LIFE SE ASIA MAGAZINE







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What is the current situation?

Travelers have returned from certain areas of Southeast Asia with Zika virus infection. While our understanding of the complications of Zika virus infection continues to evolve, and pending broader international surveillance efforts for Zika virus infection, we are providing pregnant women and their partners updated recommendations on reducing their risk for travel related Zika virus infection. CDC recommends pregnant women should consider postponing nonessential travel to Southeast Asia countries with reports of Zika virus infection from local transmission or related to travel to those countries, and those countries with adjacent borders where limited information is available to fully evaluate risk of Zika virus infection. 

Travel Considerations for Pregnant Women Traveling to Southeast Asia

Zika virus infection during pregnancy causes severe birth defects, including microcephaly and severe fetal brain abnormalities. Therefore, pregnant women should talk with their healthcare provider and consider postponing nonessential travel to Southeast Asia. Zika virus testing should be offered to pregnant women and considered for other people who have symptoms of Zika virus disease if they have recently traveled to Southeast Asia.

Zika virus has been present in areas of Southeast Asia for many years, and several countries have reported occasional cases or small outbreaks of Zika virus infections. Zika virus is considered endemic in some countries, and a large number of local residents are likely to be immune. However, US travelers to endemic areas may not be immune to Zika virus and infections have occurred among travelers to Southeast Asia. Recent variations have been observed in the number of cases reported in Southeast Asia. This can reflect changes in awareness of Zika virus, surveillance and testing for Zika virus, or changes in intensity of Zika virus transmission. Pregnant women traveling to Southeast Asia could become infected with Zika virus. The level of this risk is unknown and likely lower than in areas where Zika virus is newly introduced and spreading widely.

Countries included in this travel message include those listed below. For country-specific information, please visit Health Information for Travelers for individual countries:

What can travelers do to prevent Zika?

There is no vaccine or medicine for Zika virus infection. Travelers can protect themselves by preventing mosquito bites:

  • Cover exposed skin by wearing long-sleeved shirts and long pants.
  • Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE, also called para-menthane-diol [PMD]), or IR3535. Always use as directed.
    • Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
    • Most repellents, including DEET, can be used on children older than 2 months. (OLE should not be used on children younger than 3 years.)
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
  • Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs to protect them from mosquito bites.

Zika virus can be passed through sex from a person who has Zika virus to his or her sex partners. The use of condoms during sex (vaginal, anal, and oral) or abstaining from sex while traveling to these areas and after returning from these areas is recommended to avoid getting or passing Zika virus infection.

After travel:

Many people infected with Zika virus do not feel sick. If a mosquito bites an infected person while the virus is still in that person’s blood, it can spread the virus by biting another person. Even if they do not feel sick, travelers returning to the United States from countries where Zika virus is endemic should take steps to prevent mosquito bites for 3 weeks so that they do not spread Zika virus to uninfected mosquitoes.

Travelers returning from countries where Zika virus is endemic and who have a pregnant partner should either use condoms or not have sex for the rest of the pregnancy.

For more information, see Zika and Sexual Transmission.

If you feel sick and think you may have Zika virus:

  • Talk to your doctor if you develop a fever with a rash, joint pain, or red eyes. Tell him or her about your travel.
  • Take acetaminophen (paracetamol) to relieve fever and pain. Do not take aspirin, products containing aspirin, or other nonsteroidal anti-inflammatory drugs, such as ibuprofen.
  • Get lots of rest and drink plenty of liquids.

If you are pregnant:

Talk to a doctor or other healthcare provider after your trip, even if you don’t feel sick. Pregnant women who have symptoms and have traveled to these countries should be offered testing for Zika virus infection. Pregnant women who have symptoms and who have had a possible sexual exposure during pregnancy to a partner who traveled to these countries should be offered testing for Zika virus infection.

  • If you develop a fever with a rash, joint pain, or red eyes, talk to your doctor immediately and tell him or her about your travel or possible sexual exposure.

Clinician Information

Zika virus during pregnancy causes severe birth defects, including microcephaly and severe fetal brain abnormalities. All pregnant women should be evaluated for possible Zika virus exposure and signs or symptoms consistent with Zika virus disease at each prenatal care visit.

Possible exposures include

  • Travel to an area where there is epidemic or endemic Zika virus transmission
  • Sex with a partner who has traveled to or lived in an area with epidemic or endemic Zika virus transmission

The recommendations for testing vary according to whether exposure occurred in an area where Zika virus has been newly introduced and is spreading widely or in an area with endemic Zika virus transmission. Dengue and Japanese encephalitis viruses circulate widely in Southeast Asia and might cause false positive results in blood tests. Because of this and related testing factors, routine serologic testing of asymptomatic pregnant women who have traveled to areas of Southeast Asia without epidemic Zika virus transmission is not recommended. For more information, please visit the Clinical Guidance for Healthcare Providers Caring for Pregnant Womenwebpage.

Clinical Guidance for Healthcare Providers Caring for Infants & Children is also available.

Additional Resources

For Travelers:

For Clinicians:

National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

Division of Global Migration and Quarantine (DGMQ)

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Situation update
29 September 2015 — Countries in the Western Pacific Region and the South-East Asia Region continue to report new Zika cases. The South-East Asia Region has also reported cases of microcephaly that are currently under investigation to determine if they may be linked to Zika infection.

Clink link below for interactive map of where

http://www.who.int/emergencies/zika-virus/situation-report/Zika-timeline-22-sept.png?ua=1

Key updates

  • Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
  • None
  • Mosquito-borne Zika infections acquired by travelers returning from the Maldives were reported by Germany and Spain in the past week. Prior Zika cases were reported in January 2016.
  • Countries in the Western Pacific Region continue to report new cases as seen in Singapore, Philippines, Malaysia and Viet Nam. Thailand, in the South-East Asia Region, has also recently reported Zika cases. Key areas of the response as identified by members of the Association of Southeast Asian Nations (ASEAN) are disease surveillance and risk assessment, relevant and timely sharing of data, regional surveillance and response, vector control, diagnostic testing, laboratory networks and risk communication, and sharing knowledge and best practices. The Ministry of Public Health of Thailand is investigating cases of microcephaly to determine if they may be linked to Zika infection.
  • Zika Virus protect against it bulletin

    Protect Against It

    Protect Against It

    	Zika: The Basics of the Virus and How to Protect Against It

    We will provide a brief overview of the virus then brief about the virus in SE Asia. We will give the source of our information and links.

    We are not doctors and if ill or would like more information please check with a health professional.

    From the CDC.  http://www.cdc.gov/zika/about/overview.html

    Overview

    Zika can be transmitted through

    Learn how Zika is transmitted >>

    Zika symptons

    	most common symptoms

    Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are

    • Fever
    • Rash
    • Joint pain
    • Conjunctivitis (red eyes)

    Other symptoms include:

    • Muscle pain
    • Headache

    Symptoms can last for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. Once a person has been infected with Zika, they are likely to be protected from future infections.

    Learn about symptoms >>

    Why Zika is risky for some people

    Zika infection during pregnancy can cause a birth defect of the brain called microcephalyand other severe fetal brain defects. Other problems have been detected among fetuses and infants infected with Zika virus before birth, such as defects of the eye, hearing deficits, and impaired growth. There have also been increased reports of Guillain-Barré syndrome, an uncommon sickness of the nervous system, in areas affected by Zika.

    Learn about risks >>

    How to prevent Zika

    There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites. Here’s how

    	Treat your clothing

    Clothing

    • Wear long-sleeved shirts and long pants.
    • Treat your clothing and gear with permethrin or buy pre-treated items.

    	using insect spray

    Insect repellent

    • Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients:
      DEET, picaridin, IR3535, or oil of lemon eucalyptus or para-menthane-diol. Always follow the product label instructions.
    • When used as directed, these insect repellents are proven safe and effective even for pregnant and breastfeeding women.
    • Do not use insect repellents on babies younger than 2 months old.
    • Do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old.

    	Mosquito netting

    At Home

    • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
    • Take steps to control mosquitoes inside and outside your home.
    • Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs.
    • Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

    	Using condoms or not having sex to prevent Zika

    Sexual transmission

    • Prevent sexual transmission of Zika by using condoms or not having sex.

    Learn about prevention >>

    How Zika is diagnosed

    • Diagnosis of Zika is based on a person’s recent travel history, symptoms, and test results.
    • A blood or urine test can confirm a Zika infection.
    • Symptoms of Zika are similar to other illnesses spread through mosquito bites, like dengue and chikungunya.
    • Your doctor or other healthcare provider may order tests to look for several types of infections.

    Learn about diagnosis >>

    	how to treat zika

    What to do if you have Zika

    There is no specific medicine or vaccine for Zika virus. Treat the symptoms:

    • Get plenty of rest.
    • Drink fluids to prevent dehydration.
    • Take medicine such as acetaminophen to reduce fever and pain.
    • Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs).
    • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.

    Learn about treatment >>

    History of Zika

    Zika virus was first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations. Before 2007, at least 14 cases of Zika had been documented, although other cases were likely to have occurred and were not reported. Because the symptoms of Zika are similar to those of many other diseases, many cases may not have been recognized.

    What we know
    Zika is spread mostly by the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). These mosquitoes are aggressive daytime biters. They can also bite at night.Zika can be passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects.There is no vaccine or medicine for Zika.

    Where Is the Zika Virus in Southeast Asia?

    Laos becomes just the latest country to report a local transmission.

     

    Earlier this month, Laos became the latest country to report a local transmission of the Zika virus, joining neighbors Cambodia, Thailand, and other Southeast Asian countries such as the Philippines, Indonesia, and Malaysia that have each reported at least one Zika-related case since 2010. Thailand has been the worst-hit amongst the lot so far, with nine cases reported since 2012.

    The World Health Organization (WHO) believes that the Zika virus is more common in Southeast Asia that the sprinkling of cases reported in the region in the past several years. Southeast Asia’s growing urban centers, tropical climate, and often poor waste management are factors that increase the risk of a Zika epidemic. The region is also susceptible to bi-annual monsoon seasons that increase breeding sites for the Aedes aegypti mosquito, which is also responsible for spreading dengue and chikungunya virus.

    Since being detected in the 1950s, sporadic Zika cases have not attracted enough attention from medical researchers. It is worrying that little is known about Zika’s prevalence in Southeast Asia and the population’s immunity against it.

    Governments in the region are taking no chances in their efforts to fight the disease. Countries like Singapore and Malaysia have stepped up a series of measures to curb the outbreak of an epidemic – including added detection measures, hospital and clinic management, and stringent quarantine rules – should the number of cases surge. Scientists from the region are also racing to put together a detection kit for the virus, with kits expected to be available from the end of March.

    According to the WHO, there has so far been no link between Zika and microcephaly in Southeast Asia. Microcephaly is a birth defect associated with abnormal smallness of the head and incomplete brain development. The Zika virus first caught the world’s attention when thousands of cases reported in Brazil dating back to 2015 appeared to suggest a strong correlation with fetal brain deformities amongst the newborn children of infected pregnant women.

    For now, the WHO classifiesThailand and the Philippines as countries with “sporadic transmission” of the Zika virus, as opposed to most countries in South America and the Caribbean which have seen “increasing or widespread transmission.” Indonesia, Malaysia, and Cambodia have not made the list.

    The Laos case confirms the widening of Zika’s prevalence in the region even if its spread is not yet as explosive as in South America. With the WHO’s attention focused on containing the Zika virus and avoiding another Ebola debacle, in Southeast Asia, the worry is not so much an undetected epidemic as it is regional states being ill-equipped to respond if an outbreak does occur. 

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