Monday, January 18, 2016

Hong Kong Issues Zika Travel Advice & Letter To Doctors

# 10,904

Due to the rapid spread of the  Zika Virus in the tropical Americas, and a concurrent rise in microcephalic birth defects in Brazil, the CDC issued a revised travel advisory and a HAN: Recognizing, Managing & Reporting ZIka Virus Infections In Travelers for clinicians late on Friday. 

While a firm connection between the Zika virus and the increase in Microcephalic births in Brazil has yet to be completely established, the risks to women and their unborn babies is considered great enough to demand immediate action.

Today it is Hong Kong's turn.  First with a statement on their CHP website, and then via a letter sent to all local doctors asking them to stay vigilant for possible imported cases.

18 January 2016
DH alerts travellers to risk of Zika virus infection 

The Department of Health (DH) today (January 18) drew the public's attention to the latest situation of the mosquito-borne Zika virus infection and appealed to travellers for vigilance and due consideration of health risks before travel.

According to the latest report by the Pan American Health Organization (PAHO)/World Health Organization (WHO), autochthonous transmission of Zika virus was reported from epidemiological week 17 of 2015 to epidemiological week 2 of 2016 in the following countries and territories in the Americas Region: Brazil, Columbia, Ecuador, El Salvador, French Guiana, Guyana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Saint Martin, Suriname and Venezuela.

"We have been monitoring Zika virus transmission overseas and noted reports of microcephaly and other poor pregnancy outcomes in babies whose mothers were infected with Zika while pregnant and studies are being carried out to determine what effects Zika virus can have on foetuses. In view of the latest situation, as a precautionary measure, we advise pregnant women and those planning pregnancy to adopt necessary anti-mosquito precautions. We will issue letters to doctors and hospitals for heightened vigilance," a spokesman for the DH said.

Pregnant women should consider deferring their trip to areas with past or current evidence of ongoing Zika virus transmission. Those who must travel to any of these areas should seek medical advice from their doctor before the trip, strictly follow steps to avoid mosquito bites during the trip, and consult and reveal their travel history to their doctor if symptoms develop after the trip.

Women preparing for pregnancy should also consult their doctor before travelling to these areas, strictly follow anti-mosquito precautions during the trip, and report to their doctor if feeling unwell after the trip.

"Locally, no human cases have been reported to the Centre for Health Protection (CHP) of the DH so far and the CHP's Public Health Laboratory Services Branch (PHLSB) is capable of detecting Zika virus. Although Zika virus infection is not a statutorily notifiable infectious disease under the Prevention and Control of Disease Ordinance (Cap 599) now, we appeal to doctors to stay alert to the possibility of Zika in travellers returning from affected areas who present a clinically compatible picture not attributable to dengue fever or chikungunya fever. Laboratory testing for Zika virus infection is available at the PHLSB. They should contact the PHLSB for further information as necessary," the spokesman said.

Zika is primarily transmitted to humans through bites from Aedes mosquitoes. Aedes aegypti, which is currently not found in Hong Kong, is considered the most important vector for Zika transmission to humans. Other Aedes mosquito species such as Aedes albopictus widely present locally are also considered as potential vectors. There is therefore a risk of secondary spread for imported infections in Hong Kong.

(Continue . . .)

The letter to doctors (Vigilance against Zika virus infection PDF 717.93 Kb) repeats much of the above information, and adds:

Medical practitioners should be aware of the possibility of Zika virus infection for travellers returning from affected areas and present with clinically compatible picture. Laboratory testing for Zika virus infection is available at the Public Health Laboratory Services Branch (PHLSB) of CHP. Please contact PHLSB for further information as necessary. 

If you encounter patients with laboratory confirmed Zika virus infection please report to the Central Notification Office (CENO) of CHP via fax (2477 2770), CENO On-line ( or phone (2477 2772) for investigation and control measures.

While there is always great reluctance to issue travel advice that will negatively impact  a nation's economy - particularly one as precarious, and as dependent upon tourism as Brazil's -  until the risks are better understood health departments much act out of an abundance of caution.

The concern is two-fold.     

First and foremost over the concerns for mothers and their unborn child, but secondly because viremic travelers who return to areas where suitable mosquito vectors are present, could potentially `seed' the virus to the local mosquito population and start chains of local transmission.

For some recent blogs on that possibility, you may wish to revisit:

Despite What You May Have Heard About The 1st Zika Case In The US . . .
The International Exchange Rate Of Infectious Diseases
PNAS: Asymptomatic Humans Transmit Dengue Virus To Mosquitoes

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