ZIKA VIRUS IN SOUTH AFRICA BRIEFING TO THE PORTFOLIO COMMITTEE ON HEALTH, 9 MARCH 2016 NATIONAL DEPARTMENT OF HEALTH

Outline Background to Zika virus First case of Zika virus in South Africa Public health implications Actions taken Preparedness and response to Zika virus in SA Coordination Work in Progress

Background (i) Zika virus is transmitted to humans through a mosquito vector, Aedes, that also transmit dengue, yellow fever and chikungunya viruses Symptoms include, acute onset of fever, rash, joint and muscle pain, conjunctivitis and headache. These symptoms are usually mild and self-limiting, however, it has been associated with microcephaly and other neurologic disorders There is no evidence of human-to-human transmission other than the 2 cases of sexual transmission recently reported in the USA

Background (ii) There is international concern regarding infection with the virus. As of February 2016, over 34 countries have been affected, mostly in South America On 1 February 2016, WHO declared the recent Zika virus outbreak in Brazil and other South American countries, a public health emergency of international concern (PHEIC), WHO called on countries to put in place mechanisms for detection, prevention and response.

Key concern to South Africa Of key concern to South Africa is the risk posed to pregnant women travelling to affected countries Because there is neither vaccine nor specific treatment available, the national Department of Health recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing If a pregnant women travels to an area with Zika virus transmission she is advised to strictly follow steps to avoid mosquito bites

First case of Zika virus in South Africa (i) On 20 February 2016, the National Institute for Communicable Diseases (NICD) confirmed first case of Zika virus disease in a traveller from Colombia. The test had initially been submitted to Lancet laboratories on 16 February by a General practitioner, tested positive for Zika virus by PCR assay The patient, a 36 year-old Colombian national , an industrial mechanic came to South Africa for 3 months to work on a factory development project

First case of Zika virus in South Africa (ii) Patient had travelled from his home town of Cali, Colombia, via Bogota, Paris and arrived Johannesburg on Wednesday, 10 February He started to feel unwell 5 days later on Monday, 15 February Symptoms of loss of appetite, fever and fine macular skin rash described as ‘small red dots’ on his hands, legs, chest and neck No history of dengue fever and had received yellow fever vaccination in 2013. No underlying chronic condition He was managed symptomatically and all symptoms resolved within 3 days of presentation, and was well by Friday, 16 February

Public health implications In South Africa the local mosquito species although present, is unlikely to act as vectors to transmit Zika virus due to them being different and having a different behavioural pattern compared to the vectors in the current outbreak in South America In addition, Zika virus has not been identified further south than Uganda in Africa Therefore secondary spread of Zika virus into South Africa on account of this case is unlikely

Actions taken Media statement was issued by the National Department of Health and NICD on Friday, 19 February An emergency meeting was held on 22 February in Chief Directorate: Communicable Diseases where need to enhance early detection and prevention were emphasised

Epidemic Preparedness and response (EPR) to Zika virus in SA Coordination : EPR activities led by MNORT at national level & PORT at provincial level Existing structures that are handling Ebola preparedness and response are adapted to include Zika virus National action plan for EPR has been developed; major elements include: ORTs at provincial and district levels alerted & followed-up with teleconference Action plan, guidelines have been shared with provinces ORTs at provincial and district levels have been trained on EPR National Operation Centre (NATHOC) is handling queries from public Emergency Operations Centre (EOC) is on standby and will be active in the event of an outbreak in the country

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

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, travel advisory etc. Information is available on DOH Website and will be updated as new information becomes available Media briefings and interviews have been conducted by the NICD

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

Work in progress: The following measures/studies are in progress to enhance prevention and control of Zika virus: Environmental studies to learn more about the nature of the vector (Aedes aegypti) in SA Review of pathogenicity of the virus in humans Review of diagnosis and treatment of cases including pregnant women

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