BANGKOK (Reuters) - Thailand is investigating four suspected cases of Zika-related microcephaly in three babies and a 36-week old unborn baby, the public health minister said on Tuesday, in what could be the first cases of Zika-linked microcephaly in Southeast Asia.

A city worker fumigates the area to control the spread of mosquitoes at a university in Bangkok, Thailand, September 13, 2016. REUTERS/Athit Perawongmetha

Several countries in Southeast Asia have reported increasing cases of infection from the mosquito-borne Zika virus but Thailand has one of the highest numbers in the region, with 349 confirmed since January, including 25 pregnant women.

Public Health Minister Piyasakon Sakolsatayadorn said authorities needed to be thorough in their investigation of the cases as confirmation would be “sensitive”.

“The lab results will take at least two days because we have to be thorough with this as it is a big deal and a link hasn’t been detected before,” Piyasakon told Reuters.

“This is a sensitive matter for Thailand,” he said.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies.

Piyasakon said the three babies were born with small heads and an ultrasound appeared to indicate the unborn baby had a small head.

Of the four mothers, two were diagnosed with Zika when they were pregnant but two were not confirmed to have had Zika, said Apichai Mongkol, director-general of the ministry’s Department of Medical Sciences.

If a Thai case were confirmed, it would be the first in Southeast Asia, the World Health Organization (WHO) said in a statement emailed to Reuters.

The connection between Zika and microcephaly first came to light last year in Brazil, which has confirmed more than 1,600 cases of microcephaly that it considers to be related to Zika infections in the mothers.

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Some health experts have accused Thailand, which has a thriving tourist industry, of playing down the risk from Zika.

But officials dismiss that saying the response has been adequate and another mosquito-born disease, dengue, which can be deadly, is a bigger threat.

The director-general of Thailand’s Disease Control Department, Amnuay Gajeena, said the four cases were being monitored but he declined to say exactly where they were suspected of contracting the virus.

“It is not in Bangkok,” Amnuay told Reuters. “Both the mothers and babies are being tested and we have sent the tests to several labs.”

There are no specific tests to determine if a baby will be born with microcephaly, but ultrasound scans in the third trimester of pregnancy can identify the problem, according to the WHO.

The World Health Organization lists Singapore, the Philippines, Malaysia, Thailand and Vietnam as countries reporting new cases of Zika.

Singapore has recorded 393 cases since diagnosing its first in August. It has confirmed 16 pregnant women with the virus.

The WHO has also said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

According to the WHO, there are two major lineages of Zika - an African lineage, which has only been reported in Africa, where the virus was first discovered in 1947, and an Asian lineage of strains.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes. An estimated 80 percent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.</s>Microcephaly is a rare birth defect that has been linked, in Brazil in particular, to the mosquito-borne Zika virus, which is spreading in Southeast Asia.

Thai health authorities said on Tuesday they were investigating four suspected cases of Zika-related microcephaly in three babies and a 36-week old unborn baby.

But on Wednesday, Apichai Mongkol, director-general of the ministry's Department of Medical Sciences, said Zika had been ruled out as the cause in two of the cases.

"The test results showed that two did not have the Zika virus but it is still unclear with the other two because we found three flavivirus which means it could be dengue, Zika or meningitis," Apichai told Reuters.

"To be sure which of the three they contracted we need to investigate further."

There are no specific tests to determine if a baby will be born with microcephaly but ultrasound scans in the third trimester of pregnancy can identify the problem, according to the World Health Organization (WHO).

It was not clear which of the four cases had been ruled out as having a link to Zika.

Zika has been linked to more than 1,800 confirmed cases of microcephaly in Brazil but there have been no confirmed cases of Zika causing the condition in Southeast Asia, according to the WHO.

Microcephaly has several potential causes including various infections, exposure to toxins and malnutrition, the WHO says.

Health authorities in Southeast Asia have reported a rising number of Zika cases with Thailand confirming 349 since January, including 33 pregnant women. Singapore has recorded 393, including 16 pregnant women.

The Philippines, Malaysia and Vietnam have also reported Zika cases.

Thailand's public health ministry said earlier the four suspected microcephaly cases were not in Bangkok but it declined to say where they were found.

The Bangkok Metropolitan Authority said on Wednesday officials had confirmed 26 Zika cases in the city this month.

The director-general of the Disease Control Department, Amnuay Gajeena, said out of 33 cases of pregnant women with Zika, eight had given birth without complications.

There is no vaccine or treatment for Zika. An estimated 80 percent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.

Zika was first identified in Uganda in 1947 and was first isolated in Asia in the 1960s. It was unknown in the Americas until 2014.</s>The Ministry of Public Health confirms there are four infants with microcephaly in Thailand but lab tests show that the birth defects of two of the infants are not caused by the Zika virus.

Minister of Public Health M.D. Piyaskol Sakolsattayathon said the ministry was still waiting for the lab results for the other two babies. One of them has yet to be born but an ultrasound scan found that it has microcephaly, said the minister. The other one was born with an unusually small head but it was still unconfirmed whether the infant’s microcephaly was caused by the virus, he added.

On 30 September, the ministry will invite obstetrics and gynecology, pediatrics and virology experts to discuss measures to protect pregnant women from the Zika disease.

From 17-23 September there were 35 confirmed new Zika patients. All of them were found in provinces where a Zika infection had already been reported.</s>India is vulnerable to the risk of Zika virus transmissions owing to high travel volumes from the disease affected areas in the America, presence of mosquitoes capable of transmitting the virus and limited health resources, a new study on Friday said.

"Many countries across Africa and Asia-Pacific may be vulnerable to Zika virus outbreaks, with India, China, the Philippines, Indonesia, Nigeria, Vietnam, Pakistan, and Bangladesh expected to be at greatest risk of Zika virus transmission...

"...due to a combination of high travel volumes from Zika affected areas in America, local presence of mosquitoes capable of transmitting Zika virus, suitable climatic conditions, large populations or limited health resources," a new study published in The Lancet Infectious Diseases said.

The modeling study said countries with large volumes of travellers arriving from Zika virus-affected areas of the Americas and large populations at risk include India (6,74,22 travellers arriving per year and 1.2 billion residents in potential Zika transmission areas) and China (2,38,415 travellers, 242 million residents).

For Indonesia it was 1,38,65 travellers, 197 million residents, Philippines (35,635 travellers, 70 million residents and Thailand (29,241 travellers, 59 million residents).

India, Philippines, Indonesia, Nigeria, Vietnam, Pakistan, and Bangladesh might be most vulnerable to impact because of their limited per capita health resources, the study said.

"An estimated 2.6 billion people live in areas of Africa and Asia-Pacific where the local mosquito species and suitable climatic conditions mean that local zika virus transmission is theoretically possible.

"However, there are still many unknowns about the virus and how it spreads, including which local species of mosquito are most capable of transmitting the virus, and whether immunity exists in areas that have previously reported cases of Zika virus.

"The impact on populations will also depend heavily on the country's ability to diagnose and respond to a possible outbreak," said study author Kamran Khan, St Michael's Hospital, Toronto, Canada.

The study comes after thirteen Indians were tested positive for Zika virus in Singapore and are undergoing treatment in the city-state which is grappling with rising number of the mosquito-borne disease.

Khan said warmer temperatures in the northern hemisphere (where mosquitoes are more active) increase the risk of new outbreaks appearing outside of the Americas.

"The potential for epidemics to occur in parts of Africa and the Asia-Pacific region is particularly concerning given that the vast numbers of people who could be exposed to Zika virus are living in environments where health and human resources to prevent, detect, and respond to epidemics are limited.

"Our findings could offer valuable information to support time-sensitive public health decision-making at local, national and international levels," he said.

The research team, which included scientists from the London School of Hygiene and Tropical Medicine, Oxford University and the University of Toronto, established the ecological niche for Zika virus in the America.

At the time of the analysis, local transmission of Zika virus had been confirmed in 40 countries in Central and South America and the Caribbean. The researchers then gathered data on airline ticket sales from all 689 cities with one or more airports in the region travelling to Africa or Asia-Pacific over a whole year-Dec 2014 to Nov 2015.

The team also mapped the monthly volume of travellers arriving into Africa and Asia-Pacific in order to identify countries at greatest risk of Zika virus importation.

"While the analysis emphasises the potential for human infection via mosquitoes, sexual transmission of Zika virus infection is now well documented.

"The authors say that travellers returning from affected areas would benefit from health education to prevent sexual transmission," the study said.

The authors note that the health consequences of imported Zika virus will depend on local ability to diagnose and respond to a possible outbreak, but will also depend on possible underlying levels of immunity to Zika virus.

Although sporadic cases of Zika virus have been reported in both Africa and Asia-Pacific, the breadth and extent of its previous infection remains unknown and it is not known whether the current Asian strain of the virus will affect individuals differently if they have previously been infected with the African strain.</s>America’s newest emerging disease – the Zika virus – continues to spread, with 23 cases in Oregon, as reported by the Center for Disease Control.

At the University of Oregon Health Center, doctors and medical staff are setting up protocol and pushing to inform students about the disease.

Dr. Elisabeth Maxwell, UO health promotion specialist, wrote in an email to the Emerald that the Health Center is distributing flyers to organizations on campus that work with international students. Triage nurses at the Health Center have also received training to identify specific symptoms of the Zika virus and are prepared to route students to additional resources for treatment.

Maxwell said the Health Center is also prepared to draw blood samples for Zika virus testing and screening if they suspect a case. The samples would be shipped to a state institution for laboratory testing, and they would not actually tested at the UO.

“I feel like we’re as prepared as we could be,” Maxwell said, “There really isn’t anything to be alarmed about on this campus.”

Of the 23 cases in Oregon, none have contracted the virus in the state – only during travel, according to the CDC. In other words, there are no locally acquired cases in Oregon. Florida, where the species of mosquito live that carry Zika, has 519 reported cases. Florida is also the only state that has reported any locally acquired cases – that number being 43.

Zika can be transmitted through blood and sexual contact, according to Dr. Richard Brunader, medical director at the UO Health Center, but transmission of the virus through a mosquito bite in Oregon is highly unlikely due to the species of mosquito that carry it.

Brunader said the symptoms for Zika are similar to other illnesses, such as the flu and colds, but with additional symptoms like conjunctivitis (red eyes) and sometimes a rash.

The World Health Organization defines an Emerging Disease as “one that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range.”

Like other emerging diseases, the Zika virus is evolving, and there is still much research to be conducted, according to Brunauder.

“For a normal, healthy adult, Zika doesn’t really present a threat,” Maxwell said. “Someone might not even know they have it.”

She said the Zika virus poses the biggest threat to pregnant women, whose babies could be born with microcephaly – an abnormally small head — according to the CDC, although it’s not a certainty.

No treatment or vaccine exists for the Zika virus, according to the CDC.

The UO Health Center has not tested for the Zika virus yet, according to Maxwell. If UO discovered a case of Zika, the local county health department would run a case investigation. Maxwell said they would try to identify how, when and where the person was infected.</s>The Lausanne University Hospital is starting a worldwide register of women who contracted the Zika virus during pregnancy. The aim is to aid understanding of the virus.

The monthly infectious diseases journal The Lancet ID published an article on the Zika register on Tuesday. Specialists David Baud and Alice Panchaud want the register to include as many women as possible who have been affected by Zika during pregnancy. The researchers believe that large-scale epidemiological studies are needed to properly analyse the virus.

Baud explained: “Many questions about the virus remain unanswered and an answer can only be found through investigating a large number of cases.”

Studies published up until now include only a few cases, without excluding other possible birth defects in the brain. The virus can cause a rare skull deformity called microcephaly in babies and is transmitted primarily by mosquitoes.



One of the questions the Lausanne researchers want to find out is whether transmission of the virus through sexual intercourse is as dangerous as an infection from a mosquito.



To obtain the necessary data for the research the hospital has sent 4,000 requests for cooperation to obstetricians around the world. The data will be analysed in Lausanne. It’s hoped that information from several hundred cases can be collected.



The United States also has a register, but only for domestic cases. There is still no treatment for the Zika virus.</s>Executive Director of the Caribbean Public Health Agency (CARPHA) Dr. James Hospedales has argued that the number of confirmed Zika cases is just the “tip of the iceberg” and is not a true reflection of the reality of those potentially infected with the virus.

Using a graphic titled “Lab confirmation of Zika: iceberg phenomenon”, the executive painted a grim image in which the submerged (largest) portion of the iceberg represents the hidden mass of the disease, which includes subclinical cases, carriers and undiagnosed cases.

The tip of the iceberg, the smallest area, represents the number of confirmed Zika cases; this is followed by the percentage of persons tested, those eligible for testing, persons who came for medical attention and those who are symptomatic. The largest area of the chart showed persons who are infected with Zika.

“As is seen in the iceberg phenomenon, only a small percentage of all the infected persons end up being laboratory confirmed positive cases. The iceberg phenomenon is important and provides valuable information for public health decision making.

“It gives an indication of the magnitude of the infection so that action can be taken to reach those who cannot be seen and are ‘under the water’. Often times when the figures of confirmed laboratory cases of diseases such as chikungunya and Zika are reported by officials to the media, we normally get a surprising reaction from the public. Comments like; ‘those figures can’t be true because my whole village had Zika’ are not uncommon,” said Hospedales.

Reports say 58 countries/territories currently have active Zika transmission. That includes one country in Africa (Cape Verde), eight in the Pacific Islands and 48 in North, Central and South America.

The number of confirmed Zika cases in New Providence is now 11. The first case of Zika was reported on August 10.

Chief Medical Officer (CMO) Dr. Glen Beneby said the government plans to set aside an estimated $2.5 million every month to fight the Zika virus, which would add up to almost $30 million per year.

“The reported figures are often laboratory confirmed positive cases. These cases do not represent everyone who have been infected. The figures are only what is described as the ‘tip of the iceberg’ as demonstrated in the diagram...,” said Hospedales.

“In the context of the Zika outbreak, the reported cases are the persons who have been infected with Zika, were symptomatic and then sought medical attention. They were the ones who were eligible for testing and then got tested,” he said.

Currently, those being tested for Zika in The Bahamas have to wait approximately two to three weeks for results. The test blood samples are sent to CARPHA, in Port-of-Spain, Trinidad and Tobago.

The government is upgrading a lab intended to be used to test for the virus in The Bahamas and would cost $50,000 to $100,000 in modifications.

Beneby said once the upgrades are complete, it should cut the wait time by 50 percent.</s>THE Department of Health (DOH) recently added three new Zika cases to the list of confirmed cases in the country for 2016, including a pregnant woman in Cebu City.

There are now a total of 12 cases. All were reported in September after tests conducted at the Research Institute for Tropical Medicine (RITM).



“Of these 12 cases, eight were females while age ranged from nine years to 55 years. Ten of these cases were from Region VI (Western Visayas) and one each from Region VII (Central Visayas) and NCR. The previously reported case from Laguna (Calabrazon) was traced to Muntinlupa upon verification. Among cases from Region VI, 9 were from Iloilo City and 1 from Oton, just a few kilometers outside Iloilo City,” Health Secretary Paulyn Jean B. Rosell-Ubial explained.



These cases did not have history of travel to an affected country a month prior to the onset of their illness. All of these confirmed cases presented with skin rashes with any one of the following: fever, muscle or joint pains, conjunctivitis without eye discharge. All have recovered from their mild illness.



The health chief added the 22-year-old confirmed case from Cebu is also 19 weeks pregnant with her first child. Initial ultrasound did not detect any fetal abnormalities. She will be monitored regularly during the entire period of the pregnancy.



DOH quick response teams were sent to affected areas to conduct case investigations and to recommend specific measures to prevent further spread. Iloilo city is carrying out indoor residual spraying coupled with fogging in affected and high risk areas to reduce adult mosquito density. This were done only after search and destroy were done in the same areas in order to eliminate mosquito breeding sites. All cases were advised to avoid mosquito bites by applying insect repellent over exposed areas at least a week after onset of their illness.



Zika virus disease is primarily transmitted via mosquito bites. The aedes aegypti is responsible for spreading Zika virus and also dengue and chikungunya viruses. In Brazil and other countries, pregnant women who got infected at anytime during their pregnancy have increased risk of giving birth to babies with congenital defects affecting the brain (microcephaly). Sexual transmission was also reported as another means of getting the zika virus.



DOH reiterates its appeal to local government units to find ways and be very vigorous so that households are able to search and destroy mosquito breeding sites, commonly seen inside and around homes. Pregnant women may use insect repellent or mosquito nets at daytime to avoid mosquito bites and potential Zika infection. Any individual who presents with skin rash and any other symptom should visit the nearest facility to rule out zika infections.



Zika can be mistaken for measles, dengue or chikungunya. A laboratory test is needed to confirm them. Pregnant women should follow advice of their doctors with regards to risks associated with zika and on ways to prevent zika infection.



The 4S means (1) Search and destroy mosquito breeding places, (2) Self-protection measures like using insect repellent and mosquito bed nets especially at day time, as well as the use of condom for protection against this sexually transmitted infection, (3) Seek early consultation for skin rashes and fever, joint pain or red eyes, and (4) Say Yes to fogging when there is an impending outbreak. Ugaliin nating gawin ang 4S sa ating komunidad para maprotektahan ang ating pamilya at mahal sa buhay,” Ubial concluded.</s>The Ministry of Health has taken charge of the baby who was recently diagnosed with microcephaly.

Confirmation came from Health Minister Terrence Deyalsingh in a telephone interview yesterday.

Deyalsingh’s comments came hours after the ministry in a press release on Monday confirmed the birth of a baby born with microcephaly at a private hospital.

“We have taken over care of the child around last week Thursday or Friday. The baby is in the Neonatal Intensive Care Unit (at Mt Hope). The paediatricians there are working with the baby. They are doing whatever needs to be done,” Deyalsingh said.

As for the mother, who was confirmed as being infected with the Zika virus, Deyalsingh said she was discharged from the private institution (Gulf View Medical Centre) last week.

“But I can’t say much about her condition because of patient confidentiality.”

Blood and tissue samples have since been taken from the baby, Deyalsingh said, which were sent to the Pan American Health Organisation (PAHO) for testing.

“That is what PAHO is now working on. We did not have control of the birthing process. We only came in after the fact. That is why I need the specialist intervention of PAHO. I spoke to PAHO in Washington (DC) yesterday about this.”

Deyalsingh could not say when the test results would be available.

“PAHO will be getting back to me on that. PAHO can’t give me a time frame as yet. I only engaged them yesterday.”

He said the ministry was trying to avoid fear and panic among T&T women who were tested positive with Zika, stating that the country registers approximately 12 cases of microcephaly annually due to a variety of genetic factors.

Medical Chief of Staff of Mt Hope Women's Hospital Dr Karen Sohan also weighed in on the issue, stating it was too early to tell if the Zika virus was linked to the baby’s birth with microcephaly.

As of yesterday, Sohan stated T&T had recorded 308 Zika-positive pregnancies, compared to the 294 women as of September 22.

“We have not confirmed that it is Zika. We do have microcephalic babies being born due to genetic syndrome chromosomal torch infection. Because we are in the midst of a Zika epidemic the question will be asked.”

Sohan said as soon as “information about the first set of cases that have been screened antenatally, that is those pregnant women who are coming to Mt Hope for their screening, we would be able to provide our own data as to what is happening in our population.”

Before 18 weeks of pregnancy, Sohan said, women faced the highest risk.

Colombia which is going through an epidemic, Sohan said, has had 1,800 Zika-positive pregnant women who in their third trimester (28 weeks and over) of pregnancy delivered normal babies.</s>MANILA: The Philippines on Monday reported its first known case of a pregnant woman infected with the Zika virus that threatens unborn babies, as authorities warned people to avoid mosquitos.

Health Secretary Paulyn Ubial said 12 cases of Zika had been detected across the Philippines this month, including a 22-year-old woman from the central island of Cebu who is 19 weeks’ pregnant with her first child.

“Initial ultrasound did not detect any foetal abnormalities. She will be monitored regularly during the entire period of the pregnancy,” the health department said.

Zika-infected pregnant women can give birth to babies with microcephaly, a deformation marked by abnormally small brains and heads.

Of the country’s 12 Zika cases, eight were female and ranged in age from 9 to 55, the department said.

None of those infected had travelled a month before testing positive and all had since recovered, it said.

Special teams have been dispatched to all the affected areas to investigate where the infection came from and recommend measures to deal with the virus, which can be spread by the bite of a mosquito or via sexual contact.

Ubial called on the public to destroy mosquito breeding places, use insect repellent and wear condoms during sex.

Scientists warned this month that the world should prepare for a “global epidemic” of microcephaly due to Zika as there is no cure or vaccine for the disease. — AFP
Thailand authorities investigate what could be the first cases of Zika virus-linked microcephaly in Southeast Asia.