WHO Response to the PHEIC:
Microcephaly, Guillain-Barré Syndrome
& association with Zika
February 2016
Epidemiology Strategy overview Technical Challenges Research & Development Performance Tracking
Contents
Overview of Zika Virus, microcephaly, and Guillain-Barré Syndrome
Epidemiology
▪
Zika Virus geographical distribution has steadily increased since its discovery in 1947, especially 2015-2016▪
Clinically mild, self-limited disease with rash, fever, conjunctivitis and arthralgias▪
33 countries have reported Zika circulation in 2014-2016 (evidence of transmission in 6 additional countries)▪
2 countries with Zika Virus have reported an increase in microcephaly and 5 report Guillain-Barré syndrome▪
Further spread to countries with the Aedes mosquito thought likely3
Countries and territories with Zika Virus spread (1947-2016)
Status of epidemiology: Zika Virus
Countries and territories with autochthonous transmission of Zika virus, 2015 – 2016 WHO Regional Office Country or territory
Reported
autochthonous transmission
AFRO Cape Verde
AMRO/PAHO Barbados, Bolivia, Brazil, Colombia, Curaçao, Costa Rica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe,
Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua,
Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, United States Virgin Islands,
Venezuela (Bolivarian Republic of)
SEARO Maldives
5
Status of Epidemiology: Microcephaly
Country
Brazil
French Polynesia
Other
Microcephaly epidemiology
▪ In Oct 2015, the Brazil Ministry of Health reported increase in microcephaly cases
▪ As of 30 Jan 2016, 4,783 suspected cases of microcephaly (above the average 163/year)
▪ were reported
– 1,113 cases were investigated:
▫ 709 discarded
▫ 387 were compatible with congenital infection
– Of the 76 reported deaths, Zika was identified in 5 cases, all from northeast Brazil
▪ Microcephaly cases in Brazil followed the detection of Zika detection earlier the same year
▪ French Polynesia: A review of births indicated an increase in CNS malformation in children between Mar 2014 and May 2015: 18 cases reported, 9 with microcephaly (typical average of 0 to 2 cases of per year)
▪ On 8/1/2016, CDC confirmed a baby born in Hawaii with microcephaly and evidence of past Zika virus infection. The mother likely acquired Zika in Brazil, May 2015, infecting her newborn in utero
Status of epidemiology: Guillain-Barré Syndrome
Colombia Columbia GBS cases
GBS cases
▪
Brazil, Colombia, El Salvador, Suriname, Venezuela reported increase of GBS▪
Guillain-Barré syndrome is a rare immune-mediated, self-limiting paralysis7
DG/WHO declared microcephaly and GBS to be a Public Health Emergency of International Concern (PHEIC)
Response Timeline
May 2015: Incident management established in PAHO May 2015
May-Dec 2015: Regular sit reps issued by PAHO and HQ on spread of Zika Virus, microcephaly, and GBS
26 Jan 2016: WHO declared grade 2 emergency and established IMS 1 Feb 2016: DG declares PHEIC
3-4 Feb 2016: Strategic plan reviewed with GOARN and IASC partners 8 Feb 2016: $2.3 m released from Contingency Emergency Fund
DG/WHO declared microcephaly and GBS to be a Public Health Emergency of International Concern
PHEIC Declaration
▪
Emergency committee convened under International Health Regulations (2005) on 1/2/2016▪
DG declared clusters of microcephaly cases and other neurological disorders in Brazil and French Polynesia in 2014 to constitute a PHEIC▪
Temporary recommendations:– Microcephaly and Neurologic Disorders:
▫ Standardize and enhance surveillance for microcephaly and GBS in areas of Zika
▫ Research into the cause of new microcephaly cases should be intensified
– Precautionary Measures:
▫ Zika Virus transmission: surveillance, new diagnostics, risk communications and community engagement, vector control, recommendations for personal protection and pregnancy
▫ Longer-term measures: R&D in vaccines, therapeutics, and diagnostics; preparation for neurological syndromes and congenital malformations in affected areas
▫ Travel measures: No restrictions recommended on travel and trade
▫ Data Sharing: Clinical, virologic and epi data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared
Epidemiology
Strategy overview Technical Challenges Research & Development Performance Tracking
Contents
Goal
Investigate and respond to the cluster of microcephaly and other neurological
complications that could be linked to Zika virus infection, while increasing preventive measures, communicating risks and providing care to those
affected.
11
Response Strategy
SURVEILLENCE Enhanced surveillance for Zika virus disease, neurological syndromes and congenital
malformations
RESPONSE Engage communities to communicate the risks associated with Zika virus disease and promote healthy behaviors, reduce anxiety, address stigma, dispel rumors and cultural misperceptions
Increase efforts to control the spread of the Aedes aegypti mosquito as well as access to personal protection measures
Provide guidance and mitigate the impact on
pregnant women and those considering pregnancy, as well as families with children affected
RESEARCH Investigate the etiology of microcephaly, neurological syndromes and establish the possible consequences of Zika virus infection
Fast-track the research and development (R&D) of new products (e.g. rapid diagnostics, vaccines, therapeutics).
GOARN partner network
Primary Partnerships
UN and NGO operational partners
Technical networks R&D partners
Application of response strategy
Aedes + Zika + microcephaly
and other neurological
disorders
Aedes + Zika Aedes Other countries
Surveillance, laboratory testing, risk communications and
community engagement Vector control and personal protection
Management of microcephaly congenital malformations &
neurologic syndromes Public health research to investigate associated risks
13
WHO Global Incident Management Team IHR Emergency
Committee
Member States &
National Incident Management
International Incident Management
International Coordination Mechanisms WHO Regional
Incident Management Teams
WHO Country Incident Management Teams National Incident
Management Teams1
Global
Coordination Mechanisms
Regional Coordination Mechanisms
Country Coordination Mechanisms
GOARN UN Agencies & NGOs Research Partners Regional Neoworks R&D Partners
WHO Technical Programmes
1 For countries with no WHO Country Team, National Incident Management will interface with WHO Regional Incident Management
Concept of Operations
Urgent needs
WHO initial ask for urgent needs $25 million
• Development of global strategy and joint operations plan
• Establishment of incident management and coordination mechanisms
• Development research agenda and field research activities
• Scaling up operations in affected countries for community engagement, vector control, guidance and care for those affected
• Increased surveillance and global reports, risk communication
• Initial Overview of Needs and Requirements based on
Epidemiology Strategy overview
Technical Challenges Research & Development Performance Tracking
Contents
Technical and programmatic priorities
Technical Issue
Case definitions
Laboratory Diagnosis
Clinical Management
Vector Control
Travel and Trade
Description
Standardized case definition for Zika virus, Microcephaly, GBS, etc.
Laboratory algorithms, confirmatory tests, national lab capacities, availability of reagents
Clinical management and monitoring (i) of
pregnant women infected with Zika virus (ii) fetus and newborns with congenital malformation (microcephaly)
Reduction of vector densities through community engagement and removal of breeding sites Aircraft/ship disinsection recommendations for international travel
WHO Guidance
WHO interim case definitions
Validation/dissemination of laboratory testing algorithms. Tech support to national reference labs
Development of WHO technical guidance
Technical guidance, mobilization of social science networks
Technical guidance for international travel and transport agencies (ICAO, IMO, UNWTO)
17
Technical and programmatic priorities
Technical Issue Sexual and
Reproductive Health
Maternal, Newborn, and Child Health
Coordination
WHO guidance
Communicate evidence-based messages to affected populations and recommend country responses
Guidance on antenatal, intrapartum and postpartum care in the context of Zika virus infection and on management of infants with microcephaly
Mapping research, monitoring, policy and program activities on and providing technical support for strengthening coordination of existing and future undertakings
Epidemiology Strategy overview Technical Challenges
Research & Development Performance Tracking
Contents
19
Research and development priorities
R&D Activity Vaccine
development
Development of therapies
Diagnostics
Blood products
Vector Control
WHO progress to date
▪
Mapping of the current efforts to develop candidate vaccines▪
Initiation of consultations to establish Target Product Profiles▪
Strengthening of regulatory capacities▪
Mapping of current landscape including anti-virals, host-directed therapeutics, immune products, and other therapeutic interventions▪
Mapping of Diagnostics tests under development including PCR and serology▪
Initiation of work to establish Target Product Profiles to guide developers▪
Issuance of a call to submit candidate tests to WHO emergency listing procedure (EUAL)▪
Preparation of guidance for blood banks on Zika testing▪
Mapping the current landscape of novel approaches: biological and geneticEpidemiology Strategy overview Technical Challenges Research & Development Performance Tracking
Contents
21 1 Includes acute event in protracted crisis situation
ERF Function Transformative Change Performance Target Zika Performance Description Zika Performance Leadership ▪ Incident Manager identified and given agreed delegated
responsibilities within 24 hours of grading; ‘HC-certified’
WR (HC/WR) in all protracted crises
▪ Incident Manager (Ian Clark) identified within 24 hours of grading
Information ▪ Health situation analysis published within 72hrs for Acute events
▪ Standardized weekly SitRep published for all graded emergencies: single format for all emergencies
▪ First Sit rep published 5 days after emergency grading
Coordination /
Planning ▪ Joint operations plan within 5 days for all acute, graded
emergencies; updated 6 monthly in protracted. ▪ Joint Operations plan to be completed by 10 days (near to final draft already reviewed extensively by partners) Core Services ▪ Initial disbursement of emergency funds of up to $500K
USD within 24 hours
▪ Non-roster staff and consultants recruited within 3 days and deployed within 5 days1
▪ PAHO received $2.3M within 24 hours of request
▪ N/A
Operations Support &
Logistics
▪ All staff and consultants fully operational
(accommodation, office space, transport, computer, phone, connectivity) within 24hrs of arriving in-country
▪ Minimum essential emergency supplies distributed to points of service within 72 hours
▪ N/A
Health
Operations ▪ All essential health services provided to minimum
standards, as per Sphere ▪ N/A
WHO performance against emergency processes
On Target In process Needs improvement
WHO Response to the PHEIC:
Microcephaly, Guillain-Barré Syndrome
& association with Zika
February 2016
23
Countries and territories with autochthonous transmission of Zika virus,
2007 – 2016
Overview WHO emergency funding for the 2016-17 biennium
$M, biennium
~400 ~500
~160
~340 Approved budget for existing
technical and preparedness functions
Additional Budget for core capacities required to be operational agency
Current resources required for
protracted and acute events based on existing scope of operations
Potential additional resources required to increase activities in protracted and acute events based on assessment of full operational needs
Fixed resources Variable resources
2016-17 expected needs
Of which, already funded
1471 (43%)
0 (0%)
2072 (52%)
A B
C
~25 (25%)
~100
Capitalization of contingency fund
