In new Zika virus developments over the past few days, the World Health Organization (WHO) issued a response update showing a large funding gap, rejected a call to lobby for relocation or postponement of the Olympic games in Brazil, and expanded the recommended safe-sex or abstinence period for men who visit affected areas.
In another development, the US Centers for Disease Control and Prevention (CDC) today updated its guidance on Zika antibody testing to address difficulties in weeding out cross-reactions from related viruses.
Response funding falls far short
The WHO spelled out details of the funding gap in a May 27 interim report on the global response to the Zika virus outbreak since the February launch of its strategy framework, which has involved 23 health partners.
In its original plan, the WHO and its collaborators requested $56 million to fund the first 6 months of the response, with the total amount needed outstripping that amount. The WHO said it quickly released $3.8 million from an emergency contingency fund that was established in May 2015 as part of reforms in the wake of West Africa's Ebola outbreak. It added that plans include reimbursing the contingency fund.
With funding falling far short of the need, the WHO said requirements have been reprioritized into essential activities to ensure that the limited support is funneled to where it is needed most.
WHO headquarters has the largest funding gap, at $15.4 million, with additional shortfalls of $6.5 million and $3.2 million at its regional offices in the Americas and the Western Pacific, respectively. The next biggest funding gap is $12 million needed by the United Nations Children's Fund (UNICEF), which is working on mosquito control and risk communications.
Another group reporting a significant gap is the UN Population Fund (UNFPA), which has received only $250,000 of the $9.6 million it needs in its work to provide contraceptive security in affected areas, launch risk-communication campaigns, and recruit and organize a network of trained providers for counseling and services.
Earlier this month UN Secretary-General Ban Ki-moon set up a multipartner trust fund to pay for critical Zika response actions that haven't secured financial support. The WHO said it and its partners are working on a plan for the next phase of the response, which runs from July through the end of 2017.
WHO rejects group's Olympics request
Turning back pressure from a group of scientists, clinicians, bioethicists, and others who signed an open letter to WHO Secretary-General Margaret Chan, MD, MPH, to call for the Summer Olympic Games in Brazil to be postponed or moved due to public health concerns, the WHO on May 28 said any change to the plan or venue wouldn't significantly alter the spread of Zika virus.
In the open letter, the signers said the strain of virus affecting Brazil is more serious than originally thought and that Rio de Janeiro is one of the most affected parts of Brazil, which is struggling to battle the mosquito with a weakened health system. They noted that though the games will be held in Brazil's winter season when mosquito activity is generally low, many potentially infected travelers will be returning to weather conditions in which mosquito activity is high.
The group also questioned if the WHO is rejecting alternatives because of a conflict of interest, as it is a partner of the International Olympic Committee. So far, 188 people from 35 countries have signed the letter.
The WHO in its response said that Brazil is 1 of 60 countries to report ongoing Zika transmission and that travel and trade continues for a variety of reasons. It said the best way to protect against Zika virus is to follow public health advice, including that pregnant women shouldn't travel to areas reporting local transmission, including Brazil.
A focus of the WHO's advice to Rio's organizing committee and to Brazil's government is measures to reduce populations of Aedes mosquitoes that transmit Zika and other infections, the agency said in its statement.
Based on current assessments, "There is no public health justification for postponing or cancelling the games. WHO will continue to monitor the situation and update our advice as necessary, the WHO said.
The letter group yesterday posted a response to the WHO's statement on its Web site.
Sexual transmission guidance
In updated guidance yesterday, the WHO doubled the recommended amount of time a man should practice safe sex or abstain from sex after returning from an area of known Zika transmission, to 8 weeks. The new recommendation brings its advice in line with advice from the CDC.
The WHO adds that men who had Zika symptoms should practice safe sex or abstain for 6 months.
The agency said its expert staff based the change on new evidence from the medical literature. The longer time period reflects a maximum 14-day incubation period for flaviviruses, combined with triple the longest published period of viremia after symptom onset, plus extra time to account for variation in an individual's immune system.
The condom use recommendation for symptomatic men is conservative, based on limited data on duration of Zika virus in semen. The longest documented duration is 62 days, and the WHO and CDC precautions reflect a tripling of that time period.
CDC antibody testing guidance
The CDC today released interim guidance on Zika virus antibody testing and how to interpret results. Zika antibody tests can be hard to interpret because of cross-reactions caused by earlier infections or vaccination against other flaviviruses, such as dengue.
A conservative approach to interpreting antibody tests is needed to reduce missed diagnoses of both Zika and dengue infections to make sure patients get the right clinical care and in view of the risk of adverse pregnancy outcomes in women infected with Zika virus, the CDC said. It detailed the recommendations in an early release in Morbidity and Mortality Weekly Report (MMWR).
Today's new guidance reflects changes in IgM antibody testing and thresholds of plaque-reduction neutralization testing (PRNT). The CDC said IgM antibody tests should be preformed if real-time reverse transcription polymerase chain reaction (RT-PCR) test results are negative, no matter when the specimen was collected.
Regarding PRNT, the CDC said earlier flavivirus research and early information specific to Zika virus suggests that the fourfold higher titer cutoff might not discriminate between Zika antibodies and cross-reacting antibodies in those infected by or vaccinated against another flavivirus. The updated guidance says a PRNT titer greater than 10 should be interpreted as evidence of infection with a specific flavivirus when the PRNT to the other flavivirus or viruses tested is less than 10.
See also:
May 27 WHO Zika Virus outbreak global response interim report
May 28 WHO statement on Rio games
May 30 WHO updated sexual transmission prevention guidance
May 31 CDC early release MMWR report
