Zika Virus Update

PRESENTED BY:

Dr. Michael Braida

Wednesday, 25 May 2016 | 10:00 – 11:00

2

Zika Virus Outbreak

• Canadian medical doctor living and working in UK and Germany

• Medical Director at MedAire Farnborough UK

• Intensive Care Specialist plus 17 years HEMS in Munich Germany

• Regional Medical Director at International SOS supporting the Oil and

Gas Industry

Author - Disclosure

3

Aviation and Global Outbreaks

5

Zika Virus – where did it start?

1947

• Routine yellow fever monitoring in the Zika

Forest in Uganda blood taken from rhesus

monkeys Zika virus

1948

• Virus isolated from Aedes africanus captured in

the Zika forest

1952

• First human cases in Uganda and Tanzania

6

Zika Virus

Chronology - I

Sources: enter sources here

7

Zika Virus

Chronology - II

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8

Zika Virus

Chronology - III

Sources: enter sources here

What is Zika Virus disease?

• Zika virus disease is an emerging

mosquito-borne illness.

• Spreads via mosquito bites – to non-human

primates and humans

• Prior to this outbreak, limited studies.

• Present in tropical areas of Africa, Asia,

South America and Caribbean Islands

• No specific treatment, and no vaccine

are available

A lot more research is underway

Zika Virus Symptoms

Mostly mild. One in five will get symptoms about two to seven days

after the mosquito bite. Similar to dengue, chikungunya, malaria.

Common symptoms include:

• Fever

• Rash

• Muscle and joint pain

• Conjunctivitis (red eye)

• Headache

Most people recover in about a week.

Growing evidence, but not clear if Zika alone is responsible.

Appears to be associated with

• Brain malformations in the babies of women who were infected while

pregnant, including “microcephaly” (small head circumference and

brain damage)

• “Poor outcomes” in pregnancy such as miscarriage or still birth

• Guillain-Barré syndrome - muscular weakness which can be mild or

severe, leading to respiratory failure

Several affected nations have advised women to delay pregnancy

Zika Virus Complications

How does Zika Virus spread?

• Via Aedes mosquitoes (the same mosquito spreads dengue,

chikungunya and yellow fever). Life cycle 1½ to 3 weeks!

• These mosquitoes mostly bite during the day - inside and outside.

• Other types of transmission

• Sexual – from males to female – appears to be more than previously

suspected. Unknown how long virus persists in semen (detected at 62

days post illness)

• From mother to newborn around time of delivery or possibly during

pregnancy

• Blood transfusion

• Perhaps through infected monkey bite (rare)

Zika Virus Diagnostics and Treatment

Diagnosis:

• Suspected based on symptoms and history of exposure (e.g. travel).

• Specialised blood tests are needed to confirm the diagnosis.

Treatment

• No specific treatment is available.

• Treatment is mainly supportive and includes rest, plenty of water.

• If using medicine to relieve fever and pain, AVOID aspirin / non-

steroidal anti-inflammatories (such as ibuprofen) unless dengue has

been excluded, as these medicines can make bleeding worse.

Diagnostics

http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/patient-case-management/PublishingImages/zika-virus-laboratory-diagnosis-LARGE.jpg

• An individual risk assessment

• Some authorities are advising pregnant women to consider

postponing travel, especially to areas with increasing or

widespread transmission.

• US CDC travel notice applies to >20 countries, other

authorities identify other locations

• Some authorities advise women to delay getting pregnant

for at least 28 days after travel to a Zika-affected area due to

the risk of birth defects

Should I travel to a Zika region?

• Monitor the information, which is changing

• If travelling to an affected area, prevent infection by reducing your chance of

getting mosquito bites

• Pregnant women - consult your doctor for an individual risk assessment.

Consider avoiding travel to affected areas. If travel must proceed, prevent

mosquito bites.

• In addition to the infectious risks consider the standard of available healthcare,

and obstetric and neonatal specialist support.

Travel Advice

• Monitor your health for two to three weeks

• If symptoms develop, seek medical care, and

advise your doctor of your travel history

• Some authorities are advising women to delay

pregnancy for 28 days, and men to use condoms

(for at least 28 days up to 6 months)

Returning Travellers

Research in the Scientific Community

Indoor bite prevention

• Use insecticide sprays or vaporisers:

– Spray bedrooms before going to sleep.

– Plug-in electric vaporisers release insecticide.

• Install insect screens on doors and windows:

– The mesh size should be less than 1.5mm.

• If possible use air conditioning:

– It may reduce the chance you will be bitten

• Use an insecticide-treated bed net:

– Make sure the net does not have any tears.

– Tuck the ends in under the mattress, or make sure it reaches the

floor.

– Use it if resting / sleeping during the daytime (and also at night).

Outdoor bite prevention

• Wear clothing that covers most of the body (long sleeves and long pants).

– Wear socks and shoes.

– Consider treating clothing with an insecticide if you are very likely to be exposed to

mosquitoes

• Be aware of peak exposure times.

• Avoid mosquito breeding areas (stagnant or still water).

• Use an effective insect repellent:

– Such as one containing DEET, Picaridin, PMD, or IR3535. Reapply after swimming

or excessive sweating.

– Coils: Release pyrethroids which repel mosquitoes. Use outdoors only.

What does NOT repel mosquitoes

• Sound-producing vibrating buzzers

• UV Blue light electric zappers

• Herbal preparations

• Vitamins

• Citronella candles / burners

Zika virus prevention

Prevent mosquito breeding sites:

• Aedes mosquitoes like stagnant water found in man-made

containers around homes and urban areas.

• Make sure any containers you have outdoors don’t collect

standing water.

• Turn buckets and watering cans upside down when not in use.

• Don’t place dishes of water under pot plants.

• Clean up and dispose of fallen leaves regularly.

• Clear any stagnant water in air conditioning units and gutters.

(Un)usual mosquito breeding sites

Air-con trayTree hole Plant axil

Discarded receptacleCanvas sheetBBQ pit

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Zika Virus

Aviation

Sources: http://www.capsca.org/ http://www.who.int/ihr/ports_airports/zika-aircraft-disinsection/en/

Pre-flight

• A pre-flight aerosol containing an insecticide with rapid action and limited

residual action is applied by ground staff to the flight deck, passenger cabin

including toilet areas, open overhead and side-wall lockers, coat lockers

and crew rest areas. The spray is applied before the passengers board the

aircraft but not more than 1 h before the doors are closed.

• A 2% permethrin cis:trans (25:75) formulation is currently recommended

• t½ up to 2 weeks

• Preflight spraying is followed by a further in-flight spray, i.e. top-of-descent

as the aircraft starts its descent to the arrival airport.

Blocks Away

• Spraying is carried out by crew members when the passengers are on board,

after closure of the cabin door and before the flight takes off.

• The air-conditioning system should be switched off during cabin spraying. The

flight deck is sprayed before the pilot boards (when no passengers are on

board). The doors of overhead luggage racks should be closed only after

spraying has been completed.

• An aerosol containing 2% D-phenothrin is currently recommended by WHO

• t½ 38 to 72 minutes

• Cargo holds should also be disinsected

Top of descent

• Carried out as the aircraft starts its descent to the arrival airport.

• 2% D-phenothrin is currently recommended by WHO for this purpose and

is applied with the air recirculation system set at from high to normal flow.

Residual

• The internal surfaces of the passenger cabin and cargo hold, excluding food

preparation areas, are sprayed with a compression sprayer that has a constant

flow valve and flat fan nozzle according to WHO specifications

• Permethrin 25:75 (cis:trans) emulsifiable concentrate is currently recommended

by WHO

• Air-conditioning packs should be run for at least 1 h before the crew and

passengers embark to clear the air of the volatile components

• Residual disinsection is a professional service!

https://www.transportation.gov/office-policy/aviation-policy/aircraft-disinsection-requirements

Crystal BallWhat May Lie Ahead?

• Expect Zika to spread to all countries in the Americas (except Canada and

continental Chile)

• More exported cases, imported cases will be detected. Outbreaks may occur

in places with the mosquito vector

• Expect outbreak to lessen in South America with onset of winter

• Expect outbreaks in the USA this summer – southern states, and other African

and Asian countries at-risk too

• Progress with diagnostics

• Vaccine may be years away?

Thank You