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National health advisory - Zika virus


This email is the second update on the Zika virus.  The World Health Organization Director-General has declared that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC).  There are no recommendations for restrictions on travel or trade to prevent the spread of Zika virus. At present, the most important protective measures are the control of mosquito populations in affected countries and the prevention of mosquito bites in at-risk individuals, especially pregnant women.

Advisory:

As previously advised, Zika virus is an arboviral disease spread by certain mosquito species but mosquito species in New Zealand will not spread the Zika virus.  It cannot be passed on from person to person.  The general public are not at risk of catching Zika virus from travellers.  

On 2 February 2016, the Director-General of the World Health Organization convened an Emergency Committee, under the International Health Regulations, to gather advice on the severity of the health threat associated with the continuing spread of Zika virus disease in Latin America and the Caribbean.  

In assessing the level of threat, the 18 experts and advisers looked in particular at the strong association, in time and place, between infection with the Zika virus and a rise in detected cases of congenital malformations and neurological complications. The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better. The experts also considered patterns of recent spread and the broad geographical distribution of mosquito species that can transmit the virus. The lack of vaccines and rapid and reliable diagnostic tests, and the absence of population immunity in newly affected countries were cited as further causes for concern.

A coordinated international response is needed to improve surveillance, the detection of infections, congenital malformations, and neurological complications, to intensify the control of mosquito populations, and to expedite the development of diagnostic tests and vaccines to protect people at risk, especially during pregnancy.  However, the committee found no public health justification for restrictions on travel or trade to prevent the spread of Zika virus. At present, the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals, especially pregnant women.

As you know, New Zealand has strong biosecurity and border health systems, including:

  • mosquito surveillance and monitoring programmes in place at international ports and airports
  • responses to suspected interceptions of exotic mosquitoes
  • disinsection of aircraft (MPI lead)
  • inspection of vessels (including yachts) and risk goods for mosquitoes and mosquito habitat (MPI lead)
  • implementation of Import Health Standards requiring treatment of risk goods to exclude mosquitoes (MPI lead)
  • updated advice for travellers to affected areas on MFAT's Safe Travel website and the Ministry of Health website
  • signage and wallet cards at international airports advising returning travellers to phone healthline and/or seek medical attention if they become unwell
  • requests to Air NZ and Qantas to link their websites to the Safe Travel and Ministry of Health websites
  • request to shipping agents to ask their Masters to maintain vigilence and exclude potential mosquito habitat
  • request for all border agencies, airport/port authorities, and port/airport staff to report any suspected exotic mosquitoes.

Ministry of Health officials will continue to monitor international developments.  More information about Zika virus.  


20 January 2016

Notification of update to Ministry of Health webpage regarding zika virus and risks to pregnant women.

Please find below the wording of an update to the Ministry of Health zika virus webpage particularly addressing the risks of infection in pregnant individuals. A similarly phrased travel advisory will be posted on the SafeTravel website in the near future.

Zika virus

Zika virus infection is a mild febrile viral illness transmitted by mosquitoes. The mosquitoes that are able to transmit Zika virus are not normally found in New Zealand, therefore Zika should only be considered in people who have recently travelled overseas.

Note - the following information on Zika virus infection is provided as it is an emerging disease. As such no particular guidance has previously been available in New Zealand.

On this page:

About Zika virus

Zika virus is a flavivirus, closely related to dengue.  Outbreaks of zika virus have previously been reported in tropical Africa, Southeast Asia and more recently in the Pacific Islands. Beginning in 2014 zika virus outbreaks have occurred throughout the tropical and sub-tropical areas of the western hemisphere, as far north as Mexico and Puerto Rico.

Countries where zika virus has been found can be seen here: http://www.cdc.gov/zika/geo/index.html.

Because zika, dengue and chikungunya viruses are transmitted by mosquitoes mostly active during daytime, it's important that all travelers visiting affected areas continue to take protective measures to prevent mosquito bites throughout the day.  

Zika virus infection is symptomatic in only about one out of every five cases. When symptomatic, zika infection usually presents as an influenza-like syndrome, often mistaken for other arboviral infections like dengue or chikungunya.

New Zealand currently has 15 mosquito species. The mosquito species (Aedes sp.) that are able to spread Zika virus are not normally found in New Zealand however they are found in many other countries around the world.

A national mosquito surveillance programme has been operating for some years at New Zealand's international points of entry (ports and airports). The ports and airports are monitored regularly throughout the year to ensure the early detection of any exotic mosquitoes.

You can find more information about mosquitoes on the Ministry of Health websitehttp://www.health.govt.nz/your-health/healthy-living/travelling/avoiding-bug-bites-while-travelling and also tips on how to avoid mosquito bites while travelling.http://www.health.govt.nz/your-health/healthy-living/environmental-health/pests-and-insects/exotic-mosquitoes
 

Zika virus infection is notifiable in New Zealand as an arboviral disease.

Symptoms of Zika virus infection

  • low-grade fever (between 37.8°C and 38.5°C)
  • arthralgia, notably of small joints of hands and feet, with possible swollen joints
  • myalgia
  • headache, retro-ocular headaches
  • conjunctivitis
  • cutaneous maculopapular rash
  • post-infection asthenia which seems to be frequent.

More rarely observed symptoms include digestive problems (abdominal pain, diarrhoea, constipation), mucous membrane ulcerations (aphthae), and pruritus.

Zika virus infection causes a mild disease (with the possible exception in pregnant women, as discussed below) and, other than notification, no particular action is required.  However, as Zika infection may cause a rash that could be confused with more serious diseases such as measles or dengue, these more serious diseases do need to be ruled out. Diagnosis of zika will first and foremost be by exclusion, based on symptoms, travel history and exclusion of more serious diseases including measles, rubella and dengue.

The incubation period is typically 3-12 days. There is no specific therapy for zika virus infection and acute symptoms typically resolve within 4-7 days.

In French Polynesia, after a local zika virus outbreak in 2013 and 2014 an increase in autoimmune and neurological diseases has been observed (73 cases, 42 of them being Guillain-Barré Syndrome, in a population of about 270,000). There is no proven link at this stage other than this temporal sequence. The simultaneous circulation of dengue serotype 1 and 3 viruses may also play a role.

Zika virus and pregnancy

There are concerns that pregnant women who become infected with zika virus can transmit the disease to their unborn babies, with potentially serious consequences. Reports from several countries, most notably Brazil, demonstrate an increase in severe foetal birth defects and poor pregnancy outcomes in babies whose mothers were infected with zika virus while pregnant.

Additional international research is necessary and ongoing to determine the link between zika virus and foetal damage.

Until more is known, the Ministry of Health recommends that women who are pregnant or plan to become pregnant in the near term consider delaying travel to areas with zika virus present. If travelling in zika infected areas, women who are pregnant or plan to become pregnant should consult with their healthcare provider and take all precautions to avoid mosquito bites, including:

  • Wear long-sleeved shirts and long pants
    • Use insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed.
    • Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant and nursing women and children older than 2 months when used according to the product label. Oil of lemon eucalyptus products should not be used on children under 3 years of age.
  • If you use both sunscreen and insect repellent, apply the sunscreen first and then the repellent.
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents).
  • Use bed nets as necessary
  • Stay and sleep in screened-in or air-conditioned rooms.

If you are pregnant and develop a rash, red eyes, fever, or joint pain within 14 days of travel to a zika virus infected country, please consult your health care provider and let them know your travel history.

This information will be updated as more research becomes available.

Further information

Further information on Zika virus infection is available at:

Zika virus infection complicated by Guillain-Barré syndrome - case report, French Polynesia, December 2013 - Eurosurveillance (www.eurosurveillance.org)

Zika Virus Outside Africa - Centers for Disease Control and Prevention (www.cdc.gov)

Factsheet for health professionals - European Centre for Disease Prevention and Control (www.ecdc.europa.eu)

Laboratory testing

If laboratory testing is required, the following instructions should be followed:

  1. Order test from local laboratory:  
    • IgM, IgG and PCR for Zika virus
    • acute serum (taken within 5 days of symptom onset) and convalescent serum (2-3 weeks later) should be taken. The two samples are important to rule out false positive tests due to cross reactivity with similar viruses such as Dengue
  2. Provide overseas travel details and clinical history including the onset day and patient's DHB.  Onset date is extremely important to ensure that the most appropriate test is performed
  3. The local laboratory will forward samples to ESR who will arrange testing at an Australian Arbovirus Reference Laboratory (no labs in NZ currently test for Zika virus).

Note: there is currently no particular action expected following Zika virus confirmation, there may be a longer turnaround time for these tests.

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