Right Steps & Poui Trees


1 Comment

Births Fall in Jamaica in 2016…Because of #Zika Warning?

RJR birth decline in 2016 report - 4-5-17I heard the tail end of a report on RJR’s 5pm newscast yesterday (May 4, 2017), which said that there had been a significant decline in births in Jamaica last year. This seemed interesting in the context of the warning to delay pregnancy issued by the Ministry of Health (MOH) in January 2016, in advance of the country’s first confirmed case of the zika virus.

 

MOH warning to pregnant women 1-2016

During his Sectoral Debate presentation on May 3, 2017, Minister of Health Christopher Tufton tabled the first edition of Vitals, a new quarterly report published by his Ministry, which contains the following information:MOH reduced births 2016 chart

MOH reduced births 2016 text

(p.12, Vitals: Quarterly Report of the Ministry of Health – April 2017)

 

This 28% decline in the 4th Quarter of 2016 – nine to twelve months after the zika warning was issued – does on the face of it seem related to the warning. It certainly invites further study to understand how women and their partners responded to the warning and what part various factors, such as discussions and planning, increased use of contraceptives, access to abortion, for example, played in the subsequent decrease in births. It would also be interesting to compare this decrease in Jamaica with other countries which issued similar warnings. I also wonder whether there has been another recent year in which Jamaica has seen an annual decrease in births as large as 7.4%. (The RJR report mistakenly stated that the 28% decline was for the entire 2016, rather than only the 4th Quarter.)

Zika Update

The issue of Vitals also gives an update on the situation with zika in Jamaica up to the first week of April 2017:MOH zika update - Vitals 4-2017

It also reported on the cases of pregnant women with zika infections and the babies with suspected or probable cases of Congenital Syndrome Associated with Zika Virus (CSAZ).

There were 827 cases of notified Zika virus infection in pregnant women reported as at 10th April, 2017; 698 have been classified as suspected Zika based on the case definition. Of the 698 suspected cases, seventy-eight (78) have had positive PCR results confirming Zika virus infection. There were 170 notifications received regarding babies suspected as Congenital Syndrome Associated with Zika Virus Infection (CSAZ), 50 were classified as suspected cases of CSAZ (46 Microcephaly – 35 non-severe, 11 severe; 4 other congenital abnormalities). Three infants based on Pan American Health Organization/World Health Organization were classified as probable cases of CSAZ.

(p. 17, Vitals: Quarterly Report of the Ministry of Health – April 2017)

There is obviously more to be said about the cases of babies suspected to have been affected by the zika virus, including why the numbers were fewer than initially feared, how the cases of microcephaly compare to previous years in number and severity and how the programmes to support the babies, their mothers and families are proceeding.MOH Vitals 4-2017

Vitals – A New Publication by the Ministry of Health

 

When he introduced the new publication during his Sectoral Debate presentation, Minister Tufton said that he hoped it would be a source of information and a tool for accountability.Tufton sectoral debate presentation 3-5-17 Vitals

I welcome this new quarterly report and think that it can indeed be a useful source of information about a variety of topics that are part of the remit of the Ministry of Health. I hope, however, that it will be easily and widely available. I found the link to it on Minister Tufton’s Twitter account. Up to the time of publishing this blog post, it wasn’t available on the MOH website or via the Jamaica Information Service website. I hope it soon will be.

 

 

 


Jamaica & #Zika One Year Later: First Probable Case of Zika-Related Microcephaly

On January 30, 2016, the Ministry of Health (MOH) notified the public of Jamaica’s first confirmed case of the zika virus. Almost a year later it has notified the public of the first probable case of a baby born with zika-related microcephaly.

The MOH post on its website gave brief information about the case and some background information regarding actions taken and to be taken by the Ministry. (Click here for full brief.)moh-1st-probable-case-zika-related-microcephaly-post-19-1-17

dr-winston-de-la-hayeIn media interviews, Chief Medical Officer Dr Winston De La Haye indicated that the baby had been born in late December 2016 at the Victoria Jubilee Hospital, that the mother had had a rash during her pregnancy and that tests done for other possible causes of microcephaly, such as HIV  and toxoplasmosis, had come back negative. He said that the Ministry is now awaiting results of tests for zika infection in the baby, which would confirm this as zika-related microcephaly, if the results are positive. He also spoke about the support which will be given to the family and the baby over the coming years.

Dr De La Haye noted that to date there have been 21 suspected cases of zika-related microcephaly in Jamaica, but only this one probable case and no confirmed cases.Suspected, probable and confirmed cases are classified as follows:

We wait to see if this probable case is confirmed and if there are more babies born with probable or confirmed conditions related to zika infection. Jamaica, like so many other countries which have had a zika outbreak, may not experience the level of problematic conditions in babies that has been documented in Brazil.

Other Caribbean countries, including Trinidad & Tobago, Grenada and Guadeloupe, have reported confirmed cases of Zika congenital syndrome.

Zika Outbreak Data

The following chart showing zika data from August – December 2016 is compiled from data posted in periodic updates on the MOH website. The actual number of zika infections would be significantly higher than given, taking into consideration those who had symptoms but never visited a doctor or clinic, those doctors who may not have reported all cases they saw and those people who had a zika infection but never displayed any symptoms. moh-zika-data-chart-aug-dec-2016

The October 26, 2016 MOH brief, also on the website,  contains further information about the status of the zika outbreak in Jamaica at that point in time, such as this figure showing the distribution of zika across the parishes:moh-zika-brief-26-10-16

and this section giving figures for cases of dengue and chikungunya during the same period.moh-zika-brief-26-10-16-arboviruses

A year after the first confirmed case of zika in Jamaica, the outbreak is long past its peak; the number of reported cases has been on a downward trend for months. Now we wait to see what level of impact the virus has on babies being born in the wake of the outbreak. It will also be useful to see at some point an assessment of the government’s overall response to the outbreak.

 

 


1 Comment

Jamaica: Ministry of Health #Zika Virus Update – June 2, 2016

Last week Thursday morning (June 2, 2016), the Ministry of Health (MOH) held a press briefing to give an update on the current situation regarding the zika virus outbreak in Jamaica. Minister of Health, Dr Christopher Tufton, made an initial statement and was supported during the question and answer session  by MOH Permanent Secretary, Dr Kevin Harvey & Chief Medical Officer, Dr Winston De La Haye. Also participating in the briefing was Dr Noreen Jack, PAHO/WHO representative in Jamaica.

moh 2-6-16

L to R: Dr De La Haye, Minister Tufton, Dr Harvey

Dr Tufton first gave his statement, the text of which can be seen on the MOH website, but he and others gave additional information during the briefing. He has also posted the link to his Periscope video of the briefing on his Facebook page. (The video does not contain the entire briefing; however, it contains a substantial amount.) Below is some of the information given during the briefing.

Ministry of Health Zika statistics as of May 29, 2016

  • 1969 notifications
  • 1387 notifications fit the case definition for suspected zika
  • 465 suspected cases in Kingston & St Andrew
  • 405 suspected cases in St Catherine
  • 787 samples tested
  • 403 test results received
  • 16 positives for zika, with lab test confirmation
  • 6 additional preliminary positives now being retested
  • 2 pregnant women have tested positive
  • all 16 positive cases have fully recovered

Dr Tufton said that 16 confirmed cases doesn’t reflect the reality on the ground, which is why the MOH is also giving the numbers of suspected cases at this time.

MOH zika briefing 2-6-16 Tufton ab

The MOH is also investigating clusters of people with rash that is suspected to be zika; these reports are coming primarily from the parishes of Kingston, St Catherine, Westmoreland and Clarendon.

Microcephaly & Guillain-Barre Syndrome (GBS)

At the briefing, an update was given on the two main complications of zika infection which have been of concern to the MOH, as they have been to the global community – microcephaly and GBS.  So far there have been no confirmed cases of microcephaly or GBS linked to zika virus in Jamaica.

Microcephaly

  • 1 case of microcephaly reported; on investigation  found to be negative for zika. Woman would have become pregnant before zika reported in island.
  • Dr Harvey noted that there is no baseline data for microcephaly in Jamaica, as it is not a reportable condition.
  • MOH is now going back and doing docket searches to establish a baseline.
  • The head circumference of all babies born in medical facilities is now being measured.
  • MOH will be monitoring carefully, particularly from September onwards, which will be 9 months since first confirmed case of zika.

GBS

  • 7 cases of GBS are currently being managed; 3 at Spanish Town Hospital, 3 at Kingston Public Hospital (KPH) & 1 at University Hospital of the West Indies (UHWI).
  • Results as at June 1, 2016 showed that the patient at UHWI and 2 of the patients at Spanish Town Hospital are zika negative.
  • Since start of 2016, MOH has been actively searching for cases of GBS. So far 13 investigated, 6 of which also tested negative for zika.
  • Dr Tufton cautioned that a negative zika test does not absolutely rule out zika association, due to the short window of 3 to 5 days for testing.

Going Forward: The 2nd Phase of the Outbreak

During the second phase of its activities, the Minister indicated that there will be more focus on pregnant women and their partners, as well as those who develop severe complications such as GBS. The MOH will continue “to engage the population and stress the importance of taking personal responsibility.”

Among the activities listed were the following:

  • Employing 1000 temporary workers to support the public health team in engaging in island-wide community vector control and public education activities.
  • Hosting island-wide education sessions working through agencies such as the Social Development Commission, Neighbourhood Watch and the police to get to communities.
  • Continuing the monitoring of pregnant women at the community level throughout their pregnancies including providing them with educational support.
  • Providing 20,000 bed nets over six months to all pregnant women who visit antenatal clinics; these nets have been obtained with the help of Food for the Poor.
  • Carrying out Vector Control activities through ‘fogging’ and larvicidal activities.
  • Conducting heightened House to House Surveillance in sections of the population where the infection has been notified and/or confirmed.
  • Working with the international partners such as PAHO/WHO/CARPHA/CDC to ensure that MOH actions are aligned with international standards and best practices.

moh ps harvey 2-6-16Dr Harvey noted that reporting of zika cases is currently a manual process, but that the MOH is working on a web-based form, which it intends to roll out in a couple of weeks. moh dlh 2-6-16Dr De La Haye indicated that some doctors have said that they find the form long & that a review is underway. He also reiterated that the MOH doesn’t wait for confirmation of zika cases before it takes action, but acts on reports of suspected cases. He said that some doctors have indicated that they are seeing as many as 20-25 cases of zika per day.

One question from a reporter was whether there has been a decrease in the number of pregnancies, given the MOH advice to women earlier this year to delay pregnancies. Dr Harvey responded that what is counted is births, and so any such decrease could only be noted later in the year. (Dr Tufton had indicated earlier in the briefing that there are approximately 40,000 births annually in Jamaica.)

moh who rep 2 2-6-16

The Olympic Games in Brazil

In response to a question, Dr Tufton said that the MOH did have concerns about our athletes going to the Olympics and continued to monitor the international debate regarding postponement of the games, though not a part of such discussions. He said that the MOH would be proactive in ensuring that athletes and supporters were given appropriate information and support, and that they understood the risks. On their return, people would be monitored for zika symptoms.

Dr Jack added that at this point WHO advice is not to stop the Olympics. She said that 60 countries have active zika transmission and that the risk of visiting Brazil is no greater than visiting any other country with active transmission. She said that current advice is that pregnant women not travel to countries with active zika transmission; others may travel, but are advised to take the recommended precautions to prevent being bitten by mosquitoes. It is advised that people are monitored for symptoms on return and that they abstain from sex or have safe sex for a month to prevent sexual transmission of zika.

(Last week a WHO spokesperson said that the Emergency Committee on zika will discuss concerns about zika and the Olympic Games at a meeting in June.)

Dr Tufton said that he will be giving a report on zika to Parliament on Tuesday,  June 7 and will give additional details during that report.

 

PS: Live Coverage of Media Briefing 

On the morning of the briefing, I called both the Jamaica Information Service (JIS) and the Public Broadcasting Corporation of Jamaica (PBCJ) to find out if either would be carrying live coverage of the event. I was very disappointed to find out that neither agency planned to do so.

I certainly appreciate the live coverage that did take place:

  • Minister Tufton carried the briefing live via Periscope on his Twitter account: @christufton
  • Jamaica News Network (part of the RJR Group) carried live coverage on television & online
  • Power106FM interrupted their regular programming to carry part of the briefing live.

It is not acceptable, however, that a public health briefing of this nature and importance was not carried live by either of the government broadcasting agencies.