Situation of Zika virus infection in Thailand...
Transcript of Situation of Zika virus infection in Thailand...
Situation of
Zika virus infection in
Thailand
2012-2016
Rome BUATHONG, MD., FETP., MIH.,
Prev. Med. (Epidemiology)
Bureau of Epidemiology,
Department of Disease Control
Thailand Ministry of Public Health
Introduction
• Zika virus is a member of Flavivirus, in
Spondweni virus group
• Zika fever commonly presents with fever,
rash, conjunctivitis and joint pain and it is
transmitted by Aedes mosquito
• Average incubation period in human is 4 - 7 days (3-12)
• Extrinsic incubation period in Aedes spp. is about 10 days
Members in the family Flaviviridae
Flavivirus in Thailand
1. JEV
2. Denv-1
3. Denv-2
4. Denv-3
5. Denv-4
6. Zikv
http://viralzone.expasy.org/
Enveloped virus with diameter of about 40 nm
Hill, M.A. (2016) Embryology Abnormal Development - Zika Virus. https://embryology.med.unsw.edu.au/
Zika virus transmissions
Main vector
• Aedes aegypti
Other vector involvement
• Ae. africanus (ZIKV, 1948)
• Ae. albopictus
• Ae. henselli (outbreak in Yap Island, 2007 )
Possible vector (research)
• An. coustani
• Mansonia uniformis
• Culex perfunicus
Vector-borne transmissions
Non-vector-borne transmissions• Infected monkey bite (infected human bite ?)
• Blood transfusion
• Organs transplantation (Kidney/Liver)
• Sexual intercourse
• Tranplacental infection to fetus
• Perinatal infection
• Breast milk? (virus detected in breast milk)
Zika virus detected Blood : 5 – 7 days
Saliva : 5 – 7 days
Urine : up to 14 days
Semen : up to 2 months
CSF : acute phase of meningoencephalitis
Amniotic fluid : until delivery
Death fetus in utero : autopsy
Breast milk : infected during perinatal period
Zika virus detected in blood and urine
Ann-Claire Gourinat, Olivia O’Connor, Elodie Calvez, Cyrille
Goarant and Myrielle Dupont-Rouzeyrol
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21,
No. 1, January 2015
Zika virus detected in saliva and blood
Sexual transmission
• Foy is the first person known to have passed on an insect-borne virus to another human by sexual contact.
• In 2009 Brian Foy, a biologist from the Arthropod-borne and Infectious Diseases Laboratory at Colorado State University, sexually transmitted Zika virus to his wife after returning from Senegal.
• He and his wife developed symptom from Zikavirus infection.
Blood transmission
• Transmission of Zika virus via transfusion of infected blood or blood products remains a possibility.
• Three percent (3%) of asymptomatic blood donors (42/1 505) were found positive for Zikavirus by PCR during the Zika virus outbreak in French Polynesia between November 2013 and February 2014.
• No documented cases of infections via transfusion.
Safety guideline of blood transfusion
• For areas with no local transmission, it recommends donors who are at risk of Zika infection be deferred for 4 weeks.
People at risk : those who had symptoms consistent with Zika virus infection within the past 4 weeks, had sexual contact with someone who visited or lived in an area of local spread during the past 3 months, and anyone who traveled in the past 4 weeks to an area where the virus is circulating.
• In areas with active Zika transmission, such as Puerto Rico and the US Virgin Islands, the FDA urges authorities to obtain whole blood and blood components from parts of the United States with no local transmission.
Global Zika Virus in the past 1947 - 2007
Source : Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep
African lineage
Asian lineage
Discovery of Zika virus
Apr 1947:
The virus was isolated from sentinel rhesus monkey
in Zika forest, Uganda through monitoring of
yellow fever.
Jan 1948:
The virus was isolated from Aedes africanus
mosquito in Uganda
Year 1952:
Human infections were found in Uganda and
Tanzania.
From its discovery until 2007, Zika virus infection were rare in
Africa and Southeast Asia.
Zika virus outbreaks
• From its discovery until 2007, Zika virus infection
were rare in Africa and Southeast Asia.
• 2007- an outbreak occurred in Yap Island,
Federation States of Micronesia. Zika was first
considered as an emerging disease.
• 2013 - the outbreak occurred in French Polynesia.
Complication with Guillain-Barré syndrome was
suspected.
• May 2015 - the outbreak occurred in Brazil
Zika virus spreading in
Southern Pacific Islands and Asia
2010Cambodia
2013Indonesia
2013Thailand
Source:
2012Philippines
Molecular Seq of Zika virus in South East Asia and Latin America
Thailand
R. Buathong,Thailand MOPH & S. Wacharapluesadee, Chulalongkorn University
Brazil
Asian lineage
Zika fever in Yap Islands, 2007
Source : Mark R. Duffy et al. Zika Virus Outbreak on Yap Island, Federated States of
Micronesia. N Engl J Med 2009;360:2536-43
Zika fever in Yap Islands, 2007
Source : Mark R. Duffy et al. Zika Virus Outbreak on Yap Island, Federated States of
Micronesia. N Engl J Med 2009;360:2536-43
Zika fever in Yap Islands, 2007
Source : Mark R. Duffy et al. Zika Virus Outbreak on Yap Island, Federated States of
Micronesia. N Engl J Med 2009;360:2536-43
Epi & Clinical Characteristicsof confirmed Zika fever outbreak
0
1
2
3
4
5
14
Fe
b 1
2
16
Fe
b 1
2
18
Fe
b 1
2
20
Fe
b 1
2
22
Fe
b 1
2
24
Fe
b 1
2
26
Fe
b 1
2
28
Fe
b 1
2
1 M
ar
12
3 M
ar
12
5 M
ar
12
7 M
ar
12
9 M
ar
12
11
Ma
r 1
2
13
Ma
r 1
2
15
Ma
r 1
2
17
Ma
r 1
2
19
Ma
r 1
2
21
Ma
r 1
2
23
Ma
r 1
2
25
Ma
r 1
2
Moo 7 Moo 4
Moo 3 Moo 2
T. Tantitaweewat & R. Buathong,Thailand MOPH
1st
symptom
Fever
Mostly low grade or undetectable
1/3rd report no fever
short duration and short viremia except in
severe case
Fever(low)
Rash(MP)
Red eyes(non-purulent)
JointInvolvement
27
Maculopapular rash among cases
T. Tantitaweewat & R. Buathong,Thailand MOPH
MP Rash (pruritic and nonpruritic)
Rome Buathong,Thailand MOPH
29
Bilateral Conjuctival Hyperemia(Red eyes)
T. Tantitaweewat & R. Buathong,Thailand MOPH
Conjuctival Hyperemia
Rome Buathong,Thailand MOPH
Joint involvement
inflammation
Pain and stiffness
swelling
Zika virus spreading in Latin America and the Caribbean
Source : WHO PAHO, http://www.paho.org/ February 2016
Countries and territories with Zika virus transmission
Source : ECDC, http://ecdc.europa.eu/ February 2016
Zika virus spreading in
NE Brazil and Microcephaly in NB
Average
200 case/year
>4,000 case/2015
Source : TheLipTV, youtube.com/watch?v=zmDIoTNqJ0o and AP
Association and now Zika virus
infection is one in many microcephaly Causations
• Microcephaly and poor birth defect in NB affected in all trimester
Zika virus in third trimester
Zika virus affected to fetus and infant
Virus in the fetus brain CT Brain in microcephaly
Number of reported cases of microcephaly* in full-term newborns
following laboratory-confirmed Zika virus transmission —Pernambuco, Paraíba, and Bahia states, Brazil, 2015
MMWR, US CDC
Number of reported cases of microcephaly* in full-term newborns
following laboratory-confirmed Zika virus transmission —Pernambuco, Paraíba, and Bahia states, Brazil, 2015
MMWR, US CDC
Warm climate and outbreaks
• With warm weather, mosquitoes fly
more and bite more.
• Warm weather speeds up virus
replication rate in mosquitoes.
Alert signal
• On May 2013, Canada IHR focal point
notified Thai MoPH about a Canadian
traveler confirmed Zika virus infection
returning from Thailand
• A 45-year-old female Canadian stayed in
Thailand during 20th Jan – 4th Feb, 2013
• Her onset date was 4th Feb with backache,
irritable, headache when she transited at
the airport in Hong Kong
Exported case#1The case
45-year-old female Canadian tourist
Stayed in Thailand during Jan 20th - Feb 4th, 2013
Onset began Feb 4th while onboard with backache,
irritable, headache, then at home chilled, rash with
red eyes (suspected Measles), severe joint pain, vomiting, thrombocytopenia (suspected Dengue)
Clinical long lasting for 2 ½ weeks
Zika virus confirmed by PCR and sequencing
linage similar to Cambodia and Micronesia strain
and serology confirmed
Suspected area of exposure to virus: Bangkok and Phuket
Molecular Detection
Uganda_YP_002790881.1|:3065-3309 polyprotein [Zika virus]
Uganda_AEN75263.1|:3069-3313 polyprotein, partial [Zika virus]
Uganda_AAC58803.1|:88-332 NS5 protein, partial [Zika virus]
Uganda_ABI54475.1|:3063-3307 polyprotein [Zika virus]
Senegal_AEN75266.1|:3069-3313 polyprotein, partial [Zika virus]
Nigeria_AEN75265.1|:3063-3307 polyprotein, partial [Zika virus]
Malaysia_AEN75264.1|:3069-3313 polyprotein, partial [Zika virus]
Cambodia_AFD30972.1|:3069-3313 polyprotein, partial [Zika virus]
Micronesia_ACD75819.1|:3069-3313 polyprotein [Zika virus]
C13VS012396 Serum
100
85
98
56
65
0.005
Curtsey : Kevin FonsecaAlberta Health Service, Canada
Exported case# 2
Exported case# 2
Exported case# 2
Exported case# 3
Travel period 25 – 31 July 2014/ visited Koh Samui
Journal of Travel Medicine, 2016, 1–3 doi: 10.1093/jtm/tav011
Exported case# 3
-Thai 24 year old,
-Northern province,
-Quarantined at
Taoyuan Airport coz
of fever on 10
January 2016
-Clinical developed
in Thailand 1 day
before departure to
Taiwan
-Zika PCR in positive in patient’s blood
Exported case # 4
Source: http://outbreaknewstoday.com/
When Zika virus was detected in Thailand?
Pond WL. Transac Royal Soc Trop Med Hyg 1963; 57:364
Mouse NT
• ตงแตป พ.ศ. 2556 เปนตนมา พบเหตการณการระบาดในจงหวดตางๆ ทเขาเกณฑสอบสวน ดงน – ศรสะเกษ กนยายน 2556
สงตรวจ 8 ราย : พบ PCR 1 ราย, ZIKV IgM 5 ราย– ล าพน กนยายน 2556
สงตรวจ 21 ราย : พบ PCR ยนยน 1 ราย, ZIKV IgM 14 ราย– เพชรบรณ กรกฏาคม 2557
สงตรวจ 20 ราย : พบ PCR ยนยน 2 ราย, เพาะเชอได 1 ราย– สมทรสาคร มกราคม 2558
สงตรวจ 5 ราย : พบ PCR ยนยน 4 ราย, เพาะเชอได 1 ราย
Zika fever in Thailand
Rome Buathong, et al. Bureau of Epidemiology, Thailand MOPH
Geographic of confirmed Zika fever case from
2012-2015
Samut Sakorn,
Jan 2015
viral isolation
Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383
2012: 3 cases
2013: 2 cases
2014: 2 cases
2015: 5 cases
Exported case 2013: 2 cases
Molecular sequencing of Zika virus in Thailand closely with French Polynesia
Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383
Exported case#2
Flavivirus cross-reactivity
Zika and Dengue
Source :
Emerg Infect Dis 2008; 14: 1232
Source: Division of Vector Borne Disease, US CDC
Source: Rome Buathong, Bureau of Epidemiology
Source: Rome Buathong, Bureau of Epidemiology
Exported Case #3
Journal of Travel Medicine, 2016, 1–3 doi: 10.1093/jtm/tav011
Surveillance for Zika virus
โรคตดเชอไวรสซกา เปนโรคตดตอทตองแจงความตอเจาพนกงานสาธารณสข ตามพรบ. โรคตดตอ พ.ศ. 2523
ผแจง คอ โรงพยาบาลทงรฐเอกชน รวมคลนก/หองปฏบตการ/เจาบาน
Surveillance for Zika virus
Surveillance for Zika virus
Surveillance for Zika virus
กรณทระบบเฝาระวงสามารถตรวจพบผปวยยนยนโรคตดเชอไวรสซกาในพนท ใหพนทด าเนนการควบคมโรค โดยอาศยแนวทางการ
ควบคมโรคตดเชอไวรสซกา ดงน
กรณทระบบเฝาระวงสามารถตรวจพบผปวยยนยนโรคตดเชอไวรสซกาในพนท ใหพนทด าเนนการควบคมโรค โดยอาศยแนวทางการ
ควบคมโรคตดเชอไวรสซกา ดงน
กจกรรม
กจกรรม
กจกรรม
กจกรรม
กจกรรม
กจกรรม
ตวอยางแบบตดตามอาการผสมผส
Where to submit sample (1)
• Thai NIH, Department of Medical Sciencescontact tel. number : 029511485
plasma/serum/urine for realtime PCR for Zikv
plasma/serum for Zikv IgM by ELISA
1500 – 2000 THB/sample
Where to submit sample (2)
• Laboratory network for Zika outbreak investigation
3) Faculty of Medical Technology Mahidol University, Salaya, Nakhon Prathom
2) EID Laboratory Center Chulalongkorn University Thai Red Cross
1) Medical Technology and Reference Laboratory for Infectious Diseases: MTRL Bamrasnaradura Infectious Disease Insitute, MoPH
BUREAU OF EPIDEMIOLOGY- MOPH, THAILAND
SAWASDEE
KRUB
Thank you for your kind attention