Health Ministry issues guidelines on Zika Virus Disease
Health Ministry
issues guidelines on Zika Virus Disease
The Ministry of Health and Family Welfare issued guidelines on the
Zika virus disease, here today. The text of the guidelines is as follows.
Background
Zika virus disease is an emerging viral disease transmitted
through the bite of an infected Aedes mosquito. This is the same mosquito that
is known to transmit infections like dengue and chikungunya. Zika
virus was first identified in Uganda in 1947.
World Health Organization has reported 22
countries and territories in Americas1 from where local transmission of Zika
virus has been reported. Microcephaly in the newborn and other neurological
syndromes (Guillain Barre Syndrome) have been found temporally associated with
Zika virus infection. However, there are a number of genetic and other causes
for microcephaly and neurological syndromes like Guillain Barre Syndrome.
Zika virus disease has the potential for further
international spread given the wide geographical distribution of the mosquito
vector, a lack of immunity among population in newly affected areas and the
high volume of international travel. As of now, the disease has not been
reported in India. However, the mosquito that transmits Zika virus, namely
Aedes aegypti , that also transmits dengue virus, is widely prevalent in
India.
A majority of those infected with Zika virus
disease either remain asymptomatic (up to 80%) or show mild symptoms of fever,
rash, conjunctivitis, body ache, joint pains. Zika virus infection should be
suspected in patients reporting with acute onset of fever, maculo-papular rash
and arthralgia, among those individuals who travelled to areas with ongoing
transmission during the two weeks preceding the onset of illness.
Based on the available information of previous
outbreaks, severe forms of disease requiring hospitalization is uncommon and
fatalities are rare. There is
no vaccine or drug available to prevent/ treat Zika virus disease at present.
World Health Organization has declared Zika virus disease to be a
Public Health Emergency of International Concern (PHEIC) on 1st February, 2016.
[1] Zika virus disease has been reported so far in
the following countries; Brazil, Barbados, Bolivia, Columbia, Dominican
Republic, Equador, El Salvador, French Guyana. Guadeloupe, Guatemala, Guyana,
Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, St Martin,
Suriname, Virgin Island and Venezuela. It may be noted that
this list is likely to change with time. Hence, updated information should be
checked periodically.
In the light of the current disease trend, and
its possible association with adverse pregnancy outcomes, the Directorate
General of Health Services, Ministry of Health and Family Welfare advises on
the following:
1.
Enhanced Surveillance
1.1. Community based Surveillance
· Integrated Disease Surveillance
Programme (IDSP) through its community and hospital based data gathering
mechanism would track clustering of acute febrile illness and
seek primary case, if any, among those who travelled to areas with
ongoing transmission in the 2 weeks preceding the onset of illness.
· IDSP would also
advise its State and District level units to look for clustering of cases of
microcephaly among newborns and reporting of Gullian Barre Syndrome.
· The Maternal and
Child Health Division (under NHM) would also advise its field units to look for
clustering of cases of microcephaly among new borns.
1.2 International Airports/ Ports
· All the International Airports /
Ports will display billboards/ signage providing information to travelers on
Zika virus disease and to report to Custom authorities if they are returning
from affected countries and suffering from febrile illness.
· The Airport / Port Health
Organization (APHO / PHO) would have quarantine / isolation facility in
identified Airports.
· Directorate General of Civil
Aviation, Ministry of Civil Aviation will be asked to instruct all
international airlines to follow the recommended aircraft disinsection
guidelines
· The APHOs shall circulate guidelines
for aircraft disinsection (as per International Health Regulations) to all the
international airlines and monitor appropriate vector control measures with the
assistance from NVBDCP in airport premises and in the defined perimeter.
1.3 Rapid Response Teams
· Rapid Response Teams (RRTs) shall be
activated at Central and State surveillance units. Each team would comprise an
epidemiologist / public health specialist, microbiologist and a medical /
paediatric specialist and other experts (entomologist etc) to travel at
short notice to investigate suspected outbreak.
· National Centre for Disease Control
(NCDC), Delhi would be the nodal agency for investigation of outbreak in any
part of the country.
1.4 Laboratory Diagnosis
· NCDC, Delhi and National Institute
of Virology (NIV), Pune, have the capacity to provide laboratory diagnosis of
Zika virus disease in acute febrile stage. These two institutions would be the
apex laboratories to support the outbreak investigation and for confirmation of
laboratory diagnosis. Ten additional laboratories would be
strengthened by ICMR to expand the scope of laboratory diagnosis.
· RT- PCR test would remain the
standard test. As of now there is no commercially available test for Zika virus
disease. Serological tests are not recommended.
· The States/ UT Administrations would
create increased awareness among clinicians including obstetricians,
paediatricians and neurologists about Zika virus disease and its possible link
with adverse pregnancy outcome (foetal loss, microcephaly etc). There should be
enhanced vigilance to take note of travel history to the affected countries in
the preceding two weeks.
· The public needs to be reassured
that there is no cause for undue concern. The Central/ State Government shall
take all necessary steps to address the challenge of this infection working
closely with technical institutions, professionals and global health partners.
3. Vector Control
· There would be enhanced integrated
vector management. The measures undertaken for control of dengue/ dengue
hemorrhagic fever will be further augmented. The guidelines for the integrated
vector control will stress on vector surveillance (both for adult and larvae),
vector management through environmental modification/ manipulation; personal
protection, biological and chemical control at household, community and
institutional levels. Details are at Annexure-I.
· States where dengue transmission is
going on currently due to conducive weather conditions (Kerala, Tamil Nadu etc)
should ensure extra vigil.
4. Travel Advisory
· Non-essential travel to the affected
countries to be deferred/ cancelled2.
· Pregnant women or women who are
trying to become pregnant should defer/ cancel their travel to the affected
areas.
· All travelers to the affected
countries/ areas should strictly follow individual protective measures,
especially during day time, to prevent mosquito bites (use of mosquito
repellant cream, electronic mosquito repellants, use of bed nets, and dress
that appropriately covers most of the body parts).
· Persons with co-morbid conditions
(diabetes, hypertension, chronic respiratory illness, Immune disorders etc)
should seek advice from the nearest health facility, prior to travel to an
affected country.
· Travelers having febrile illness
within two weeks of return from an affected country should report to the
nearest health facility.
· Pregnant women who have travelled to
areas with Zika virus transmission should mention about their travel during
ante-natal visits in order to be assessed and monitored appropriately.
5.
Non-Governmental Organizations
· Ministry of Health &FW / State
Health Departments would work closely with Non-Governmental organizations such
as Indian / State Medical Associations, Professional bodies etc to sensitize
clinicians both in Government and private sector about Zika virus disease.
2 Based on available evidence,
World Health Organization is not recommending any travel or trade
restrictions.
6. Co-ordination with
International Agencies
· National Centre for Disease Control,
Delhi, the Focal Point for International Health Regulations (IHR), would seek/
share information with the IHR focal points of the affected countries and be in
constant touch with World Health Organization for updates on the evolving
epidemic.
7. Research
· Indian Council of Medical Research
would identify the research priorities and take appropriate action.
8. Monitoring
· The situation would be monitored by
the Joint Monitoring group under Director General of Health Services on regular
basis. The guidelines will be updated from time to time as the emerging
situation demands.
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