased incidence of Guillain-Barr? syndrome or laboratory confirmation of a Zika virus infection among GBS cases. A retrospective case-control study of GBS associated with Zika in French Polynesia recorded no deaths, but the disease progressed rapidly and a large percentage of patients required admission to an intensive care unit for as long as 51 days.
Growing evidence of a link with GBS expands the group at risk of complications well beyond women of child-bearing age. GBS has been detected in children and adolescents but is more common in older adults and slightly more common in men. The anticipated need for expanded intensive care adds a further burden on health systems.
Reports and investigations from several countries strongly suggest that sexual transmission of the virus is more common than previously assumed.
All of this news is alarming.
Women who are pregnant in affected countries or travel to these countries are understandably deeply worried.
I convened this second meeting of the Emergency Committee to gather expert advice on the strength and significance of these new research results. We also asked the experts whether the findings warrant changes in WHO recommendations to countries.
The Committee underscored the increasing strength of evidence showing a likely association between Zika infection and fetal malformations and neurological disorders.
At the same time, the experts pinpointed the types of studies needed to establish a causal relationship, but stressed their view that strong public health actions should not wait for definitive scientific proof.
I will now ask Dr David Heymann, the Chair of the Emergency Committee, to brief you on specific recommendations.
Thank you.


http://www.who.int/mediacentre/news/statements/2016/zika-ec/en/