Sunday, August 28, 2016

Singapore Confirms Local Zika Transmission: Finds 41 Cases

















#11,580


Only 24 hours ago Singapore's MOH announced their 1st Locally Acquired Zika Case, and today we learn they have now identified at least 41 locally acquired cases, 7 of which are still symptomatic and have been hospitalized to prevent forward transmission.

Given Singapore's population density (#3rd in the world with nearly 8,000 per sq. km), it's location just 1 degree north of the equator, and an ample supply of  Aedes mosquitoes, the Zika virus appears to has a lot going in its favor.

Working in vector control's favor - June, July, and August are the driest months of the year in Singapore - and the true `rainy season' doesn't begin until November.

Also, although it was planned months ago to help with the suppression of Dengue, yesterday Singapore's National Environment Agency (NEAannounced plans to Conduct Wolbachia-Aedes Small-Scale Field Study At Three Selected Sites From October 2016.

You may recall we looked at the potential uses for Wolbachia infected mosquitoes in the fight against Zika last May in Cell Host & Microbe: Wolbachia Blocks Zika Virus In Brazilian Aedes Aegypti Mosquitoes.


Here is the full MOH announcement on 40 additional locally acquired Zika cases, including their expectation that more will be detected.




Localised Community Spread Of Zika Virus Infection With More Cases Confirmed

    News Highlights

       The Ministry of Health (MOH) has confirmed 41 cases of locally transmitted Zika virus infection in Singapore. Of these cases, 36 were identified through active testing of potentially infected persons.

Aljunied Crescent/ Sims Drive Cluster

2.    All the cases are residents or workers in the Aljunied Crescent/ Sims Drive area.  They are not known to have travelled to Zika-affected areas recently, and are thus likely to have been infected in Singapore. This confirms that local transmission of Zika virus infection has taken place.  At this point, the community transmission appears to be localised within the Aljunied Crescent/ Sims Drive cluster.

3.    34 have fully recovered. The other 7, who are still symptomatic and potentially infectious, are recovering at Tan Tock Seng Hospital.

4.    The profile of the 41 cases are as follows:

    A 47-year-old female Malaysian had developed fever, rash and conjunctivitis from 25 August. She was referred to the Communicable Diseases Centre (CDC) at Tan Tock Seng Hospital, where she was tested positive for Zika on 27 August. She has since been hospitalised for observation at the CDC.
    A Singaporean father and his son who reside at Block 62 Sims Drive. The former is a 65 year-old retiree, while his son is a 21 year-old full time National Serviceman who is doing his National Service at Khatib Camp. They developed symptoms of fever and rash from 23 August and 21 August respectively and were warded at CDC on 27 August.
    A 30 year-old male Singaporean who works at a construction site at 60 Sims Drive and lives at Sembawang Drive. He developed fever and rash since 22 August and was warded at CDC on 27 August.
    A 44-year-old unemployed male Singaporean who lives at Block 54 Sims Drive. He developed symptoms on 23 August and is currently warded at CDC.
    36 foreign workers were tested positive, of which 7 are warded at the CDC. They were among the 118 persons working at the construction site at 60 Sims Drive who were tested[1]. The other 29 who tested positive have fully recovered.

Other Areas of Concern

5.    Given that the Zika virus is spread by the Aedes mosquito vector, MOH cannot rule out further community transmission in Singapore, since some of those tested positive also live or work in other parts of Singapore. At this point, these other areas of concern include Khatib Camp, Sembawang Drive and places where the construction workers live (Kranji Road, Joo Chiat Place, Senoko South Road, Toh Guan Road East and Lor 101 Changi).

Ongoing Screening and Testing

6.    MOH will continue to screen the close contacts of confirmed cases. MOH is also carrying out Zika testing on others living and working in the Aljunied Crescent/ Sims Drive area and other areas of concern who have symptoms of fever and rash.  In particular, MOH has worked with the contractors at a construction site at Sims Drive to screen the workers there who were recently reported by a general practitioner (GP) to have symptoms of fever, rash and conjunctivitis. We have verified with Khatib Camp that there were no symptomatic cases to date.

7.    MOH has also alerted all GPs, polyclinics and hospitals to be extra vigilant and to immediately report patients with symptoms associated with Zika virus infection to MOH.  

Current Assessment

8.    We expect to identify more positive cases. Given that the majority of Zika cases are asymptomatic or mildly symptomatic, and mosquitoes in the affected areas may already have been infected, isolation of positive cases may have limited effect to managing the spread. We should focus our efforts on vector control.

Vector Control

9.    Since receiving notification from MOH on 27 August, NEA has intensified vector control operations to control the Aedes mosquito population in the vicinity of Aljunied Crescent/ Sims Drive. NEA has deployed more than 200 officers to inspect the area and conduct outreach to residents and other stakeholders in the vicinity. NEA’s intensified vector control operations include:

    Inspecting all premises, ground and congregation areas
    Conducting mandatory treatment such as ultra-low volume (ULV) misting/spraying of premises and thermal fogging of outdoor areas to kill adult mosquitoes
    Increasing frequency of drain flushing and oiling to prevent breeding
    Public education outreach and distribution of insect repellents

10.    On 27 August, NEA accessed more than 1,800 premises out of an estimated 6,000 premises to check for mosquito breeding, and also conducted ground checks in the vicinity. 19 breeding habitats -  comprising 13 in homes and 6 in common areas, were detected and destroyed

11.    On 27 August, NEA also followed up on an earlier inspection on 24 August at the construction site at Sims Drive to re-inspect the site and conduct misting and thermal fogging. A Stop Work Order was issued to the construction site on 27 August, as the housekeeping of the construction site was found to be unsatisfactory with potential breeding habitats favourable to mosquito breeding. The construction site is required to rectify these conditions and step up preventive measures to prevent recurrence of mosquito breeding.

12.    The on-site workers quarters at the construction site and two other dormitories at Senoko South and Kranji were also inspected on 27 August.  One breeding was detected and destroyed at the dormitory at Kranji.  NEA is conducting vector control operations at the remaining dormitories and the vicinity of Sembawang Drive today.

13.    NEA officers and grassroots volunteers also conducted outreach in 14 blocks of flats in the vicinity of Aljunied Crescent and Sims Drive, to distribute Zika information leaflets and insect repellents on 27 August. We completed outreach to the remaining blocks in the vicinity on 28 August. NEA will similarly be conducting outreach in the Sembawang Drive residential area.

14.    As the majority of people infected with the virus do not show symptoms, it is likely that some transmission may already have taken place before these cases of Zika were confirmed. Hence, even as NEA conducts operations to contain the transmission of the Zika virus, residents are urged to cooperate fully with NEA and allow its officers to inspect their premises for mosquito breeding and to spray insecticide to kill any mosquitoes. NEA may need to gain entry into inaccessible premises by force after serving of requisite Notices, to ensure any breeding habitats are destroyed quickly. 

15.    To minimise the risk of further spread of Zika in Singapore, it is critical that all of us as a community take immediate steps to prevent mosquito breeding in our homes by doing the 5-step Mozzie Wipeout   and protect ourselves from mosquito bites by applying insect repellent regularly.

Health Advisory

16.    We advise those living or working in the affected area of Aljunied Crescent/ Sims Drive and the other areas of concern, especially pregnant women, to monitor their health. They should seek medical attention if they are unwell, especially with symptoms of fever and rash. They should also inform their doctors of the location of their residence and workplace.

17.    Zika is generally a mild disease and many people infected with the Zika virus do not even develop symptoms. Like dengue, it is transmitted by the bite of an infected Aedes mosquito.

18.    Zika virus infection can however cause microcephaly in the unborn foetuses of pregnant mkwomen. Pregnant women should adopt strict mosquitoes precaution if travelling to an affected area. Individuals working, studying or living in an affected area who are sexual partners of pregnant women should adopt safe sexual practices (e.g. consistent and correct use of condoms during sex) or consider abstinence throughout the women’s pregnancy.

19.    MOH will provide updates on any further developments and our latest public health risk assessments. Singaporeans should refer to MOH’s webpage on Zika (www.moh.gov.sg/zika) for the latest health advisory.


[1] Of those tested, 78 were negative. 4 results are pending.
  

Last updated on 28 Aug 2016

Saturday, August 27, 2016

Singapore MOH: 1st Locally Acquired Zika Case


















#11,579

As an international destination and a global commerce, financial and transportation hub, Singapore sees several times its population of 5.6 million visit each year.

And like all international cities in tropical climes,  it is vulnerable to the importation of mosquito borne diseases, including Zika.

Today their MOH announces what appears to be a locally acquired case of Zika, likely imported by a viremic visitor who provided a blood meal to a local mosquito.   



       The Ministry of Health (MOH) and National Environment Agency (NEA) have been informed of a case of Zika virus infection. The patient is a 47-year-old female Malaysian who resides at Block 102 Aljunied Crescent and works in Singapore. As she had not travelled to Zika-affected areas recently, she was likely to have been infected in Singapore.

2.    The patient had developed fever, rash and conjunctivitis from 25 August. She visited a general practitioner (GP) on 26 August and was referred to the Communicable Diseases Centre (CDC) at Tan Tock Seng Hospital, where she was tested positive for Zika on 27 August. She has since been hospitalised for observation at the CDC. The patient is currently well and recovering.

3.     With the presence of Zika in our region and the volume of travel by Singaporeans as well as tourists, it is inevitable that there will be imported cases of Zika into Singapore. There is also risk of subsequent local transmission, as the Aedes mosquito vector is present here. While MOH and NEA have stepped up precautionary measures, we expect that there may be further cases, as most infected persons may display mild or no symptoms.

Screening of Contacts
4.     MOH is screening the patient’s close contacts, including household members. MOH is also carrying out Zika testing on others living and working in the area who have symptoms of fever and rash. At this point, three other suspect cases – two in a family who live in the area and an individual who works in the area – had preliminarily tested positive based on their urine samples. They are pending further confirmation tests.

5.     MOH has alerted all GPs around the patient’s home and workplace to be extra vigilant and to immediately report patients with symptoms associated with Zika virus infection to MOH. MOH and NEA will also actively alert residents in the vicinity to seek medical attention should they develop symptoms.

6. Minister for Health, Mr Gan Kim Yong, said, “MOH and NEA are working together to carry out vector control and testing of residents in that area with fever and rashes so as to reduce the risk of further spread. I encourage those who are unwell and with these symptoms to visit their doctors for medical attention. We have also alerted our clinics in the area to look out for suspect cases and refer them to the CDC for testing."

7. For now, as an added precaution, all suspect cases of Zika virus infection will be isolated while awaiting confirmation of the blood test results.

Vector Control

8. NEA has intensified vector control operations to control the Aedes mosquito population in the vicinity of Aljunied Crescent by immediately deploying about 100 officers to inspect the area. NEA is also conducting outreach efforts and distributing Zika information leaflets and insect repellents to residents living in the area. NEA’s intensified vector control operations include:
  • Inspecting all premises, ground and congregation areas
  • Conducting mandatory treatment such as ultra-low volume (ULV) misting of premises and thermal fogging of outdoor areas to kill adult mosquitoes
  • Increasing frequency of drain flushing and oiling to prevent breeding
  • Public education outreach and distribution of insect repellents
9. NEA will also be activating partner agencies of the Inter-Agency Dengue Task Force to step up localised search and destroy efforts in their respective areas to help reduce the risk of the virus spreading further.

10. The patient’s residence at Aljunied Crescent is not located in an active dengue cluster. However there are two active dengue clusters nearby, each with two cases. Prior to the Zika case being notified, NEA had been inspecting the premises in nearby dengue clusters to detect and destroy mosquito breeding.

11. As the majority of people infected with the virus do not show symptoms, it is possible that some transmission may already have taken place before this case of Zika was notified. Hence, even as NEA conducts operations to contain the transmission of the Zika virus, residents are urged to cooperate fully with NEA and allow its officers to inspect their premises for mosquito breeding and to spray insecticide to kill any mosquitoes. NEA may need to gain entry into inaccessible premises by force after serving of requisite Notices, to ensure any breeding habitats are destroyed quickly.

12. To minimise the risk of any spread of Zika in Singapore, it is critical that all of us as a community take immediate steps to prevent mosquito breeding in our homes by doing the 5-step Mozzie Wipeout every alternate day, and protect ourselves from mosquito bites by applying insect repellent regularly.

Health Advisory

13. Zika is generally a mild disease. It may cause a viral fever similar to dengue or chikungunya, with fever, skin rashes, body aches, and headache. But many people infected with the Zika virus infection do not even develop symptoms.

14. Zika virus infection can however cause microcephaly in the unborn foetuses of pregnant women. We advise residents, especially pregnant women, in the Aljunied Crescent area to monitor their health. They should seek medical attention if they are unwell, especially with symptoms such as fever and rash. They should also inform their doctors of the location of their residence and workplace. Those without these symptoms but who are concerned that they have been infected with the Zika virus should consult and follow the advice of their doctors regarding the monitoring of their pregnancy.

15. MOH will provide updates on any further developments and our latest public health risk assessments. Singaporeans should refer to MOH’s webpage on Zika (www.moh.gov.sg/zika) for the latest health advisory.

Annex A - Areas in the Vicinity of the First Local Case of Zika
MINISTRY OF HEALTH AND NATIONAL ENVIRONMENT AGENCY
27 AUGUST 2016

APHIS: Detection Of HPAI H5N2 In Wild Alaskan Duck














#11,578



After HPAI H5 arrived to North America in the fall of 2014, and went on to spark the largest epizootic outbreak in U.S. history during the spring of 2015, the expectation was it would return with a vengeance the following fall.

Not only did that not happen, the virus has literally disappeared from wild and migratory birds sampled in North America since the summer of 2015. 

The surprise finding by researchers, published in PNAS: The Enigma Of Disappearing HPAI H5 In North American Migratory Waterfowl earlier this summer, is that while migratory waterfowl can briefly carry HPAI H5, they are not a long-term reservoir for highly pathogenic avian flu viruses. 

HPAI viruses appear to burn out fairly quickly in aquatic waterfowl populations, likely due to their immunity to LPAI viruses, and would have to be reintroduced periodically. 


Another study, published earlier this month in Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1, suggests that waterfowl pick up new HPAI viruses in the spring (likely from poultry or terrestrial birds) on their way north to their summer breeding spots.

The following fall enough of the virus may still be circulating among them - due in part to immunologically naive hatchlings born over the summer - to be spread during their southbound migration. 

At least, that's the current thinking.  There are still huge gaps in our understanding of the ecology of avian flu in migratory birds, and so none of this is writ in stone.


Which brings us to a new report, released late Friday afternoon by APHIS, which announces the detection of a lone mallard from Alaska which tested positive for HPAI H5N2 earlier this month.

This is the first detection of HPAI in North America since the summer of 2015 - and while one duck does not a harbinger make - it does raise the possibility that HPAI has been reintroduced into North American waterfowl.

First the USDA press release, then I'll return with a bit more.


USDA Confirms Highly Pathogenic H5N2 Avian Influenza in a Wild Mallard Duck in Alaska
 
Published: Aug 26, 2016

  The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H5N2 avian influenza (HPAI) in a wild mallard duck from a state wildlife refuge near Fairbanks, Alaska.  CDC considers the risk to the general public from these HPAI H5 infections to be low.  No human infections with Eurasian H5 viruses have occurred in the United States. As a reminder, the proper handling and cooking of poultry and eggs to an internal temperature of 165 ˚F kills bacteria and viruses, including HPAI.

H5N2 HPAI has NOT been found in the U.S. – in either wild or commercial birds – since June 2015.  However, anyone involved with poultry production from the small backyard to the large commercial producer should review their biosecurity activities to assure the health of their birds. To facilitate such a review, a biosecurity self-assessment and educational materials can be found at http://www.uspoultry.org/animal_husbandry/intro.cfm

The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.  The wild mallard duck was captured and a sample tested as part of ongoing wild bird surveillance.  Since July 1, 2016, USDA and its partners have tested approximately 4,000 samples, with a goal to collect approximately 30,000 samples before July 1, 2017.  Approximately 45,500 samples were tested during wild bird surveillance from July 1, 2015-June 30, 2016.

Since wild birds can be infected with these viruses without appearing sick, people should minimize direct contact with wild birds by using gloves. If contact occurs, wash your hands with soap and water and change clothing before having any contact with healthy domestic poultry and birds.  Hunters should dress game birds in the field whenever possible and practice good biosecurity to prevent any potential disease spread.  Biosecurity information is available at: https://www.aphis.usda.gov/publications/animal_health/2015/fsc_hpai_hunters.pdf

In addition to practicing good biosecurity, all bird owners should prevent contact between their birds and wild birds and report sick birds or unusual bird deaths to State/Federal officials, either through their state veterinarian or through USDA’s toll-free number at 1-866-536-7593.  Additional information on biosecurity for backyard flocks can be found at http://healthybirds.aphis.usda.gov.

Additional background

 
Avian influenza (AI) is caused by an influenza type A virus which can infect poultry (such as chickens, turkeys, pheasants, quail, domestic ducks, geese and guinea fowl) and is carried by free flying waterfowl such as ducks, geese and shorebirds. AI viruses are classified by a combination of two groups of proteins: hemagglutinin or “H” proteins, of which there are 16 (H1–H16), and neuraminidase or “N” proteins, of which there are 9 (N1–N9). Many different combinations of “H” and “N” proteins are possible. Each combination is considered a different subtype, and can be further broken down into different strains. AI viruses are further classified by their pathogenicity (low or high)— the ability of a particular virus strain to produce disease in domestic chickens.



Alaska's Arctic Refuge, where more than 200 bird species spend their summers, serves as a central hub, and funnels migratory birds south via all four North American Flyways. 



Over the next couple of months wild bird surveillance will ramp up in the lower 48, and we'll hopefully get a better idea whether this HPAI detection in Alaska is a fluke or a trend. 

Friday, August 26, 2016

MMWR: Likely Sexual Transmission Of Zika From An Asymptomatic Male










#11,577



The CDC has published a pair of Zika related MMWR Early Releases today.

The first looks at epidemic surveillance of Guillain-BarrĂ© Syndrome in Puerto Rico concurrent with the arrival of Zika (see Guillain-BarrĂ© Syndrome During Ongoing Zika Virus Transmission — Puerto Rico, January 1–July 31, 2016).


The second describes what appears to be sexual transmission of the Zika virus from an asymptomatic male to a female partner.

While not a complete surprise, this is the sort of thing that is very difficult to determine in areas where other methods of transmission are also possible. 

Follow the link below to read it in its entirety.



Likely Sexual Transmission of Zika Virus from a Man with No Symptoms of Infection — Maryland, 2016

Early Release / August 26, 2016 / 65


Richard B. Brooks, MD1,2; Maria Paz Carlos, PhD3; Robert A. Myers, PhD3; Mary Grace White, MPH4; Tanya Bobo-Lenoci, MS4; Debra Aplan, MSN5; David Blythe, MD2; Katherine A. Feldman, DVM2 (View author affiliations)


In June 2016, the Maryland Department of Health and Mental Hygiene (DHMH) was notified of a nonpregnant woman who sought treatment for a subjective fever and an itchy rash, which was described as maculopapular by her provider. Laboratory testing at the Maryland DHMH Laboratories Administration confirmed Zika virus infection.
Case investigation revealed that the woman had not traveled to a region with ongoing transmission of Zika virus, but did have sexual contact with a male partner who had recently traveled to the Dominican Republic. The male partner reported exposure to mosquitoes while traveling, but no symptoms consistent with Zika virus infection either before or after returning to the United States. The woman reported no other sex partners during the 14 days before onset of her symptoms and no receipt of blood products or organ transplants.
(SNIP)

Current recommendations for the prevention of sexual transmission of Zika virus in returning travelers differ depending on whether the returning traveler is symptomatic and on whether the couple is planning to become pregnant (3,6). Couples in areas without active Zika transmission with circumstances in which one partner traveled to an area with active Zika virus transmission but did not develop symptoms of Zika virus disease should wait at least 8 weeks after the partner who traveled returned from the Zika-affected area before attempting conception, regardless of the sex of the traveler. Men with a diagnosis of Zika virus infection should wait at least 6 months before attempting conception, and women with a diagnosis of Zika virus infection should wait at least 8 weeks before attempting conception. Health care providers should counsel couples that correct and consistent use of condoms reduces the risk for sexually transmitted diseases and discuss the use of the most effective contraceptive methods that can be used correctly and consistently (6).
Couples who do not desire pregnancy should consider abstaining from sex or using the most effective contraceptive methods that can be used correctly and consistently in addition to barrier methods, such as condoms, which reduce the risk for sexual transmission of Zika virus and other sexually transmitted infections (3). As more is learned about the incidence and duration of seminal shedding of Zika virus in infected men, recommendations to prevent sexual transmission of Zika virus will be updated if needed.
      (Continue. . . )


 

CDC FluView: 7 More H3N2v Cases (4 Michigan, 3 Ohio) In Week 33
















#11,576


For the second week in a row the CDC's Weekly FluView is reporting 7 new H3N2v cases linked to swine exposures at county fair agricultural exhibits in Michigan and Ohio.   Swine variant viruses include H1N1v, H1N2v, and (most commonly) H3N2v.

This brings the August total to 18  H3N2v cases, and 2016's swine variant total to 22 cases (3 H1N1v cases & 1 additional H3N2v). 

Most years, we see fewer than 10 cases, although in 2012 we saw a multi-state outbreak with more than 300 confirmed infections, nearly all linked to county and state fairs (see EID Journal: H3N2v Swine To Human Transmission At Agricultural Fairs – 2012).

Due to their (often) unremarkable presentation, and limited laboratory testing, cases likely occur more often than we know (see CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012).


Here is today's announcement, after which I'll return with a bit more.
Novel Influenza A Viruses:

Seven human infections with novel influenza A viruses were reported by two states (Michigan [4] and Ohio [3]) during week 33. All seven persons were infected with influenza A (H3N2) variant (H3N2v) viruses and reported exposure to swine in fair settings during the week preceding illness onset. To date, a total of 18 (Michigan [12] and Ohio [6]) human infections with H3N2v viruses have been identified during 2016, all reported during the month of August. One of the 18 persons were hospitalized as a result of H3N2v illness. No deaths have occurred. All variant virus infections have been associated with swine exposure in fair settings. No human-to-human transmission has been identified. Public health and agriculture officials are investigating the extent of disease among humans and swine, and additional cases may be identified as the investigation continues.

Early identification and investigation of human infections with novel influenza A viruses are critical to ensure timely risk assessment and so that appropriate public health measures can be taken. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.


We’ve not seen sustained or efficient spread of these swine flu viruses in humans - but like all flu viruses - swine variant viruses are capable of evolving, reassorting, and adapting to their hosts.
People who raise, or work with pigs are probably at greatest risk of infection, but County and State Fair animal exhibits also provide opportunities for these viruses to jump to humans.

The CDC offers the following advice to the public. 


CDC Recommendations For People At High Risk:
  • If you are at high risk of serious flu complications and are going to a fair where pigs will be present, avoid pigs and swine barns at the fair. This includes children younger than 5 years, people 65 years and older, pregnant women, and people with certain long-term health conditions (like asthma, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions).
If you are not at high risk, take these precautions:
  • Don’t take food or drink into pig areas; don’t eat, drink or put anything in your mouth in pig areas.
  • Don’t take toys, pacifiers, cups, baby bottles, strollers, or similar items into pig areas.
  • Wash your hands often with soap and running water before and after exposure to pigs. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid close contact with pigs that look or act ill.
  • Take protective measures if you must come in contact with pigs that are known or suspected to be sick. This includes wearing personal protective equipment like protective clothing, gloves and masks that cover your mouth and nose when contact is required.
  • To further reduce the risk of infection, minimize contact with pigs in the pig barn and arenas.


And for more on swine and swine variant influenza, you may wish to revisit some of these blogs:


Front. Microbiol.: A Novel H1N2 Reassorted Influenza Virus In Chinese Pigs 

Sci Rpts: Transmission & Pathogenicity Of Novel Swine Flu Reassortant Viruses
JID: Evolutionary Dynamics Of Influenza A Viruses In US Exhibition Swine 

Live Markets & Novel Flu Risks In The United States

FDA Recommends Universal Testing Of All Donated Blood In U.S. For Zika

Credit WHO











#11,575


As the Zika virus has encroached further into the Northern Americas, we've seen a series of increasingly tougher measures designed by the FDA to protect the blood supply, starting with FDA: Recommendations To Reduce Risk Of Zika Infection From Human Cell & Tissue Transplants issued on March 1st. 
Roughly a month ago, after local transmission of Zika was reported in South Florida, the FDA recommended the testing of all donated blood products from that region (see CIDRAP Zika prompts FDA to curb blood collection in Florida).

Today, the FDA has ratcheted up those recommendations once again, and is now recommending the testing of all blood donations in the United States and its Territories.



FDA advises testing for Zika virus in all donated blood and blood components in the US


For Immediate Release

August 26, 2016
Release

As a further safety measure against the emerging Zika virus outbreak, today the U.S. Food and Drug Administration issued a revised guidance recommending universal testing of donated Whole Blood and blood components for Zika virus in the U.S. and its territories.

“There is still much uncertainty regarding the nature and extent of Zika virus transmission,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “At this time, the recommendation for testing the entire blood supply will help ensure that safe blood is available for all individuals who might need transfusion.”

The FDA first issued guidance on Feb. 16 recommending that only areas with active Zika virus transmission screen donated Whole Blood and blood components for Zika virus, use pathogen-reduction devices, or halt blood collection and obtain Whole Blood and blood components from areas of the U.S. without active virus transmission. All areas with active transmission in the U.S. are currently in compliance with this guidance. The revised guidance announced today recommends that all states and U.S. territories screen individual units of donated Whole Blood and blood components with a blood screening test authorized for use by the FDA under an investigational new drug (IND) application, or a licensed test when available. Alternatively, an FDA-approved pathogen-reduction device may be used for plasma and certain platelet products.

The FDA is updating its guidance after careful consideration of all available scientific evidence, consultation with other public health agencies, and taking into consideration the potential serious health consequences of Zika virus infection to pregnant women and children born to women exposed to Zika virus during pregnancy. Testing of donated blood is already underway in Florida and Puerto Rico, as well as in other areas, and it has shown to be beneficial in identifying donations infected with Zika virus. Expanded testing will continue to reduce the risk for transmission of Zika virus through the U.S. blood supply and will be in effect until the risk of transfusion transmission of Zika virus is reduced.

Zika virus is transmitted primarily by the Aedes mosquito. Zika virus can also be spread by sexual contact. Although 4 out of 5 people infected with Zika virus never develop symptoms, when symptoms do occur they may include fever, arthralgia (joint pain), maculopapular rash (red area with small bumps), and conjunctivitis (red, irritated eyes). In addition, Zika virus infection during pregnancy can cause serious birth defects and is associated with other adverse pregnancy outcomes.

“As new scientific and epidemiological information regarding Zika virus has become available, it’s clear that additional precautionary measures are necessary,” said Luciana Borio, M.D., the FDA’s acting chief scientist. “We are issuing revised guidance for immediate implementation in order to help maintain the safety of the U.S. blood supply.”

The first local or non-travel related transmission of Zika virus in the U.S. by mosquitoes was reported from Puerto Rico in December 2015; and soon thereafter, local transmission was reported in American Samoa and the U.S. Virgin Islands. In July 2016, the first cases of local or non-travel related transmission of Zika virus in the continental U.S. were reported in Miami-Dade County, Florida.

In addition to protecting the nation’s blood supply, the FDA works to protect the safety of our nation’s supply of human cells, tissues, and cellular and tissue-based products; supports the development and availability of diagnostic tests that may be useful for identifying the presence of or prior exposure to the Zika virus; works with commercial and government developers to advance the development of investigational vaccines and therapeutics; and monitors for fraudulent products and false product claims related the Zika virus.

The FDA, an agency within the U.S. Department of Health and Human Services, promotes and protects the public health by, among other things, assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.