Helen V. Madamba, MD MPH-TM FPOGS FPIDSOGDecember 2, 2016

11th Medical World Congress

SICK KA?

WHO: PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN

C Chang et. Al 2016@helenvmadamba

Zika virus

• Zika virus, a flavivirus transmitted by Aedes mosquitoes.

Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr

@helenvmadamba

• Zika virus (ZIKV), a mosquito-borne flavivirus, was first isolated from a rhesus monkey in Uganda in 1947.

Hayes EB 2009 at http://wwwnc.cdc.gov/eid@helenvmadamba

MARCH 2012

• A prospective longitudinal cohort study, which included active surveillance for acute febrile illness, was initiated in Cebu City, Philippines.– 270 acute febrile illnesses– 267 samples for serologic testing for

evidence of influenza, dengue, chikungunya, Japanese encephalitis, and Zika virus infections

Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid@helenvmadamba

MAY 2012

• A 15-year old boy in Cebu City with subjective fever, headache, conjunctivitis, sore throat, myalgias, stomach pain, anorexia, nausea and vomiting, but no rash

• The boy recovered fully by the 3-week study follow up visit.

• ZIKV RNA was detected in the patient’s serum sample

Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid@helenvmadamba

Why the fuss now?

• Rapid spread since its first detection in May 2015 in Brazil to 22 other countries and other territories in the Americas

• Possible association with a significant rise in the number of babies born with microcephaly and neurological disorders

• “Global Emergency” by the WHO

Petersen E et.al. 2016 at http://wwwnc.cdc.gov/eid@helenvmadamba

Mode of Transmission of ZIKV

• Mosquito-borne ZIKV transmission• Sexual transmission• Blood transfusion and transmission of

ZIKV

Peterson et.al. 2016 at http://ac.els-cdn.com@helenvmadamba

• Zika virus outbreak in French Polynesia started October 2013 and ended April 2014 and 66% of the general population were infected.

• 7 out of 8 microcephaly cases occurred in the 4-month period from March 1 to July 10, 2014 – period of risk in the first trimester of pregnancy

Cauchemez S et al. 2016@helenvmadamba

• Baseline prevalence of microcephaly was 2 in 10,000 neonates

• Risk of microcephaly associated with zika virus is 95 in 10,000 women infected in the first trimester

Cauchemez S et al. 2016@helenvmadamba

Dr Willie Ong on facebook at https://www.facebook.com/drwillieong@helenvmadamba

"We are not downgrading the importance of Zika, by placing this as a longer program of work, we

are sending the message that Zika is here to stay,"

Dr. Peter Salama, Executive DirectorWHO's Health Emergencies Programme

http://www.medscape.com@helenvmadamba

WHO: TRAVEL MEASURES• There should be no restrictions on travel or

trade with countries, areas and/or territories with Zika virus transmission.

• Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.

• Standard WHO recommendations regarding disinfection of aircraft and airports should be implemented.

http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/@helenvmadamba

MANILA — A pregnant 16-year-old girl from Las Piñas City is among the latest victims of Zika virus infection,

according to the Department of Health.

@Dok_Pau confirms second pregnant #Zika; 16 year old from Las Pinas City; had skin rash & fever at 32nd week of her pregnancy; No ultrasound

DOH spokesperson Dr. Eric TayagNovember 16, 2016 at http://newsinfo.inquirer.net/

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“Total number of #zika in #ph is 33 including 2 pregnant cases (Cebu & Las Pinas)”

DOH Spokesperson Dr Eric Tayag in his Twitter account

12 Iloilo 2 Muntinlupa4 Bacoor 1 Cebu3 Mandaluyong 1 Quezon City3 Calamba 1 Makati2 Antipolo 1 Caloocan2 Las Pinas 1 Manila

November 16, 2016 at http://newsinfo.inquirer.net/@helenvmadamba

ONE PHILIPPINES AGAINST ZIKA• All suspected cases will be tested for Zika virus

using Realone-time Polymerase Chain Reaction (RT-PCR).

• Currently, the Research Institute for Tropical Medicine (RITM) is capable of testing suspected cases of Zika virus through RT PCR. The test is also available in Visayas and Mindanao.

First National Summit on Zika on October 28, 2016 at Conrad Hotel

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ACTIVE ZIKA VIRUS DISEASE SURVEILLANCE

PROTOCOL• Health personnel and health facilities should

continue reporting cases of suspected Zika Virus Disease

• Each region will submit 100 blood and urine or NPS/OPS samples of cases that fit the case definitions from November 2016 to January 2017

DOH Region VII RESU@helenvmadamba

ACTIVE ZIKA VIRUS DISEASE SURVEILLANCE SENTINEL SITES

1. Cebu City: Vicente Sotto Memorial Medical Center

2. South General Hospital – Naga City, Cebu3. Mactan Doctors’ Hospital4. Cebu City: Chong Hua Hospital – Capitol5. Cebu City: Cebu Doctors’ University Hospital

DOH Region VII RESU@helenvmadamba

Flow of Testing of Zika Virus Cases from Designated

Sentinel Sites

DOH Region VII RESU

• Patient with skin rash and one of the following: fever, arthralgia or conjunctivities

• Pregnanct woman with skin rash (not associated with pregnancy)

Conduct routine Surveillance

Fit Case Definition

No

Yes@helenvmadamba

DOH Region VII RESU

Notify assigned Health Facility Zika Point Person

Health Facility to do the following:1. Fill out iCIF (integrated case investigation

form)2. Ensure appropriate collection of blood, urine

and NPS/OPS3. Coordinate with RESU for submission of iCIF

and specimens

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Fill out iCIFBlood, urine and NPS/OPSCoordinate with RESU for submission

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DOH Region VII RESU

RESU sends specimens to RITM with iCIF

FETP to do the ff:1. Encode the iCIF2. Manage database3. Provide profile report

RITM send results to RESU, pidsr2@gmail.com, fetp27@gmail.com

@helenvmadamba

ROUTINE ZIKA CASE REPORTING

• A pregnant woman with skin rash at any time during pregnancy

• A patient with skin rash and one of the following: fever, arthralgia, arthritis or conjunctivitis

• A fetus, newborn or infant whose mother had confirmed or presumed infection with Zika virus during pregnancy

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ROUTINE ZIKA CASE REPORTING• A mother whose fetus, newborn or

infant has any of the following neurological conditions that cannot be explained by other etiologies– Head circumference <3SD or occipito-

frontal circumference <3rd percentile on standard growth charts

– Disproportionately small head compared to infant’s length

– Intra-cranial calcifications• All newly diagnosed GBS cases

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SICK KA?DOH VI RESU # 418 7010

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These slides are on http://www.slideshare.net/HelenMadamba

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