Mi Micr crocephaly a and Zika ka Epidemiological situation and Management ECONOMIC C AND S SOCI CIAL C COUNCIL Bri riefing o on n the he Zika ka Virus us ECOSOC OC Cha hamber, ber, UN Headqua uart rters ers, New York rk Cláud udio M Maier erovitch Dir irector De Department o of Co Commu mmunica cable Di Disease Su Surveillance Secret etaria iat of Healt lth Sur urve veillanc nce Brasília, february 2015
H ISTORY RY – R EPORT TO TO IHR-OPAS/OMS ABOUT OUT Z IKA KA , , G UILLAIN -B ARRÉ E M ICROCEPHAL EPHALY Around 29 reports to IHR: March, 12, 2015 – First report about exanthematous syndrome May, 02, 2015 – Report about Zika virus circulation June, 26, 2015 – Guillain-Barre information October, 23, 2015 – Microcephaly information reported to PAHO October, 30, 2015 – OMS starts sharing data with Brazil November, 12, 2015 – Health Emergency Declaration November, 18, 2015– Communication from ESPIN to WHO November, 27, 2015– Communication of identification of zika virus in 2 deaths November, 29, 2015– Association between zika and microcephaly Week updates on microcephaly since october 22nd to WHO and other requesting countries.
H ISTORY APR/2015 AUG/2015 OCT/2015 OCT/2015 NOV/2015 OCT/2015 NOV- EW 17 EW 31 EW 41 EW 43 EW 45 EW 42 MAY/2015 APR/2015 April/2015 – May/2015 August/2015 – 22/10 – 26/10 – Start 30/04 – 12/11 – Changes in – Northeast First epidemiologic Pernambuco investigations detection of Statement of region First cases microcephaly al profile reports cases to Zika virus emergency reporting of Guillain cases Ministry of Camaçari/B exanthemat Barre Healh A ous syndrome NOV/2015 DEC/2015 DEC/2015 JAN/2016 JAN/2016 NOV/2015 EW 47 EW 49 EW 50 EW 02 EW 03 EW 45 20/01 – Confirmed the 28/11 – Relation 09/12 – 14/12 – 12/01 – National 17/11 – passage of the zika virus confirmed between Disclosure of Disclosure of the guidelines for First national guidelines placental barrier; microcephaly and the Protocol of Microcephaly early stimulation for microcephaly (33 Zika virus - IEC/SVS Microcephaly- Protocol – Health in babies with cm); Zika virus care Protocol of surveillance – microcephaly ; confirmation in amniotic Microcephaly- version 1 – fluid in pregnant PB - surveillance – version changes in CP CDC: Fiocruz 1,3 alteration to 32 identifcation of 4 cm and zika virus cases others* *EW – epidemiological week
WH WHO – I NTERNACIONA NAL E MER CY ERGE GENCY February 1st 2016: WHO declared a Public Health Emergency of International Concern due to zika epidemic and microcephaly association Recognition of transparency and efficiency on information sharing through the International Health Regulations (IHR/WHO)
RELATION BETWEEN MICRCEPHALY AND ZIKA VIRUS An increase of exanthematous syndrome before microcephaly occurrence in Northeast of Brazil Mothers of Microcephaly cases reporting rash during pregnancy Positive zikavirus in amniotic fluid, tissues and blood sample 5
M ICROCEPHALY S URVAILLANCE Newborn with microcephaly Suggestive miscarriage of congenital infection Stillbirth with microcephaly and / or malformation suggestive of congenital infection Fetus with microcephaly and / or compromised central nervous system, suggesting congenital infection 6
S URVAILLANCE AND H EALTH C ARE Report Microcephaly Microcephaly with delay in intellectual development, motor and neurological Follow up disorders Investigated causes Suggestive microcephaly of congenital infection Z-STORCH: Zika vírus, syphilis, toxoplasmosis, other viruses (Chikungunya, Diseases and etiological agents Dengue , HIV, etc.) , Rubella, Cytomegalovirus and Herpes virus 7
Microcephaly protocols Surveillance: compulsory notification Care: care to pregnant women and babies with microcephaly Guidelines for early stimulation on children with microcephaly until three years age
R EPORT RTED CA CASES OF MICROCE HALY OR MALFOR ON OF CEPHA ORMA MATION THE NE US CENT RAL SYSTE STEM , , B RA ZIL AND ND RE REGION , , UNT UNTIL THE NERVOUS NTRA RAZI EW 05/2016 Reported cases of microcephaly and/or malformation of nervous central system, suggestive of congenital infection in fetuses , Total cases reported abortions , stillbirths or live births Regions 2015 - 2016 (A+B+C) (A) In (B) Investigated (C) Investigated investigation and confirmed and discarded Brazil 3.852 462 765 5.079 Northeast 3.120 453 595 4.168 Southeast 400 5 75 480 North 126 1 17 144 Midwest 205 2 68 275 South 1 1 10 12 Source: Ministry of Health and State Secretariats of Health 9
E SPACIAL D ISTRIBUTION OF MUNICIPALITIES WITH CONFIRMED CASES OF MICROCEPHALY , B RAZIL , UNTIL EW 05/2016 Legend Municipalities with confirmed cases States with confirmed cases States without confirmed cases Total number of municipalities with confirmed cases: 175 Source : Ministry of Health and State Secretariats of Health (last update: 06/02/2016). 10
Estratégias de Comunicação - http://combateaedes.saude.gov.br/
Research and Development Iniciatives of vaccines against zika virus supported by the Ministry of Health Produção final Partnerships Desenvolvimento 1. INSTITUTO EVANDRO CHAGAS (IEC/SVS/MS) + UNIVERSIDADE DO TEXAS 1. UNIVERSITY OF TEXAS MEDICAL BRANCH INSTITUTO EVANDRO BIO MANGUINHOS MEDICAL BRANCH CHAGAS 2. GlaxoSmithKline 1. GlaxoSmithKline BIOMANGUINHOS 1. NATIONAL INSTITUTES OF HEALTH OF USA( VACCINE AGAINST INSTITUTO BUTANTÃ 1. NATIONAL INSTITUTES OF HEALTH DOS ESTADOS UNIDOS (VACINA DENGUE) CONTRA DENGUE) INSTITUTO BUTANTÃ 2. USP (UNIV. SÃO PAULO) 2. USP (UNIV. SÃO PAULO) FIN FINANCIN ING– brazil ilian ian governm nment nt: : Brazilian Development Bank (BNDS) – Ministry of Development, • Industry and Foreign Trade (MDIC); Financing Agency for Studies and Projects (FINEP) – Ministry of • Science, Technology and Innovation (MCTI) Secretariat of Science, Technology and Strategic Inputs • (SCTIE / MS)
N ATIONAL C OORDINATION AND C ONTROL R OOM AGAINST A EDES AND ITS CONSEQUENCES (SNCC) Goals: ES PR CE SC DF • Intensify the campaign against the mosquito from AM MT December 2015 to June 2016; RR TO • Inspect all households and public and private urban RN PE facilities by the end of February 2016 through a taskforce with participation of agent of endemics, MS MG community health agents, armies, civil defense, brigades (of firemen) and military forces; RO MA • Conduct monthly visits until February and bimonthly RS AC visits, starting from March to June 2016 through the taskforce. GO PB AP SP • Reduce the rate of infestation by Aedes to less than SE AL 1% in all municipalities. RJ BA PI
Brazilian Estrategy on zika: in accordange with PAHO/WHO estrategy Researche Detecting s Evidencies rapid detection of the virus, its complications, monitoring and report to WHO the evolution of the epidemic Preventing Reduction of risk by eliminating the vector and reducing the chances of transmission. #ZIKAZERO Responding The response includes preparation of health services, clinical guidelines, communication of risk and research and development
Notified Dengue Cases by Epidemiological weeks 2013, 2014 e 2015, Brazil Number of cases Source: Sinan, *dados atualizados em Epi week of first symptoms 29/12/2015.
Notified cases by month, Rio de Janeiro State, 2013-2015 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 Janeiro Fevereiro Marco Abril Maio Junho Julho Agosto Setembro Outubro Novembro Dezembro January February Mars April May June July August September October November December 2013 2014 2015
25000 Notified cases of dengue by month, city of Rio de Janeiro, 2013-2015 20000 15000 10000 5000 0 January February Mars April May June July August September October November December 2013 2014 2015
Secretariat of Health Surveillance www.saude.gov.br/svs Disque Notifica 0800-644-6645 notifica@saude.gov.br www.resp.saude.gov.br
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