Archive for February, 2016
Current flu season: Watch out for H1N1 (so far evidence suggests the circulating strains are similar enough to the one in the vaccine to trigger protection.)
Wednesday, February 10th, 2016“…..8 February 2016
Compared to previous years, northern hemisphere seasonal influenza activity commenced late in some countries in western Europe, North America and eastern Asia. Transmission, as demonstrated by influenza-like illness (ILI) rates, has started to exceed country-specific baseline rates, but is still relatively low in general with the exception of some eastern European countries where a sharp increase of ILI rates has been observed and countries in western Asia where influenza activity may have already peaked.
Among the currently circulating seasonal influenza viruses in the temperate zone, influenza A(H1N1)pdm09 virus is predominating, except in northern China where influenza A(H3N2) and influenza B viruses are widely co-circulating though the proportion of A(H1N1)pdm09 virus is increasing. In a few European countries, influenza A(H3N2) and influenza B viruses are also circulating.
In some countries there have been reports of hospitalizations with severe disease associated with influenza A(H1N1)pdm09 virus infections. Based on the WHO global influenza surveillance, in countries with influenza A(H1N1)pdm09 virus predominating, the hospitalization and intensive care unit (ICU) admission patterns seem to be similar to previous seasons when this virus predominated and where young/middle-aged adults experienced severe disease……”
UN Panel: The world underestimates the risk of a health threat worse than Ebola
Wednesday, February 10th, 2016UN_Final_Report_Global_Response_to_Health_Crises_2-5-2016
The panels three top-priority steps:
- Creation by the World Health Organization (WHO) of a new “Centre for Emergency Preparedness and Response” that has real command and control capacity and can access the personnel and resources it needs to respond.
- Countries should meet their required International Health Regulations capacities, and those that aren’t able should receive global support to implement them, the panel advised.
- Provide financing in three areas: helping countries meet their IHR obligations, funding the proposed new WHO emergency center, and supporting the research and development of vaccines, drugs, and diagnostics.
Update: The Bavarian Train Collision
Wednesday, February 10th, 2016- At least 10 people were killed and scores more were injured, 18 seriously.
- The accident occurred on a single-track route between Rosenheim and Holzkirchen at about 07:00 local time (06:00 GMT)
- Officials say they assume both train drivers had no visual contact before the crash as the site is on a bend – and therefore crashed into each other largely without braking
- The stretch of line had an automatic braking system designed to halt any train that passed a stop signal. It is not yet known why this failed to stop the crash
- Two of the three data recorders or “black boxes” on board the trains have been recovered
The White House: Preparing for and Responding to the Zika Virus at Home and Abroad
Wednesday, February 10th, 2016Since late last year, the Administration has been aggressively working to combat Zika, a virus primarily spread by mosquitoes that has recently been linked to birth defects and other concerning health outcomes. The Federal Government has been monitoring the Zika virus and working with our domestic and international public health partners to alert healthcare providers and the public about Zika; provide public health laboratories with diagnostic tests; and detect and report cases both domestically and internationally.
The Administration is taking every appropriate measure to protect the American people, and today announced that it is asking Congress for more than $1.8 billion in emergency funding to enhance our ongoing efforts to prepare for and respond to the Zika virus, both domestically and internationally. The Administration will submit a formal request to Congress shortly.
The Pan American Health Organization reports 26 countries and territories in the Americas with local Zika transmission. While we have not yet seen transmission of the Zika virus by mosquitoes within the continental United States, Puerto Rico and other U.S. territories in warmer areas with Aedes aegpyti mosquito populations are already seeing active transmission. In addition, some Americans have returned to the continental U.S. from affected countries in South America, Central America, the Caribbean and the Pacific Islands with Zika infections. The Centers for Disease Control and Prevention reports 50 laboratory-confirmed cases among U.S. travelers from December 2015- February 5, 2016. As spring and summer approach, bringing with them larger and more active mosquito populations, we must be fully prepared to mitigate and quickly address local transmission within the continental U.S., particularly in the Southern United States.
The requested resources will build on our ongoing preparedness efforts and will support essential strategies to combat this virus, such as rapidly expanding mosquito control programs; accelerating vaccine research and diagnostic development; enabling the testing and procurement of vaccines and diagnostics; educating health care providers, pregnant women and their partners; improving epidemiology and expanding laboratory and diagnostic testing capacity; improving health services and supports for low-income pregnant women, and enhancing the ability of Zika-affected countries to better combat mosquitoes and control transmission.
There is much that we do not yet know about Zika and its relationship to the poor health outcomes that are being reported in Zika-affected areas. We must work aggressively to investigate these outbreaks, and mitigate, to the best extent possible, the spread of the virus. Congressional action on the Administration’s request will accelerate our ability to prevent, detect and respond to the Zika virus and bolster our ability to reduce the potential for future infectious disease outbreaks.
Department of Health and Human Services – $1.48 billion
Centers for Disease Control and Prevention – $828 million. The request includes funding to support prevention and response strategies through the following activities:
- Support Zika virus readiness and response capacity in States and territories with mosquito populations that are known to transmit Zika virus, with a priority focus on areas with ongoing Zika transmission;
- Enhance mosquito control programs through enhanced laboratory, epidemiology and surveillance capacity in at-risk areas to reduce the opportunities for Zika transmission;
- Establish rapid response teams to limit potential clusters of Zika virus in the United States;
- Improve laboratory capacity and infrastructure to test for Zika virus and other infectious diseases;
- Implement surveillance efforts to track Zika virus in communities and in mosquitoes;
- Deploy targeted prevention and education strategies with key populations, including pregnant women, their partners, and health care professionals;
- Expand the CDC Pregnancy Risk Assessment Monitoring System, improve Guillain Barré syndrome tracking, and ensure the ability of birth defect registries across the country to detect risks related to Zika;
- Increase research into the link between Zika virus infections and the birth defect microcephaly and measure changes in incidence rates over time;
- Enhance international capacity for virus surveillance, expand the Field Epidemiology Training program, laboratory testing, health care provider training, and vector surveillance and control in countries at highest risk of Zika virus outbreaks; and
- Improve diagnostics for Zika virus, including advanced methods to refine tests, and support advanced developments for vector control.
Centers for Medicare and Medicaid Services – $250 million. The request seeks a temporary one-year increase in Puerto Rico’s Medicaid Federal Medical Assistance Percentage (FMAP) to provide an estimated $250 million in additional Federal assistance to support health services for pregnant women at risk of infection or diagnosed with Zika virus and for children with microcephaly, and other health care costs. This request does not make any changes to Puerto Rico’s underlying Medicaid program, and the additional funding will not be counted towards Puerto Rico’s current Medicaid allotment. Puerto Rico is experiencing ongoing active transmission of Zika. Unlike States, Puerto Rico’s Medicaid funding is capped, which has limited capacity to respond to these emergent and growing health needs.
Vaccine Research and Diagnostic Development & Procurement – $200 million. The request includes $200 million for research, rapid advanced development and commercialization of new vaccines and diagnostic tests for Zika virus. It includes funding for the National Institutes of Health to build upon existing resources and work to develop a vaccine for Zika virus and the chikungunya virus, which is spread by the same type of mosquito. Funding will accelerate this work and improve scientific understanding of the disease to inform the development of additional tools to combat it. The request also includes resources for the Food and Drug Administration to support Zika virus medical product development including the next generation diagnostic devices.
Other HHS Response Activities – $210 million. The request includes funding to establish a new Urgent and Emerging Threat Fund to address Zika virus and other outbreaks. This funding would be available to support emerging needs related to Zika, including additional support to States for emerging public health response needs should mosquito populations known to be potential Zika carriers migrate to additional States.
In addition, the request includes funding to support Puerto Rico’s community health centers in preventing, screening, and treating the Zika virus, expand home visiting services targeting low-income pregnant women at risk of Zika virus, and provide targeted maternal and child health.
U.S. Agency for International Development – $335 million
The request includes investments to support affected countries’ ability to control mosquitoes and the transmission of the virus; support maternal health; expand public education on prevention and response; and create new incentives for the development of vaccines and diagnostics. The request would also provide flexibility in the use of remaining USAID Ebola funds. Activities would focus particularly on South America, Central America, the Caribbean, and would:
- Implement integrated vector management activities in countries at-risk of Zika virus;
- Stimulate private sector research and development of vaccines, diagnostics, and vector control innovations through public private partnerships and mechanisms to provide incentives such as advance market commitments or volume guarantees;
- Support training of health care workers in affected countries, including providing information about best practices for supporting children with microcephaly;
- Support for pregnant women’s health, including helping them access repellant to protect against mosquitos.
- Establish education campaigns to empower communities in affected countries to take actions to protect themselves from Zika Virus as well as other mosquito-borne diseases; and
- Issue a Global Health Security Grand Challenge calling for groundbreaking innovations in diagnostics, vector control, personal protection, community engagement and surveillance for Zika and other infectious diseases.
U.S. Department of State – $41 million
The funding request includes support for U.S. citizens in affected countries, medical support for State Department employees in affected countries, public diplomacy, communications, and other operations activities. State would also support the World Health Organization and its regional arm, the Pan American Health Organization (PAHO), to minimize the Zika threat in affected countries while reducing the risk of further spreading the virus. These resources will support critical public health actions underway, including preparedness, surveillance, data collection, and risk communication. Activities would also include support for UNICEF’s Zika response efforts in Brazil; activities to bolster diagnostic capabilities through deployment of equipment and specialized training.
For more information on the Zika virus and CDC guidance about how Americans can protect themselves, visit http://www.cdc.gov/zika/.
Hawaii’s Big Island declares emergency over dengue fever infections with 250 cases confirmed over the past 4 months.
Tuesday, February 9th, 2016Hong Kong: A government crackdown on illegal street food vendors turned violent as riot police clash with protesters
Tuesday, February 9th, 2016Germany: 4 dead and 15 seriously injured following a collision between two trains in Bavaria
Tuesday, February 9th, 20162 cases of Guillain-Barré Syndrome (GBS) in Martinique
Tuesday, February 9th, 2016- The first case is a 19-year-old with onset of symptoms (paraesthesia of hands and feet) on 26 December. Urine samples, which were taken on 7 January, tested positive for Zika virus by reverse transcription polymerase chain reaction (RT-PCR) at the University Hospital of Martinique. Currently, the patient is being intubated and ventilated in an intensive care unit.
- The second case is a 55-year-old who was admitted to an intensive care unit on 21 January. On the same day, urine samples were collected from the patient. The samples tested positive for Zika virus by RT-PCR at the University Hospital of Martinique. Currently, the patient is being ventilated because of his respiratory failure.
Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016
Tuesday, February 9th, 2016Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016
Early Release / February 5, 2016 / 65(5);1–2
Alexandra M. Oster, MD1; John T. Brooks, MD1; Jo Ellen Stryker, PhD1; Rachel E. Kachur2; Paul Mead, MD3; Nicki T. Pesik, MD4; Lyle R. Petersen, MD3
Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes (1,2). Infection with Zika virus is asymptomatic in an estimated 80% of cases (2,3), and when Zika virus does cause illness, symptoms are generally mild and self-limited. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes, such as congenital microcephaly (4,5), as well as a possible association with Guillain-Barré syndrome. Currently, no vaccine or medication exists to prevent or treat Zika virus infection. Persons residing in or traveling to areas of active Zika virus transmission should take steps to prevent Zika virus infection through prevention of mosquito bites (http://www.cdc.gov/zika/prevention/).
Sexual transmission of Zika virus is possible, and is of particular concern during pregnancy.
Current information about possible sexual transmission of Zika is based on reports of three cases.
The first was probable sexual transmission of Zika virus from a man to a woman (6), in which sexual contact occurred a few days before the man’s symptom onset. The second is a case of sexual transmission currently under investigation (unpublished data, 2016, Dallas County Health and Human Services). The third is a single report of replication-competent Zika virus isolated from semen at least 2 weeks and possibly up to 10 weeks after illness onset; reverse transcriptase-polymerase chain reaction testing of blood plasma specimens collected at the same time as the semen specimens did not detect Zika virus (7). The man had no sexual contacts. Because no further testing was conducted, the duration of persistence of Zika virus in semen remains unknown.
In all three cases, the men developed symptomatic illness. Whether infected men who never develop symptoms can transmit Zika virus to their sex partners is unknown. Sexual transmission of Zika virus from infected women to their sex partners has not been reported. Sexual transmission of many infections, including those caused by other viruses, is reduced by consistent and correct use of latex condoms.
The following recommendations, which apply to men who reside in or have traveled to areas with active Zika virus transmission (http://wwwnc.cdc.gov/travel/notices/) and their sex partners, will be revised as more information becomes available.
Recommendations for men and their pregnant partners
Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy. Pregnant women should discuss their male partner’s potential exposures to mosquitoes and history of Zika-like illness (http://www.cdc.gov/zika/symptoms) with their health care provider; providers can consult CDC’s guidelines for evaluation and testing of pregnant women (8).
Recommendations for men and their nonpregnant sex partners
Men who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus might consider abstaining from sexual activity or using condoms consistently and correctly during sex. Couples considering this personal decision should take several factors into account. Most infections are asymptomatic, and when illness does occur, it is usually mild with symptoms lasting from several days to a week; severe disease requiring hospitalization is uncommon. The risk for acquiring vector-borne Zika virus in areas of active transmission depends on the duration and extent of exposure to infected mosquitoes and the steps taken to prevent mosquito bites (http://www.cdc.gov/zika/prevention). After infection, Zika virus might persist in semen when it is no longer detectable in blood.
Zika virus testing has been recommended to establish a diagnosis of infection in some groups, such as pregnant women (8). At present, Zika virus testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the incidence and duration of shedding in the male genitourinary tract is limited to one case report in which Zika virus persisted longer than in blood (7). At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended. As we learn more about the incidence and duration of seminal shedding from infected men and the utility and availability of testing in this context, recommendations to prevent sexual transmission of Zika virus will be updated.
References
- Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15:1347–50. CrossRef PubMed
- CDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://www.cdc.gov/zika/index.html.
- Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536–43. CrossRef PubMed
- European Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré syndrome. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2015. http://ecdc.europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf.
- Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016;47:6–7. CrossRef PubMed
- Foy BD, Kobylinski KC, Chilson Foy JL, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011;17:880–2. CrossRef PubMed
- Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis 2015;21:359–61. CrossRef PubMed
- Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65.
Suggested citation for this article: Oster AM, Brooks JT, Stryker JE, et al. Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2. DOI: http://dx.doi.org/10.15585/mmwr.mm6505e1er.