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Asia Pacific: Zika Preparedness - Information Bulletin n° 1

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This bulletin is issued for information only, and reflects the current situation and details available at this time. The International Federation of Red Cross and Red Crescent Societies (IFRC), in consultation with the National Societies in Asia Pacific, is finalizing a preparedness plan for potential support to the National Societies of countries at risk in Asia Pacific region.

The situation

On 1 February 2016, WHO declared the Zika Virus1 a Public Health Emergency of International Concern due to i) the rapid spread of disease with strongly suspected causal relation with clusters of microcephaly2 and other neurological abnormalities and ii) wide global distribution of the mosquitoes that can transmit the virus. WHO has called for a coordinated and multisectoral response through an interagency Strategic Response Framework focusing on response, sureveillance and research.

In response to the disease outbreak in the Americas, IFRC launched an emergency appeal on 2 February 2016 to combat Zika virus and other vector borne diseases in the region.

The Zika virus, first discovered in Uganda in 1947 in the rhesus monkeys, made its way across to Asia Pacific in the late 60s followed by the Americas in the recent outbreak.

The risk of the virus spreading within Asia Pacific is potentially high as sporadic cases have been reported in Malaysia (1969), Indonesia (1977),
New Zealand (2002), Cambodia (2010), Thailand and Philippines (2012), Australia (2014) and Maldives (2015) in the past. Risk factors that are of concern are the chronic infestation of Aedes mosquitoes and the lack of immunity to the Zika virus in many populations in the region.
The risk is further heightened in places with the tropical heat, widespread poverty, overcrowding and poor sanitation. In addition, international travel can cause the virus to cross borders into new territories.

Although initial documentation of transmission focused only around the Aedes mosquito as the sole mode of transmission, it has unfolded that the Zika virus can be indeed transmitted sexually (reported cases in the USA and Senegal) and via bodily fluids such as blood, urine and saliva. It can also be vertically transmitted from mother to foetus during pregnancy and possibly lead to complications such as birth defects (microcephaly) and neurological conditions (Guillian Barre Syndrome). There is much yet unknown about the virus.

Only 1 out of 5 infected people develop mild symptoms such as fever, rash, joint pain, and conjunctivitis that last a week. This makes surveillance difficult, as majority of infected people do not show symptoms, and those with mild symptoms may not seek medical attention. Apart from sharing the same vector, Zika and Dengue share similar symptoms which can also lead to misdiagnosis and under-reported of Zika. There is currently no rapid testing for Zika as yet, and diagnosis is dependent on polymerase chain reaction (PCR) and virus isolation from blood samples, which makes diagnosing a lengthy and costly process. There is no vaccine nor specific curative treatment for Zika. Climate change and possible resistance to chemical vector control further complicates the situation. Stigma, religious and cultural beliefs may also challenge prevention activities around sexual reproductive and maternal health.