According to WHO's Zika situation report on 29 September 2016, in the past week, mosquito-borne Zika infections acquired by travelers returning from the Maldives were reported by Germany and Spain. Prior Zika cases were reported in January 2016; countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week: Saint Kitts and Nevis; Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week: Guatemala; Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week: Ecuador.
Key updates
Countries in the Western Pacific Region continue to report new cases as seen in Singapore, Philippines, Malaysia and Viet Nam. Thailand, in the South-East Asia Region, has also recently reported Zika cases. Key areas of the response as identified by members of the Association of Southeast Asian Nations (ASEAN) are disease surveillance and risk assessment, relevant and timely sharing of data, regional surveillance and response, vector control, diagnostic testing, laboratory networks and risk communication, and sharing knowledge and best practices. The Ministry of Public Health of Thailand is investigating cases of microcephaly to determine if they may be linked to Zika infection.
The sequencing results from two Zika virus cases reported in Malaysia indicate that both are from the "Asian" lineage but are from slightly different strains. The first imported case is similar to the virus that was circulating in French Polynesia in 2013, i.e., a post-2007 "Asian" strain. The second locally acquired case is reported to be a similar to a previously circulating Southeast Asian strain of the "Asian" lineage.
Further sequencing analysis in Singapore indicates that in addition to the locally acquired cases which were caused by viruses from older strains of the "Asian" lineage, an imported case with travel history to Brazil was found to be caused by a virus similar to the strain of the "Asian" lineage currently circulating in the Americas.
The 2016 Summer Paralympic Games closed in Rio de Janeiro, Brazil on 18 September. WHO assesses the individual risk of Zika virus infection in travellers returning from the Paralympic Games as low, albeit not zero. To date, WHO has not received any official notification of Zika cases associated with this event. In accordance with WHO guidance, men and women returning should adopt safer sex practices or consider abstinence for at least 6 months upon return and apply insect repellent for at least 3 weeks upon return to reduce the risk of onward transmission.
Analysis
Overall, the global risk assessment has not changed.
The investigation of microcephaly cases in Thailand is important to determine whether these cases are linked to Zika infection - if found to be linked, these would be the first identified cases of Zika-associated microcephaly in Southeast Asia. If Zika is identified, viral sequencing would be necessary to determine the strain of the virus to determine whether it is a local or imported strain.
The sequencing results from 5 Zika virus cases reported in Malaysia indicate that all are from the "Asian" lineage. Two of the cases, including the imported case, are similar to the virus that was circulating in French Polynesia in 2013, i.e., a post-2007 "Asian" strain. The other 3 locally acquired cases are reported to be a similar to a previously circulating Southeast Asian strain of the "Asian" lineage.
Asean members join hands to tackle Zika
TO STRENGTHEN collaboration among Asean member states in order to promote collective action for regional preparedness, surveillance and response to emerging and re-emerging infectious diseases including Zika virus disease, Asean health ministers convened a Special Video Conference on the threat of Zika virus in the region on 19 Sep. 2016.
The meeting was chaired by Dato Seri Setia Dr Awang Haji Zulkarnain bin Haji Hanafi, Minister of Health and hosted by the Ministry of Public Health of Thailand.
In his opening remarks, the Minister of Health noted that engaging with communities to promote environmental sanitation, health and wellbeing and encouraging shared responsibility for health, through a Health is Everyone's Business approach, is the most effective counter to public health threats such as Zika virus disease and other emerging and re-emerging diseases.
Among the issues discussed during the video conference were the global and the regional situation of Zika virus, strategic management approaches for cooperation among Asean member states such as surveillance, prevention, control, public communication, preparedness and response to Zika virus in the region.
The Asean Health Ministers Meeting (AHMM) issued a Joint Statement among other things reaffirming Asean preparedness and response to Zika virus disease and other emerging and re-emerging diseases in the region through effective implementation of the strategies and measures to the best of their capacities for the health security and well-being of everyone. These include:
strengthening in-country disease surveillance and risk assessment with support from the World Health Organization;
taking appropriate measures to manage risks of Zika virus;
to communicate such risks appropriately; and
knowledge sharing and knowledge generation.
Prior to Asean Health Ministers Meeting, a Senior Officials Meeting on Health Development (SOMHD) was held and chaired by Dr Hajah Maslina binti Haji Mohsin, Deputy Permanent Secretary (Professional) at the Ministry of Health in preparation for the Asean Health Minister Meeting.