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PHL on alert; WHO sets emergency conference as Zika virus spreads

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MANILA — President Aquino has directed the Department of Health (DOH) to be on alert as Zika virus spreads in the Americas and in Asia and the Pacific prompting the World Health Organization (WHO) to call for an emergency meeting among countries affected.


At press time, the DOH is not yet imposing travel restrictions to countries where Zika virus cases have been reported and is also not considering any plan for monitoring arriving passengers in the airports and seaports to check if they are sick or infected with the virus.


This as Zika virus, a close cousin of dengue and chikungunya, is spreading "explosively" in the Americas, and could spread even further afield amid an "extremely high" level of alarm, according to a senior official of the World Health Organization (WHO).


Margaret Chan, WHO director-general, made the statement while briefing WHO's board members in Geneva on the Zika situation, UN spokesman Stephane Dujarric said.


Chan said that Zika cases have been reported in 23 countries and territories in the region.


Symptoms of Zika virus, which is spread to people through mosquito bites, include low-grade fever, joint pain, rash, conjunctivitis, headache, muscle pain and eye pain.


"Chan explained that a causal relationship between the virus infection, and birth malformations and neurological syndromes has not yet been established, but is strongly suspected," Dujarric said. "And the possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions."


"WHO is deeply concerned about the rapidly evolving situation for four main reasons -- the possible association with birth malformations and neurological syndromes; the potential for further international spread; the lack of population immunity in newly affected areas; and the absence of vaccines, specific treatments, and rapid diagnostic tests," Dujarric said.


"Conditions associated with this year's El Nino weather pattern are also expected to increase mosquito populations greatly in many areas," the spokesman said.


Chan convened an International Health Regulations Emergency Committee on the virus and observed increase in neurological disorders and neonatal malformations on February 1 in Geneva to ascertain whether the outbreak constitutes a Public Health Emergency of International Concern, he said.


Australia and Pacific island countries are on high alert for the mosquito-borne Zika virus that has been linked to severe birth defects.


Following WHO decision to convene an emergency committee on the Zika virus situation, unit chief for International Health Regulations epidemic alert and response Sylvain Aldighieri said: "We expect huge numbers of infections, some detected and others undetected."


"There is great deal that remains unknown about the Zika virus, but the reports and suspected links to birth defects and neurological problems mean that this threat must be taken very seriously," said Papua New Guinea's Prime Minister Peter O'Neill in a statement.


Australian authorities have implemented measures to help stop the spread of the virus through the Torres Strait with monitoring in the nation's remote north already underway.


"We'll monitor closely through the Torres Strait. We already do that with a number of infectious diseases," Queensland state health minister Cameron Dick said.


Dick said the Zika virus does not pose a significant health risk to Queensland "at this time ... but we're going to continue to monitor that."


Zika carrying mosquitoes are endemic to tropical and sub-tropical environments.


There are currently no reported cases of Zika in Australia.


Though the World Health Organisation (WHO) is convening an emergency meeting in Geneva to determine its response to the spread of the virus, vaccine manufacturers have said a vaccine for wide-scale public use is months, if not years away.


Current efforts to combat Zika are focused on protecting people from being bitten and on eradicating mosquitoes, a tough task for many parts of the poverty stricken Pacific islands that have been saving water from the El Nino enforced drought, inadvertently providing a breeding ground for the disease spreading insect.


Based on dengue epidemiology in the Americas and the over 2 million cases which are reported in the region every year, Aldighieri estimated that there could be "between 3 and 4 million cases of Zika infections in the Americas."


"With respect to China and Asia, at this moment we don't have any official notification of Zika virus in that area," he said, adding he did not know what would be the required timeframe, or indeed the feasibility, of developing a vaccine.


Zika is transmitted primarily by Aedes mosquitoes, which also transmit chikungunya and dengue viruses and which are present in every country of the Americas except Canada and continental Chile.


It is strongly suspected of causing birth malformations. Thus, women in Brazil, Colombia and El Salvador have been advised against getting pregnant during the outbreak.


Zika virus was first isolated from a monkey in the Zika forest in Uganda in 1947.


“We have no travel restrictions,” said DOH Spokesperson Dr. Lyndon Lee Suy.


Dr. Suy explained that it is not feasible to implement the same kind of measures that the DOH utilized during the threats of emerging infectious diseases such as Ebola virus diseases (EVD) and Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) wherein they gave travel advisories and monitored arriving passengers through the thermal scanners at the airports.


He said that imposing such measures is not feasible because they do not want to create the wrong impression of fear that may cause confusion which they are trying to avoid.


He said it is also not proper to suspect any arriving passengers with symptoms similar to that of Zika virus infection and will be placed in quarantine sites.


He added that while they recognize the need to be on alert against the disease, the public must be made aware that the means of acquiring or transmission of the Zika virus is very much different from EVD and MERSCoV and other infectious diseases.


Dr. Lee Suy stressed that the transmission of infectious diseases such as EVD and MERSCoV is through people-to-people contact while Zika virus can be transmitted by bites of Aedes aegypti mosquitoes carrying the Zika virus.


The DOH spokesperson added that what should be given much attention is the “potential source/s” of Zika virus which is also present in the country -- the aedes mosquito which should be stopped from growing in numbers.


Aedes mosquitoes are also the same mosquitoes that can cause dengue hemorrhagic fever.


The Health official said that what should be strengthened at this point in time is the people’s participation in cleanliness activities that will help stop the breeding or growing of the number of aedes mosquitoes that can possibly transmit and become carriers of the Zika virus.


He reiterated that the best preparation still is boosting of awareness on cleanliness and ensuring that stagnant water is properly covered so that the mosquitoes will not be able to lay their eggs there.


He also said that helping in destroying the breeding sites can help a lot in reducing the risk of the threat of Zika virus, dengue and even chikungunya infections.


He also said that there is a need for people to know and realize that they need to help in bringing down the population of mosquitoes which have the tendency to bite when they are “hungry for blood” and do not select the next target or victim to bite -- man, woman, old and young, pregnant woman or not, etc.


For pregnant women, he reminded that while the DOH is not imposing any travel restrictions, it is best for them to consider the welfare of the baby in their wombs and wisely decide on their own to definitely avoid going to places where Zika virus are reported to be spreading.


“If you're pregnant, as much as possible, think twice before you get to travel… Kailangan ba, urgent ba na pumunta ka sa lugar na may ganitong problema?” he added.


The Health spokesperson said that in case traveling or going to destinations where Zika virus cases are reported is unavoidable, pregnant women taking the risk should ensure that they have adequate protection from the bites of mosquitoes carrying the Zika virus.


He said that wearing long pants and long sleeves are good options.


He explained that the Zika virus effects to humans are relatively mild infections (similar to manifestations of influenza) such as mild fever, joint pains, rashes, and conjunctivitis.


“Kung titingnan natin ay parang trangkasong-trangkaso ang dating,” he added.


He also clarified that dengue manifestations are more severe than the Zika virus.


In terms of mortality, Dr. Lee Suy said it is not life- threatening.


“Kung life threatening ito? It’s not life threatening… Very rare do we hear of patient dying because of Zika,” he added.


He said that what makes the Zika virus something to be feared about is the possibility of Zika virus to cause microcephaly, a congenital defect where a baby has an abnormally small head and incomplete development of brain.


Dr. Lee Suy explained that while there were some studies done connecting microcephaly to Zika virus, it is not likely that all pregnant women will have babies born with microcephaly.


“It is not 100 percent… Only possibility because there is no clear evidence yet in terms of linking the Zika virus to microcephaly,” he added.


At present, there is still no vaccine treatment for Zika virus, which is a close cousin of dengue and chikungunya.


The first case of Zika virus infection in the country was in 2012 wherein a male individual was reported to have been infected with a Zika virus-carrying mosquito.


Since then, no additional case has been reported in the country.


At present, Zika virus is spreading through Latin America and the Caribbean countries.


The infection is being linked to thousands of the birth defect microcephaly in Brazil. 

The situation since has drastically changed. In 2015, the mosquito-borne virus was detected in the Americas with Brazil reporting its first case in May last year.


Zika infections have now been reported in 23 countries and territories in the region.


"We must use dengue dynamics as our reference point. Where you had a dengue outbreak in previous years and the mosquito aedes aegypti is still present, you have a risk of zika transmission," Aldighieri highlighted.


According to data, only around one in four infected individuals develop symptoms which include fever, rash, joint pain and conjunctivitis.


"Most of the cases don't present many clinical signs. 75 percent of patients infected by the virus will not develop any clear symptoms, or not enough to go to the clinic and see a doctor," Aldighieri said.


Experts strongly suspect two main factors have driven the virus' progress in the Americas according to WHO, which also explained that though a causal relationship between Zika virus infection and birth defects including babies being born with abnormally small heads and other neurological syndromes has not been established.


"First, the population is totally naive in terms of immunology against this virus. The second point is that the vector is everywhere in the Americas, from southern United States to northern Argentina," Aldighieri said.


WHO Assistant Director-General Bruce Aylward warned that though the Zika virus is currently circulating at a very high intensity in the region, gaps remain regarding the situation on the ground.


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