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

INTRODUCT
ION
MAY 2015
Pan American Health Organisation (PAHO)
issued a Warning regarding 1st case of
Zika Infection
FEBRUARY 1st, 2016
World Health Organisation (WHO)

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

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

ZIKAs TIMELINE
TIME / YEAR

ZIKAs 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 Yapps 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.
st

TIME / YEAR

ZIKAs 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
Major outbreak at 4 places (Pacific Islands)
-French Polynesia
- Easter Island
- Cook Island
- New Caledonia
During this period reveal possible association
between Zikas infection and congenital malformation
/ severe neurological / autoimmune complication

2013 2014

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

ZIKAs 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

TIME / YEAR

ZIKAs 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 GuillainBarr syndrome. Of these
cases, all but 2 had a prior history of infection with
Zika, chikungunya or dengue.
30th October
2015

Brazil reports an unusual increase in the number of

cases of 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 (37.5C)
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 Zikas infected person will show symptom (80% didnt
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

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 tandatanda 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/jour
nal.pntd.0001477
KKM (February 4th, 2016). ZIKA ALERT DAN
ARAHAN PENTADBIRAN UNTUK PEMANTAUAN DAN
PENGURUSAN JANGKITAN VIRUS ZIKA. Ruj: KKM600-29/4/56Jld.2(89)

SEKIAN
&
TERIMA KASIH