WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

WHO statement

1 February 2016

The first meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurological disorders in some areas affected by Zika virus was held by teleconference on 1 February 2016, from 13:10 to 16:55 Central European Time.

The WHO Secretariat briefed the Committee on the clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have been temporally associated with Zika virus transmission in some settings. The Committee was provided with additional data on the current understanding of the history of Zika virus, its spread, clinical presentation and epidemiology.

The following States Parties provided information on a potential association between microcephaly and other neurological disorders with Zika virus: Brazil, France, United States of America, and El Salvador.

The Committee advised 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).
The Committee provided the following advice to the Director-General for her consideration to address the PHEIC (clusters of microcephaly and other neurological disorders) and their possible association with Zika virus, in accordance with IHR (2005).

Microcephaly and other neurological disorders

• Surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk of such transmission.
• Research into the etiology of new clusters of microcephaly and other neurological disorders should be intensified to determine whether there is a causative link to Zika virus and/or other factors or co-factors.

As these clusters have occurred in areas newly infected with Zika virus, and in keeping with good public health practice and the absence of another explanation for these clusters, the Committee highlights the importance of aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of childbearing age.

As a precautionary measure, the Committee made the following additional recommendations:

Zika virus transmission

• Surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas.
• The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures.
• Risk communications should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures.
• Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus.
• Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.
• Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies.

Longer-term measures

• Appropriate research and development efforts should be intensified for Zika virus vaccines, therapeutics and diagnostics.
• In areas of known Zika virus transmission health services should be prepared for potential increases in neurological syndromes and/or congenital malformations.

Travel measures

• There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission.
• Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.
• Standard WHO recommendations regarding disinsection of aircraft and airports should be implemented.

Data sharing

• National authorities should ensure the rapid and timely reporting and sharing of information of public health importance relevant to this PHEIC.
• Clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with WHO to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Based on this advice the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV

In 2013, WHO published the first consolidated guidelines on the use of antiretroviral (ARV)
drugs for HIV treatment and prevention across all age groups and populations. A comprehensive
revision of these guidelines based on new scientific evidence and lessons from implementation is
being undertaken in 2015.
This early-release guideline makes available two key recommendations that were developed
during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in
everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure
prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV
infection as part of combination prevention approaches. The first of these recommendations is
based on evidence from clinical trials and observational studies released since 2013 showing that
earlier use of ART results in better clinical outcomes for people living with HIV compared with
delayed treatment. The second recommendation is based on clinical trial results confirming the
efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide
variety of settings and populations.
The two recommendations are being made available on an early-release basis because of
their potential to significantly reduce the number of people acquiring HIV infection and dying
from HIV-related causes and significantly impact global public health. By publishing these
recommendations as soon as possible, WHO aims to help countries to anticipate their implications
in a timely fashion and begin the dialogue necessary to ensure that national standards of HIV
prevention and treatment are keeping pace with important scientific developments.
The target audience for this guideline is primarily national HIV programme managers, who will be
responsible for adapting the new recommendations at country level. The guideline will also be of
interest to a wide range of other stakeholders, including national TB programme managers and
civil society organizations, as well as domestic and international funders of HIV programmes.
The recommendations in this guideline will form part of the revised consolidated guidelines on
the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016.
The full update of the guidelines will consist of comprehensive clinical recommendations together
with revised operational and service delivery guidance to support implementation.
A Clinical Guideline Development Group convened by WHO developed the recommendations in
this guideline based on systematic reviews that summarized the evidence available up to June
2015. The GRADE approach was used to determine the quality of the evidence and the strength
of the recommendation.
The ambitious UNAIDS Fast-Track targets for 2020, including achieving major reductions in
HIV-related mortality and new HIV infections and the 90–90–90 targets, will require countries
to further accelerate their HIV responses in the coming years. Much greater effort is also needed
to ensure that key and vulnerable populations and adolescents gain access to essential HIV
treatment and prevention services. Implementation of the recommendations in this guideline will
contribute to achieving these goals and to ultimately ending the AIDS epidemic as a major public
health threat by 2030.
Authors:WHO
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THESE GUIDELINES ARE WHO RECOMMENDATIONS AND  YET TO BE ADOPTED IN TANZANIA