WHO

“…..They should start breastfeeding within one hour of birth, be exclusively breastfed for six months and have timely introduction of adequate, safe and properly fed complementary foods, while continuing breastfeeding up to two years of age or beyond…..In light of the evidence available, the benefits of breastfeeding for the infant and mother outweigh any potential risk of Zika virus transmission through breast milk…….”

WHO

Brazil – Health Advice for Travellers to the 2016 Summer Olympic and Paralympic Games

21 June 2016

The XXXI Summer Olympic and Paralympic Games Rio de Janeiro 2016, Brazil, will take place from 5 to 21 August 2016 and from 7 to 18 September 2016 respectively. Five additional cities will be hosting matches of the Olympic football tournament – Belo Horizonte, Brasilia, Manaus, Salvador, and São Paulo.

The following recommendations are intended to advise national health authorities and health care providers about practices and measures for travellers visiting Brazil to stay safe and healthy.

Before departure, travellers should be advised about health risks in the areas they plan to visit and related preventive practices and measures to minimize the probability of acquiring diseases and of having accidents.

Travellers to Brazil should consult the travel advice issued by their national authorities.

Health authorities of Brazil provide health advice for visitors to Brazil on their website in portuguese (see list of websites below). Health services affiliated to the public Unified Health System of Brazil (Sistema Único de Saúde, SUS) are free of charge for all individuals, including visitors.

Vaccine preventable diseases

A medical consultation should be scheduled as early as possible before travel but at least 4–8 weeks before departure in order to allow sufficient time for immunization schedules to be completed for both routine vaccines and vaccines indicated according to the specific destinations. Even when departure is imminent, there is still time to provide both advice and some vaccines.

Routine vaccines

Travellers should be vaccinated according to their national immunization schedule, which will vary from one country to another. Routine immunization schedules, established by national authorities, include vaccination against diphtheria, pertussis, tetanus, polio, measles, hepatitis B, Haemophilus influenzae type b and, in many countries, additional diseases such as rubella, mumps, flu, yellow fever, human papillomavirus, and rotavirus and pneumococcal diseases.

Since July 2015, Brazil has interrupted measles transmission, following an outbreak associated with an imported case. As measles is still endemic or circulating in many countries, measles vaccinations should be up to date to prevent importation of the virus to Brazil. Similar considerations apply for rubella, which was eliminated from Brazil in 2009.

Wild poliovirus has been eliminated from Brazil since 1989. To prevent the re-introduction of polio into Brazil, travellers from countries where polio cases have recently occurred should be fully immunized.

For travellers at risk of serious complications of influenza, vaccination should be considered. WHO recommends seasonal influenza vaccination for pregnant women, the elderly, individuals with specific chronic medical conditions, children aged 6-59 months, and healthcare workers. Note that WHO advices pregnant women not to travel to the Olympics or any area where Zika virus is circulating. The influenza strain currently circulating in Brazil, A(H1N1)pdm09, is included in both the northern hemisphere 2015-2016 and the southern hemisphere 2016 vaccines. The Olympic and Paralympic Games will take place after the influenza season in Rio de Janeiro is expected to have peaked in June and July; however, there are regional variations and cases occur throughout the year in Brazil. At-risk travellers should ideally receive influenza vaccine at least two weeks prior to departure.

Travel-related vaccines

Depending on the specific travel itinerary, additional vaccines might be considered for some travelers. Unvaccinated travellers should be offered such vaccines in accordance to their national recommendations.:

• Hepatitis A: Brazil is an intermediate endemicity country and prone to hepatitis A outbreaks;
• Hepatitis B: The risk of contracting hepatitis B is likely to be low, except for travellers engaging in high risk behaviours such as tattoos and injecting drug use. Hepatitis B vaccine was introduced into the national immunization schedule in Brazil in 1998;
• Typhoid fever: The incidence of typhoid fever in Brazil is highest in the North and North-East, including Amazonas and Manaus which is hosting the Olympic football tournament;
• Rabies: The risk of rabies infection in Rio de Janeiro and the remaining five cities hosting the Olympic football tournament is negligible;
• Yellow fever: A single, lifetime dose of Yellow Fever vaccine is recommended for all travellers older than 9 months visiting areas at risk of yellow fever transmission. The vaccination should be conducted at least 10 days before departure. The vaccine confers lifelong protection. Vaccination is not recommended for travellers limiting their stay to the following cities hosting Olympic and Paralympic Games’ events: Rio de Janeiro, Salvador, São Paulo. Further international spread of the ongoing yellow fever outbreak in Angola could potentially require WHO to adjust these recommendations (see list of websites below for more information).

Mosquito-borne diseases

Personal protective measures

Although the risk of mosquito borne disease is lower during winter, travellers should still take personal protective measures to prevent mosquito bites. These include:

• Whenever possible, wearing clothes (preferably light-coloured) that cover as much of the body as possible during the day;
• Using repellents that contain DEET (diethyltoluamide), or IR 3535, or icaridin andare applied to exposed skin or to clothing and used in strict accordance with the label instructions, especially regarding the duration of protection and timing of re-application. If repellents and sunscreen are used together, sunscreen should be applied first and the repellent thereafter;
• Choosing sanitary accommodations with piped water and physical barriers such as proper window and door screens to prevent mosquitoes from entering rooms;
• Avoiding areas in cities and towns with no piped water and poor sanitation, which constitute ideal breeding grounds for mosquitoes.

Arboviruses transmitted by Aedes mosquitoes

In addition to yellow fever (see above vaccination requirements), mosquito-borne diseases transmitted by Aedes species mosquitoes include chikungunya, and dengue and Zika virus disease.

Dengue and chikungunya

Detailed information about dengue and chikungunya is available on the websites of Brazil’s Ministry of Health, WHO and PAHO/AMRO (see list of websites below). There is no vaccination for chikungunya. Dengue vaccination is not recommended for travellers.

Zika virus disease

Zika virus infection usually causes a mild disease, and many cases of Zika virus infection are asymptomatic. However, following an outbreak of Zika virus in Brazil in 2015 and its subsequent spread in the Americas, an unusual increase in serious neurological disorders was seen in the off-springs of pregnant women who had been infected, including cases of microcephaly and congenital neurological malformations. Cases of Guillain-Barré Syndrome (GBS), a rare but serious form of muscle weakness, were observed among adults. Based on a growing body of research, there is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome. Zika virus is primarily spread by mosquitoes, though sexual transmission has increasingly been documented.

On the basis of current knowledge about Zika virus disease and its complications, the following is recommended to national health authorities and health care practitioners:

• To provide travellers to areas of ongoing Zika virus transmission, including Brazil, with up-to-date advice on appropriate measures to reduce the risk of becoming infected, including by preventing mosquito bites and practicing safe sex (e.g. use condoms correctly and consistently); and on the potential consequences and complications of infection, especially for women who are pregnant or planning a pregnancy; non-barrier forms of birth control will not protect against sexual transmission of Zika virus infection;
• To advise pregnant women not to travel to areas of ongoing Zika virus outbreaks, including Brazil;
• To advise women who inadvertently become pregnant or discover they are pregnant in or shortly after returning from Brazil, and/or other areas with ongoing Zika virus transmission, to contact their health care providers;
• To advise pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks to ensure safe sexual practices or abstain from sex for the duration of their pregnancy;
• To advise travellers to practice safe sex or abstain from sex during their stay in Brazil, and/or other areas with ongoing Zika virus transmission, and for at least eight weeks after their return. If men experience symptoms of Zika virus disease, they should adopt safer sex practices or abstain from sex for at least six months;
• To advise travellers returning from Brazil, and/or other areas with ongoing Zika virus transmission, not to donate blood for at least four weeks after departure from the area¹;
• To advise health care practitioners to be on alert for Zika virus disease in travellers returning from Brazil and/or other areas with ongoing Zika virus transmission;
• National authorities should provide health care practitioners with clear guidance on how to refer travellers with suspected Zika virus infection for suitable clinical management and testing where appropriate.

Malaria (transmitted by Anopheles mosquito)

The risk of malaria transmission is negligible or non-existent except in the administrative region of Amazonas, corresponding to the Northern states of Brazil. This includes the city of Manaus which is hosting some of the Olympic football matches.

Plasmodium falciparum infections account for approximately 15% of malaria cases in Brazil. In malaria-affected areas, in addition to mosquito bite prevention (including use of repellents and sleeping under an insecticide treated mosquito net), chemoprophylaxis with atovaquone–proguanil, or doxycycline, or mefloquine should be considered and selected according to reported side-effects and contraindications. Alternatively, for travel to rural areas with low risk of malaria infection, mosquito bite prevention can be combined with stand-by emergency treatment (SBET).

Based on the risk assessment by Brazilian health authorities, the national guidelines do not include recommendations on malaria chemoprophylaxis. Therefore, the access to these drugs while in Brazil will be limited and antimalarial drugs should be purchased before travelling. Travellers who become ill with a fever while traveling in a malaria-risk area within Brazil should seek immediate medical attention (see list of websites below for diagnostic and treatment health centres). Travellers who become ill with a fever for up to one year after their travel should inform their health care practitioners about their travel history. There is no vaccination recommended for malaria.

Sexually Transmitted Infections (other than Zika virus infection)

The risk of infection with HIV, syphilis, gonorrhoea, chlamydia, herpes, Hepatitis B virus (HBV), and other sexually transmitted infections is primarily limited to travellers engaging in sexual risk behaviours, especially unprotected sex and particularly with sex workers and among men who have sex with men and injecting drug users. Therefore, the adoption of safe sex practices, and specifically consistent and correct condom use, is recommended. Brazilian authorities launched a health promotion and prevention campaign in relation with sexually transmitted diseases, AIDS and hepatitis (see list of websites below).

Food and water safety

As gastrointestinal infections can be common in Brazil, health care practitioners should advise travellers to take precautions to avoid illnesses caused by unsafe food and drink. These precautions include: frequent hand washing and always before handling and consuming food; making sure that food has been thoroughly cooked and remains steaming hot; choosing safe water (e.g. bottled water or, if in doubt, water vigorously boiled); avoiding any uncooked food, apart from fruits and vegetables that can be peeled or shelled; avoiding foods at buffets, markets, restaurants and street vendors if they are not kept hot or refrigerated/on ice.

The quality of recreational water in Rio de Janeiro, including in the venues hosting Olympic and Paralympic Games events, has been suboptimal because of sewage contamination. While corrective actions are being taken, travellers should follow the advice issued by competent local authorities (see list of websites below).

Other infectious disease risks

The risk for travellers of acquiring airborne infections, such as tuberculosis and meningitis is limited, unless they stay in overcrowded indoor spaces.

Travellers to the Belo Horizonte area should be aware of the risk of acquiring tickborne Brazilian spotted fever, caused by the bacterium Rickettsia rickettsii, and that might result from contact with an infected rodent called capybara.

Travellers to the Salvador area should be aware of the risk of acquiring leptospirosis, caused by the Leptospira bacterium, which might result from skin and mucosal exposure to water and soil contaminated with the urine of infected animals. A wide range of animals can carry the bacterium.

The risk of leishmaniasis (both cutaneous and visceral), schistosomiasis, lymphatic filariasis, and other neglected tropical diseases is mostly associated with rural areas of the north-eastern region of Brazil.

Safety and security and other health risks

Crime, including theft and violent crime, does occur in Brazil. Travellers should be advised to exercise caution and only use authorized airport taxis or shuttle buses, not travel alone at night, avoid questionable areas, and travel with a companion.

Traffic accidents and injuries, mostly caused by motor vehicle crashes, are the leading causes of death among travellers under the age of 55 years. After heavy rainfall, flash floods and landslides, especially in urban areas, have been a frequent cause of injuries and other emergencies.

Travellers should be aware of the presence of poisonous animals, such as scorpions and snakes, and take precautions to avoid any contact with such animals. Local health authorities can provide more detailed information about specific areas of risk.

It is good practice for health care practitioners to systematically collect the travel history from their patients, taking into account that some travel associated infections have a long incubation period.

List of websites for further information

• National travel and health advice websites
  • http://www.who.int/ith/links/national_links/en/
• Health advice for travellers to Brazil on Brazil’s Ministry of Health website
  • http://portalsaude.saude.gov.br/index.php?option=com_content&view=article&id=9643#preparando3
• Information on global polio vaccination requirements
  • http://www.polioeradication.org/
• Information on influenza in Brazil (in Portuguese)
  • http://portalsaude.saude.gov.br/index.php/situacao-epidemiologica-dados-influenza
• Information on rabies in Brazil
  • http://saude.sp.gov.br/resources/instituto-pasteur/pdf/wrd2015/situacaodaraivanobrasil-eduardopachecodecaldas.pdf
• Information on yellow fever vaccination requirements
  • http://who.int/emergencies/yellow-fever/en/
  • http://www.who.int/ith/2015-ith-county-list.pdf?ua=1
  • http://gamapserver.who.int/mapLibrary/Files/Maps/
  ITH_YF_vaccination_americas.png?ua=1
• Information on dengue fever
  • http://www.who.int/mediacentre/factsheets/fs117/en/
  • http://www.paho.org/hq/index.php?option=com_topics&view=article&id=1&Itemid=40734&lang=en
• Information on Chikungunya
  • http://www.who.int/mediacentre/factsheets/fs327/en/
  • http://www.paho.org/hq/index.php?option=com_topics&view=article&id=343&Itemid=40931&lang=en
• Information on Zika virus disease
  • http://www.who.int/emergencies/zika-virus/en/
  • http://www.paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688&lang=en
  • http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603:countries-territories-zika-autochthonous-transmission-americas&Itemid=41696&lang=en
  • http://portalsaude.saude.gov.br/index.php/situacao-epidemiologica-dados-zika
  • http://combateaedes.saude.gov.br/ and
  • http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/secretarias/svs/zika
  • http://www.paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688&lang=en
  and at http://www.who.int/emergencies/zika-virus/en/
• Information on Malaria
  • http://portalsaude.saude.gov.br/images/jpg/2015/junho/24/Mapa-de-risco-2014.jpg
  • http://bvsms.saude.gov.br/bvs/publicacoes/guia_prevencao_malaria_
  viajantes.pdf
  • http://www.who.int/ith/2016-ith-county-list.pdf?ua=1
  • http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/leia-mais-o-ministerio/662-secretaria-svs/vigilancia-de-a-a-z/malaria/12193-centros-para-diagnostico-e-tratamento
• Information about the health promotion campaign launched by the Brazilian Government on the occasion of the Olympic and Paralympic Games
  • http://www.aids.gov.br/noticia/2016/ddahv-e-unaids-anunciam-campanha-em-parceria-para-os-jogos-rio-2016
• Information on water and sanitation
  • http://www.who.int/water_sanitation_health/bathing/statement-rio-water-quality/en/

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¹ National health authorities/national blood services should put in place and implement appropriate procedures to reduce the risk of transmission of mosquito-borne infections through transfusion, including temporarily deferring donors who are at high risk of infection due to international travel.

WHO

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

The third meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding microcephaly, other neurological disorders and Zika virus was held by teleconference on 14 June 2016, from 13:00 to 17:15 Central European Time. In addition to providing views to the Director-General on whether the event continued to constitute a Public Health Emergency of International Concern (PHEIC), the Committee was asked to consider the potential risks of Zika transmission for mass gatherings, including the Olympic and Paralympic Games scheduled for August and September 2016, respectively, in Rio de Janeiro, Brazil.

The Committee was briefed on the implementation of the Temporary Recommendations issued by the Director-General on 8 March 2016 and updated on the epidemiology and association of Zika virus infection, microcephaly and Guillain-Barré Syndrome (GBS) since that time. 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. Advisors to the Committee provided further information on the potential risks of Zika virus transmission associated with mass gatherings and the upcoming Olympic and Paralympic Games, and the Committee thoroughly reviewed the range of public perspectives, opinions and concerns that have recently been aired on this subject.

The Committee concurred with the international scientific consensus, reached since the Committee last met, that Zika virus is a cause of microcephaly and GBS, and, consequently, that Zika virus infection and its associated congenital and other neurological disorders is a Public Health Emergency of International Concern (PHEIC). The Committee restated the advice it provided to the Director-General in its 2^nd meeting in the areas of public health research on microcephaly, other neurological disorders and Zika virus, surveillance, vector control, risk communications, clinical care, travel measures, and research and product development.

The Committee noted that mass gatherings, such as the Olympic and Paralympic Games, can bring together substantial numbers of susceptible individuals, and can pose a risk to the individuals themselves, can result in the amplification of transmission and can, potentially, contribute to the international spread of a communicable disease depending on its epidemiology, the risk factors present and the mitigation strategies that are in place. In the context of Zika virus, the Committee noted that the individual risks in areas of transmission are the same whether or not a mass gathering is conducted, and can be minimized by good public health measures. The Committee reaffirmed and updated its advice to the Director-General on the prevention of infection in international travellers as follows:

• Pregnant women should be advised not to 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 through mosquito bites and sexual transmission and, upon return, should take appropriate measures, including practicing safer 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.

Based on the existing evidence from the current Zika virus outbreak, it is known that this virus can spread internationally and establish new transmission chains in areas where the vector is present. Focusing on the potential risks associated with the Olympic and Paralympic Games, the Committee reviewed information provided by Brazil and Advisors specializing in arboviruses, the international spread of infectious diseases, travel medicine, mass gatherings and bioethics. The Committee concluded that there is a very low risk of further international spread of Zika virus as a result of the Olympic and Paralympic Games as Brazil will be hosting the Games during the Brazilian winter when the intensity of autochthonous transmission of arboviruses, such as dengue and Zika viruses, will be minimal and is intensifying vector-control measures in and around the venues for the Games which should further reduce the risk of transmission.

The Committee reaffirmed its previous advice that there should be no general restrictions on travel and trade with countries, areas and/or territories with Zika virus transmission, including the cities in Brazil that will be hosting the Olympic and Paralympic Games. The Committee provided additional advice to the Director-General on mass gatherings and the Olympic and Paralympic Games as follows:

• Countries, communities and organizations that are convening mass gatherings in areas affected by Zika virus outbreaks should undertake a risk assessment prior to the event and increase measures to reduce the risk of exposure to Zika virus,
• Brazil should continue its work to intensify vector control measures in and around the cities and venues hosting Olympic and Paralympic Games events, make the nature and impact of those measures publicly available, enhance surveillance for Zika virus circulation and the mosquito vector in the cities hosting the events and publish that information in a timely manner, and ensure the availability of sufficient insect repellent and condoms for athletes and visitors,
• Countries with travellers to and from the Olympic and Paralympic Games should ensure that those travellers are fully informed on the risks of Zika virus infection, the personal protective measures that should be taken to reduce those risks, and the action that they should take if they suspect they have been infected. Countries should also establish protocols for managing returning travellers with Zika virus infection based on WHO guidance,
• Countries should act in accordance with guidance from the World Health Organization on mass gatherings in the context of Zika virus outbreaks, which will be updated as further information becomes available on the risks associated with Zika virus infection and factors affecting national and international spread.

Based on this advice the Director-General declared the continuation of the Public Health Emergency of International Concern (PHEIC). The Director-General reissued the Temporary Recommendations from the 2^nd meeting of the Committee, endorsed the additional advice from the Committee’s 3^rd meeting, and issued them as Temporary Recommendations under the IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

WHO

Defining the syndrome associated with congenital Zika virus infection

Anthony Costello ^a, Tarun Dua ^b, Pablo Duran ^c, Metin Gülmezoglu ^d, Olufemi T Oladapo ^d, William Perea ^e, João Pires ^f, Pilar Ramon-Pardo ^g, Nigel Rollins ^a & Shekhar Saxena ^b

a. Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
b. Department of Mental Health and Substance Abuse, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
c. Center For Perinatology, Women and Reproductive Health, Pan American Health Organization/World Health Organization, Montevideo, Uruguay.
d. Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
e. Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
f. Division of Communicable Diseases and Health Security, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
g. Department of Communicable Diseases and Health Analysis, Pan American Health Organization/ World Health Organization, Washington, USA.

Correspondence to Tarun Dua (email: duat@who.int).

Bulletin of the World Health Organization 2016;94:406-406A. doi: http://dx.doi.org/10.2471/BLT.16.176990

Zika virus infection in humans is usually mild or asymptomatic. However, some babies born to women infected with Zika virus have severe neurological sequelae. An unusual cluster of cases of congenital microcephaly and other neurological disorders in the WHO Region of the Americas, led to the declaration of a public health emergency of international concern by the World Health Organization (WHO) on 1 February 2016. By 5 May 2016, reports of newborns or fetuses with microcephaly or other malformations – presumably associated with Zika virus infection – have been described in the following countries and territories: Brazil (1271 cases); Cabo Verde (3 cases); Colombia (7 cases); French Polynesia (8 cases); Martinique (2 cases) and Panama (4 cases). Additional cases were also reported in Slovenia and the United States of America, in which the mothers had histories of travel to Brazil during their pregnancies.¹

Zika virus is an intensely neurotropic virus that particularly targets neural progenitor cells but also – to a lesser extent – neuronal cells in all stages of maturity.

Viral cerebritis can disrupt cerebral embryogenesis and result in microcephaly and other neurological abnormalities.² Zika virus has been isolated from the brains and cerebrospinal fluid of neonates born with congenital microcephaly and identified in the placental tissue of mothers who had had clinical symptoms consistent with Zika virus infection during their pregnancies.^3–5 The spatiotemporal association of cases of microcephaly with the Zika virus outbreak and the evidence emerging from case reports and epidemiologic studies, has led to a strong scientific consensus that Zika virus is implicated in congenital abnormalities.^6,7

Existing evidence and unpublished data shared with WHO highlight the wider range of congenital abnormalities probably associated with the acquisition of Zika virus infection in utero. In addition to microcephaly, other manifestations include craniofacial disproportion, spasticity, seizures, irritability and brainstem dysfunction including feeding difficulties, ocular abnormalities and findings on neuroimaging such as calcifications, cortical disorders and ventriculomegaly.^3–6,8–10 Similar to other infections acquired in utero, cases range in severity; some babies have been reported to have neurological abnormalities with a normal head circumference.

Preliminary data from Colombia and Panama also suggest that the genitourinary, cardiac and digestive systems can be affected (Pilar Ramon-Pardo, unpublished data).

The range of abnormalities seen and the likely causal relationship with Zika virus infection suggest the presence of a new congenital syndrome.

WHO has set in place a process for defining the spectrum of this syndrome. The process focuses on mapping and analysing the clinical manifestations encompassing the neurological, hearing, visual and other abnormalities, and neuroimaging findings. WHO will need good antenatal and postnatal histories and follow-up data, sound laboratory results, exclusion of other etiologies and analysis of imaging findings to properly delineate this syndrome. The scope of the syndrome will expand as further information and longer follow-up of affected children become available. The surveillance system that was established as part of the epidemic response to the outbreak initially called only for the reporting of microcephaly cases. This surveillance guidance has been expanded to include a spectrum of congenital malformations that could be associated with intrauterine Zika virus infection.¹¹

Effective sharing of data is needed to define this syndrome. A few reports have described a wide range of abnormalities,^3–6,8–10 but most data related to congenital manifestations of Zika infection remain unpublished. Global health organizations and research funders have committed to sharing data and results relevant to the Zika epidemic as openly as possible.¹² Further analysis of data from cohorts of pregnant women with Zika virus infection are needed to understand all outcomes of Zika virus infection in pregnancy.

Thirty-seven countries and territories in the Region of the Americas now report mosquito-borne transmission of Zika virus and risk of sexual transmission. With such spread, it is possible that many thousands of infants will incur moderate to severe neurological disabilities. Therefore, routine surveillance systems and research protocols need to include a larger population than simply children with microcephaly. The health system response, including psychosocial services for women, babies and affected families will need to be fully resourced.

The Zika virus public health emergency is distinct because of its long-term health consequences and social impact. A coordinated approach to data sharing, surveillance and research is needed. WHO has thus started coordinating efforts to define the congenital Zika virus syndrome and issues an open invitation to all partners to join in this effort.

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Acknowledgements

We thank the guideline development group members for the management of Zika virus associated complications, including Melania Amorim, Adriana Melo, Marianne Besnard, Jose Guilherme Cecatti, Gustavo Malinger and Vanessa van Der Linden who shared their unpublished data during the meeting.

References

• Zika situation report (5 May 2016). Geneva: World Health Organization; 2016. Available from: http://www.who.int/emergencies/zika-virus/situation-report/5-may-2016/en/ [cited 2016 May 10].
• Tang H, Hammack C, Ogden SC, Wen Z, Qian X, Li Y, et al. Zika virus infects human cortical neural progenitors and attenuates their growth. Cell Stem Cell. 2016 May 5;18(5):587–90. http://dx.doi.org/10.1016/j.stem.2016.02.016 pmid: 26952870
• Driggers RW, Ho CY, Korhonen EM, Kuivanen S, Jääskeläinen AJ, Smura T, et al. Zika virus infection with prolonged maternal viremia and fetal brain abnormalities. N Engl J Med. 2016 Mar 30;NEJMoa1601824. http://dx.doi.org/10.1056/NEJMoa1601824 pmid: 27028667
• Brasil P, Pereira JP Jr, Raja Gabaglia C, Damasceno L, Wakimoto M, Ribeiro Nogueira RM, et al. Zika virus infection in pregnant women in Rio de Janeiro – preliminary report. N Engl J Med. 2016 Mar 4;NEJMoa1602412. http://dx.doi.org/10.1056/NEJMoa1602412 pmid: 26943629
• Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016 Mar 10;374(10):951–8. http://dx.doi.org/10.1056/NEJMoa1600651 pmid: 26862926
• Cauchemez S, Besnard M, Bompard P, Dub T, Guillemette-Artur P, Eyrolle-Guignot D, et al. Association between Zika virus and microcephaly in French Polynesia, 2013-15: a retrospective study. Lancet. 2016 Mar 15;S0140-6736(16)00651-6. pmid: 26993883
• SA Rasmussen, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects – reviewing the evidence for causality. N Engl J Med. 2016 Apr 13.
• Besnard M, Eyrolle-Guignot D, Guillemette-Artur P, Lastère S, Bost-Bezeaud F, Marcelis L, et al. Congenital cerebral malformations and dysfunction in fetuses and newborns following the 2013 to 2014 Zika virus epidemic in French Polynesia. Euro Surveill. 2016 Mar 31;21(13):30181. http://dx.doi.org/10.2807/1560-7917.ES.2016.21.13.30181 pmid: 27063794
• de Paula Freitas B, de Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, Maia M, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol. 2016 Feb 9; http://dx.doi.org/10.1001/jamaophthalmol.2016.0267 pmid: 26865554
• Miranda-Filho DB, Martelli CM, Ximenes RA, Araújo TV, Rocha MA, Ramos RC, et al. Initial Description of the presumed congenital Zika syndrome. Am J Public Health. 2016 Apr;106(4):598–600. http://dx.doi.org/10.2105/AJPH.2016.303115 pmid: 26959258
• Case definitions. Washington: Regional Office in the Americas/World Health Organization; 2016. Available from: http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en [cited 2016 May 10].
• Dye C, Bartolomeos K, Moorthy V, Kieny MP. Data sharing in public health emergencies: a call to researchers. Bull World Health Organ. 2016 Mar 1;94(3):158. http://dx.doi.org/10.2471/BLT.16.170860 pmid: 26966322

WHO

Address to the Sixty-ninth World Health Assembly

Dr Margaret Chan
Director-General of the World Health Organization

Mister President, Excellencies, honourable ministers, ambassadors, distinguished delegates, colleagues, ladies and gentlemen,

Public health constantly struggles to hold infectious diseases at bay, to change lifestyle behaviours, and to find enough money to do these and many other jobs.

But sometimes we need to step back and celebrate.

Commitment to the Millennium Development Goals brought focus, energy, creative innovation, and above all money to bear on some of the biggest health challenges that marred the start of this century.

We can celebrate the 19 000 fewer children dying every day, the 44% drop in maternal mortality, and the 85% of tuberculosis cases that are successfully cured.

Africa in particular can celebrate the 60% decline in malaria mortality, especially since the African Leaders Malaria Alliance, supported by partners, did so much to make this happen.

We can celebrate the fastest scale-up of a life-saving treatment in history. More than 15 million people living with HIV are now receiving antiretroviral therapy, up from just 690 000 in 2000.

A culture of measurement and accountability evolved to make aid more effective. Greater transparency brought the voice of civil society to bear in holding governments and donors accountable for their promises.

The profile of health changed, from a drain on resources to an investment that builds stable, prosperous, and equitable societies.

Everyone in this room can be proud of these achievements.

You have saved many millions of lives. Your strategic and technical innovations have left us well-prepared to set our sights even higher. You deserve an applause.

Ladies and gentlemen,

In an interconnected world characterized by profound mobility of people and goods, few threats to health are local anymore.

Air pollution is a transboundary hazard that affects the global atmosphere and contributes to climate change.

Drug-resistant pathogens, including the growing number of “superbugs”, travel well internationally in people, animals, and food.

The marketing of unhealthy foods and beverages, especially to children, is now a global phenomenon.

Safeguarding the quality of pharmaceutical products has become much harder, with complex manufacturing procedures and supply chains spanning multiple companies and countries.

Ensuring the quality of the food supply is also much harder when a single meal can contain ingredients from all around the world, including some potentially contaminated with exotic pathogens.

The refugee crisis in Europe taught the world that armed conflicts in faraway places will not stay remote.

The Ebola outbreak in 3 small countries paralyzed the world with fear and travel constraints.

Last year, a business traveller returning home to the Republic of Korea, infected with the MERS coronavirus, disrupted the country’s economy as well as its health system.

The rapidly evolving outbreak of Zika warns us that an old disease that slumbered for 6 decades in Africa and Asia can suddenly wake up on a new continent to cause a global health emergency.

This year’s appearance of urban yellow fever in Africa, now confirmed in the capital cities of Angola and the Democratic Republic of Congo, is yet another serious event with potential for further international spread.

Ladies and gentlemen,

For infectious diseases, you cannot trust the past when planning for the future.

Changes in the way humanity inhabits the planet have given the volatile microbial world multiple new opportunities to exploit. There will always be surprises.

The possibility that a mosquito bite during pregnancy could be linked to severe brain abnormalities in newborns alarmed the public and astonished scientists.

Confirmation of a causal link between infection and microcephaly has transformed the profile of Zika from a mild disease to a devastating diagnosis for pregnant women and a significant threat to global health.

Outbreaks that become emergencies always reveal specific weaknesses in affected countries and illuminate the fault lines in our collective preparedness.

For Ebola, it was the absence of even the most basic infrastructures and capacities for surveillance, diagnosis, infection control, and clinical care, unaided by any vaccines or specific treatments.

For Zika, we are again taken by surprise, with no vaccines and no reliable and widely available diagnostic tests. To protect women of childbearing age, all we can offer is advice. Avoid mosquito bites. Delay pregnancy. Do not travel to areas with ongoing transmission.

Zika reveals an extreme consequence of the failure to provide universal access to sexual and family planning services. Latin America and the Caribbean have the highest proportion of unintended pregnancies anywhere in the world.

Above all, the spread of Zika, the resurgence of dengue, and the emerging threat from chikungunya are the price being paid for a massive policy failure that dropped the ball on mosquito control in the 1970s.

The lesson from yellow fever is especially brutal. The world failed to use an excellent preventive tool to its full strategic advantage.

For more than a decade, WHO has been warning that changes in demography and land use patterns in Africa have created ideal conditions for explosive outbreaks of urban yellow fever. Africa’s urbanization has been rapid and rampant, showing the fastest growth rates anywhere in the world.

Migrants from rural areas, and workers from mining and construction sites, can now carry the virus into urban areas with powder-keg conditions: dense populations of non-immune people, heavy infestations with mosquitoes exquisitely adapted to urban life, and the flimsy infrastructures that make mosquito control nearly impossible.

The world has had a safe, low-cost, and effective vaccine that confers life-long protection against yellow fever since 1937. That’s nearly 80 years. Yellow fever vaccines should be and must be used more widely to protect people living in endemic countries. Yellow fever is not a mild disease.

Let me give you a stern warning. What we are seeing now looks more and more like a dramatic resurgence of the threat from emerging and re-emerging infectious diseases. The world is not prepared to cope.

High-level assessments of the Ebola response have consistently called for more resilient health systems as a first line of defence. This is also the position taken at the G7 summit being held later this week in Japan.

I welcome the current joint external evaluations that are looking at preparedness and response capacities in several countries. The evaluations need to continue with the utmost urgency, as a tool under WHO authority and coordination.

WHO is the organization with universal legitimacy to implement the International Health Regulations. The evaluations must be accompanied by well-resourced efforts to fill the gaps. Many generous countries have promised to support 76 countries to build IHR core capacities. I urge you to keep this promise.

Given what we face right now, and the next surprises that are sure to come, the item on your agenda with the most sweeping consequences, for a danger that can quickly sweep around the world, is the one on the reform of WHO’s work in health emergency management.

The Secretariat’s report gives you an overview of the design, oversight, implementation plan, and financing requirements of the new health emergencies programme.

Setting this up marks a fundamental change for WHO, in which our traditional technical and normative functions are augmented by operational capacities needed to respond to outbreaks and humanitarian emergencies. Implementation of this change has moved forward quickly.

The programme’s design is aligned with the principles of a single programme, with one clear line of authority, one workforce, one budget, one set of rules and processes, and one set of standard performance metrics.

In March, I established an Independent Oversight and Advisory Committee. This 8-member committee is monitoring the development and performance of the programme. The Committee will report its findings through the Executive Board to the Health Assembly.

I urge you to give this item the serious consideration it deserves. Anything short of full political and financial support for the programme will handicap the WHO response, right now and into the future.

Ladies and gentlemen,

Few health threats are local anymore. And few health threats can be managed by the health sector acting alone.

As the international community enters the era of sustainable development, the global health landscape is being shaped by 3 slow-motion disasters: a changing climate, the failure of more and more mainstay antimicrobials, and the rise of chronic noncommunicable diseases as the leading killers worldwide.

These are not natural disasters. They are man-made disasters created by policies that place economic interests above concerns about the well-being of human lives and the planet that sustains them.

This is the way the world works. The burning of fossil fuels powers economies.

Medicines for treating chronic conditions are more profitable than a short course of antibiotics. Highly processed foods that are cheap, convenient, and tasty gain a bigger market share than fresh fruits and vegetables.

Unchecked, these slow-motion disasters will eventually reach a tipping point where the harm done is irreversible.

This is best documented by the 2° C limit for catastrophic climate change. For antimicrobial resistance, we are on the verge of a post-antibiotic era in which common infectious diseases will once again kill. If you want to know the future consequences of markets saturated with unhealthy foods and beverages, read the report of the Commission on Ending Childhood Obesity.

The 2030 agenda for sustainable development wants to make sure these and many other disasters are averted. The agenda aims to do nothing less than transform the way the world, and the international systems that govern it, work.

The goals and targets are broad, visionary, and supremely ambitious. They have been criticized by some as utopian, unaffordable, out of touch, and out of reach.

I disagree. The vision inspires optimism and hope, but it is also firmly anchored in the realities of a world that desperately needs to change.

The ambition of the agenda is to tackle the root causes of the world’s many woes, from the degrading misery of poverty to the consequences of terrorism and violence, in an integrated and interactive way.

The agenda puts the people left behind first. We know what this implies.

R&D market failures punish the poor. User fees punish the poor. User fees discourage people from seeking care until a condition is severe and far more difficult and costly to manage. Diabetes is a prime example. User fees waste resources as well as human lives.

The agenda is indeed broad, but so are the social, economic, and environmental determinants of health. The advantage of addressing these broad determinants is well-reflected in the operational framework for implementing the Global strategy for women’s, children’s and adolescents’ health.

Health holds a prominent and central place that benefits the entire agenda. In the final analysis, the ultimate objective of all development activities, whether concerning the design of urban environments or the provision of modern energy to rural areas, is to sustain human lives in good health.

In an interactive agenda, the broad determinants of health, coupled with methodologies that let us track progress with confidence, make improvements in health a reliable marker of overall progress.

Member States have approved roadmaps of strategic actions for taking forward work on individual health targets. Nearly all these strategies and plans map out priority R&D innovations that will boost the prospects of reaching ambitious goals.

Innovations help, but ambitious goals are feasible and affordable only if we cut out waste and inefficiency.

We do so through integrated, people-centred care that spans the life course, from pre-conception through ageing, and brings prevention to the fore. The target for universal health coverage moves us in that direction.

UHC is the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind. It also has the best chance of meetings people’s expectations for comprehensive care that does not drive them below the poverty line.

And we have other resources to tap. The Women Deliver conference, held last week in Copenhagen, provides evidence of the energy unleashed when women are freed from the constraints of violence, discrimination, and unintended pregnancies.

It also falls to the health sector to show some principled ethical backbone in a world that, for all practical appearances, has lost its moral compass. We must express outrage at the recent bombings of hospitals and refugee camps in Syria and Yemen, the use of rape and starvation as weapons of war, and the killing of innocent civilians in the pursuit of terrorist goals.

Ladies and gentlemen,

We need to celebrate not only the wealth of achievements and lessons learned during the MDG era, but also every victory that permanently eliminates a health threat.

Earlier this month, WHO declared that India has eliminated yaws from its vast population. Last year, human cases of sleeping sickness reached the lowest level seen since data collection began 75 years ago. This year, only 2 cases of guinea worm disease have been detected, both in Chad.

After Cuba was validated as the first country in the world to eliminate mother-to-child transmission of HIV and syphilis, a second wave of countries will be considered by the global validation committee this week.

Polio eradication has never been so close to the finish line, with Africa now free of wild poliovirus for nearly 2 years.

During the short span of 2 weeks in April, 155 countries successfully switched from trivalent to bivalent oral polio vaccine, marking the largest coordinated vaccine withdrawal in history. I thank you and your country teams for this marvellous feat. This is another milestone towards a world permanently free of a crippling disease.

We have victories on other fronts. More countries are exercising their legal right to mandate plain packaging for tobacco products, with the UK being the latest on the list. One tobacco giant has decided not to appeal, adding to the victory. 

These are critical victories. No country can hope to bring down the burden of noncommunicable diseases in the absence of strong legislation for tobacco control in line with the WHO Framework Convention on Tobacco Control.

World leaders are fully aware of the major challenges affecting health in general and this Organization in particular.

Many recent meetings have focused on the crisis caused by antimicrobial resistance. I thank Member States for taking this crisis so seriously, including the pressing need for incentives to get new products into the pipeline.

World leaders are concerned about the world drug problem and the need to broaden and balance the response by adopting a public health approach.

They are concerned about a humanitarian system that is overwhelmed and badly needs reform. This concern is reflected in the first-ever World Humanitarian Summit being held this week in Istanbul.

They are concerned about the costs, to economies as well as to health, incurred by noncommunicable diseases. Thanks to last year’s successful event in Paris, the world now has a climate treaty.

I thank Member States for recognizing the critical importance of strengthening health systems and embracing the vision of universal health coverage. You have approved many resolutions that contribute to this end. We are well-poised to implement the SDGs.

You are also on the verge of delivering a solid framework for engagement with non-state actors that will mainstream a major area of reform.

This Health Assembly, with its record-breaking number of agenda items and participants, tells me how much you expect from WHO.

We have entered an ambitious new era for health development. We have a solid foundation of success to build on.

WHO, together with its multiple partners, is poised to save many more millions of lives. I ask you to remember this purpose as we go through an agenda that can mean so much for the future.

Thank you.

WHO

Meeting of the Emergency Committee under the International Health Regulations (2005) concerning Yellow Fever

An Emergency Committee (EC) regarding yellow fever was convened by the Director-General under the International Health Regulations (2005) (IHR 2005) by teleconference on 19 May 2016, from 13:00 to 17:15 Central European Time¹.

The following affected States Parties participated in the information session of the meeting: Angola and the Democratic Republic of Congo.

The WHO Secretariat briefed the Committee on the history and impact of the Yellow Fever Initiative, the urban outbreak of yellow fever in Luanda, Angola and its national and international spread to the Democratic Republic of Congo, China and Kenya. The Committee was provided with additional information on the evolving risk of urban yellow fever in Africa and the status of the global stockpile of yellow fever vaccine.

After discussion and deliberation on the information provided, it was the decision of the Committee that the urban yellow fever outbreaks in Angola and the Democratic Republic of the Congo is a serious public health event which warrants intensified national action and enhanced international support. The Committee decided that based on the information provided the event does not at this time constitute a Public Health Emergency of International Concern (PHEIC).

While not considering the event currently to constitute a PHEIC, Members of the Committee strongly emphasized the serious national and international risks posed by urban yellow fever outbreaks and offered technical advice on immediate actions for the consideration of WHO and Member States in the following areas:

• the acceleration of surveillance, mass vaccination, risk communications, community mobilization, vector control and case management measures in Angola and the Democratic Republic of Congo;

• the assurance of yellow fever vaccination of all travellers, and especially migrant workers, to and from Angola and Democratic Republic of Congo;

• the intensification of surveillance and preparedness activities, including verification of yellow fever vaccination in travellers and risk communications, in at-risk countries and countries having land borders with the affected countries.

The Committee also emphasized the need to manage rapidly any new yellow fever importations, thoroughly evaluate ongoing response activities, and quickly expand yellow fever diagnostic and confirmatory capacity. Recognizing the limited international supply of yellow fever vaccines, the Committee also advised the immediate application of the policy of 1 lifetime dose of yellow fever vaccine² and the rapid evaluation of yellow fever vaccine dose-sparing strategies by the WHO Strategic Advisory Group of Experts on Immunization (SAGE).

Going forward, the Committee agreed with the planned review and revision of the global strategy for preventing urban yellow fever outbreaks in keeping with WHO’s assessment that the risk of such events is increasing.

Based on these views and the currently available information, the Director-General accepted the Committee’s assessment that the current yellow fever situation is serious and of great concern and requires intensified control measures, but does not constitute a PHEIC at this time.

The Director-General urges Member States to enforce the yellow fever vaccination requirement for travellers to and from Angola and the Democratic Republic of the Congo in accordance with the IHR (2005)³

The Director-General thanked the Committee for its thorough advice on priority actions for affected and at-risk countries, and on further yellow fever risk management work for WHO. The Director-General appreciated the concurrence of the Committee to be reconvened if needed.

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[1] The names and summary biographies of the Emergency Committee Members and Advisors are available at http://www.who.int/ihr/procedures/yellow-fever-ec-members/en/

[2] World Health Assembly Resolution WHA 67.13.

[3] as per Annex 7 of the International Health Regulations (2005)

WHO

TB_Short_MDR_regimen_factsheet-WHO

12 MAY 2016 | GENEVA – New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

“This is a critical step forward in tackling the MDR-TB public health crisis,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”

Shorter treatment with better outcomes

At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.

The conventional treatment regimens, which take 18–24 months to complete, yield low cure rates: just 50% on average globally. This is largely because patients find it very hard to keep taking second-line drugs, which can be quite toxic, for prolonged periods of time. They therefore often interrupt treatment or are lost to follow-up in health services.

The shorter regimen is recommended for patients diagnosed with uncomplicated MDR-TB, for example those individuals whose MDR-TB is not resistant to the most important drugs used to treat MDR-TB (fluoroquinolones and injectables), known as “second-line drugs”. It is also recommended for individuals who have not yet been treated with second line drugs.

WHO’s recommendations on the shorter regimens are based on initial programmatic studies involving 1200 patients with uncomplicated MDR-TB in 10 countries . WHO is urging researchers to complete ongoing randomised controlled clinical trials in order to strengthen the evidence base for use of this regimen.

Rapid diagnostic test to identify second-line drug resistance

The most reliable way to rule out resistance to second-line drugs is a newly recommended diagnostic test for use in national TB reference laboratories. The novel diagnostic test – called MTBDRsl – is a DNA-based test that identifies genetic mutations in MDR-TB strains, making them resistant to fluoroquinolones and injectable second-line TB drugs.

This test yields results in just 24-48 hours, down from the 3 months or longer currently required. The much faster turnaround time means that MDR-TB patients with additional resistance are not only diagnosed more quickly, but can quickly be placed on appropriate second-line regimens. WHO reports that fewer than 20% of the estimated 480 000 MDR-TB patients globally are currently being properly treated.

The MTBDRsl test is also a critical prerequisite for identifying MDR-TB patients who are eligible for the newly recommended shorter regimen, while avoiding placing patients who have resistance to second-line drugs on this regimen (which could fuel the development of extensively drug-resistant TB or XDR-TB).

“We hope that the faster diagnosis and shorter treatment will accelerate the much-needed global MDR-TB response,” said Dr Karin Weyer, Coordinator of Laboratories, Diagnostics and Drug Resistance, WHO Global TB Programme. “Anticipated cost-savings from the roll out of this regimen could be re-invested in MDR-TB services to enable more patients to be tested and retained on treatment.”

WHO is working closely with technical and funding partners to ensure adequate resources and support for the uptake of the rapid test and shorter, cheaper regimen in countries.

Quick facts

• Resistance to standard TB drugs exists in most countries worldwide. Drug resistance, fuelled by inadequate treatment, can spread through the air, from person to person, in the same way as drug-susceptible TB.
• Multidrug-resistant TB (MDR-TB) is caused by TB bacteria that are resistant to at least isoniazid and rifampicin, the two most effective TB drugs. Based on figures from 2014, the latest year for which data are available, WHO estimates that 5% of TB cases are multidrug-resistant. This translates into 480 000 cases and 190 000 deaths each year.
• Extensively drug-resistant TB (XDR-TB) is a form of MDR-TB that is also resistant to any fluoroquinolone and any of the second–line anti-TB injectable agents (i.e. amikacin, kanamycin or capreomycin). About 9% of MDR-TB patients develop XDR-TB, which is even more difficult to treat.
• The WHO “End TB Strategy“, adopted by all WHO Member States, serves as a blueprint for countries to reduce TB incidence by 80% and TB deaths by 90%, and to eliminate catastrophic costs for TB-affected households by 2030.

WHO

WHO and the Pan American Health Organization (PAHO) recognize that athletes and visitors are seeking more information on the risks of Zika and ways to prevent infection while attending the Olympic and Paralympic Games Rio 2016 (5 August to 18 September 2016).

Brazil is one of the 58 countries and territories which to-date report continuing transmission of Zika virus by mosquitoes. While mosquitoes are the primary vectors, a person infected with Zika virus can also transmit the virus to another person through unprotected sex. Zika virus disease usually causes mild symptoms(1), and most people will not develop any symptoms. However, there is scientific consensus that Zika virus is a cause of microcephaly (children being born with unusually small heads) and other brain malformations and disorders in babies born to women who were infected with Zika virus during pregnancy, and Guillain-Barré syndrome (a rare but serious neurological disorder that could lead to paralysis and death).

Athletes and visitors to Rio de Janeiro, and other areas where Zika virus is circulating, are being encouraged to:

• follow the travel advice(2) provided by WHO and their countries’ health authorities, and consult a health worker before travelling;
• whenever possible, during the day, protect themselves from mosquito bites by using insect repellents and by wearing clothing – preferably light-coloured – that covers as much of the body as possible;
• practice safer sex (e.g. use condoms correctly and consistently) or abstain from sex during their stay and for at least 4 weeks after their return, particularly if they have had or are experiencing symptoms of Zika virus;
• choose air-conditioned accommodation (windows and doors are usually kept closed to prevent the cool air from escaping, and mosquitoes cannot enter the rooms);
• avoid visiting impoverished and over-crowded areas in cities and towns with no piped water and poor sanitation (ideal breeding grounds of mosquitoes) where the risk of being bitten is higher.

Pregnant women continue to be advised not to travel to areas with ongoing Zika virus transmission. This includes Rio de Janeiro. Pregnant women’s sex partners returning from areas with circulating virus continue to be counselled to practice safer sex or abstain throughout the pregnancy(3). The Games will take place during Brazil’s wintertime, when there are fewer active mosquitoes and the risk of being bitten is lower.

WHO/PAHO is providing public health advice to the Government of Brazil and, under a Memorandum of Understanding, the International Olympic Committee and, by extension, the Rio 2016 Local Organizing Committee, on ways to further mitigate the risk of athletes and visitors contracting Zika virus during the Games. An important focus of WHO advice revolves around measures to reduce populations of Aedes mosquitoes which transmit chikungunya, dengue and yellow fever in addition to Zika virus.

WHO/PAHO will continue to monitor the Zika virus transmission and risks in Brazil and in other affected areas to provide updates on how Zika virus outbreaks, risks and prevention interventions develop between now and August and beyond.

ABC-TV

 

 

WHO

Statement on the 9th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa

The 9th meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the Ebola virus disease (EVD) outbreak in West Africa took place by teleconference on Tuesday, 29 March 2016 from 12:30 until 15:15 hr.

The Committee was requested to provide the Director-General with views and perspectives as to whether the event continues to constitute a Public Health Emergency of International Concern (PHEIC) and whether the current Temporary Recommendations should be extended, rescinded or revised.

Representatives of Guinea, Liberia and Sierra Leone presented the epidemiological situation, ongoing work to prevent Ebola re-emergence, and capacity to detect and respond rapidly to any new clusters of cases in each country.

The Committee noted that since its last meeting all three countries have met the criteria for confirming interruption of their original chains of Ebola virus transmission. Specifically, all three countries have now completed the 42 day observation period and additional 90 day enhanced surveillance period since their last case that was linked to the original chain of transmission twice tested negative. Guinea achieved this milestone on 27 March 2016.

The Committee observed that, as expected, new clusters of Ebola cases continue to occur due to reintroductions of virus as it is cleared from the survivor population, though at decreasing frequency. Twelve such clusters have been detected to date, the most recent of which was reported on 17 March 2016 in Guinea and is ongoing. The Committee was impressed that to date all of these clusters have been detected and responded to rapidly, limiting transmission to at most two generations of cases in the 11 clusters which have now been stopped.

The Committee provided its view that Ebola transmission in West Africa no longer constitutes an extraordinary event, that the risk of international spread is now low, and that countries currently have the capacity to respond rapidly to new virus emergences. Accordingly, in the Committee’s view the Ebola situation in West Africa no longer constitutes a Public Health Emergency of International Concern and the Temporary Recommendations adopted in response should now be terminated. The Committee emphasized that there should be no restrictions on travel and trade with Guinea, Liberia and Sierra Leone, and that any such measures should be lifted immediately.

As in other areas of sub-Saharan Africa where Ebola virus is present in the ecosystem, and recognizing that new clusters due to re-emergence may occur in the coming months, the Committee reinforced that these countries must maintain the capacity and readiness to prevent, detect and respond to any ongoing and/or new clusters in future. National and international efforts must be intensified to ensure that male survivors can have their semen tested for virus persistence and know their status. Work must continue on the use of Ebola vaccination for intimate and close contacts of those survivors who have persistent virus excretion. Particularly important will be to ensure that communities can rapidly and fully engage in any future response, cases are quickly isolated and managed, local population movement in the affected areas is managed, and appropriate contact lists are shared with border authorities.

The Committee further emphasized the crucial need for continued international donor and technical support to prevent, detect and respond rapidly to any new Ebola outbreak in West Africa. International support is required in particular to maintain and, where needed, expand diagnostic laboratory and surveillance capacity, sustain vaccination capacity for outbreak response, and continue relevant research and development activities (e.g. on therapeutic options to clear persistent virus excretion). The Committee gave special attention to the need to ensure that sufficient and appropriate clinical care, testing capacity and welfare services are available to all survivors of this extraordinary health crisis.

Based on the advice of the Emergency Committee, and her own assessment of the situation, the Director-General terminated the Public Health Emergency of International Concern (PHEIC) regarding the Ebola virus disease outbreak in West Africa, in accordance with the International Health Regulations (2005). The Director-General terminated the Temporary Recommendations that she had issued in relation to this event, supported the public health advice provided above by the Committee, and reinforced the importance of States Parties immediately lifting any restrictions on travel and trade with these countries. The Director-General thanked the Emergency Committee members and advisors for their service and expert advice, and requested their availability to reconvene if needed.