UK PHE: Updated Travel Advice For Pregnant Women Traveling To Areas With Zika Virus

CDC%2BZika%2BMap.jpg
Credit CDC – Zika In The Americas

# 11,080

While establishing a causal link between Zika and Microcephaly may still be months away, as more pregnant women are diagnosed with the infection (including via sexual transmission), some public health agencies around the world are doubling down on their travel advice for pregnant women.

Previously the UK `encouraged’ pregnant women to consider avoiding travel to areas where Zika is spreading, today they change that to recommending that pregnant women postpone non-essential travel to such areas until after pregnancy.

It’s an incremental change, signifying a ratcheting up of concern, but it also gives the PHE another opportunity to repeat the message, and their advice on avoiding the sexual transmission of the virus from male partners who have recently traveled to Zika prone areas.

Zika virus: updated travel advice for pregnant women

From: Public Health EnglandFirst published:1 March 2016

Pregnant women advised to postpone non-essential travel to areas with active Zika virus transmission.

Public Health England (PHE) and the National Travel Health Network and Centre (NaTHNaC) have been carefully monitoring the evolving Zika virus outbreak in South and Central America and the Caribbean and are now issuing updated travel advice for pregnant women and advice on preventing sexual transmission.

Travel and pregnancy

It is recommended that pregnant women should postpone non-essential travel to areas with active Zika transmission until after pregnancy. This is a change to the previous advice which encouraged pregnant women to consider avoiding travel and seek travel health advice.

In addition it is recommended that women should avoid becoming pregnant while travelling in an area with active Zika virus transmission, and for 28 days following return home. If a woman develops symptoms compatible with Zika virus infection on her return to the UK, it is recommended she avoids becoming pregnant for a further 28 days following recovery.

If a woman develops symptoms compatible with Zika virus infection on her return to the UK, it is recommended she avoids becoming pregnant for a further 28 days following recovery.

Advice has also been updated for healthcare professionals. In the event that travel to an area with current active Zika virus transmission cannot be postponed, the pregnant traveller or those planning pregnancy should discuss with their healthcare provider the risks which Zika may present. In addition, the use of scrupulous mosquito bite avoidance measures both during daytime and night time hours (but especially during mid-morning and late afternoon to dusk, when the mosquito is most active) should be emphasised, and an information leaflet provided.

Preventing sexual transmission

A number of cases of sexual transmission of Zika virus have been reported, and in a limited number of cases, the virus has been shown to be present in semen. The risk of sexual transmission of Zika virus is thought to be very low.

Our advice:

  • condom use is advised for male travellers if their partner is pregnant, during travel and for the duration of the pregnancy
  • if there is a risk of pregnancy, or pregnancy is planned, condom use is advised during travel and for 28 days on return from an active Zika transmission area if the male traveller does not have any symptoms compatible with Zika virus infection. If a clinical illness compatible with Zika virus infection has been suspected or confirmed, this advice should be followed for 6 months following the start of symptoms.
  • even if not pregnant or planning to be, couples who wish to reduce the very low risk of virus transmission may consider using condoms if the man has had clinical illness compatible with Zika infection

Lancet: Zika/GBS Case Control Study – French Polynesia

Guillian%2BBarre.jpg

,079

Until it sparked a large outbreak on Yap Island in 2007, the Zika virus had kept a very low profile; causing sporadic and mild infections as it slowly spread out of Africa into equatorial Asia (India, Indonesia, Malaysia, Pakistan) during the 1970s and 1980s.

Yap Island (pop. 7,000) in the Western Pacific was the first large outbreak of Zika recorded, with more than 70% of the island’s population estimated to have been infected (see (see 2009 EID Journal Zika Virus Outside Africa by Edward B. Hayes), although no serious illness or deaths were reported. 

Zika re-emerged in 2013 in French Polynesia (pop. 276,000), and quite unexpectedly there, we began get reports of more severe illness associated with Zika infection (see Zika, Dengue & Unusual Rates Of Guillain Barre Syndrome In French Polynesia). The number of cases was small, but estimated to be 20 times greater (cite Eurosurveillance) than normal.

In 2015, when Zika began circulating widely in Brazil (and later spreading to much of South & Central America), we began to get similar reports of unexpectedly high GBS numbers in the region, although their association to Zika infection was far from established.

One of the tools epidemiologist’s use to find risks for a specific outcome is a case-control study, where they compare laboratory-confirmed cases to a large number of unaffected controls, matched for age, sex, and by neighborhood. 

While a case control study is not enough to prove causation, it can often provide compelling evidence of a link or an association between two or more events.

Although the exact cause of Guillain Barre Syndrome isn’t known, we do know it often follows an infection (bacterial or viral), and it has been seen in both Dengue and Chikungunya patients in the past. 

Last night the The Lancet published a case control study conducted in French Polynesia which finds additional evidence supporting the idea that Zika may cause Guillain Barre Syndrome.

The abstract may be read at the link above, while the full study can be downloaded as a  PDF (204 KB).


Nicely summarizing their findings, The Lancet published a press release yesterday, which also includes comments from an accompanying editorial comment (see Zika virus and Guillain-Barré syndrome: another viral cause to add to the list).

The Lancet: Zika virus might cause Guillain-Barré syndrome, according to new evidence from French Polynesia

The Lancet

Analysis of blood samples from 42 patients diagnosed with Guillain-Barré syndrome (GBS) during the Zika virus outbreak in French Polynesia provides the first evidence that Zika virus might cause GBS, a severe neurological disorder, according to new research published in The Lancet today. Based on the analysis of data from French Polynesia, if 100000 people were infected with Zika virus, 24 would develop GBS.

(SNIP)
 

The aim of the study was to determine the link between Zika virus infection and GBS. Since French Polynesia is also prone to outbreaks of dengue virus, the researchers also wanted to see whether dengue virus was an additional risk factor for GBS. 

All 42 patients with GBS diagnosed at the Centre Hospitalier de Polynésie Française in Papeete, Tahiti were included in the study. Researchers recruited two control groups. The first control group (CTR 1), matched for age, gender and island of residence, consisted of 98 patients who attended the same hospital but did not have a fever. The second control group (CTR 2) consisted of 70 patients who tested positive for Zika virus infection, but did not develop any of the neurological symptoms associated with GBS. Blood samples were collected from all patients. 

Most (88%) of the patients with GBS reported symptoms of Zika virus infection approximately 6 days before the onset of neurological symptoms. While none tested positive for a Zika virus infection once in hospital, blood tests showed that 41 (98%) were carrying Zika virus antibodies, and all (100%) had neutralizing antibodies against Zika virus. 

By comparison, only 54 (56%) of the patients without a fever (CTR 1 group) were carrying Zika virus neutralizing antibodies. Most patients with GBS (95.2%) had signs of past dengue virus infection, as did most patients in the two control groups (88.8% in CTL 1; 82.9% in CTL 2). The authors therefore concluded that, in this case, past infection with dengue virus did not increase the risk of GBS among patients infected with Zika virus. 

All 42 patients were diagnosed with a type of GBS called ‘acute-motor axonal neuropathy’ (AMAN), but few carried the biological markers typically associated with AMAN, suggesting a previously unknown disease mechanism. The patients in the study generally recovered faster than is usually expected with GBS.

Of the 42 patients with GBS, 16 (38%) were admitted to the hospital’s intensive care unit and 12 (29%) required breathing assistance. On average, patients were hospitalised for 11 days, but those in intensive care remained for longer (51 days). Three months after discharge, 24 (57%) patients were able to walk without assistance. No patients with GBS died.

(Continue . . .)

Interestingly, this study finds those affected had a type of GBS called acute-motor axonal neuropathy’ (AMAN), which is normally associated with pediatric cases in China.  The authors wrote:

No clear pathophysiological mechanism for the Guillain-Barré syndrome could be identified, because the typical AMAN-associated anti-ganglioside antibodies were rarely present.

The authors also looked for evidence that prior infection with Dengue might increase the risks of developing GBS, but found no evidence to support that idea.

Like all studies, this one suffered from some limitations.  It was relatively small, testing for Zika infection was retrospective, and based on ELISA testing for IgM and IgA antibodies, and not RT-PCR tests. 

 

Still, this adds to the evidence that Zika can, at least on rare occasions, cause serious illness.  We’ll need to get more information in order to know if GBS is more common with Zika infection than with other flavivirus infections like Dengue or Chikungunya.

New clip from Danish mosque: Hit kids who don’t pray – The Local

The Grimhøj Mosque received a transcript of the recordings and responded by stating that the video only gives a small insight into the teachings of the mosque and does not reflect the whole picture. “We cannot believe everything that comes from you. The recording only shows a few seconds rather than hours. Therefore, it is not certain that you did not just collect things to cheat people,” the mosque’s chairman, Oussama El-Saadi, told TV2. Child psychologist Kuno Sørensen from Save the Children Denmark (Red Barnet) believes the mosque’s teachings could be criminal. “It is very problematic. In this way, as it is said here, it is supporting something that is a criminal act, an act that is harmful to children,” Sørensen told TV2. The new TV2 documentary has re-ignited a national debate about the Grimhøj Mosque, which in September 2014 declared its support for the terrorist group Isis, comments reiterated by El-Saadi just a few months later.

Source: New clip from Danish mosque: Hit kids who don’t pray – The Local

Racist hate speech has ‘become routine in France’ – The Local

Even the current Prime Minister Manuel Valls was reprimanded for his comments made in March 2013 about Roma people having “no interest in integrating in France”. French Mayor and MP Gilles Bourdouleix was also pulled up for his comments about Roma made in July

French Mayor and MP Gilles Bourdouleix was also pulled up for his comments about Roma made in July 2013, when he was recorded saying “Hitler didn’t kill enough”. National Front leader Marine Le Pen was singled out for picking on Muslims, particularly with her rants against the distribution of halal meat and comparing Muslims praying in the streets to the Nazi occupation. And Nicolas Sarkozy’s

National Front leader Marine Le Pen was singled out for picking on Muslims, particularly with her rants against the distribution of halal meat and comparing Muslims praying in the streets to the Nazi occupation. And Nicolas Sarkozy’s

And Nicolas Sarkozy’s Republicains party were chastised for hosting its “conference on Islam” last year, which was boycotted by many Muslim groups. And there was the infamous recent case of MEP Nadine Morano repeatedly insisting “France was a country of

And there was the infamous recent case of MEP Nadine Morano repeatedly insisting “France was a country of white race.”

Source: Racist hate speech has ‘become routine in France’ – The Local

Second Look Behind the Headlines – News you can use…

Baldacchino di Perla

"Luce di parole, ombra di sogni."

Northern Desert Photography

Living on the Edge of the Sagebrush Ocean

Susana Cabaço

Spiritual Insights & Personal Empowerment

Barbara Picci

Artist & Art Blogger

craft journey

Furnicraft, woodwork, and art

musings corner

reveries and rants

Japão para Românticos

Bem Vindos a este espaço onde compartilhamos um pouco da realidade do Japão à todos aqueles que desejam visitar ou morar no Japão. Aqui neste espaço, mostramos a realidade do Japão e dos imigrantes. O nosso compromisso é com a realidade. Fique por dentro do noticiário dos principais jornais japoneses, tutoriais de Faça você mesmo no Japão e acompanhe a Série Histórias de Imigrantes no Japão. Esperamos que goste de nossos conteúdos, deixe seu like, seu comentário, compartilhe e nos ajudar você e à outras pessoas. Grande abraço, gratidão e volte sempre!

Leben als Mensch

Willkommen auf Elke´s Glücks-Blog

Sharpshot Nature .Com

- Specializing in the great outdoors, capturing nature at its finest!

Diane Ravitch's blog

A site to discuss education and democracy

Expansão e Percepção

Seu Guia de Inspirações e Reflexões Diárias

noga noga.

my-health-and-beauty.com/

Uğurcan'ın Ütopyası

Benim Gezegenime Hoş geldiniz !!!

AKILS

Blog de viajes y lugares

Ed Mooney Photography

The official blog of Ed Mooney Photography. Dad of 3, Photographer, Blogger, Powerlifter. Exploring the historical sites of Ireland.

everything Explored on the earth

It has new aidias,news, about education , motivation, social, historical, culture, marketing creation new aidias education of language science culture and history

Born to die

L'unico modo sensato di vivere è senza regole

Early Morning Memories

by Anuran (A) & Sayoni (S)

My thoughts

Fun for the Brain

Neo Vision College

An exemplary learning community.

Anthony’s Crazy Love and Life Lessons in Empathy

Loves, lamentation, and life through prose, stories, passions, and essays.

Episodic Squalid Rants

public tantrums by a non-two-year-old

The Street Art Directory

Public, street and urban art worldwide

Artie & Stu

all the rules of free form

Everyone read that they fell in love first

<script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-2937106805202763" crossorigin="anonymous"></script>

davidscottmoyer

Lapsed Painter, Occasional Photographer, Compulsive Writer

Health & Fitness

Health Blogs

Buildings Tell Tales

Exploring the hidden architectural heritage of Budapest

Divit kalem

Yaşamdan

Roy's Weblog

The third incarnation...

Thought Pukes

More than a thought less than a question

"بوصلة الحياة"

"بوصلة الحياة: مدونة متعددة المجالات، من السياسة إلى الرومانسية، ومن تطوير الذات إلى الأدب وأكثر!" بقلم مشاعر بنت عبدالرحمن

parallax

The view from here ... Or here!

ClearingSpace4Joy

Bringer and seeker of joy

Belladonna’s Flashlight

The One Where She Stumbled Through Her 40's and Faced Her Demons

~ Trivial Music Silliness ~

Baw wit da baw. Just sayin'.

mo mnsoor blog

Website storys

Chronicles of an Anglo Swiss

Welcome to the Anglo Swiss World

gnaddrig ad libitum

Querbeet und ohne Gewähr

Peace & Truth

KINDNESS IS FREE, sprinkle it all over the world, and 😁 smile

Ética de la vida diaria

Nuestra ética de todos los días...

Elizabeth Gauffreau

Fiction Writer in Poet's Clothing