This is a lecture given during the 11th Cebu Institute of Medicine Medical World Congress at the Radisson Blu entitled "ZIKA, Sick ka?" as updates on the zika virus epidemic in the Philippines.

1. Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
December 2, 2016
11th Medical World Congress
SICK KA?

2. WHO: PUBLIC HEALTH EMERGENCY OF
INTERNATIONAL CONCERN
C Chang et. Al 2016
@helenvmadamba

3. Zika virus
• Zika virus, a flavivirus transmitted
by Aedes mosquitoes.
Schuler-Faccini et al 2016 at http://www.cdc.gov/mmwr
@helenvmadamba

4. • Zika virus (ZIKV), a mosquito-borne flavivirus,
was first isolated from a rhesus monkey in
Uganda in 1947.
Hayes EB 2009 at http://wwwnc.cdc.gov/eid
@helenvmadamba

5. MARCH 2012
• A prospective longitudinal cohort
study, which included active
surveillance for acute febrile illness,
was initiated in Cebu City, Philippines.
– 270 acute febrile illnesses
– 267 samples for serologic testing for
evidence of influenza, dengue,
chikungunya, Japanese encephalitis, and
Zika virus infections
Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid
@helenvmadamba

6. MAY 2012
• A 15-year old boy in Cebu City with
subjective fever, headache,
conjunctivitis, sore throat, myalgias,
stomach pain, anorexia, nausea and
vomiting, but no rash
• The boy recovered fully by the 3-
week study follow up visit.
• ZIKV RNA was detected in the
patient’s serum sample
Alera MT et.al. 2015 at http://wwwnc.cdc.gov/eid@helenvmadamba

7. Why the fuss now?
• Rapid spread since its first
detection in May 2015 in Brazil to
22 other countries and other
territories in the Americas
• Possible association with a
significant rise in the number of
babies born with
microcephaly and
neurological disorders
• “Global Emergency” by the WHO
Petersen E et.al. 2016 at http://wwwnc.cdc.gov/eid
@helenvmadamba

8. Mode of Transmission of ZIKV
• Mosquito-borne ZIKV transmission
• Sexual transmission
• Blood transfusion and transmission of
ZIKV
Peterson et.al. 2016 at http://ac.els-cdn.com@helenvmadamba

9. • Zika virus outbreak in French
Polynesia started October 2013 and
ended April 2014 and 66% of the
general population were infected.
• 7 out of 8 microcephaly cases
occurred in the 4-month period from
March 1 to July 10, 2014 – period of
risk in the first trimester of pregnancy
Cauchemez S et al. 2016@helenvmadamba

10. • Baseline prevalence of microcephaly
was 2 in 10,000 neonates
• Risk of microcephaly associated with
zika virus is 95 in 10,000 women
infected in the first trimester
Cauchemez S et al. 2016@helenvmadamba

11. Dr Willie Ong on facebook at https://www.facebook.com/drwillieong
@helenvmadamba

12. "We are not downgrading the
importance of Zika, by placing this
as a longer program of work, we
are sending the message that Zika
is here to stay,"
Dr. Peter Salama, Executive Director
WHO's Health Emergencies Programme
http://www.medscape.com@helenvmadamba

13. WHO: TRAVEL MEASURES
• There should be no restrictions on travel or
trade with countries, areas and/or
territories with Zika virus transmission.
• Travellers to areas with Zika virus
transmission should be provided with up to
date advice on potential risks and
appropriate measures to reduce the
possibility of exposure to mosquito bites.
• Standard WHO recommendations regarding
disinfection of aircraft and airports should
be implemented.
http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/@helenvmadamba

14. MANILA — A pregnant 16-year-old girl from Las Piñas
City is among the latest victims of Zika virus infection,
according to the Department of Health.
@Dok_Pau confirms second pregnant
#Zika; 16 year old from Las Pinas City; had
skin rash & fever at 32nd week of her
pregnancy; No ultrasound
DOH spokesperson Dr. Eric Tayag
November 16, 2016 at http://newsinfo.inquirer.net/
@helenvmadamba

15. “Total number of #zika in #ph
is 33 including 2 pregnant
cases (Cebu & Las Pinas)”
DOH Spokesperson Dr Eric Tayag in his Twitter account
12 Iloilo 2 Muntinlupa
4 Bacoor 1 Cebu
3 Mandaluyong 1 Quezon City
3 Calamba 1 Makati
2 Antipolo 1 Caloocan
2 Las Pinas 1 Manila
November 16, 2016 at http://newsinfo.inquirer.net/@helenvmadamba

16. ONE PHILIPPINES AGAINST ZIKA
• All suspected cases will be tested for Zika virus
using Realone-time Polymerase Chain Reaction
(RT-PCR).
• Currently, the Research Institute for Tropical
Medicine (RITM) is capable of testing suspected
cases of Zika virus through RT PCR. The test is
also available in Visayas and Mindanao.
First National Summit on Zika on
October 28, 2016 at Conrad Hotel
@helenvmadamba

17. ACTIVE ZIKA VIRUS
DISEASE SURVEILLANCE
PROTOCOL
• Health personnel and health facilities should
continue reporting cases of suspected Zika
Virus Disease
• Each region will submit 100 blood and urine or
NPS/OPS samples of cases that fit the case
definitions from November 2016 to January
2017
DOH Region VII RESU@helenvmadamba

18. ACTIVE ZIKA VIRUS DISEASE
SURVEILLANCE SENTINEL SITES
1. Cebu City: Vicente Sotto Memorial Medical
Center
2. South General Hospital – Naga City, Cebu
3. Mactan Doctors’ Hospital
4. Cebu City: Chong Hua Hospital – Capitol
5. Cebu City: Cebu Doctors’ University Hospital
DOH Region VII RESU@helenvmadamba

19. Flow of Testing of Zika Virus
Cases from Designated
Sentinel Sites
DOH Region VII RESU
• Patient with skin rash and one of the
following: fever, arthralgia or conjunctivities
• Pregnanct woman with skin rash (not
associated with pregnancy)
Conduct routine
Surveillance
Fit Case
Definition
No
Yes
@helenvmadamba

20. DOH Region VII RESU
Notify assigned Health
Facility Zika Point Person
Health Facility to do the following:
1. Fill out iCIF (integrated case investigation
form)
2. Ensure appropriate collection of blood, urine
and NPS/OPS
3. Coordinate with RESU for submission of iCIF
and specimens
@helenvmadamba

21. Fill out iCIF
Blood, urine
and NPS/OPS
Coordinate
with RESU for
submission
@helenvmadamba

22. DOH Region VII RESU
RESU sends specimens to
RITM with iCIF
FETP to do the ff:
1. Encode the iCIF
2. Manage database
3. Provide profile report
RITM send results to RESU,
pidsr2@gmail.com,
fetp27@gmail.com
@helenvmadamba

23. ROUTINE ZIKA CASE REPORTING
• A pregnant woman with skin rash at
any time during pregnancy
• A patient with skin rash and one of
the following: fever, arthralgia,
arthritis or conjunctivitis
• A fetus, newborn or infant whose
mother had confirmed or presumed
infection with Zika virus during
pregnancy
@helenvmadamba

24. ROUTINE ZIKA CASE REPORTING
• A mother whose fetus, newborn or
infant has any of the following
neurological conditions that cannot
be explained by other etiologies
– Head circumference <3SD or occipito-
frontal circumference <3rd percentile
on standard growth charts
– Disproportionately small head
compared to infant’s length
– Intra-cranial calcifications
• All newly diagnosed GBS cases
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25. @helenvmadamba

26. @helenvmadamba

27. @helenvmadamba

28. These slides are on
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https://www.facebook.com/Helen-V-Madamba
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