Clinical Prcatice Guideline (CPG)

ARAHAN PENTADBIRAN UNTUK

PEMANTAUAN DAN PENGURUSAN
JANGKITAN VIRUS ZIKA-ARAHAN
NOTIFIKASI SECARA PENTADBIRAN

Disampaikan Oleh;
MOHD AZRIN BIN MD JAAFAR
PENOLONG PEGAWAI PERUBATAN U29
UNIT PENOLONG PEGAWAI PERUBATAN
HOSPITAL QUEEN ELIZABETH
INTRODUCTION
MAY 2015
Pan American Health Organisation (PAHO) issued a
Warning regarding 1st case of Zika Infection

FEBRUARY 1st, 2016

World Health Organisation (WHO) Announced Zika as a
Public Health Emergency of International Concern
•Came from family Flaviviridae / Genus Flavivirus
1947 - Was firstly isolated when scientist doing routine surveillance for Yellow Fever –
sample was taken from captive, sentinel rhesus monkey
1948 – The virus recovered from Mosquito Aedes Africanus, caught on a platform
tree in the Zika Forest
1952 – 1st case of human cases detected in Uganda and United Republic of Tanzania
in study demonstrating the presence of neutralizing antibodies to Zika Virus in Sera
 ZIKA’s TIMELINE
TIME / YEAR ZIKA’s DEVELOPMENT / EVOLUTION
1964 A researcher in Uganda infected by Zika while working on the virus
confirming that Zika virus causes human illnesses and reporting
the illnesses as “mild”
1960s-1980s Human cases are confirmed through blood test but no
hospitalization or mortality reported.
-1st half of the 20th century mapped the spreading of the disease
from Uganda to Western Africa and Asia
1969 – 1983 Zika virus detected in mosquitos found in equtorial Asia (India,
Malaysia and Pakistan)
2007 Large outbreak in Pacific Island of Yapp. Estimated 73% of Yapp’s
resident were infected by Zika. Prior to this, no outbreak had been
noted and only 14 cases been documented anywhere in the world
2008 A US Scientist conducting field work in Senegal fall ill with Zika.
Returned home, he infected his wife.
-this is the 1st case of sexual transmission
 TIME / YEAR ZIKA’s DEVELOPMENT / EVOLUTION
2012 Researchers identifies two distinct lineages of Zika that are Asian
and African
-3 lineage according to certain Journal (Andrew D. H. et. al, 2012)
Ref:
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.
0001477
2013 – 2014 Major outbreak at 4 places (Pacific Islands)
-French Polynesia
- Easter Island
- Cook Island
- New Caledonia
During this period reveal possible association between Zika’s
infection and congenital malformation / severe neurological /
autoimmune complication
20th March 2014 2 mothers and their newborns (4 days of birth) are found infected
by Zika. 1st case to be believed transplacental infection / during
delivery
 TIME / YEAR ZIKA’s DEVELOPMENT / EVOLUTION
29th March 2015 Brazil notifies WHO of an illness characterized by skin rash in
northeastern states. From February 2015 to 29 April 2015, nearly
7000 mild cases are reported, with no reported deaths. Of 425
blood samples taken for differential diagnosis, 13% are positive for
dengue. Tests for chikungunya, measles, rubella, parvovirus B19,
and enterovirus are negative. Zika was not suspected at this stage,
and no tests for Zika were carried out.
31st March 2014 During the same outbreak of Zika virus in French Polynesia 1,505
asymptomatic blood donors are reported to be positive for Zika by
PCR. These findings alert authorities that Zika virus can be passed
on through blood transfusion.
7th May 2015 Brazil's National Reference Laboratory confirms Zika virus is
circulating in the country. This is the first report of locally acquired
Zika disease in the Americas.
WHO/PAHO release an epidemiological alert for possible Zika virus
infection in Brazil. The Organization recommends that countries
establish and maintain Zika virus infection detection, clinical
management and community engagement strategies to reduce
transmission of the virus.
TIME / YEAR ZIKA’s DEVELOPMENT / EVOLUTION
17th July 2015 Brazil reports neurological disorders associated with a history of
infection, primarily from the north-eastern state of Bahia. Among
these reports, 49 cases were confirmed as Guillain–Barré
syndrome. Of these cases, all but 2 had a prior history of infection
with Zika, chikungunya or dengue.
30th October Brazil reports an unusual increase in the number of cases of
2015 microcephaly among newborns.

The basal position of the ZIKV strain isolated in Malaysia in 1966 suggests
that the recent outbreak in Micronesia (island of Yapp) was initiated by a
strain from Southeast Asia. Because ZIKV infection in humans produces an
illness clinically similar to dengue fever and many other tropical infectious
diseases, it is likely greatly misdiagnosed and underreported. (Andrew D. H
et. Al, 2012)
 Signs & Symptoms:
1) Patient with rash or fever (37.5◦C)
2) Arthralgia or myalgia
3) Non-purulent conjunctivitis or conjunctival hyperemia
4) Headache or malaise
5) Presented with Guillain Barre Syndrome or
microcephaly

Only 1 out of 5 Zika’s infected person will show symptom (80% didn’t show any symptom)
Many reported case of newborn with Microcephaly from a mother Zika-Infected.
47 cases in Brazil with prior infection of Zika develop Guillain Barre Syndrome
 ARAHAN PENTADBIRAN
Memo Perhubungan Ruj: (04)HQE.600-4/9 Jld.6 Tarikh: 05 Sept 2016
Edaran KKM : KKM-600-29/4/56Jld.2(89) Tarikh: 04 feb 2016

SISTEM PELAPORAN KES DISYAKI (SUSPECTED CASE)

ZIKA DAN MICROCEPHALY
Semua kes yang disyaki jangkitan Virus Zika
(Suspected Case) seperti dalam lampiran 1
hendaklah dilaporkan kepada Pejabat Kesihatan
Daerah (PKD) dalam tempoh 24jam dari tarikh
diagnosa melalui panggilan telefon diikuti dengan
menghantar borang notifikasi kes Zika1 / case/
2016 (Lampiran 3)
 PENGURUSAN KLINIKAL
• HOSPITAL
Bagi kes yang disyaki jangkitan virus Zika samada di
rawat sebagai pesakit luar atau pesakit dalam,
sampel darah hendaklah diuji di hospital tersebut
atau dihantar ke IMR (Lampiran 2A). Bagi hospital
swasta, sampel boleh dihantar ke makmal hospital
kerajaan berdekatan yang menjalankan ujian
tersebut atau ke IMR dan caj seperti di dalam Akta
Fee adalah terpakai
 KES MICROCEPHALY
• Bagi kes yang didiagnosa sebagai
microcephaly mengikut kes definisi
“microcephaly” (Lampiran 1), sampel klinikal
hendaklah dihantar ke IMR untuk ujian
pengesahan jangkitan Virus Zika dengan
segera (Lampiran 2A)
• Bagi kes microcephaly yang disahkan positif
hendaklah dirujuk kepada pakar pediatrik di
negeri masin-masing untuk tindakan lanjut
 PANDUAN PENJAGAAN PESAKIT ZIKA
SEBAGAI PESAKIT LUAR
• Kes yang menunjukkan gejala klinikal
– Menghadkan pergerakan dan berada di rumah sehingga tanda-tanda dan
gejala telah tiada
– Menggunakan repellent/ memakai baju lengan panjang / seluar panjang /
kelambu untuk elak gigitan nyamuk
– Jika terdapat tanda-tanda Guillain Barre Syndrome; dapatkan rawatan segera
di hospital
– Makan ubat demam paracetamol dan ikut nasihat Doktor
– Sponge atau lap badan dengan kain basah untuk kurangkan suhu badan
– Rehat secukupnya
– Minum banyak cecair nutrisi (meminum air kosong sahaja tidak memadai)
– Melakukan langkah pencegahan di rumah
– Menggunakan sembuarn aerosol / penghalau nyamuk
– Memasang jejaring pada tingkap untuk mengelakkan nyamuk masuk
 RUJUKAN
• WHO (Update 6th September, 2016). “Zika Virus”.
http://www.who.int/mediacentre/factsheets/zika/en/
• Andrew D. Haddow , et. al (February 28th, 2012).
“Genetic Characterization of Zika Virus Strains:
Geographic Expansion of the Asian Lineage”. PLOS,
Neglected Tropical Diseases.
http://journals.plos.org/plosntds/article?id=10.1371/jo
urnal.pntd.0001477
• KKM (February 4th, 2016). “ZIKA ALERT” DAN ARAHAN
PENTADBIRAN UNTUK PEMANTAUAN DAN
PENGURUSAN JANGKITAN VIRUS ZIKA. Ruj: KKM-600-
29/4/56Jld.2(89)
 SEKIAN
&
TERIMA KASIH