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Washington, D.C., PAHO, 2017. 38 p.This document provides technical content on ZIKV, its manifestations, complications, modes of transmission, and prevention measures to be used in answering frequently asked questions and conveying messages in information and communication materials, community talks, press conferences, etc. Recommendations for the preparation of risk communication and action plans to respond to ZIKV are included. This guide to activities and recommendations for managing risk communication on ZIKV is designed for spokespersons, health authorities and health workers, other sectors, and partners inside and outside the health sector to assist them in tailoring communication initiatives to the needs of each country and target audience. The elimination of mosquito breeding sites remains the most important strategy for the prevention and control of ZIKV (as well as dengue and chikungunya) infection. Therefore, communication plans for the response to ZIKV should include intersectoral action and community engagement to modify behaviors and encourage sustained practices to eliminate breeding sites and control the mosquito, as well as to inform and educate target audiences about the steps they can take to prevent ZIKV transmission. The fourth meeting of the Emergency Committee under the International Health Regulations agreed that, “due to continuing geographic expansion and considerable gaps in understanding of the virus and its consequences, Zika virus infection and its associated congenital malformations and other related neurological disorders, ZIKV continues to be a public health emergency of intenational concern.
[Geneva, Switzerland], International Federation of Red Cross and Red Crescent Societies, 2016 Feb 29.  p.This document is an emergency plan of action created by International Federation of Red Cross and Red Crescent Societies for the country of Honduras. The document includes a situational analysis of the Zika emergency in Honduras and an operational strategy and plan to combat the outbreak.
[Geneva, Switzerland], WHO, 2016 Jun 9.  p.As of 8 June 2016, 60 countries and territories report continuing mosquito-borne transmission of which: 46 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos. 14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission. In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA -Chile and YAP (Federated States of Micronesia). Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route. In the week to 8 June 2016, no new country reported mosquito-borne or person-to-person Zika virus transmission. As of 8 June 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported by eleven countries or territories. Three of those reported microcephaly borne from mothers with a recent travel history to Brazil (Slovenia, United States of America) and Colombia (Spain), for one additional case the precise country of travel in Latin America is not determined. In the context of Zika virus circulation, 13 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. As of 8 June, Cabo Verde has reported a total of six cases of microcephaly and other neurological abnormalities with serological indication of previous Zika infection. Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS. The global Strategic Response Framework launched by the World Health Organization (WHO) in February 2016 encompasses surveillance, response activities and research. An interim report has been published on some of the key activities being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency. A revised strategy for the period July 2016 to December 2017 is currently being developed with partners and will be published in mid-June. WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO’s latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online. (Excerpt)
Geneva, Switzerland, WHO, 2016 May 13.  p. (WHO/ZIKV/MOC/16.2 Rev.1)The mosquito vector that carries the Zika virus thrives in warm climates and particularly in areas of poor living conditions. Pregnant women living in or travelling to such areas are at equal risk as the rest of the population of being infected by viruses borne by this vector. Maternal infection with Zika virus may go unnoticed as some people will not develop symptoms. Although Zika virus infection in pregnancy is typically a mild disease, an unusual increase in cases of congenital microcephaly, Guillain-Barré syndrome and other neurological complications in areas where outbreaks have occurred, has significantly raised concern for pregnant women and their families, as well as health providers and policy-makers. The aim of this document is to provide interim guidance for interventions to reduce the risk of maternal Zika virus infection and to manage potential complications during pregnancy. This guidance is based on the best available research evidence and covers areas prioritized by an international, multidisciplinary group of health care professionals and other stakeholders. Specifically, it presents guidance for preventing Zika virus infection; antenatal care and management of women with infection; and care during pregnancy for all pregnant women living in affected areas, with the aim of optimizing health outcomes for mothers and newborns. The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission. It is not intended to provide a comprehensive practical guide for the prevention and management of Zika virus.
Geneva, Switzerland, WHO, 2016 May 30.  p. (WHO/ZIKV/MOC/16.1 Rev.1)This document is an update of guidance published on 18 February 2016 to provide advice on the prevention of sexual transmission of Zika virus.The primary transmission route of Zika virus is via the Aedes mosquito. However, mounting evidence has shown that sexual transmission of Zika virus is possible and more common than previously assumed. This is of concern due to an association between Zika virus infection and adverse pregnancy and fetal outcomes, including microcephaly, neurological complications and Guillain-Barre syndrome. The current evidence base on Zika virus remains limited. This guidance will be reviewed and the recommendations updated as new evidence emerges.
Lancet. 2016 Mar 19; 387:1147.WHO convened a multidisciplinary consultation last week to identify the tools and interventions needed to outsmart the Zika epidemic. Towards the end of the meeting, delegates representing the major regulatory agencies in the USA, Europe, and Brazil, committed to putting Zika-related products on a regulatory fast-track. They also agreed that instead of waiting, as they usually do, for manufacturers to approach them, they would take the initiative and approach companies working on promising products. Their gesture, in a sense, encapsulates the success of the meeting in bringing together so many minds from so many disciplines to focus, for 3 intensive days, on a single issue of vital importance. (Excerpts)
Zika virus infection: global update on epidemiology and potentially associated clinical manifestations.
Releve Epidemiologique Hebdomadaire. 2016 Feb 19; 91(7):73-81.Add to my documents.
[Geneva, Switzerland], WHO, 2016 Mar 2.  p. (WHO/ZIKV/MOC/16.2)The mosquito vector that carries the Zika virus thrives in warm climates and particularly in areas of poor living conditions. Pregnant women living in or travelling to such areas are at equal risk as the rest of the population of being infected by viruses borne by this vector. Maternal infection with Zika virus may go unnoticed as some people will not develop symptoms. Although Zika virus infection in pregnancy is typically a mild disease, an unusual increase in cases of congenital microcephaly, Guillain-Barré syndrome and other neurological complications in areas where outbreaks have occurred, has significantly raised concern for pregnant women and their families, as well as health providers and policy-makers. The aim of this document is to provide interim guidance for interventions to reduce the risk of maternal Zika virus infection and to manage potential complications during pregnancy. This guidance is based on the best available research evidence and covers areas prioritized by an international, multidisciplinary group of health care professionals and other stakeholders. Specifically, it presents guidance for preventing Zika virus infection; antenatal care and management of women with infection; and care during pregnancy for all pregnant women living in affected areas, with the aim of optimizing health outcomes for mothers and newborns. The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission. It is not intended to provide a comprehensive practical guide for the prevention and management of Zika virus infections.
[Geneva, Switzerland], WHO, 2016 Feb.  p.WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it. The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.
[Geneva, Switzerland], WHO, 2016 Feb.  p.This fact sheet on Zika virus contains a list of key facts and information on its signs and symptoms, potential complications, transmission, diagnosis, prevention, treatment, and WHO response.
Provisional remarks on Zika virus infection in pregnant women: Document for health care professionals.
Montevideo, Uruguay, PAHO, 2016 Jan 25.  p.The aim of this document is to provide health care professionals in charge of the care of pregnant women with updated information based on the best evidence available for the prevention of infection, timely diagnosis, suggested therapy and monitoring of pregnant women, and notification of cases to the competent health authorities. The information presented in this document was updated on January 22, 2016; it may be further altered if new evidence appears on the effects / consequences of Zika virus Infection in pregnant women and their children. New updates may also be found regularly at www.paho.org/viruszika. (Excerpt)
Geneva, Switzerland, UNAIDS, 2014.  p. (Reference)It is essential that all people, including people living with HIV, are able to access health services and ongoing treatment. If people living with HIV who are on ART stop abruptly because they cannot access new supplies they could rapidly become unwell, drug resistance may build and the chances of onward transmission of the virus would increase. UNAIDS is working to mitigate the impact the EVD outbreak is having on access to treatment and care for people living with HIV and on new patient enrolment. In order to provide continuity of treatment to people on ART, community networks, supported by UNAIDS have been working with the National AIDS Councils to establish additional service delivery points. People on ART have been collecting their medicines from the offices of the National AIDS Councils and wherever possible, patients have been given supplies for longer periods than usual. UNAIDS is fully supporting United Nations Mission for Ebola Emergency Response (UNMEER) and the five pillar framework. UNAIDS country offices in each of the three countries, as well as the Regional Support Team in Dakar, are contributing to the Ebola operations centres, the national Ebola task forces or committees, the presidential Ebola task forces and other coordination mechanisms. (Excerpts)
Evidence behind the WHO guidelines: hospital care for children: what is the aetiology of pneumonia in HIV-infected children in developing countries?
Journal of Tropical Pediatrics. 2009 Aug; 55(4):219-24.This clinical review discusses the most common cause of pneumonia in HIV-infected children--bacterial pathogens and includes recommendations for the management of pneumonia in HIV-infected children from World Health Organization (WHO).
Commentary: From scarcity to abundance: Pandemic vaccines and other agents for "have not" countries.
Journal of Public Health Policy. 2007; 28(3):322-340.The recent impasse between the Indonesian Ministry of Health and the World Health Organization (WHO) over sharing H5N1 viruses in return for access to affordable pandemic vaccines highlights slow progress in defining an antigen sparing vaccine formulation, developing licensing requirements that meet the needs of populations and obtaining government funding for vaccine trials. Currently, vaccine-producing countries would have difficulty producing enough doses for their own people and few doses would be left over for non-producing ("have not") countries. Yet within a few months of the onset of a new pandemic, several billion doses of live-attenuated and recombinant hemagglutinin H5 vaccines could be produced for "have not" countries, provided a new and disruptive system of "top down" management could be organized. In its absence, a "bottom-up" alternative that uses widely available and inexpensive generic agents like statins must be considered. The "have not" countries must continue to put pressure on WHO and leading countries to ensure that they will have access to the interventions they will need. (author's)
Lancet. 2006 Apr 22; 367(9519):1299-1300.Merck's vaccine for cervical cancer is being reviewed as a priority by the US Food and Drug Administration (FDA), with a ruling due on June 8, and GlaxoSmithKline submitted an application for its vaccine in the European Union on March 9. The issue of how best to introduce these vaccines to young people before they become sexually active is now, therefore, a research priority. Vaccination against cervical cancer is especially important in developing countries, where nearly 80% of cases are reported and where effective methods of diagnosis--such as the Pap smear--are rarely used. Modelling studies indicate that vaccines against human papillomavirus (HPV) could be effective in preventing cervical cancer provided all adolescents--not just those at high risk--are vaccinated before they become sexually active. The need to reach large numbers of adolescents with a series of three injections is a challenge, however, especially in sub-Saharan Africa. (excerpt)
Cervical cancer, human papillomavirus, and vaccination. Vaccines work, but we need more information before widespread immunisation [editorial]
BMJ. British Medical Journal. 2005 Oct 22; 331(7522):915-916.At the beginning of October one of the trials of vaccines against human papillomavirus (HPV) infection, the primary risk factor for cervical cancer, announced an encouraging result. Large scale, multi-country, multi-site trials of several HPV vaccines are currently under way. The end points comprise incident and persistent HPV infection (during 2-3 years’ follow-up) and associated precancerous cytological and histological lesions (cervical intraepithelial (CIN) neoplasia during 2-3 and 4-5 years’ follow-up). The World Health Organization is expecting at least one of these vaccines to be licensed for use in 2006. How promising are the available trial results? What other questions need answering? And is it time to accelerate preparations for programmes to provide HPV vaccination? The latest data release concerns a trial of a quadrivalent recombinant vaccine that included HPV types 6, 11, 16, and 18. In all, 12,167 women at 90 centres in 13 countries participated in the trial, the FUTURE II study. In this prospective double blind study, women aged 16 to 26 were randomised to receive three doses of either vaccine or placebo over six months. (excerpt)
The promise of science. Today's innovations bring hope, but will they reach low-resource areas tomorrow?
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):103-104.This publication has shown that the ICPD’s Programme of Action covers cultural, behavioural, and policy issues that all favour a comprehensive approach to sexual and reproductive health and rights. Questions of equity— in access to information, education, technology, and services—lie at the heart of many of the goals. In getting to these goals, science has an immensely important role to play. We have already seen enormous scientific strides in global health during our lifetimes—in prevention, treatment and cure. New vaccines and better delivery systems have saved the lives and health of countless children. New ways to regulate fertility have expanded women’s reproductive health choices. Antiretroviral treatments are powerful tools for reducing or delaying the effects of HIV infection. New tests are helping us detect sexually transmitted infections (STIs) faster, cheaper, and more accurately, reducing complications and chances for further transmission. (excerpt)
International Journal of Gynecology and Obstetrics. 2005 Jul; 90(1):4-9.Alliance for Cervical Cancer Prevention, January 10, 2005. A consortium of international public health agencies has published a “how-to” manual on implementing effective screening programs for cervical cancer in developing countries. The Alliance for Cervical Center Prevention is a partnership of global agencies, including the World Health Organization’s International Agency for Research on Cancer. For the past 5 years, the alliance has worked in more than 50 countries on identifying, promoting, and implementing effective, safe, and affordable cervical prevention strategies in low-resource settings. The resulting 279-page manual, Planning and Implementing Cervical Cancer Prevention and Control Programs, is fully endorsed by the WHO. In the forward, Catherine LeGales Camus and Joy Phumaphi, assistants to the WHO director general, write that cervical cancer is one of the most preventable and treatable cancers, and that well organized programs in developed countries have led to a “remarkable reduction in mortality and morbidity.” (excerpt)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they may be unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. (excerpt)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they maybe unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. Since H5N1 starting spreading through Asian poultry flocks in 2003, the World Health Organization (WHO) has been sounding the pandemic alarm. Two main actions are required. First, surveillance for human and animal flu viruses in affected countries needs to be stepped up, to provide an early warning of the emergence of a possible pandemic strain. Second, nations around the world must develop plans to protect their populations should this occur. This will require stringent quarantine procedures, plus the rapid deployment of vaccines and antiviral drugs. (excerpt)
Progress in development and use of antiviral drugs and interferon. Report of an informal consultation, Geneva, Switzerland, 13-15 March 1995.
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1995. 30 p. (WHO/EMC/LTS/95.1)Considerable progress has been made in the development of antiviral agents. Several new compounds have become available to physicians over the past few years and many more are under development. Many of the recently developed agents represent incremental improvements related to improved pharmacokinetic and/or tolerance profiles. One of the reasons behind this progress has been the fight against the epidemic of HIV infection and its sequelae, with a resulting expansion in antiviral drug research. Other viral diseases have benefited from this increased interest, but with these successes problems of toxicity and viral resistance have also been encountered. Although there has been significant progress in the field, much still needs to be done to control and treat viral infections. There is a need to develop more effective vaccines and antiviral agents, to be alert in monitoring resistance and in devising strategies to overcome this problem, and to develop a better understanding of the epidemiology and pathogenesis of many viral infections. An international group of experts met at WHO to assess today's state of the art in this field and to offer recommendations for the future. (excerpt)
Current Opinion in Obstetrics and Gynecology. 2004 Feb; 16(1):27-29.The issue of whether there might be an increased risk of cervical cancer associated with the use of oral contraceptives has been debated for decades. Early studies found a modest association with long-term use. A literature review was performed over the past 3 years, to establish whether there is any new evidence linking cervical cancer with the use of oral contraceptives. A new analysis from eight studies conducted by the International Agency for Research on Cancer and a systematic review of cervical cancer and the use of hormonal contraceptives are two recent major epidemiological links strongly suggesting the increased risk of cervical cancer (up to twofold), but only for women who were both long-term users (5 years or more) and who had persistent human papilloma virus infections of the cervix. These findings seem biologically plausible, but weighing the various risks and benefits, the World Health Organization does not recommend any change in oral contraceptive use or practice. (author's)
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases, 1997. , 30 p. (WHO/EMC/ DIS/97.7)Ebola virus causes the acute viral syndrome known as Ebola haemorrhagic fever (EHF). Named after a river in northern Zaire (now Congo) where it was first discovered in 1976, Ebola is morphologically related to the Marburg virus recognized in 1967, but is antigenically distinct. EHF is a severe disease, with or without haemorrhagic symptoms, characterized by person-to-person transmission through close contact with patients, dead bodies or infected body fluids. The potential for explosive nosocomial infection in health care centres with poor hygiene standards constitutes its main threat to public health. The case fatality rate of EHF is over 50%; there are no individual preventive treatments or vaccines available although supportive care, particularly proper rehydration, significantly reduces the number of deaths. The epidemic potential of EHF can be prevented through proper management in health care centres, such as rapid investigation and strict follow-up of contacts, patient isolation and the rigorous use of universal precautions. (excerpt)
Atlanta, Georgia, United States Centers for Disease Control and Prevention [CDC], National Center for Infectious Diseases, Division of Viral and Rickettsial Diseases, Special Pathogens Branch, 1998 Dec. , 198 p.This manual describes a system for using VHF Isolation Precautions to reduce the risk of transmission of VHF in the health care setting. The VHF Isolation Precautions described in the manual make use of common low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Although the information and recommendations are intended for health facilities in rural areas in the developing world, they are appropriate for any health facility with limited resources. The information in this manual will help health facility staff to: 1. Understand what VHF Isolation Precautions are and how to use them to prevent secondary transmission of VHF in the health facility. 2. Know when to begin using VHF Isolation Precautions in the health care setting. 3. Apply VHF Isolation Precautions in a large-scale outbreak. (When a VHF occurs, initially as many as 10 cases may appear at the same time in the health facility.) 4. Make advance preparations for implementing VHF Isolation Precautions. 5. Identify practical, low-cost solutions when recommended supplies for VHF Isolation Precautions are not available or are in limited supply. 6. Stimulate creative thinking about implementing VHF Isolation Precautions in an emergency situation. 7. Know how to mobilize community resources and conduct community education. (excerpt)
Contraception. 2004 May; 69(5):347-351.A recent review article by Smith et al. in The Lancet purports to find a causal relationship between long-term use of oral contraceptives (OCs) and cervical cancer. While we endorse the search for such a relationship, we felt it important to critically examine Smith et al.’s review process and, as a result, we have questions about the validity of their conclusions. In our view, the findings of published articles as presented by Smith et al. do not confirm a causal connection between long-term use of OCs and cervical cancer. Our goal is not to conduct another formal review of the evidence, but to evaluate whether Smith et al. have met the burden of proof for establishing a causal relationship. Given the importance of OCs to women the world over, we urge reproductive health professionals to consider this issue carefully before accepting that a causal relationship exists. (author's)