On 7 April 2016, the National IHR Focal Point of Saint Lucia notified PAHO/WHO of the first 2 confirmed cases of locally-acquired Zika virus infection.
The first case is a 25-year-old male from the Castries district. On 16 March, he experienced fever, pain (joint, head, waist), neck stiffness and lymphadenopathy. Blood samples were collected on 17 March.
The second case is a 28-year-old pregnant female from the Castries district in Saint Lucia. On 6 March, she experienced fever and rash (chest, hands, wrists, fingers, bottoms of her feet). She was at 9 weeks of gestation at the time of symptom onset. Blood samples were collected on 10 March.
On 29 March, blood samples were sent to the Caribbean Public Health Agency (CARPHA) for testing and, on 6 April, samples were confirmed positive for Zika virus by real-time polymerase chain reaction (RT-PCR). None of the cases had recent travel history.
Public health response
To date, the Ministry of Health of Saint Lucia has implemented the following public health measures:
conducting stakeholder consultations with
the public and private sectors as well as nongovernmental organizations that focus on vector borne disease;
with the tourism sector (Tourist Board, Ministry of Tourism and St. Lucia Hotel and Tourism Association) that led to a collaborative action plan to reduce the possible economic and health impact of Zika Virus;
carrying out public awareness campaigns to encourage the public to take action to reduce the breeding of mosquitoes in and around their homes and within their communities;
organizing clean-up campaigns in collaboration with private and public sector organizations to remove sources of mosquito breeding and to disseminate information on mosquito borne disease prevention;
strengthening antenatal care to reduce the impact of Zika Virus on neonatal health by providing bed nets to antenatal clinics at the community level, with assistance of PAHO;
training health care workers and preparing facilities to manage potential congenital malformations (e.g., Guillain-Barre Syndrome and microcephaly);
strengthening surveillance for Zika virus, microcephaly and Guillain-Barre Syndrome at the two main public hospitals;
conducting routine Vector control measures.
WHO risk assessment
The detection of autochthonous cases of Zika virus infection indicates that the virus is spreading geographically to previously unaffected areas (Saint Lucia). The notification of autochthonous transmission in a new country does not change the overall risk assessment. The risk of a global spread of Zika virus to areas where the competent vectors, the Aedes mosquitoes, are present is significant given the wide geographical distribution of these mosquitoes in various regions of the world. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.
All patients (male and female) with Zika virus infection and their sexual partners (particularly pregnant women) should receive information about the potential risks of sexual transmission of Zika virus, contraceptive measures and safer sexual practices, and should be provided with condoms when feasible. Women who have had unprotected sex and do not wish to become pregnant because of concern with infection with Zika virus should also have ready access to emergency contraceptive services and counselling.
Sexual partners of pregnant women, living in or returning from areas where local transmission of Zika virus is known to occur, should use safer sexual practices or abstinence from sexual activity for the duration of the pregnancy.
As most Zika virus infections are asymptomatic:
Men and women living in areas where local transmission of Zika virus is known to occur should consider adopting safer sexual practices or abstaining from sexual activity.
Men and women returning from areas where local transmission of Zika virus is known to occur should adopt safer sexual practices or consider abstinence for at least four weeks after return.
Independently of considerations regarding Zika virus, WHO always recommends the use of safer sexual practices, including the correct and consistent use of condoms to prevent HIV, other sexually transmitted infections and unwanted pregnancies.
Investigation teams in Guinea had been searching for the wife and three young children of a man who died of Ebola last month in the southern prefecture of Macenta. The family members were considered high-risk contacts. It is now believed that the wife travelled to Liberia with her children after her husband’s death to join relatives who live in the capital, Monrovia. It is there that she reportedly developed symptoms. She initially sought care in local clinics and died en route to a Monrovia hospital on 31 March. Two of her sons, a five-year old and a two-year old, have since tested positive for Ebola and are being treated at an Ebola care facility in Monrovia.
Rapid response in Liberia
Liberian health authorities immediately reactivated the country’s emergency response mechanisms, and with support from WHO, CDC and other partners, set to work identifying, isolating and monitoring contacts of the confirmed cases, strengthening infection prevention and disease control measures and stepping up community outreach. More than 100 contacts of the confirmed cases have been identified in Liberia and placed under voluntary medical observation. Affected households have been offered food, water, hygiene supplies and counselling. Preparations are underway for vaccination of contacts with the Ebola vaccine to prevent potential spread of the virus.
Vaccination of Ebola contacts in Guinea
A large-scale government-led response continues in Guinea’s prefectures of Nzérékoré and Macenta, where there have been 9 Ebola cases since the flare-up began in late February. Eight people have died and one 11-year old child remains in treatment in an Ebola care centre. To date, over 1,400 people who may have been in contact with the confirmed cases and contacts of theirs have been vaccinated with the Ebola vaccine.
Ebola flare-ups anticipated
Tests from blood samples of the confirmed cases indicate the source of the virus is from a single and known transmission chain – suggesting exposure to infected body fluids from a survivor – rather than a re-introduction of Ebola virus from the wild animal population. WHO has stressed that flare-ups of Ebola like this one are likely to occur for some time, due to virus persistence in some survivors. WHO says Ebola-affected countries must remain ready to respond and maintain strong prevention, surveillance and survivor care programmes.
On 26 March 2016, the National IHR Focal Point of Chile notified PAHO/WHO of a confirmed case of sexual transmission of Zika virus; this is the first case acquired in continental Chilean territory where there is no presence of aedes [vector] mosquitoes. The case (Person A) developed symptoms consistent with Zika virus disease: rash, retroauricular adenopathies, conjunctivitis, and arthritis on 4 February. Her partner (Person B) developed symptoms consistent with Zika virus disease after travelling to a country where local transmission of Zika virus is known. Infection by Zika virus was confirmed for both cases IgM and IgG positive for Zika virus (Person A) and IgM and IgG positive for Zika virus, and negative for dengue IgM (Person B).
Public health response
Health authorities in Chile are taking the following measures:
conducting social risk communication on safer sexual practices,
advising travellers to areas where Zika virus is circulating to seek medical assistance if presenting symptoms associated with Zika virus infection after return
All patients (male and female) with Zika virus infection and their sexual partners (particularly pregnant women) should receive information about the potential risks of sexual transmission of Zika virus, contraceptive measures and safer sexual practices, and should be provided with condoms when feasible. Women who have had unprotected sex and do not wish to become pregnant because of concern with infection with Zika virus should also have ready access to emergency contraceptive services and counselling.
Sexual partners of pregnant women, living in or returning from areas where local transmission of Zika virus is known to occur, should use safer sexual practices or abstinence from sexual activity for the duration of the pregnancy.
As most Zika virus infections are asymptomatic:
Men and women living in areas where local transmission of Zika virus is known to occur should consider adopting safer sexual practices or abstaining from sexual activity.
Men and women returning from areas where local transmission of Zika virus is known to occur should adopt safer sexual practices or consider abstinence for at least four weeks after return.
