Right Steps & Poui Trees


#ZikaVirus Update: Jamaica, Caribbean & Beyond

The news regarding the Zika virus is being updated all the time. Underlying the updates is an acute awareness of how much is not yet known about the virus and its effects, how much there is still to learn. Almost on a daily basis, new information about the virus’ spread is reported. In this post, I’ll touch on a few of these updates.

Jamaica: 7 weeks after 1st confirmed case of Zika, 4 new cases confirmed

Up until Thursday, March 17, 2016, Jamaica had one confirmed case of Zika virus, a case which had been confirmed on January 29. The 4-year-old child had started to show symptoms on January 17. This was the first confirmed case and remained the only confirmed case for the following 7 weeks.

As I was driving to a Technical Update on Zika, Gillain-Barre & Microcephaly being held on the evening of March 17 at the Faculty of Medical Sciences at the University of the West Indies (UWI) Mona, this was the foremost question in my mind: Why hadn’t there been any further cases of Zika reported? I wondered what explanations the experts might have for this.

The Technical Update was a collaboration by UWI, the Ministry of Health and PAHO/WHO. A PAHO/WHO technical team was in Jamaica for consultations and the opportunity was seized to have an update which was open to the public.

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Dr Winston De La Haye, Chief Medical Officer, was chairing the proceedings and after the opening remarks, the first presentation began. Dr Stephane Hugonnet of WHO presented on Zika and arbovirus surveillance, microcephaly and other neurological disorders – recent evidence & implications for health systems. IMG_9648 (2)

At the end of his update regarding the global situation, Dr Hugonnet made some comments about the situation regarding the Zika virus in Jamaica. He said that for Jamaica, the epidemic curve of about 95 suspected cases showed a sharp increase, with a peak in week 5, which corresponded with the week in which there was the first confirmed case at the end of January.  This was then followed by a decrease in suspected cases.

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Dr Hugonnet said it was very surprising that there hadn’t been any other cases and it was hard to understand having only one case. He said that the surveillance system was working well, and there were suspected cases of dengue, chikungunya or fever and rash that were being picked up and sampled.

He said that it was a priority to assess whether or not the Zika virus was circulating in the country and that it was necessary to strengthen the investigation around the index case, including retesting to check if it was indeed positive. He also advised sampling of the negative tests to see if they were really negative.

Once it was established that the virus was circulating in Jamaica, there would be no need to keep testing all cases. It would then be necessary to monitor the trend of the epidemic and the geographical spread. It would also be necessary to monitor pregnant women and cases of Guillain-Barre Syndrome (GBS), and to establish baseline data for microcephaly and GBS.

At the end of Dr Hugonnet’s presentation, Dr De La Haye resumed the podium to continue his duties as Chairperson. In a rather dramatic turn of events, he told the gathering that on his way to the symposium, he had actually received information that 2 new cases of Zika had been confirmed. This meant that the country now had a total of 3 confirmed cases. He noted that the 2 cases had been confirmed by the recently upgraded Virology Lab at UWI, saying that it was an advantage to have a shorter turn around time for getting test results. (See JIS report regarding UWI Virology Lab upgrade)

MOH zika virus press conference 18-3-16

Ministry of Health press briefing on Zika virus, March 18, 2016 (Far left: Dr De La Haye. 2nd from left Minister Tufton.)

By the time the Ministry of Health held a press briefing the following afternoon (Friday, March 18), the number of confirmed cases had increased to 4. Remarks by Minister of Health Dr Christopher Tufton at Zika press briefing – 18-3-16 By the post-Cabinet press briefing on Tuesday, March 22, another case had been confirmed, bringing the total to 5. Four of the cases were in Portmore, St Catherine and one was in Lyssons, St Thomas. And it is expected that the number of cases will increase.

moh zika tufton more cases 18-3-16

Representatives of the Ministry of Health have been doing many media interviews, outlining the steps being taken by the Ministry regarding the increased number of cases and reiterating the ongoing public health messages about reducing the risks of being infected by the Zika virus.

Caribbean Public Health Agency Update on Zika in the Caribbean

On March 23, 2016, the Caribbean Public Health Agency (CARPHA) posted a short video in which Executive Director, Dr. C. James Hospedales provided an update on the Zika virus in the Caribbean region. (Click here for video.)carpha zika virus video update 23-3-16Some points made by Dr Hospedales:

  • 15 countries in the region have reported cases of Zika virus transmission in their countries/territories.
  • Microcephaly & Guillain-Barre are rare conditions and are not required to be reported in the Caribbean region, so there is little baseline data on these conditions.
  • CARPHA is now in the process of setting up collection of baseline data.
  • The Caribbean is vulnerable to Zika virus for a number of reasons: a susceptible population which has not met the virus before, wide spread Aedes aegypti mosquitoes & a lot of travel in and out of the region.
  • In another 2 months, many of the countries will see the start of the rainy season, which will increase possibilities for increased mosquito breeding.
  • The two most important messages for stopping the spread of Zika are stopping the mosquito breeding & stopping the mosquitoes biting.

CDC Issues Updated Zika Recommendations to do with Pregnancy and with Sexual Transmission

On March 25, 2016, the US Centres for Disease Control & Prevention (CDC), issued an update of its recommendations regarding aspects of Zika Virus. (Click here for full update.)

cdc update re zika 25-3-16

The updated recommendations, which are worth reading in full, are given under 3 headings:

Article 1: Updated interim guidance for pregnant and reproductive age women

Includes the following:

cdc zika 25-3-16 coloured page A

Article 2: Updated interim guidance for preventing sexual transmission of Zika

Includes the following:

cdc zika 25-3-16 coloured page B

Article 3: Increasing access to contraception in areas with active Zika transmission

Includes the following:

cdc zika 25-3-16 coloured page C

(It is significant to note that more than 50% of pregnancies in Jamaica are unintended, which impacts the public health education regarding Zika and pregnancy here also.)

As the spread and impact of the Zika virus continues in the region, we in Jamaica need to keep informed and act on the information to best protect ourselves from this new personal and public health challenge.

 

 


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Zika Virus News Events in Jamaica & Elsewhere

The past few days have been significant ones for news about the Zika virus.

who zika press conference 1-2-16

WHO Press briefing re Zika virus Feb 1, 2016

WHO Declares Public Health Emergency of International Concern

On Monday (Feb 1, 2016), the World Health Organization (WHO)  declared “that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern.” (WHO Director-General Dr Margaret Chan’s statement) This decision was taken after the first meeting of the Emergency Committee which had been convened by the Director-General to look at these clusters in some areas now experiencing outbreaks of Zika virus. (WHO statement on 1st meeting of International Health Regulations Committee on Zika virus)

A Case of Sexually Transmitted Zika in Texas

zika - Dallas release 2-2-16 with highlightingThen yesterday came the headline-catching news from Dallas that the Centres for Disease Control (CDC) had confirmed a case of Zika virus infection which had been sexually transmitted. The Dallas County Health and Human Services (DCHHS) sent out a press release about the case. DCHHS Press Release re Sexually Transmitted Case of Zika Virus. A case of sexually transmitted Zika virus was recorded in 2008, but no cases during the current epidemic. (Listen to a 2011 CDC podcast about the 2008 case in Colorado.) Though the main mode of infection remains via the Aedes aegypti mosquito, this new case in Dallas does add another dimension to the current epidemic.

Two Briefings in the Wake of Jamaica’s First Confirmed Case of Zika Virus

Yesterday (Feb2, 2016) in Jamaica the Ministry of Health (MOH) held a press briefing, to update the country about the first confirmed case of Zika virus, which it had informed the public of last Saturday. Five Government Ministers addressed the briefing on aspects of the Government’s actions and plans regarding the Zika outbreak. Also in attendance were some Members of Parliament and Mayors, the MOH Permanent Secretary, the new Chief Medical Officer and a number of other government personnel.

Zika - GOJ press briefing 5 ministers - 2-2-16The Ministers (from left to right) were: Minister of Local Government & Community Development, Noel Arscott; Minister of Youth & Culture, Lisa Hanna; Minister of Information, Sandrea Falconer; Minister of Health, Horace Dalley and Minister of Education, Ronald Thwaites.

The video of the press conference is posted online, with the Minister of Health’s comments about the first confirmed case and subsequent actions taken by his Ministry running from 10:37 – 16:46 of the video.

Among the things that Minister Dalley mentioned were that:

  • the child who was the 1st confirmed case of Zika has recovered & no other member of the family is showing symptoms of the disease
  • there is increased fever/rash surveillance in Portmore and the entire island
  • that 1894 households in the particular area have been checked & interviews done with 1355 people
  • that 15 blood samples were taken as a result of the interviews & were sent to the CARPHA lab in Trinidad for Zika testing

The presentations were followed by a question and answer session with journalists.

Last night, zika - PM Simpson Miller 2-2-16Prime Minister Simpson Miller made a national broadcast regarding the preparations to reduce the impact of the Zika virus (video).

Text of National Broadcast re Zika Virus by PM Simpson Miller

At 5:30 that evening, the University of the West Indies (UWI) Faculty of Medical Sciences in collaboration with PAHO/WHO and the MOH held a Public Symposium entitled “Zika Virus Update”. It is a pity that this symposium wasn’t broadcast or recorded, as it was an excellent session, with very informative presentations and a robust question and answer session.UWI Faculty of Med Zika Update 2-2-16 poster with border

The focus of this symposium was obviously different from that of the MOH press briefing in the morning and a great deal of medical and scientific information was given and issues explored. It was particularly useful to have information given about the Jamaican context for the Zika outbreak and the issues arising out of that context. I found Professor Christie’s presentation of particular interest, raising as it did issues about the seriousness of the situation being faced regarding our ability to deal with an increase in cases of children born with possibly severe microcephaly.

A few other issues that came up during the symposium:

  • the impact of the advice for women to postpone pregnancies, given the fact that 50-60% of pregnancies in Jamaica are unplanned
  • whether in Jamaica women will have the option of an abortion in cases of Zika infection
  • the complexities surrounding testing for Zika virus & Jamaica’s current and planned capability for doing such testing
  • whether the current levels of fever/rash surveillance are adequate or should be greatly increased during the early stages of the outbreak

Repeatedly the point was made regarding how much is not yet known about the Zika virus and the possible complications associated with this generally mild to moderate disease. The need for further and ongoing research was stressed, but as Professor Figueroa said, in public health, you need to take the best of what you know and act on it; you can’t tell patients to wait on the results of a study.

There is a need for more opportunities for professionals to share information of this kind regarding Zika, and to be able to answer questions and engage in discussions with members of the public. These opportunities mustn’t be scripted and limited, but must allow for the open exchange of information and for frank discussion. A wide range of options exists for sharing such information and they must be used.