Situation of

Zika virus infection in

Thailand

2012-2016

Rome BUATHONG, MD., FETP., MIH.,

Prev. Med. (Epidemiology)

Bureau of Epidemiology,

Department of Disease Control

Thailand Ministry of Public Health

Introduction

• Zika virus is a member of Flavivirus, in

Spondweni virus group

• Zika fever commonly presents with fever,

rash, conjunctivitis and joint pain and it is

transmitted by Aedes mosquito

• Average incubation period in human is 4 - 7 days (3-12)

• Extrinsic incubation period in Aedes spp. is about 10 days

Members in the family Flaviviridae

Flavivirus in Thailand

1. JEV

2. Denv-1

3. Denv-2

4. Denv-3

5. Denv-4

6. Zikv

http://viralzone.expasy.org/

Enveloped virus with diameter of about 40 nm

Hill, M.A. (2016) Embryology Abnormal Development - Zika Virus. https://embryology.med.unsw.edu.au/

Zika virus transmissions

Main vector

• Aedes aegypti

Other vector involvement

• Ae. africanus (ZIKV, 1948)

• Ae. albopictus

• Ae. henselli (outbreak in Yap Island, 2007 )

Possible vector (research)

• An. coustani

• Mansonia uniformis

• Culex perfunicus

Vector-borne transmissions

Non-vector-borne transmissions• Infected monkey bite (infected human bite ?)

• Blood transfusion

• Organs transplantation (Kidney/Liver)

• Sexual intercourse

• Tranplacental infection to fetus

• Perinatal infection

• Breast milk? (virus detected in breast milk)

Zika virus detected Blood : 5 – 7 days

Saliva : 5 – 7 days

Urine : up to 14 days

Semen : up to 2 months

CSF : acute phase of meningoencephalitis

Amniotic fluid : until delivery

Death fetus in utero : autopsy

Breast milk : infected during perinatal period

Zika virus detected in blood and urine

Ann-Claire Gourinat, Olivia O’Connor, Elodie Calvez, Cyrille

Goarant and Myrielle Dupont-Rouzeyrol

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21,

No. 1, January 2015

Zika virus detected in saliva and blood

Sexual transmission

• Foy is the first person known to have passed on an insect-borne virus to another human by sexual contact.

• In 2009 Brian Foy, a biologist from the Arthropod-borne and Infectious Diseases Laboratory at Colorado State University, sexually transmitted Zika virus to his wife after returning from Senegal.

• He and his wife developed symptom from Zikavirus infection.

Blood transmission

• Transmission of Zika virus via transfusion of infected blood or blood products remains a possibility.

• Three percent (3%) of asymptomatic blood donors (42/1 505) were found positive for Zikavirus by PCR during the Zika virus outbreak in French Polynesia between November 2013 and February 2014.

• No documented cases of infections via transfusion.

Safety guideline of blood transfusion

• For areas with no local transmission, it recommends donors who are at risk of Zika infection be deferred for 4 weeks.

People at risk : those who had symptoms consistent with Zika virus infection within the past 4 weeks, had sexual contact with someone who visited or lived in an area of local spread during the past 3 months, and anyone who traveled in the past 4 weeks to an area where the virus is circulating.

• In areas with active Zika transmission, such as Puerto Rico and the US Virgin Islands, the FDA urges authorities to obtain whole blood and blood components from parts of the United States with no local transmission.

Global Zika Virus in the past 1947 - 2007

Source : Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep

African lineage

Asian lineage

Discovery of Zika virus

Apr 1947:

The virus was isolated from sentinel rhesus monkey

in Zika forest, Uganda through monitoring of

yellow fever.

Jan 1948:

The virus was isolated from Aedes africanus

mosquito in Uganda

Year 1952:

Human infections were found in Uganda and

Tanzania.

From its discovery until 2007, Zika virus infection were rare in

Africa and Southeast Asia.

Zika virus outbreaks

• From its discovery until 2007, Zika virus infection

were rare in Africa and Southeast Asia.

• 2007- an outbreak occurred in Yap Island,

Federation States of Micronesia. Zika was first

considered as an emerging disease.

• 2013 - the outbreak occurred in French Polynesia.

Complication with Guillain-Barré syndrome was

suspected.

• May 2015 - the outbreak occurred in Brazil

Zika virus spreading in

Southern Pacific Islands and Asia

2010Cambodia

2013Indonesia

2013Thailand

Source:

2012Philippines

Molecular Seq of Zika virus in South East Asia and Latin America

Thailand

R. Buathong,Thailand MOPH & S. Wacharapluesadee, Chulalongkorn University

Brazil

Asian lineage

Zika fever in Yap Islands, 2007

Source : Mark R. Duffy et al. Zika Virus Outbreak on Yap Island, Federated States of

Micronesia. N Engl J Med 2009;360:2536-43

Zika fever in Yap Islands, 2007

Source : Mark R. Duffy et al. Zika Virus Outbreak on Yap Island, Federated States of

Micronesia. N Engl J Med 2009;360:2536-43

Zika fever in Yap Islands, 2007

Source : Mark R. Duffy et al. Zika Virus Outbreak on Yap Island, Federated States of

Micronesia. N Engl J Med 2009;360:2536-43

Epi & Clinical Characteristicsof confirmed Zika fever outbreak

0

1

2

3

4

5

14

Fe

b 1

2

16

Fe

b 1

2

18

Fe

b 1

2

20

Fe

b 1

2

22

Fe

b 1

2

24

Fe

b 1

2

26

Fe

b 1

2

28

Fe

b 1

2

1 M

ar

12

3 M

ar

12

5 M

ar

12

7 M

ar

12

9 M

ar

12

11

Ma

r 1

2

13

Ma

r 1

2

15

Ma

r 1

2

17

Ma

r 1

2

19

Ma

r 1

2

21

Ma

r 1

2

23

Ma

r 1

2

25

Ma

r 1

2

Moo 7 Moo 4

Moo 3 Moo 2

T. Tantitaweewat & R. Buathong,Thailand MOPH

1st

symptom

Fever

Mostly low grade or undetectable

1/3rd report no fever

short duration and short viremia except in

severe case

Fever(low)

Rash(MP)

Red eyes(non-purulent)

JointInvolvement

27

Maculopapular rash among cases

T. Tantitaweewat & R. Buathong,Thailand MOPH

MP Rash (pruritic and nonpruritic)

Rome Buathong,Thailand MOPH

29

Bilateral Conjuctival Hyperemia(Red eyes)

T. Tantitaweewat & R. Buathong,Thailand MOPH

Conjuctival Hyperemia

Rome Buathong,Thailand MOPH

Joint involvement

inflammation

Pain and stiffness

swelling

Zika virus spreading in Latin America and the Caribbean

Source : WHO PAHO, http://www.paho.org/ February 2016

Countries and territories with Zika virus transmission

Source : ECDC, http://ecdc.europa.eu/ February 2016

Zika virus spreading in

NE Brazil and Microcephaly in NB

Average

200 case/year

>4,000 case/2015

Source : TheLipTV, youtube.com/watch?v=zmDIoTNqJ0o and AP

Association and now Zika virus

infection is one in many microcephaly Causations

• Microcephaly and poor birth defect in NB affected in all trimester

Zika virus in third trimester

Zika virus affected to fetus and infant

Virus in the fetus brain CT Brain in microcephaly

Number of reported cases of microcephaly* in full-term newborns

following laboratory-confirmed Zika virus transmission —Pernambuco, Paraíba, and Bahia states, Brazil, 2015

MMWR, US CDC

Number of reported cases of microcephaly* in full-term newborns

following laboratory-confirmed Zika virus transmission —Pernambuco, Paraíba, and Bahia states, Brazil, 2015

MMWR, US CDC

Warm climate and outbreaks

• With warm weather, mosquitoes fly

more and bite more.

• Warm weather speeds up virus

replication rate in mosquitoes.

Alert signal

• On May 2013, Canada IHR focal point

notified Thai MoPH about a Canadian

traveler confirmed Zika virus infection

returning from Thailand

• A 45-year-old female Canadian stayed in

Thailand during 20th Jan – 4th Feb, 2013

• Her onset date was 4th Feb with backache,

irritable, headache when she transited at

the airport in Hong Kong

Exported case#1The case

45-year-old female Canadian tourist

Stayed in Thailand during Jan 20th - Feb 4th, 2013

Onset began Feb 4th while onboard with backache,

irritable, headache, then at home chilled, rash with

red eyes (suspected Measles), severe joint pain, vomiting, thrombocytopenia (suspected Dengue)

Clinical long lasting for 2 ½ weeks

Zika virus confirmed by PCR and sequencing

linage similar to Cambodia and Micronesia strain

and serology confirmed

Suspected area of exposure to virus: Bangkok and Phuket

Molecular Detection

Uganda_YP_002790881.1|:3065-3309 polyprotein [Zika virus]

Uganda_AEN75263.1|:3069-3313 polyprotein, partial [Zika virus]

Uganda_AAC58803.1|:88-332 NS5 protein, partial [Zika virus]

Uganda_ABI54475.1|:3063-3307 polyprotein [Zika virus]

Senegal_AEN75266.1|:3069-3313 polyprotein, partial [Zika virus]

Nigeria_AEN75265.1|:3063-3307 polyprotein, partial [Zika virus]

Malaysia_AEN75264.1|:3069-3313 polyprotein, partial [Zika virus]

Cambodia_AFD30972.1|:3069-3313 polyprotein, partial [Zika virus]

Micronesia_ACD75819.1|:3069-3313 polyprotein [Zika virus]

C13VS012396 Serum

100

85

98

56

65

0.005

Curtsey : Kevin FonsecaAlberta Health Service, Canada

Exported case# 2

Exported case# 2

Exported case# 2

Exported case# 3

Travel period 25 – 31 July 2014/ visited Koh Samui

Journal of Travel Medicine, 2016, 1–3 doi: 10.1093/jtm/tav011

Exported case# 3

-Thai 24 year old,

-Northern province,

-Quarantined at

Taoyuan Airport coz

of fever on 10

January 2016

-Clinical developed

in Thailand 1 day

before departure to

Taiwan

-Zika PCR in positive in patient’s blood

Exported case # 4

Source: http://outbreaknewstoday.com/

When Zika virus was detected in Thailand?

Pond WL. Transac Royal Soc Trop Med Hyg 1963; 57:364

Mouse NT

• ตงแตป พ.ศ. 2556 เปนตนมา พบเหตการณการระบาดในจงหวดตางๆ ทเขาเกณฑสอบสวน ดงน – ศรสะเกษ กนยายน 2556

สงตรวจ 8 ราย : พบ PCR 1 ราย, ZIKV IgM 5 ราย– ล าพน กนยายน 2556

สงตรวจ 21 ราย : พบ PCR ยนยน 1 ราย, ZIKV IgM 14 ราย– เพชรบรณ กรกฏาคม 2557

สงตรวจ 20 ราย : พบ PCR ยนยน 2 ราย, เพาะเชอได 1 ราย– สมทรสาคร มกราคม 2558

สงตรวจ 5 ราย : พบ PCR ยนยน 4 ราย, เพาะเชอได 1 ราย

Zika fever in Thailand

Rome Buathong, et al. Bureau of Epidemiology, Thailand MOPH

Geographic of confirmed Zika fever case from

2012-2015

Samut Sakorn,

Jan 2015

viral isolation

Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383

2012: 3 cases

2013: 2 cases

2014: 2 cases

2015: 5 cases

Exported case 2013: 2 cases

Molecular sequencing of Zika virus in Thailand closely with French Polynesia

Rome Buathong, et al. Am. J. Trop. Med. Hyg., 93(2), 2015, pp. 380–383

Exported case#2

Flavivirus cross-reactivity

Zika and Dengue

Source :

Emerg Infect Dis 2008; 14: 1232

Source: Division of Vector Borne Disease, US CDC

Source: Rome Buathong, Bureau of Epidemiology

Source: Rome Buathong, Bureau of Epidemiology

Exported Case #3

Journal of Travel Medicine, 2016, 1–3 doi: 10.1093/jtm/tav011

Surveillance for Zika virus

โรคตดเชอไวรสซกา เปนโรคตดตอทตองแจงความตอเจาพนกงานสาธารณสข ตามพรบ. โรคตดตอ พ.ศ. 2523

ผแจง คอ โรงพยาบาลทงรฐเอกชน รวมคลนก/หองปฏบตการ/เจาบาน

Surveillance for Zika virus

Surveillance for Zika virus

Surveillance for Zika virus

กรณทระบบเฝาระวงสามารถตรวจพบผปวยยนยนโรคตดเชอไวรสซกาในพนท ใหพนทด าเนนการควบคมโรค โดยอาศยแนวทางการ

ควบคมโรคตดเชอไวรสซกา ดงน

กรณทระบบเฝาระวงสามารถตรวจพบผปวยยนยนโรคตดเชอไวรสซกาในพนท ใหพนทด าเนนการควบคมโรค โดยอาศยแนวทางการ

ควบคมโรคตดเชอไวรสซกา ดงน

กจกรรม

กจกรรม

กจกรรม

กจกรรม

กจกรรม

กจกรรม

ตวอยางแบบตดตามอาการผสมผส

Where to submit sample (1)

• Thai NIH, Department of Medical Sciencescontact tel. number : 029511485

plasma/serum/urine for realtime PCR for Zikv

plasma/serum for Zikv IgM by ELISA

1500 – 2000 THB/sample

Where to submit sample (2)

• Laboratory network for Zika outbreak investigation

3) Faculty of Medical Technology Mahidol University, Salaya, Nakhon Prathom

2) EID Laboratory Center Chulalongkorn University Thai Red Cross

1) Medical Technology and Reference Laboratory for Infectious Diseases: MTRL Bamrasnaradura Infectious Disease Insitute, MoPH

BUREAU OF EPIDEMIOLOGY- MOPH, THAILAND

SAWASDEE

KRUB

Thank you for your kind attention