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Posts Tagged ‘Guillain-Barre Syndrome’

Corporate Wealth Trumps Public Health

Posted by feww on May 28, 2016

Submitted by a reader

WHO rejects call for Rio Olympic Games to be moved or postponed, despite outbreak of Zika virus in Brazil

The World Health Organization (WHO) has rejected a call for the Rio Olympic Games to be moved or postponed despite the threat posed by the outbreak of Zika virus in Brazil.

WHO public health advice regarding the Olympics and Zika virus: News Release

Based on current assessment, cancelling or changing the location of the 2016 Olympics will not significantly alter the international spread of Zika virus. Brazil is 1 of almost 60 countries and territories which to date report continuing transmission of Zika by mosquitoes. People continue to travel between these countries and territories for a variety of reasons. The best way to reduce risk of disease is to follow public health travel advice.

Based on the current assessment of Zika virus circulating in almost 60 countries globally and 39 in the Americas, there is no public health justification for postponing or cancelling the games,” the WHO said in a statement.

The statement is in response to a letter signed by a group of at least 152 doctors, researchers, and health professionals to the United Nations health agency calling for the Rio Olympics to be postponed or moved because of concerns of the spread of the Zika virus.

“Our greater concern is for global health. The Brazilian strain of Zika virus harms health in ways that science has not observed before,” states the letter, signed by experts in the United States, India, Canada, Britain, Australia, Norway, the Philippines, Russia, South Africa, Switzerland, Taiwan and Brazil, among others.

“An unnecessary risk is posed when 500,000 foreign tourists from all countries attend the Games, potentially acquire that strain, and return home to places where it can become endemic,” it said.

“Should that happen to poor, as-yet unaffected places (e.g., most of South Asia and Africa) the suffering can be great.”

“… the Brazilian viral strain causes microcephaly and probably Guillain-Barré syndrome. Further, because human, animal and in vitro studies demonstrate that the virus is neurotrophic and causes cell death, it is biologically plausible that there are other as yet undiscovered neurological injuries, as exist for similar viruses (e.g. dengue). [… ] That while Zika’s risk to any single individual is low, the risk to a population is undeniably high. Currently, Brazil’s government reports 120,000 probable Zika cases,9 and 1,300 confirmed cases of microcephaly (with another 3,300 under investigation)10, which is above the historical level of microcephaly. […] Rio de Janeiro is highly affected by Zika. Brazil’s government reports Rio de Janeiro state has the second-highest number of probable Zika cases in the country (32,000)… and the fourth-highest incidence rate (195 per 100,000), demonstrating active transmission. […] despite Rio’s new mosquito-killing program, the transmission of mosquito-borne disease has gone up rather than down. While Zika is a new epidemic and lacks historical data, using dengue fever as a proxy, cases in Rio from January thru April 2016 are up 320% and 1150% over the same periods in 2015 and 2014, respectively.”

“It is indisputable that option (a) of holding the Games as scheduled has a greater risk of accelerating the spread of the Brazilian viral strain than the alternatives. Postponing and/or moving the Games also mitigates other risks brought on by historic turbulence in Brazil’s economy, governance, and society at large—which are not isolated problems, but context that makes the Zika problem all but impossible to solve with the Games fast approaching.”

The Letter questions whether the UN health agency can give a non-biased view of the situation because of its “secret” high – level partnership with the International Olympic Committee.

WHO and IOC in Partnership

WHO has a decades – long, high – level partnership with the International Olympic Committee. That partnership was last affirmed in 2010 at an event where the Director General of WHO and President of the IOC signed a Memorandum of Understanding, which is secret because neither has disclosed it.

Inappropriately, WHO sees its role as not just providing public health advice. It established a “Virtual Interdisciplinary Advisory Group”, whose “ important promotional point,” according to WHO is “that the Group can help in bidding for major events (like the Olympic Games)”.  That is a clear conflict of interest, when WHO must also evaluate and make recommendations about Olympic travel during a Public Health Emergency of International Concern (PHEIC).

The overly close relationship between WHO and the IOC is apparent in the comments of WHO’s Executive Director responsible for Zika, just days after it was declared a PHIEC:

“Brazil is going to have a fantastic Olympics and it’s going to be a successful Olympics and the world is going to go there. I just wish I was going there, but there’s not going to be a lot of problems there by then. ”

With respect, this is a troubling statement. WHO cannot credibly assess the public health risks of Zika and the Olympics when it sets neutrality aside. Declaring that “it’s going to be a successful Olympics and the world is going to be there” implies that WHO has given the Olympics an unconditional green light, without regard to rapidly emerging medical, entomological, and epidemiological evidence — all of which must be considered in assessing whether this mass gathering could accelerate the global spread of the Brazilian strain of Zika virus. To prejudge that “there’s not going to be a lot of problems” before reviewing this evidence is extremely inappropriate of WHO, and suggests that a change in leadership may be required to restore WHO’s credibility.

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ZIKV Transmission Documented in 55 Countries and Territories

Posted by feww on March 9, 2016

Geographical distribution of Zika virus steadily widening

A total of 55 countries and territories have documented Zika virus transmission between 1 January 2007 and 3 March 2016.

  • Colombia reported 42,706 suspected cases of ZIKV btween  1 October 2015 and 20 February 2016, with 1,612 cases confirmed.
  • Starting 2007, locally acquired Zika cases have been reported in 15 countries and territories in the Western Pacific Region.
    • Four Pacific Island countries and areas (American Samoa, Marshall Islands, Samoa and Tonga) have reported Zika infections in 2016.
    • Nauru has declared Zika virus as a national emergency of concern for purposes of preparedness, but to date no Zika virus cases have been reported.
  • Between 1 October 2015 and 7 February 2016, Cabo Verde (African region), reported 7,325 suspected cases of Zika virus disease (two cases have been confirmed, so far).
    • The outbreak peaked during the week of 22 November 2015 and has been in decline since then; 44 cases were reported in the week up to 21 February 2016. The number of suspected cases of Zika virus disease reported each week in Praia (light blue) and other municipalities (dark blue) of Cabo Verde (Fi g. 4).
    • The outbreak appears to have begun in Praia and then spread to other municipalities. Preliminary information, subject to confirmation, indicates that this outbreak has been caused by an African strain of Zika virus.
    • No neurological abnormalities have been reported.

Incidence of microcephaly

  • Between 22 October 2015 and 27 February 2016 a total of 5,909 cases of microcephaly and/or central nervous system (CNS) malformation were reported by Brazil including 139 deaths including miscarriage or stillbirth. [Previously an average of 163 microcephaly cases was recorded nationwide.]
    • 31 of these were confirmed as having microcephaly and/or CNS malformation potentially linked to congenital Zika virus infection, 96 remain under investigation and 12 were discarded.
    • The reported increase in microcephaly incidence in Brazil is concentrated in the Northeast Region.
  • An outbreak of Zika virus in French Polynesia was followed by an increase in the number of CNS malformations in children born between March 2014 and May 2015. A total of 19 cases were reported including eight microcephaly cases compared to the national average of 0 – 2 cases per year.
  • Zika virus is not yet proven to be a cause of the increased incidence of microcephaly in Brazil. However, (i) given the temporal and geographical associations between Zika virus infections and microcephaly, (ii) the repeated discovery of virus in fetal brain tissue, and (iii) in the absence of a compelling alternative hypothesis, a causal role for Zika virus is a strong possibility that is under active investigation, says WHO.

Incidence of Guillain – Barré syndrome (GBS)

In the context of Zika virus circulation, nine countries or territories have reported increased GBS incidence and/or laboratory confirmation of a Zika virus infection among GBS cases.

  • Reported increase in incidence of GBS cases, with no GBS cases biologically documented of Zika virus infection: El Salvador and Colombia.
  • Reported increase in incidence of GBS cases, with at least one GBS case confirmed with previous Zika virus infection: Brazil, French Polynesia, Suriname and Venezuela.
  • No increase in GBS incidence reported but at least one GBS case confirmed with previous Zika virus infection: Martinique, Panama and Puerto Rico.

Between October 2013 and April 2014, French Polynesia experienced the first Zika virus outbreak ever recorded in the country. During the outbreak, 42 patients were admitted to hospital with GBS. This represents a 20 – fold increase in incidence of GBS in French Polynesia compared with the previous four years.

  • Of the 42 patients, 16 (38%) required admission to an intensive care unit and 12 (29%) received mechanical ventilation. No deaths were reported.
  • The majority of these cases (88%) reported symptomatic Zika virus infection in the days that preceded the onset of neurological symptoms. A recently published formal analysis of these data (case – control study) showed a strong association between Zika infection and GBS .
  • This study is the first large observational study to compare exposure to Zika virus among people with and without GBS and provides important information about the causal role of Zika infection.
  • In 2015 in the state of Bahia in Brazil, 42 GBS cases were reported, among which 26 (62%) had a history of symptoms consistent with Zika virus infection. A total of 1,708 cases of GBS were registered nationwide, representing a 19% increase from the previous year (1,439 cases of GBS in 2014), though not all states reported an increase in incidence.
  • In Colombia, 201 GBS cases with a history of suspected Zika virus infection were reported in the nine weeks to 14 February 2016. Most of the cases are from Norte de Santander and Barranquilla – areas where many of the Zika virus cases have been registered.
  • To date, none of the cases of GBS have been laboratory confirmed for Zika virus infection, or other possible causes, and the patterns of infection and disease by age and sex need confirmation.

Additional information [sourced from who]

Zika Virus

Zika virus disease is caused by a virus transmitted by Aedes mosquitoes. Other transmission modes are still under investigation. People with Zika virus disease usually have a mild fever, skin rash (exanthema), and conjunctivitis. These symptoms normally last f or 2 – 7 days. At present there is no specific treatment or vaccine currently available. The best form of prevention is protection against mosquito bites. Zika virus is known to circulate in Africa, the Americas, Asia, and the Pacific region. Zika virus had only been known to cause sporadic infections in humans until 2007, when an outbreak in Micronesia infected 31 people.

Microcephaly

Microcephaly is an uncommon condition where a baby’s head circumference is less than expected based on the average for their age and sex. The condition is usually a result of the failure of the brain to develop properly, and can be caused by genetic or environmental factors such as exposure to toxicins, radiation, or infection during development in the womb. Microcephaly can be present as an isolated condition or may be associated with other symptoms such as convulsions, developmental delays, or feeding difficulties.

Guillain – Barré syndrome

Guillain – Barré syndrome in its typical form is an acute illness of the nerves that produces a lower, bilateral, and symmetrical sensorimotor development deficit. In many cases there is a history of infection prior to the development of the Guillain – Barré syndrome. The a nnual incidence of GBS is estimated to be between 0.4 and 4.0 cases per 100,000 inhabitants per year. In North America and Europe GBS is more common in adults and increases steadily with age. Several studies indicate that men tend to be more affected than women.

Resources from WHO

Zika virus http://www.who.int/mediacentre/factsheets/zika

Microcephaly http://www.who.int/emergencies/zi ka – virus/microcephaly/en/

Guillain – Barré syndrome http://www.who.int/mediacentre/factsheets/guillain – barre – syndrome/en/

Infants with microcephaly http://www.who.int/csr/resources/publications/zika/assessment – infants/en/

Guillain – Barré syndrome http://www.who.int/csr/resources/publications/zika/guillain – barre – syndrome/en/

Breastfeeding http://www.who.int/csr/resources/publications/zika/breastfeeding/en/

Sexual transmission http://who.int/csr/resources/publications/zika/sexual – transmission – prevention/en/

Vector control http://www.who.int/emergencies/zika – virus/articles/mosquito – control/en/

Blood safety http://who.int/csr/resources/publica tions/zika/safe – blood/en/index.html

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ZIKV Infection: Local Transmission in United States

Posted by feww on February 13, 2016

ZIKV infection: Increased risk of fetal microcephaly, Guillain-Barré syndrome —CDC

Aedes aegypti, the most common mosquito vector of ZIKV globally, is present in Puerto Rico. Therefore, the virus is expected to continue to spread throughout Puerto Rico, posing risk of infection to 3.5 million residents, including about 43,000 pregnant women per year.

The first locally acquired case of Zika virus disease in Puerto Rico was identified in early December 2015, and 29 additional laboratory-confirmed cases have been detected since, including in one pregnant woman and in a man with Guillain-Barré syndrome.

Zika virus, a mosquito-borne flavivirus, spread to the Region of the Americas (Americas) in mid-2015, and appears to be related to congenital microcephaly and Guillain-Barré syndrome (1,2). On February 1, 2016, the World Health Organization (WHO) declared the occurrence of microcephaly cases in association with Zika virus infection to be a Public Health Emergency of International Concern. On December 31, 2015, Puerto Rico Department of Health (PRDH) reported the first locally acquired (index) case of Zika virus disease in a jurisdiction of the United States in a patient from southeastern Puerto Rico. During November 23, 2015–January 28, 2016, passive and enhanced surveillance for Zika virus disease identified 30 laboratory-confirmed cases. Most (93%) patients resided in eastern Puerto Rico or the San Juan metropolitan area. The most frequently reported signs and symptoms were rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three (10%) patients were hospitalized. One case occurred in a patient hospitalized for Guillain-Barré syndrome, and one occurred in a pregnant woman. [CDC]

Clinicians in Puerto Rico are now required to report all cases of microcephaly, Guillain-Barré syndrome, and suspected Zika virus infection to PRDH. “Other adverse reproductive outcomes, including fetal demise associated with Zika virus infection, should be reported to PRDH.”

Index case. The first case of Zika virus disease identified in Puerto Rico occurred in a man aged 80 years with multiple chronic medical conditions, who reported onset of symptoms on November 23, 2015.

Eight days after illness onset, he was evaluated in a hospital emergency department for progressive weakness after several days of watery, nonbloody diarrhea, recent episodes of falling, shoulder pain, chills, malaise, and abdominal pain. He did not report myalgia, headache, or retro-orbital pain. He was febrile, tachycardic, tachypneic, and hypotensive, with bilateral erythematous sclera. Laboratory results revealed leukocytosis with a predominance of neutrophils; hemoconcentration; thrombocytopenia; elevated serum transaminases, blood urea nitrogen, and creatinine; hyponatremia; and hypoglycemia. He received a diagnosis of sepsis, was admitted to the intensive care unit for fluid resuscitation and monitoring, and was treated with broad spectrum antibiotics. Diagnostic considerations included leptospirosis and dengue. He experienced respiratory decompensation requiring intubation and 5 days of mechanical ventilation. He was hospitalized for 2 weeks, during which time he underwent an extensive evaluation. Blood and stool cultures were negative, as were serologic tests for human immunodeficiency virus, Leptospira, and Strongyloides. Schistosoma immunoglobulin G titers were elevated, for which praziquantel was administered. On December 2, serum was collected for dengue and chikungunya diagnostic testing, and was positive for anti-dengue virus IgM, negative for anti-chikungunya virus IgM, and negative for detection of dengue virus and chikungunya virus RNA. Because a hospital-based enhanced surveillance protocol was in place for detection of Zika virus, the same serum specimen was tested for Zika virus infection by RT-PCR with a positive result. Confirmatory molecular diagnostic testing was performed at CDC. Detection of anti-dengue virus IgM antibody likely was a result of cross-reactive anti-Zika virus IgM antibody. Although no pathogen other than Zika virus was identified, the patient’s clinical course suggests that he also had an occult bacterial infection. Read more…

Suggested citation: Thomas DL, Sharp TM, Torres J, et al. Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–6. DOI: http://dx.doi.org/10.15585/mmwr.mm6506e2er

Disease Outbreak News – 12 February 2016  – Mirrored from WHO

Sexually transmitted ZIKV infection in Dallas, Texas

On 5 February 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of a probable case of sexual transmission of Zika virus.

Person A, a resident of Dallas, Texas, travelled to Venezuela for one week between late December and the beginning of January. Several days after returning to the United States, Person A developed symptoms consistent with Zika virus infection, including fever, rash, conjunctivitis, and malaise. One day prior to symptom onset and once during the symptomatic period, Person A had sex with Person B (non-traveller). Approximately one week after the onset of illness in Person A, Person B developed symptoms consistent with Zika virus disease, including fever, pruritic rash, conjunctivitis, small joint arthralgia and malaise.

Laboratory tests confirmed Zika virus infection in both Person A and Person B. Samples collected from Person A at 14 days after symptom onset and from Person B at 4 and 7 days after illness onset had evidence of Zika virus IgM and neutralizing antibodies. Additional tests are being carried out. Local meteorological conditions at the time would not have supported mosquito activity; furthermore, entomological sampling that was conducted in the concerned area yielded no mosquitoes. Read more…

Related Links

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ZIKV Update – Feb. 3, 2016

Posted by feww on February 3, 2016

Zika virus acquired through sexual transmission —Texas Officials

Health officials have confirmed that a person in Dallas County, Texas, contracted the Zika virus through sexual contact, the first such case reported in the continental United States.

The patient in Texas was infected after having sex with their partner who had returned from Venezuela, according to reports.

The Centers for Disease Control and Prevention (CDC) earlier released the following statement:

CDC has confirmed through laboratory testing the first U.S. case of Zika virus infection in a non-traveler in the continental United States. According to a Dallas County Health Department investigation, a person who recently traveled to an area with Zika virus transmission returned to the United States and developed Zika-like symptoms. The person later tested positive for Zika, along with their sexual partner, who had not traveled to the area. In this instance there was no risk to a developing fetus.

“Based on what we know now, the best way to avoid Zika virus infection is to prevent mosquito bites. We do not have definitive information on the infectious time period, and will provide more guidance for individuals and clinicians as we learn more. Sexual partners can protect themselves by using condoms to prevent spreading sexually transmitted infections. People who have Zika virus infection can protect others by preventing additional mosquito bites.

Two confirmed cases of Zika virus reported in Ireland

Meanwhile, two cases of ZIKV infection have been reported in Ireland, which are being investigated by The Health Service Executive (HSE), said a report.

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ZIKV: Additional Information on Transmission

Posted by feww on January 29, 2016

 Microcephaly:  Zika virus or Guillain-Barré syndrome?

ZIKV is transmitted primarily by Aedes aegypti mosquitoes (1,7). Aedes albopictus mosquitoes also might transmit the virus. Aedes aegypti and Ae. albopictus mosquitoes are found throughout much of the Americas, including parts of the United States, and also transmit dengue and chikungunya viruses.

In addition to mosquito-to-human transmission, Zika virus infections have been documented through:

  • Intrauterine [in mother’s womb, or uterus] transmission resulting in congenital infection
  • Intrapartum [during the act of birth] transmission from a viremic mother to her newborn
  • Sexual transmission
  • Blood transfusion
  • Laboratory exposure

There is a theoretical concern that transmission could occur through organ or tissue transplantation, and although Zika virus RNA has been detected in breast milk, transmission through breastfeeding has not been documented.

The Brazil Ministry of Health has reported a marked increase in the number of infants born with microcephaly in 2015, although it is not known how many of these cases are associated with Zika virus infection. Guillain-Barré syndrome also has been reported in patients following suspected Zika virus infection. Studies are under way to evaluate the risks for Zika virus transmission during pregnancy, the spectrum of outcomes associated with congenital infection, and the possible association between Zika virus infection and Guillain-Barré syndrome.

There is no commercially available test for ZIKV. The virus testing is performed in the United States at CDC and four state health department laboratories.

Source: Hennessey M, Fischer M, Staples JE. Zika Virus Spreads to New Areas — Region of the Americas, May 2015–January 2016. MMWR Morb Mortal Wkly Rep 2016;65:55–58. DOI: http://dx.doi.org/10.15585/mmwr.mm6503e1

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that usually last for a few weeks. Most people recover fully from GBS, but some people have long-term nerve damage. In very rare cases, people have died of GBS, usually from difficulty breathing.

  • The background rate for GBS in the U.S. is about 80 to 160 cases of GBS each week, regardless of vaccination.

What causes GBS?

Many things can cause GBS; about two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with diarrhea or a respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS. People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.

 

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