CAA Meeting
COMMUNICABLE DISEASE CONTROL
20 July 2016
Middle East respiratory syndrome
coronavirus (MERS-CoV)
• Globally, since September 2012, WHO has
been notified of 1,782 laboratory-confirmed
cases of infection with MERS-CoV, including at
least 634 related deaths.
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MERS-CoV: WHO risk assessment
• MERS-CoV causes severe human infections resulting in
high mortality and has demonstrated the ability to
transmit between humans.
• Human-to-human transmission has occurred mainly in
health care settings.
• WHO expects additional cases of infection from Middle
East, and cases will continue to be exported to other
countries by individuals who might acquire the infection
from animals or animal products (e.g. dromedaries) or
human source (e.g. health care setting).
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WHO Advice
• People with diabetes, renal failure, chronic lung disease, and
immunocompromised persons considered high risk of severe disease. These
people should avoid close contact with animals, particularly camels, when
visiting farms, markets, or barn areas where virus is known to be potentially
circulating.
• General hygiene measures, such as regular hand washing before and after
touching animals and avoiding contact with sick animals, should be adhered to.
• Food hygiene practices should be observed. Avoid drinking raw camel milk or
camel urine, or eating meat that has not been properly cooked.
• WHO does not recommend travel or trade restrictions with regard to this event.
Raising awareness about MERS-CoV among travellers to and from affected
countries is good public health practice.
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Mers-CoV Action Plan
Objectives
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Coordinate timely interventions to reduce the risk of onset of pandemic
Ensure that mechanisms exist so that imminent potential human health threats can be
recognised and dealt with
Early detection and reporting of human-to-human transmission of MERS - CoV and
identification of risk factors
Prevent nosocomial transmission and laboratory infection
Heighten awareness among health care providers regarding isolated cases or clusters
Contain or reduce human-to-human virus transmission
Limit morbidity and mortality associated with current human infections
Increase readiness for possible pandemic development
Communicate transparently and coherently with the public regarding outbreak
progression and management
Ensure rapid sharing of appropriate information among health authorities, other
government departments and partners
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Lassa Fever – Nigeria
• Between Aug 2015 and 17 May 2016, WHO notified of 273 cases,
incl. 149 deaths. Of these, 165 cases and 89 deaths have been
confirmed through laboratory testing (CFR: 53.9%).
• Since August 2015, 10 HCWs have been infected, of which 2 have
died. Of these 10 cases, 4 were nosocomial infections.
• As of 17 May 2016, 8 states are currently reporting Lassa fever
cases, deaths and/or following of contacts for the maximum 21day incubation period.
• 248 contacts are being followed up in the country.
• 15 previously affected states have completed the 42-day period
following last known possible transmission.
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Lassa: WHO Risk Assessment
• Overall, the Lassa fever outbreak shows a declining
trend.
• Considering the seasonal peaks in previous years,
improvements in community and HCW awareness,
preparedness and general response activities, the risk of
a larger-scale outbreak is low.
• Close monitoring, active case search, contact tracing,
laboratory support and disease awareness (both in
community in general and specific training for health
care workers) should continue.
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WHO Advice
• Diagnosis of Lassa fever should be considered in febrile
patients returning from areas where Lassa fever is
endemic.
• HCWs seeing a patient suspected to have Lassa fever
should immediately contact local and national experts
for advice and to arrange for laboratory testing.
• WHO does not recommend any travel or trade
restriction to Nigeria based on the current information
available.
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Yellow Fever
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Yellow Fever: Angola
• Yellow fever outbreak was detected in Luanda, Angola late in December 2015.
• First cases were confirmed by NICD on 19 Jan 2016 & by Institut Pasteur Dakar
on 20 Jan.
• Subsequently, a rapid increase in the number of cases has been observed.
• As of 8 July 2016, 3625 suspected cases have been reported, of which 876 are
confirmed.
• The total number of reported deaths is 357
• Suspected cases have been reported in all 18 provinces and confirmed cases
have been reported in 16 of 18 provinces and 80 of 125 reporting districts.
• Mass reactive vaccination campaigns first began in Luanda and have now
expanded to cover most of the other affected parts of Angola.
• Despite extensive vaccination efforts circulation of the virus persists.
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Yellow Fever: DRC
• As of 11 July, suspected cases is 1798, with 68
confirmed cases and 85 reported deaths.
• Surveillance efforts have increased and
vaccination campaigns have centred on affected
health zones in Kinshasa and Kongo Central.
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Risk of spread
• 2 additional countries have reported confirmed cases
imported from Angola: Kenya (2 cases) & China (11
cases).
• These cases highlight the risk of international spread
through non-immunised travellers.
• 7 countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru
and Uganda) are currently reporting YF outbreaks or
sporadic cases not linked to the Angolan outbreak.
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Risk Assessment
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Outbreak in Angola of high concern due to:
– Persistent local transmission despite approx 15 million vaccinations.
– Local transmission has been reported in 12 highly populated provinces including Luanda.
– Continued extension of the outbreak to new provinces and new districts.
High risk of spread to neighbouring countries. As the borders are porous with substantial crossborder social and economic activities, further transmission cannot be excluded.
Viraemic travelling patients pose a risk for the establishment of local transmission especially in
countries where adequate vectors and susceptible human populations are present;
In DRC, the outbreak has spread to 3 provinces. Given the limited availability of vaccines, the large
Angolan community in Kinshasa, the porous border between Angola and DRC, and the presence
and the activity of the vector Aedes in the country, the outbreak might extend to other provinces.
The virus in Angola and DRC is largely concentrated in main cities; however, there is a high risk of
spread and local transmission to other provinces in both countries. In addition, the risk is high for
potential spread to bordering countries, especially those classified as low-risk (i.e. Namibia,
Zambia) and where the population, travelers and foreign workers are not vaccinated for yellow
fever.
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Risk Assessment cont…
• Some African countries (Chad, Ghana, Guinea, Republic of
Congo and Uganda) and some countries in South America
(Brazil, Colombia and Peru) have reported cases of yellow
fever in 2016. These events are not related to the Angolan
outbreak, but there remains a need for vaccines in those
countries, which poses additional strain on the limited global
yellow fever vaccine stockpile.
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Actions Taken
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YF is a priority notifiable medical conditions - immediate verbal report on clinical suspicion
within 24 hours
RSA has a small risk of yellow fever disease introduction as the mosquito vector occurs with a
limited distribution to northern Limpopo and Northern KwaZulu-Natal
Ongoing actions
a. Screening/monitoring for travelers with fever
b. YF vaccine certificate or certified exemption verification
c. Provision of updated informational to travelers going to YF risk countries
YF vaccine - provided at port health, public and private travel clinics
• Vaccine protection from 10 years to lifetime
• ii. Removing/addition of YF at-risk countries list
Testing for YF is available at the NHLS labs and private labs.
Other websites of reference for SA
– http://www.nicd.ac.za/?page=search&id=8&q=yellow+fever&x=0&y=0
– http://www.who.int/topics/yellow_fever/en/
– http://www.health.gov.za/index.php/diseases
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Human infection with avian influenza A(H7N9)
virus – China
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• Since 2003, a total of 851 laboratory-confirmed cases
of human infection with avian influenza A(H5N1)
virus, including 450 deaths, have been reported to
WHO from 16 countries.
• A total of 781 laboratory-confirmed cases of human
infection with avian influenza A(H7N9) viruses,
including at least 313 deaths, have been reported to
WHO
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Human infection with avian influenza
A(H7N9) virus – China
• Public health response
– The Chinese Government has taken the following
surveillance and control measures:
• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and
dissemination of information.
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WHO risk assessment
• Most human cases are exposed to the A(H7N9) virus through contact with
infected poultry or contaminated environments, including live poultry markets.
• Since the virus continues to be detected in animals and environments, further
human cases can be expected.
• Although small clusters of human cases with A(H7N9) viruses have been
reported previously including those involving healthcare workers, current
epidemiological and virological evidence suggests that this virus has not
acquired the ability of sustained transmission among humans.
• Therefore, community level spread of this virus is considered unlikely for the
time being.
• Human infections with the A(H7N9) virus are unusual and need to be
monitored closely in order to identify changes in the virus and/or its
transmission behaviour to humans as it may have a serious public health
impact.
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WHO advice
• WHO advises that travellers to countries with known outbreaks of avian
influenza should avoid poultry farms, contact with animals in live bird markets,
entering areas where poultry may be slaughtered, or contact with any surfaces
that appear to be contaminated with faeces from poultry or other animals.
• Travellers should wash hands often & follow good food safety practices.
• WHO does not advise special screening at PoE’s, nor does it currently
recommend any travel or trade restrictions.
• A diagnosis of infection with an avian influenza virus should be considered in
individuals who develop severe acute respiratory symptoms while travelling or
soon after returning from an area where avian influenza is a concern.
• WHO encourages countries to continue strengthening surveillance, including for
severe acute respiratory infections (SARI) and to carefully review unusual
patterns & ensure reporting of human infections under the IHR (2005), and
continue national health preparedness actions.
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Zika Virus
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Zika Virus
• As of 13 July 2016, 65 countries & territories have reported
evidence of mosquito-borne Zika virus transmission since 2007
(62 of these have reported evidence of mosquito-borne Zika virus
transmission since 2015):
– 48 countries and territories with a first reported outbreak from 2015
onwards.
– 4 countries are classified as having possible endemic transmission or have
reported evidence of local mosquito-borne Zika infections in 2016.
– 13 countries and territories have reported evidence of local mosquitoborne Zika infections in or before 2015, but without documentation of
cases in 2016, or with outbreak terminated.
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Global spread of Zika virus, 2013-2016
Risk assessment
• Overall, the global risk assessment has not changed.
• Zika virus continues to spread geographically to areas
where competent vectors are present.
• Although a decline in cases of Zika infection has been
reported in some countries, or in some parts of
countries, vigilance needs to remain high.
• At this stage, based on the evidence available, there is
no overall decline in the outbreak.
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Risk assessment: Olympics
• On 13 July 2016, the U.S. CDC released a risk assessment
for Zika virus spread related to travel to Olympics.
• Assessment concluded that international spread of Zika
related to the Games would not significantly alter
spread, but that 4 countries were at special risk, because
residents of those countries did not have substantial
travel to Zika affected countries, outside of potential
exposure at the Olympics: Eritrea, Djibouti, Chad, and
Yemen.
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Actions taken by DOH
• Joint stakeholder meetings were held with
CDC Directorate, Port Health, US-CDC, NICD
• Zika pamphlet was finalized and placed on
DOH website.
• Port Health is facilitating printing of
pamphlet and banner.
• Action plan was updated.
• Info was shared with MNORT & stakeholders
• Finalized pamphlet will be circulated to
Atletics-SA, the Olympics Committee,
SASTM and travel agents once printed.
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Coordination:
• Coordination EPR activities in the country is led by the Multisectoral National
Outbreak Response Team (MNORT) at national level as well as provincial
outbreak response teams (PORT) at provincial level. Existing structures that are
handling Ebola preparedness and response are adapted to include Zika virus.
• A national action plan for preparedness and response has been developed .
The major elements of the action plan include:
– ORTs at provincial and district levels are alerted.
– ORTs at provincial and district levels have been trained on EPR.
– Interim guidelines developed updated as new information emerges.
– The National Operation Centre (NATHOC) is handling queries from the
public.
– The Emergency Operations Centre (EOC) is on standby and will be active in
the event of an outbreak in the country.
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Early detection:
• Enhanced surveillance:
– Port Health: Ports of entry – temperature screening for
travellers arriving from countries reporting local transmission
– At Health facilities: guidelines with case definition and
laboratory testing protocol was developed and distributed
– Algorithm for risk assessment was developed to increase
awareness regarding pregnant women with travel history to
affected countries reporting confirmed ZVD
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Communication:
• Risk communication has been initiated to raise public
awareness on signs and symptoms of ZVD,
preventive measures, where to seek health care if
symptoms develop etc. Information is available on
the Department of Health Website and will be
updated as new information becomes available.
• Media briefings have been conducted by the NICD.
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Preventive measures:
• Vector control at airports and community level:
– Ensured appropriate disinsection of aircrafts using
Standard WHO recommendations regarding disinsection of
aircraft and airports
– Elimination of mosquito breeding sites is emphasized and
will be enhanced
– Protection measures from mosquito bites are being
enhanced through public communication; a travel advice
and fact sheet is in circulation.
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Work in progress:
• Although Zika virus(ZIKV) was discovered in 1947, it remains
relatively unknown for decades since it affected mainly monkeys
and occasionally caused a mild disease in humans residing across a
narrow equatorial belt in Africa and Asia and was self limiting. The
emergence of the implicated highly pathogenic strain in South
America raised the urgency to learn more about the disease as well
as preventive and treatment measures such as vaccines and drugs.
• The following measures are in progress to enhance prevention and
control of Zika virus:
– Environmental studies to learn more about the nature of the vector (Aedes
aegypti)
– Pathogenicity of the virus in humans
– Diagnosis and treatment of cases including pregnant women
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Thank you
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