1. ZIKA VIRUS IN SOUTH AFRICA
BRIEFING TO THE PORTFOLIO COMMITTEE ON HEALTH, 9 MARCH 2016
NATIONAL DEPARTMENT OF HEALTH

2. Outline Background to Zika virus
First case of Zika virus in South Africa
Public health implications
Actions taken
Preparedness and response to Zika virus in SA
Coordination
Work in Progress

3. Background (i)
Zika virus is transmitted to humans through a mosquito vector, Aedes, that also transmit dengue, yellow fever and chikungunya viruses
Symptoms include, acute onset of fever, rash, joint and muscle pain, conjunctivitis and headache. These symptoms are usually mild and self-limiting, however, it has been associated with microcephaly and other neurologic disorders
There is no evidence of human-to-human transmission other than the 2 cases of sexual transmission recently reported in the USA

4. Background (ii)
There is international concern regarding infection with the virus. As of February 2016, over 34 countries have been affected, mostly in South America
On 1 February 2016, WHO declared the recent Zika virus outbreak in Brazil and other South American countries, a public health emergency of international concern (PHEIC),
WHO called on countries to put in place mechanisms for detection, prevention and response.

5. Key concern to South Africa
Of key concern to South Africa is the risk posed to pregnant women travelling to affected countries
Because there is neither vaccine nor specific treatment available, the national Department of Health recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing
If a pregnant women travels to an area with Zika virus transmission she is advised to strictly follow steps to avoid mosquito bites

7. First case of Zika virus in South Africa (i)
On 20 February 2016, the National Institute for Communicable Diseases (NICD) confirmed first case of Zika virus disease in a traveller from Colombia. The test had initially been submitted to Lancet laboratories on 16 February by a General practitioner, tested positive for Zika virus by PCR assay
The patient, a 36 year-old Colombian national , an industrial mechanic came to South Africa for 3 months to work on a factory development project

8. First case of Zika virus in South Africa (ii)
Patient had travelled from his home town of Cali, Colombia, via Bogota, Paris and arrived Johannesburg on Wednesday, 10 February
He started to feel unwell 5 days later on Monday, 15 February
Symptoms of loss of appetite, fever and fine macular skin rash described as ‘small red dots’ on his hands, legs, chest and neck
No history of dengue fever and had received yellow fever vaccination in No underlying chronic condition
He was managed symptomatically and all symptoms resolved within 3 days of presentation, and was well by Friday, 16 February

9. Public health implications
In South Africa the local mosquito species although present, is unlikely to act as vectors to transmit Zika virus due to them being different and having a different behavioural pattern compared to the vectors in the current outbreak in South America
In addition, Zika virus has not been identified further south than Uganda in Africa
Therefore secondary spread of Zika virus into South Africa on account of this case is unlikely

10. Actions taken
Media statement was issued by the National Department of Health and NICD on Friday, 19 February
An emergency meeting was held on 22 February in Chief Directorate: Communicable Diseases where need to enhance early detection and prevention were emphasised

11. Epidemic Preparedness and response (EPR) to Zika virus in SA
Coordination :
EPR activities led by MNORT at national level & PORT at provincial level
Existing structures that are handling Ebola preparedness and response are adapted to include Zika virus
National action plan for EPR has been developed; major elements include:
ORTs at provincial and district levels alerted & followed-up with teleconference
Action plan, guidelines have been shared with provinces
ORTs at provincial and district levels have been trained on EPR
National Operation Centre (NATHOC) is handling queries from public
Emergency Operations Centre (EOC) is on standby and will be active in the event of an outbreak in the country

12. Early detection: Enhanced surveillance:
Port Health: Ports of entry – temperature screening for travellers arriving from countries reporting local transmission
At Health facilities: guidelines with case definition and laboratory testing protocol was developed and distributed
Algorithm for risk assessment was developed to increase awareness regarding pregnant women with travel history to affected countries reporting confirmed ZVD

13. Communication:
Risk communication has been initiated to raise public awareness on signs and symptoms of ZVD, preventive measures, where to seek health care if symptoms develop, travel advisory etc.
Information is available on DOH Website and will be updated as new information becomes available
Media briefings and interviews have been conducted by the NICD

14. Preventive measures: Vector control at airports and community level:
Ensured appropriate disinsection of aircrafts using Standard WHO recommendations regarding disinsection of aircraft and airports
Elimination of mosquito breeding sites is emphasized and will be enhanced
Protection measures from mosquito bites are being enhanced through public communication; a travel advice and fact sheet is in circulation

15. Work in progress:
The following measures/studies are in progress to enhance prevention and control of Zika virus:
Environmental studies to learn more about the nature of the vector (Aedes aegypti) in SA
Review of pathogenicity of the virus in humans
Review of diagnosis and treatment of cases including pregnant women

16. THANK YOU