【寨卡】新進展：世衛(wèi)組織召開第二次突發(fā)事件委員會議

中醫(yī)世家 2023-08-15 06:14:12

世界衛(wèi)生組織總干事根據(jù)《國際衛(wèi)生條例（2005）》召集突發(fā)事件委員會

，于歐洲中部時間2016年3月8日13:00-16:45

，以電話會議的形式召開了關(guān)于受寨卡病毒影響的部分地區(qū)出現(xiàn)小頭癥和其它神經(jīng)疾患聚集性病例問題的第二次會議

。

世衛(wèi)組織秘書處向委員會介紹了關(guān)于總干事于2016年2月1日提出的各項臨時建議的實施行動情況

，并介紹了與寨卡病毒傳播具有時間關(guān)聯(lián)的小頭癥和吉蘭 ╟ 巴雷綜合征聚集性病例

。委員會還收到關(guān)于寨卡病毒感染

、小頭癥和吉蘭 ╟ 巴雷綜合征之間可能因果關(guān)系的觀察

、比較和實驗研究的補充數(shù)據(jù)

。

下列締約國提供了在寨卡病毒傳播情況下發(fā)生的小頭癥

、吉蘭 ╟ 巴雷綜合征和其它神經(jīng)疾患信息：巴西

、佛得角、哥倫比亞

、法國和美國

。

委員會注意到締約國以及學術(shù)機構(gòu)提供的在有寨卡病毒感染情況下發(fā)生的先天性畸形和神經(jīng)疾患的病例報告、病例系列、一項吉蘭 ╟ 巴雷綜合征病例對照研究和一項小頭癥隊列研究等新信息

。這些新信息顯示需要進一步開展工作

，以收集更多的關(guān)聯(lián)證據(jù)，并解釋國家數(shù)據(jù)之間的任何出入

。委員會建議

，小頭癥和其它神經(jīng)疾患聚集性病例仍構(gòu)成國際關(guān)注的突發(fā)公共衛(wèi)生事件，并稱有越來越多的證據(jù)顯示它們與寨卡病毒存在因果關(guān)系

。

委員會根據(jù)《國際衛(wèi)生條例（2005）》向總干事提出了下列意見供其考慮

，以應對該國際關(guān)注的突發(fā)公共衛(wèi)生事件。

小頭癥

、其它神經(jīng)疾患和寨卡病毒

應加緊研究小頭癥

、其它神經(jīng)疾患（包括吉蘭 ╟ 巴雷綜合征）以及寨卡病毒新聚集病例之間的關(guān)系。

應特別重視進一步收集關(guān)于寨卡各病毒株的基因序列和臨床結(jié)果數(shù)據(jù)

，研究小頭癥的神經(jīng)病理學

，在新近受到感染的其它環(huán)境中開展更多的病例對照研究和隊列研究，并開發(fā)動物實驗研究模型

。

應加速研究寨卡病毒感染的自然史

，包括無癥狀感染的發(fā)生率，無癥狀感染的影響

，特別是對妊娠的影響

，以及病毒排出的持續(xù)時間。

應在已知發(fā)生寨卡病毒傳播

、但未觀察到聚集病例的其它地區(qū)針對小頭癥及其它神經(jīng)系統(tǒng)疾患發(fā)生率開展回顧性和前瞻性研究

。

應在研究工作中繼續(xù)探討觀察到的小頭癥和其它神經(jīng)系統(tǒng)疾患聚集性病例的其它致病因素或輔助因子的可能性。

為便于開展此項研究并確保最快速獲得研究結(jié)果：

應加強對小頭癥和吉蘭 ╟ 巴雷綜合征的標準化監(jiān)測

，特別在已知寨卡病毒傳播的地區(qū)和有傳播風險的地區(qū)

。

應著手制定“先天性寨卡感染”可能病例的定義。

與小頭癥和/或吉蘭 ╟ 巴雷綜合征的發(fā)生率上升以及寨卡病毒傳播相關(guān)的臨床

、病毒學及流行病學數(shù)據(jù)

，應迅速與世衛(wèi)組織分享，推動國際社會對這些事件的了解

，指導國際社會對防控工作的支持

，并優(yōu)先開展進一步的研究和產(chǎn)品研發(fā)。

監(jiān)測

應加強寨卡病毒感染的監(jiān)測和通報

，向傳播地區(qū)和有風險地區(qū)介紹標準病例定義和診斷方法

；新受到寨卡病毒感染的地區(qū)應采取下列病媒控制措施。

病媒控制

應增強病媒監(jiān)測

，包括查明蚊媒種屬及其對殺蟲劑的敏感性

，并應加強風險評估和病媒控制措施。

應積極推廣和實施病媒控制和適當?shù)膫€人防護措施，減少接觸寨卡病毒的風險

。

長期而言

，各國應加強病媒控制措施，世衛(wèi)組織總干事應探索采用《國際衛(wèi)生條例》機制的可能性

，并考慮將此問題提交即將召開的下一屆世界衛(wèi)生大會，以便更好地與各國就此問題進行交流

。

風險溝通

應在有寨卡病毒傳播的國家加強風險溝通

，處理群眾關(guān)切的問題，加強社區(qū)參與

，改進報告制度

，確保病媒控制和個人防護措施。

應在適當評估公眾認識

、知識和信息的基礎上采取這些措施

；應嚴格評估風險溝通措施的影響，以指導調(diào)整這些措施和增強其影響

。

應注意確保育齡婦女

，特別是孕婦掌握必要的信息和材料，以減少接觸寨卡病毒的風險

。

應向生活在據(jù)報發(fā)生寨卡病毒傳播的地區(qū)或從這些地區(qū)返回的人提供關(guān)于性傳播風險的信息并提供能夠減少此風險的措施

。

臨床照護

應根據(jù)現(xiàn)有的最佳信息及國家實踐和政策，對已接觸到寨卡病毒的孕婦進行輔導

，并隨訪分娩結(jié)果

。

在已知寨卡病毒傳播的地區(qū)，衛(wèi)生服務部門應為可能增加的神經(jīng)系統(tǒng)綜合征和/或先天性畸形做好準備

。

旅行措施

不應對存在寨卡病毒傳播疫情的國家

、地區(qū)和/或領(lǐng)土實行全面的旅行或貿(mào)易限制。

應建議孕婦不要前往目前存在寨卡病毒疫情的地區(qū)旅行

；若孕婦的性伴侶生活在有寨卡病毒疫情地區(qū)或從這些地區(qū)返回

，該孕婦應在其妊娠期確保采用安全性行為或禁絕性生活。

應向前往寨卡病毒疫區(qū)旅行者提供最新建議

，向其說明潛在風險和采取適當措施降低蚊子叮咬的可能性

。旅行者返回后應采取適當措施，包括采用安全性行為

，以降低進一步傳播的風險

。

隨著進一步了解與寨卡病毒感染相關(guān)風險的性質(zhì)和持續(xù)時間，世界衛(wèi)生組織應定期更新其旅行建議

。

應根據(jù)《國際衛(wèi)生條例（2005）》實施世衛(wèi)組織關(guān)于機場病媒控制的標準建議

。國家應考慮對飛機采取滅蟲措施。

研究與產(chǎn)品開發(fā)

應重點針對寨卡病毒感染開發(fā)新診斷工具，以協(xié)助采取監(jiān)測和控制措施

，尤其是妊娠管理

。

應特別緊急研究、制定和評估新穎的病媒控制措施

。

還應加緊開展研發(fā)工作

，爭取在中期推出寨卡病毒疫苗和治療方法。

基于此建議

，總干事宣布這仍構(gòu)成國際關(guān)注的突發(fā)公共衛(wèi)生事件

。總干事支持委員會的建議并作為《國際衛(wèi)生條例（2005）》下的臨時建議予以頒布

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？偢墒赂兄x委員會委員和顧問所提的建議。

who statement on the 2nd meeting of ihr emergency committee on zika virus and observed increase in neurological disorders and neonatal malformations

the second meeting of the emergency committee (ec) convened by the who 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 8 march 2016, from 13:00 to 16:45 central european time.

the who secretariat briefed the committee on action in implementing the temporary recommendations issued by the director-general on 1 february 2016, and on clusters of microcephaly and guillain-barr&e syndrome (gbs) that have had a temporal association with zika virus transmission. the committee was provided with additional data from observational, comparative and experimental studies on the possible causal association between zika virus infection, microcephaly and gbs.

the following states parties provided information on microcephaly, gbs and other neurological disorders occurring in the presence of zika virus transmission: brazil, cabo verde, colombia, france, and the united states of america.

the committee noted the new information from states parties and academic institutions in terms of case reports, case series, 1 case control study (gbs) and 1 cohort study (microcephaly) on congenital abnormalities and neurologic disease in the presence of zika virus infection. it reinforced the need for further work to generate additional evidence on this association and to understand any inconsistencies in data from countries. the committee advised that the clusters of microcephaly cases and other neurological disorders continue to constitute a public health emergency of international concern (pheic), and that there is increasing evidence that there is a causal relationship with zika virus.

the committee provided the following advice to the director-general for her consideration to address the pheic, in accordance with ihr (2005).

microcephaly, other neurological disorders and zika virus

research into the relationship between new clusters of microcephaly, other neurological disorders, including gbs, and zika virus, should be intensified.

particular attention should be given to generating additional data on the genetic sequences and clinical effect of different zika virus strains, studying the neuropathology of microcephaly, conducting additional case-control and cohort studies in other and more recently infected settings, and developing animal models for experimental studies.

research on the natural history of zika virus infection should be expedited, including on the rates of asymptomatic infection, the implications of asymptomatic infection, particularly with respect to pregnancy, and the persistence of virus excretion.

retrospective and prospective studies of the rates of microcephaly and other neurological disorders should be conducted in other areas known to have had zika virus transmission but where such clusters were not observed.

research should continue to explore the possibility of other causative factors or co-factors for the observed clusters of microcephaly and other neurological disorders.

to facilitate this research and ensure the most rapid results:

surveillance for microcephaly and gbs should be standardized and enhanced, particularly in areas of known zika virus transmission and areas at risk,

work should begin on the development of a potential case definition for ‘congenital zika infection’,

clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or gbs, and zika virus transmission, should be rapidly shared with the world health organization to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

surveillance

surveillance for and notification of zika virus infection should be enhanced with the dissemination of standard case definitions and diagnostics to areas of transmission and at-risk areas; newly infected areas should undertake the vector control measures outlined below.

vector control

vector surveillance, including the determination of mosquito vector species and their sensitivity to insecticides, should be enhanced to strengthen risk assessments and vector control measures.

vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to zika virus.

countries should strengthen vector control measures in the long term and the director-general of who should explore the use of ihr mechanisms, and consider bringing this to a forthcoming world health assembly, as means to better engage countries on this issue.

risk communication

risk communication 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.

these measures should be based on an appropriate assessment of public perception, knowledge and information; the impact of risk communication measures should be rigorously evaluated to guide their adaptation and improve their impact.

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.

information on the risk of sexual transmission, and measures to reduce that risk, should be available to people living in and returning from areas of reported zika virus transmission.

clinical care

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,

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 general restrictions on travel or trade with countries, areas and/or territories with zika virus transmission.

pregnant women should be advised not travel to areas of ongoing zika virus outbreaks; pregnant women whose sexual partners live in or travel to areas with zika virus outbreaks should ensure safe sexual practices or abstain from sex for the duration of their pregnancy.

travellers to areas with zika virus outbreaks should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites and, upon return, should take appropriate measures, including safe sex, to reduce the risk of onward transmission.

the world health organization should regularly update its guidance on travel with evolving information on the nature and duration of risks associated with zika virus infection.

standard who recommendations regarding vector control at airports should be implemented in keeping with the ihr (2005). countries should consider the disinsection of aircraft.

research & product development

the development of new diagnostics for zika virus infection should be prioritized to facilitate surveillance and control measures, and especially the management of pregnancy.

research, development and evaluation of novel vector control measures should be pursued with particular urgency.

research and development efforts should also be intensified for zika virus vaccines and therapeutics in the medium term.

based on this advice the director-general declared the continuation of the public health emergency of international concern (pheic). 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.