WHO and PAHO heads are meeting this week with top Brazilian officials, including Minister of Health Marcelo Castro, to assess the Zika virus situation and response.

Wednesday, February 24th, 2016

Washington, D.C., Feb. 22, 2016 (PAHO/WHO)—The director-general of the World Health Organization (WHO), Margaret Chan, and the director of the Pan American Health Organization (PAHO), Carissa F. Etienne, are meeting this week with top Brazilian officials, including Minister of Health Marcelo Castro, to assess the Zika virus situation and response.

In their visit to Brazil, Chan and Etienne will meet with President Dilma Rousseff on Tuesday, Feb. 23, at the Presidential Palace. They are scheduled to visit the National Center for Risk and Disaster Management (Cenad) for discussions with top cabinet members, including the ministers of health, national integration, defense, foreign affairs, social development and fight against hunger alleviation, as well as the secretary of government and the executive secretary of the Ministry of Education.

As part of their assessment of actions taken by Brazil in response to Zika virus infection and its possible consequences, Chan and Etienne will be in Recife, Pernambuco, on Feb. 24 to visit the Institute of Integrative Medicine Professor Fernando Figueira (IMIP), a clinical research center that is the National Referral Center for Mother and Child Care Programs. WHO Executive Director for Outbreaks and Health Emergencies Bruce Aylward will accompany them.

Chan, Etienne and Castro are slated to hold a press conference on Wednesday, Feb. 24, at 17:00h, at PAHO/WHO headquarters in Brasilia.

Media Advisory

WHAT: Press Briefing on Brazil’s response to Zika virus infection and its possible consequences

WHO: Margaret Chan, Director-General of WHO
Carissa F. Etienne, Director of PAHO
Marcelo Castro, Minister of Health of Brazil

WHEN: Wednesday, February 24, 1700h

WHERE: Office of the Pan American Health Organization / World Health Organization (PAHO / WHO)
Northern Embassy Sector, Lot 19, CEP 70800-400, Brasilia, Distrito Federal, Brazil

HOW: In person or live on TV NBR,
Web Radio Health: webradio.saude.gov.br/radio or
Twitter/Periscope Ministry of Health @minsaude

Links:

PAHO Zika: www.paho.org/zikavirus

Media Contacts:

In Brasilia, Brazil:
Luis Felipe Sardenberg, cunhaslui@paho.org, +55 61 3251-9581

In Washington, D.C.:
Media team: mediateam@paho.org,
Leticia Linn: linnl@paho.org, +1 202 974 3440
Daniel Epstein: epsteind@paho.org, +1 202 974 3579
Sonia Mey-Schmidt: maysonia@paho.org, + 1 202 974 3036

In Geneva, Switzerland:
Media team: mediainquiries@who.int

Posted in WHO, Zika virus| Comments Off

As of February 23, 2016, CDC and state public health departments are investigating 14 additional reports of possible sexual transmission of the Zika virus

Wednesday, February 24th, 2016

CDC HAN Advisory

Update: Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016

This is an official

CDC HEALTH ADVISORY

Distributed via the CDC Health Alert Network
February 23, 2016, 14:15 EST (2:15 PM EST)
CDCHAN-00388

Summary: The Centers for Disease Control and Prevention (CDC) recently published recommendations for protecting people against sexual transmission of Zika virus (1). As stated in that report, information about possible sexual transmission of Zika virus was based on one published report of transmission from a man to a woman, one published report in which Zika virus was detected in semen of a man with hematospermia, and one case of possible sexual transmission then under investigation in Texas. An additional case of Zika virus detected in semen in a man was reported after the CDC recommendations were published (2). As of February 23, 2016, CDC and state public health departments are investigating 14 additional reports of possible sexual transmission of the virus, including several involving pregnant women. While additional investigations are being completed, CDC is issuing this HAN Advisory as a strong reminder to state, local, and US territorial public health departments, clinicians, and the public to be aware of and adhere to current recommendations for preventing sexual transmission of Zika virus, particularly for men with pregnant partners. These recommendations may change as more information becomes available.

Background

CDC is working with state, local, and US territorial public health departments, US Government agencies, and international partners in response to outbreaks of Zika virus disease (Zika) in multiple territories and countries in the Americas. Accumulating evidence links maternal Zika virus infection with congenital microcephaly, miscarriages, and other adverse fetal outcomes (3). In addition, there are reports of a possible association with Guillain-Barré syndrome (4). No vaccine or specific antiviral drug is currently available to prevent or treat Zika.

Zika virus is spread primarily by the bite of infected Aedes species mosquitoes (most commonly, Aedes aegypti). In areas where Zika virus transmission is ongoing, people should follow precautions to prevent mosquito bites (http://www.cdc.gov/zika/prevention/). Sexual transmission of Zika virus also can occur and is of particular concern during pregnancy. In early February 2016, the Dallas County Department of Health and Human Services announced an occurrence of sexually transmitted Zika infection (5). On February 5, 2016, following the confirmation of this Texas sexual transmission event, CDC published interim guidelines for preventing sexual transmission of Zika virus (1).

As of February 23, 2016, CDC and state public health departments are investigating 14 additional reports of possible sexual transmission of the virus, including several events involving possible transmission to pregnant women. In two of these new suspected sexual transmission events that have been investigated to date, Zika virus infection has been confirmed in women whose only known risk factor was sexual contact with an ill male partner who had recently travelled to an area with local Zika virus transmission; testing for the male partners is pending. For four additional suspected sexual transmission events, preliminary laboratory evidence (IgM antibody test) is available for the women, but confirmatory testing is still pending. For eight suspected events, the investigation is ongoing. In all events for which information is available, travelers reported symptom onset within 2 weeks prior to their non-traveling female partner’s symptom onset.

Because these reports suggest sexual transmission may be a more likely means of transmission for Zika virus than previously considered, CDC is issuing this HAN Advisory to underscore the importance of adhering to the interim guidance published on February 5 and outlined below. The 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 (6).

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; studies to determine the duration of persistence in semen are not yet completed.

Accumulating evidence of sexual transmission suggests that exposure to Zika virus includes unprotected sexual contact with a symptomatic male partner who resides in or has traveled to an area of active Zika virus transmission. Zika virus testing is currently recommended to establish a diagnosis of infection in exposed persons with signs or symptoms consistent with Zika virus disease, and may be offered to asymptomatic pregnant women with possible exposure to Zika virus (6). However, interpretation of results is complex, and health care providers should contact their state, local, or territorial health department for assistance with arranging testing and interpreting results. At this time, testing of exposed, asymptomatic men for the purpose of assessing risk for sexual transmission is not recommended. Sexual transmission of Zika virus from infected women to their sex partners has not been documented, nor has transmission from persons who are asymptomatically infected. Sexual transmission of many infections, including those caused by other viruses, is reduced by consistent and correct use of latex condoms.

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

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;65:120–121. http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1.htm
Atkinson B, Hearn P, Afrough B, et al. Detection of Zika virus in semen [letter]. Emerg Infect Dis. 2016 May [cited February 22, 2016].http://dx.doi.org/10.3201/eid2205.160107
Martines RB, Bhatnagar J, Keating MK, et al. Evidence of Zika virus infection in brain and placental tissues from two congenitally infected newborns and two fetal losses — Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65 (Early Release)(06):1-2. http://www.cdc.gov/mmwr/volumes/65/wr/mm6506e1.htm?s_cid=mm6506e1_e. Published February 19, 2016.
European Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré syndrome – 10 December 2015. http://ecdc.europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf. Published 2015. Accessed Feb 1, 2016.
Dallas County Health and Human Services. DCHHS reports first Zika virus case in Dallas County acquired through sexual transmission. February 2, 2016. http://www.dallascounty.org/department/hhs/press/documents/PR2-2-16DCHHSReportsFirstCaseofZikaVirusThroughSexualTransmission.pdf
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.http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2.htm?s_cid=mm6505e2_e

For More Information

General information about Zika virus and disease: http://www.cdc.gov/zika/
Zika virus information for clinicians: http://www.cdc.gov/zika/hc-providers/index.html
Protection against mosquitoes: http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods
Travel notices related to Zika virus: http://wwwnc.cdc.gov/travel/notices
Information about Zika virus for travelers and travel health providers: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/zika
HAN Advisory: Recognizing, managing, and reporting Zika virus infections in travelers returning from Central America, South America, the Caribbean, and Mexico. January 15, 2016. http://emergency.cdc.gov/han/han00385.asp
Pan American Health Organization PAHO): http://www.paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688〈=en
Approximate distribution of Aedes aegypti and Ae. albopictus mosquitoes in the United States:
http://www.cdc.gov/chikungunya/resources/vector-control.html

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

HAN Message Types

Health Alert: Conveys the highest level of importance; warrants immediate action or attention. Example: HAN00001
Health Advisory: Provides important information for a specific incident or situation; may not require immediate action. Example: HAN00346
Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action. Example: HAN00342
Info Service: Provides general information that is not necessarily considered to be of an emergent nature. Example: HAN00345

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Train derailment in The Netherlands: At least 1 dead and 10 injured

Tuesday, February 23rd, 2016

Posted in Transportation incident| Comments Off

Fiji: Coming out of Typhoon Winston….

Tuesday, February 23rd, 2016

Fiji Times On-Line

Time: 10:34 PM on Tuesday 23 February

Australia to deploy helicopters for assessments

Update: 7:47PM AUSTRALIA will deploy four helicopters to Fiji to assist in carrying out assessment of damage caused by Severe Tropical Cyclone Winston. more…

Koro Island jetty closed

Update: 7:31PM THE jetty on Koro Island is closed due to causeway washout, says the Fiji Roads Authority. more…

Sanatan organisation asks members to help

Update: 7:22PM THE Shree Sanatan Dharm Pratinidhi Sabha Fiji has asked its members to assist people who have suffered from the wrath of Severe Tropical Cyclone Winston. more…

Australian assistance arrives in Fiji

Update: 6:48PM AN Australian C-17 aircraft arrived in the country this evening with relief supplies for people affected by Severe Tropical Cyclone Winston. more…<!–

–>

RIPPED APART…AN aerial view of the place where Sinuwaca Village on Koro Island was located. All houses and other buildings in the village were destroyed by Severe Tropical Cyclone Winston. Picture: JONA KONATACI.
See related story…

315 houses destroyed in Eastern Division

Update: 4:58PM AN initial assessment has revealed that 315 houses were destroyed in the Eastern Division by Severe Tropical Cyclone Winston. more…

President assures of assistance

Update: 4:48PM THE President, Jioji Konrote is encouraging people to prepare for and after the cyclone. more…

Most places in West have piped water

Update: 4:32PM WATER supply has been restored to at least 80 per cent of the Western Division, says the Water Authority of Fiji. more…

Widespread damage on Yaqeta Island in Yasawa

Update: 4:28PM FOUR houses are confirmed to have been destroyed at Yaqeta village in the Yasawa Group

Banks offer help

TWO commercial banks and the central bank have taken the lead to help their customers and businesses around the country that are adversely affected by Severe Tropical Cyclone Winston. more…

Bank gives $100k

A REGIONAL commercial bank has given $100,000 towards the relief and rehabilitation of those affected by Severe Tropical Cyclone Winston. more…

Works to restore network

A TELECOMMUNICATIONS company has made solid progress in restoring its network enabling customers to make and receive calls, text messages and emails

Posted in Tropical cyclones| Comments Off

Thrombocytopenia and subcutaneous bleedings in a patient with Zika virus infection

Tuesday, February 23rd, 2016

Thrombocytopenia and subcutaneous bleedings in a patient with Zika virus infection

Published online: February 19, 2016

Ouafae Karimi, Abraham Goorhuis, Janke Schinkel, John Codrington, Stephen Gerold S Vreden, Joost S Vermaat, Cornelis Stijnis, Martin Peter Grobusch

The Lancet

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00502-X/abstract

“…. we report a patient with Zika virus infection that was related to clinically relevant thrombocytopenia and subcutaneous haematomas…….Laboratory examination showed slight microcytic anaemia (haemoglobin concentration 7·2 mmol/L) but a normal haematocrit, and a profound thrombocytopenia of 20 × 10⁹ platelets per L, with normal coagulation parameters. A watch-and wait decision was made. On day 29, she developed gum bleeding, at a thrombocyte count of 10 × 10⁹ platelets per L. At this point, we decided to treat her presumed immune-mediated thrombocytopenia with intravenous immunoglobulins, upon which her thrombocyte count increased to 80 × 10⁹ platelets per L within a few days. …….”

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** Vaginal ring provides partial protection from HIV

Tuesday, February 23rd, 2016

NIH

Monday, February 22, 2016

Vaginal ring provides partial protection from HIV in large multinational trial

NIH-funded study finds protective effect strongest in women over age 25.

Woman holding the dapivirine vaginal ring tested in the NIH-funded ASPIRE study. International Partnership for Microbicides

A ring that continuously releases an experimental antiretroviral drug in the vagina safely provided a modest level of protection against HIV infection in women, a large clinical trial in four sub-Saharan African countries has found. The ring reduced the risk of HIV infection by 27 percent in the study population overall and by 61 percent among women ages 25 years and older, who used the ring most consistently.

These results were announced today at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston and simultaneously published online in the New England Journal of Medicine (link is external).

“Women need a discreet, long-acting form of HIV prevention that they control and want to use,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) and the primary funder of the trial. “This study found that a vaginal ring containing a sustained-release antiretroviral drug confers partial protection against HIV among women in sub-Saharan Africa. Further research is needed to understand the age-related disparities in the observed level of protection.”

Women accounted for more than half of the 25.8 million people living with HIV in sub-Saharan Africa in 2014. Finding effective HIV prevention tools for adolescent girls and young women in particular is critical, as one in four new HIV infections in sub-Saharan Africa occur in this group.

The ASPIRE study, also known as MTN-020, aimed to determine whether the experimental antiretroviral drug dapivirine could safely and effectively prevent HIV infection when continuously released in the vagina from a silicone ring replaced once every 4 weeks. The study, which began in 2012, enrolled more than 2,600 HIV-uninfected women ages 18 to 45 years who were at high risk for HIV infection at 15 sites in Malawi, South Africa, Uganda and Zimbabwe. The women were assigned at random to receive either the dapivirine ring or a placebo ring. No one knew who received which ring until the end of the trial.

All study participants received a package of HIV prevention services at each study visit, including HIV risk-reduction counseling, partner HIV testing, treatment of sexually transmitted infections in participants and their partners, and free condoms.

The investigators found that the dapivirine ring reduced the risk of acquiring HIV by 27 percent among all women enrolled in the trial. But when the scientists excluded data from two sites where it was apparent early on that many women were not returning for study visits or using the ring consistently, the ring reduced the risk of HIV infection by 37 percent.

Furthermore, the investigators found that the dapivirine ring reduced the risk of HIV infection by 61 percent in women ages 25 and older, but provided no statistically significant protection in women younger than 25 years. These younger women appeared to use the ring less consistently than other participants, based on the amount of dapivirine measured in volunteers’ blood during study visits.

To explore this age-related effect further, investigators performed analyses that were not originally planned and found that the ring reduced the risk of HIV infection by 56 percent in women older than 21 years, but provided no protection for women ages 18 to 21 years. More research is needed to determine whether behavior, biology or a combination of factors contributed to the lack of significant protection for younger women.

Finally, the investigators found that the rate of adverse medical events was similar among women who received the dapivirine ring compared to those who received the placebo ring, as was the frequency of antiretroviral resistance in women who acquired HIV.

“To help bring about an end to the HIV/AIDS epidemic, women — especially those in sub-Saharan Africa — need multiple options for HIV prevention,” said Jared Baeten, M.D., Ph.D., who co-led the study for the NIH-funded Microbicide Trials Network (MTN). “The ASPIRE study was an important step towards determining whether the dapivirine ring could become one such option.” Dr. Baeten is a professor of global health, medicine and epidemiology at the University of Washington in Seattle.

“The ASPIRE study is the first to demonstrate that a sustained drug delivery product that slowly releases an antiretroviral drug over time can offer partial protection from HIV,” added Thesla Palanee-Phillips, Ph.D., who led the study with Dr. Baeten. Dr. Palanee-Phillips is the director of network trials and research center programs at the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa.

An ongoing large multinational clinical trial called The Ring Study also tested the dapivirine ring for safety and efficacy in women. Similar to ASPIRE, The Ring Study investigators found an overall effectiveness of 31 percent, with a slightly greater reduction in risk of HIV infection among women older than 21 years. The results of The Ring Study also were announced today at CROI.

NIAID plans to consult with a panel of outside experts to determine next steps for research on the dapivirine ring, which the International Partnership for Microbicides (IPM) developed and provided for both studies as their regulatory sponsor.

The ASPIRE study was funded by NIAID, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all part of NIH, and conducted by MTN.

The Ring Study is being funded by the Bill and Melinda Gates Foundation, the U.S. President’s Emergency Plan for AIDS Relief, the U.S. Agency for International Development, and several European governments and organizations, and is being conducted by IPM.

For more information about the ASPIRE study, please see Questions and Answers: The ASPIRE HIV Prevention Study, ClinicalTrials.gov using study identifier NCT01617096 (link is external). For more information about The Ring Study, please see the IPM press release (link is external).

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health^®

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