Tuesday, April 12, 2016

ECDC:5th Rapid Risk Assessment On Zika, Microcephaly & GBS


The ECDC has released their 5th Rapid Risk Assessment on the Zika outbreak, and in this 18 page PDF File you'll find their usual in-depth review of the existing literature and scientific knowledge, plus an analysis of the risks associated with the current Zika virus epidemic.

I've only posted excerpts from the summary, click the link below to download the full PDF file to read it in its entirety.

Conclusions and options for response

Considering the continued spread of Zika virus in the Americas and Caribbean, the strong evidence of an association between Zika virus infection during pregnancy and congenital CNS malformations, the association between Zika virus infection and Guillain–BarrĂ© syndrome, and the risk of establishment of local vector-borne transmission in Europe during the 2016 summer season, EU/EEA Member States are recommended to consider a range of mitigation measures.
  • The following uncertainties have been taken into consideration in developing the proposed options for response:
  • At the present time, there is a lack of evidence on which stage of the pregnancy the foetus is most vulnerable to Zika virus infection. Therefore the entire duration of pregnancy should be considered at risk.
  •  The presence of infectious Zika virus in semen has been detected up to three weeks after onset of disease; the longest interval reported between the onset of symptoms in a male and the subsequent onset of the disease thought to be due to sexual transmission in a female partner is 19 days.
  • The role of asymptomatic males in the sexual transmission to women is unknown.
  • The roles of different mosquito species as potential vectors of Zika virus should be clarified. If current assumptions prove inaccurate or incorrect, vector control strategies have to be adapted and revised.

Information to travellers and EU residents in affected areas

Over the past two months, as of 4 April 2016, autochthonous cases of Zika virus infection have been reported from 45 countries or territories worldwide. In the past nine months, 47 countries or territories have reported autochthonous cases of Zika virus infection.

A list of countries and territories with documented autochthonous transmission during the past two months is available on the ECDC website. Information for travellers and EU citizens residing in areas with active transmission

  • Travellers visiting countries where there is active transmission of Zika virus should be made aware of the ongoing outbreak of Zika virus infection. A list of countries and territories with documented autochthonous transmission during the past two months is available on the ECDC website.
  • Travellers visiting these countries and EU citizens residing in these countries should take measures to prevent mosquito bites indoors and outdoors, especially from sunrise to sunset when Aedes mosquito vectors are most active in biting. These measures include:
  • The use of mosquito repellent in accordance with the instructions indicated on the product label.
  • Wearing long-sleeved shirts and long trousers, especially during the hours when the type of mosquito that is known to transmit the Zika virus (Aedes) is most active.
  • Sleeping or resting in screened or air-conditioned rooms, otherwise use mosquito nets, even during the day.
  • Pregnant women and women who are planning to become pregnant should consider postponing non-essential travel to affected areas until after delivery.
  • Pregnant women who plan to travel to affected areas and pregnant women residing in affected areas should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites.
  • Travellers with immune disorders or severe chronic illnesses should consult their doctor or seek advice from a travel clinic before travelling, particularly on effective prevention measures.
  • Travellers to Zika-affected areas and EU citizens residing in affected areas should be advised that using condoms could reduce the risk of sexual transmission through semen.

Information for travellers returning from areas with transmission of Zika virus

  • Pregnant women who have travelled or resided in areas with Zika virus transmission should mention their travel during antenatal visits in order to be assessed and monitored appropriately [87].
  • In order to protect the foetus, male travellers returning from affected areas should consider using a condom with a pregnant partner until the end of pregnancy.
  • Travellers showing symptoms compatible with Zika virus disease within two weeks of return from an affected area are advised to contact their healthcare provider and mention their recent travel.
  • On 11 April, WHO published an update of its travel health advice on Zika virus in which they advise travellers returning from areas with ongoing Zika virus transmission to practise safer sex for at least one month after returning, in order to reduce the potential risk of onward sexual transmission [75]. This WHO guidance will be reviewed and the recommendations updated as new evidence emerges.

Surveillance of imported cases and monitoring of transmission in the continental EU

  • Increase awareness among clinicians and travel health clinics about the evolution of the Zika virus outbreak and the affected areas so that they can include Zika virus infection in their differential diagnosis for travellers from those areas.
  • Enhance vigilance towards the early detection of imported cases of Zika virus infection in EU Member States, EU OCTs and OMRs, in particular where vectors are present, in order to reduce the risk of autochthonous transmission.
  • Clusters of unexplained illness with rash detected in receptive areas between 1 May and 31 October should be investigated, and Zika virus infection should be considered as an underlying cause.
  • Ensure early warning reporting of autochthonous cases, in particular in receptive areas.
  • Strengthen laboratory capacity to confirm suspected Zika virus infections in the European region in order to differentiate Zika virus infections from other arboviral infections (e.g. dengue, chikungunya). Increase awareness among obstetricians, paediatricians and neurologists in the EU/EEA that Zika virus infections should be investigated in patients presenting with congenital CNS malformations, microcephaly and GBS.

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