Transcript Situation of Zika virus infection in Thailand 2012-2016

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
Enveloped virus with diameter of about 40 nm
http://viralzone.expasy.org/
Hill, M.A. (2016) Embryology Abnormal Development - Zika Virus. https://embryology.med.unsw.edu.au/
Zika virus
transmissions
Vector-borne
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
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 Arthropodborne 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 Zika
virus 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 Zika
virus 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
Asian lineage
African lineage
Source : Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep
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
2012
Philippines
2013
Thailand
2013
Indonesia
Source:
2010
Cambodia
Molecular Seq of Zika virus in
South East Asia and Latin America
Brazil
Thailand
Asian lineage
R. Buathong,Thailand MOPH & S. Wacharapluesadee, Chulalongkorn University
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
Moo 7
Moo 4
Moo 3
Moo 2
25 Mar 12
23 Mar 12
21 Mar 12
19 Mar 12
17 Mar 12
15 Mar 12
13 Mar 12
11 Mar 12
9 Mar 12
7 Mar 12
5 Mar 12
3 Mar 12
1 Mar 12
28 Feb 12
26 Feb 12
24 Feb 12
22 Feb 12
20 Feb 12
18 Feb 12
16 Feb 12
14 Feb 12
Epi & Clinical Characteristics
of confirmed Zika fever outbreak
5
4
3
2
1
0
1st
symptom
T. Tantitaweewat & R. Buathong,Thailand MOPH
Fever
 Mostly low grade or undetectable
 1/3rd report no fever
 short duration and short viremia except in
severe case
Rash
(MP)
Fever
(low)
Red eyes
(non-purulent)
Joint
Involvement
Maculopapular rash among cases
T. Tantitaweewat & R. Buathong,Thailand MOPH
27
MP Rash
(pruritic and nonpruritic)
Rome Buathong,Thailand MOPH
Bilateral Conjuctival Hyperemia
(Red eyes)
T. Tantitaweewat & R. Buathong,Thailand MOPH
29
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
>4,000 case/2015
Association and now Zika virus
infection is one in many
microcephaly Causations
Average
200 case/year
Source : TheLipTV, youtube.com/watch?v=zmDIoTNqJ0o and AP
• 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#1
The 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]
65
Uganda_AEN75263.1|:3069-3313 polyprotein, partial [Zika virus]
56
Uganda_AAC58803.1|:88-332 NS5 protein, partial [Zika virus]
98
Uganda_ABI54475.1|:3063-3307 polyprotein [Zika virus]
Senegal_AEN75266.1|:3069-3313 polyprotein, partial [Zika virus]
85
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]
100
C13VS012396 Serum
0.005
Curtsey : Kevin Fonseca
Alberta 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
Exported case # 4
-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
Source: http://outbreaknewstoday.com/
When Zika virus was detected in Thailand?
Mouse NT
Pond WL. Transac Royal Soc Trop Med Hyg 1963; 57:364
Zika fever in Thailand
• ตังแต่
้ ปี พ.ศ. 2556 เป็ นต้ นมา พบเหตุการณ์การระบาดใน
จังหวัดต่างๆ ที่เข้ าเกณฑ์สอบสวน ดังนี ้
– ศรีสะเกษ กันยายน 2556
ส่ งตรวจ 8 ราย : พบ PCR 1 ราย, ZIKV IgM 5 ราย
– ลาพูน กันยายน 2556
ส่ งตรวจ 21 ราย : พบ PCR ยืนยัน 1 ราย, ZIKV IgM 14 ราย
Rome Buathong, et al. Bureau of Epidemiology, Thailand MOPH
7 Confirmed Zika Fever
Cases, 2012-2014
Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383
Geographic of confirmed Zika fever case from
2012-2015
2012: 3 cases
2013: 2 cases
viral isolation
2014: 2 cases
2015: 5 cases
Exported case
2013: 2 cases
Samut Sakorn,
Jan 2015
Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383
Molecular sequencing of Zika
virus in Thailand closely with
French Polynesia
Exported
case#2
Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383
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
้
่ องแจ้งความต่อ
โรคติดเชือไวร
ัสซิกา เป็ นโรคติดต่อทีต้
เจ้าพนักงานสาธารณสุข ตามพรบ. โรคติดต่อ พ.ศ.
2523
Surveillance for Zika virus
Surveillance for Zika virus
Surveillance for Zika virus
กรณีทรี่ ะบบเฝ้าระวังสามารถตรวจพบผู้ป่วยยืนยันโรคติดเชื้อ
ไวรัสซิกาในพืน้ ที่ ให้ พืน้ ทีด่ าเนินการควบคุมโรค โดยอาศัยแนวทางการ
ควบคุมโรคติดเชื้อไวรัสซิกา ดังนี้
กรณีทรี่ ะบบเฝ้าระวังสามารถตรวจพบผู้ป่วยยืนยันโรคติดเชื้อ
ไวรัสซิกาในพืน้ ที่ ให้ พืน้ ทีด่ าเนินการควบคุมโรค โดยอาศัยแนวทางการ
ควบคุมโรคติดเชื้อไวรัสซิกา ดังนี้
กิจกรรม
กิจกรรม
กิจกรรม
กิจกรรม
กิจกรรม
กิจกรรม
ตัวอย่ างแบบติดตามอาการผู้สัมผัส
Where to submit sample (1)
• Thai NIH, Department of Medical
Sciences
contact tel. number : 029511485
plasma/serum/urine for realtime
plasma/serum for Zikv IgM by ELISA
1500 – 2000 THB/sample
Where to submit sample (2)
• Laboratory network for Zika outbreak
investigation
1) Medical Technology and Reference
Laboratory for Infectious Diseases:
MTRL
Bamrasnaradura Infectious Disease
Insitute,
MoPH Center
2) EID Laboratory
Chulalongkorn University Thai Red
Cross
3) Faculty of Medical Technology
Mahidol University, Salaya, Nakhon
Prathom
BUREAU OF EPIDEMIOLOGY- MOPH, THAILAND
Thank you for your kind attention
SAWASDEE
KRUB