Health Advice from Ministry of Health for Travelling to Zika-affected Countries

Last updated 31 Aug 2016

1. 1. The World Health Organisation (WHO) has not issued any specific trade and travel restrictions with respect to travelling to countries affected by Zika virus disease. People continue to travel between the affected countries and territories for a variety of reasons. The best way to reduce risk of disease is to follow public health travel advice.
2. 2. Based on ongoing risk assessment, Brunei residents travelling to countries affected by Zika are advised to take the following precautions with respect to the disease:

• Appropriate measures should be taken to reduce the risk of becoming infected, including by preventing mosquito bites.
• Travellers can protect themselves from mosquito bites by wearing long-sleeved shirts and trousers, applying insect-repellent, and sleeping under mosquito nets or in rooms with wire-mesh screen to keep out mosquitoes.
• Zika virus can also be sexually transmitted. Therefore, travellers to practice safe sex or abstain from sex during their stay in areas with ongoing Zika virus transmission, and for at least eight weeks after their return. If men experience symptoms of Zika virus disease, they should adopt safer sex practices or abstain from sex for at least six months
• Travellers returning from areas with ongoing Zika virus transmission, should not donate blood for at least four weeks after departure from the area.
• Pregnant women are advised to avoid unnecessary travel to areas of ongoing Zika virus outbreaks. If travel is deemed necessary, they should speak to their clinician to consider the risk to themselves and the unborn child.
• Women who inadvertently become pregnant or discover they are pregnant in or shortly after returning from areas with ongoing Zika virus transmission should contact their health care providers or visit their nearest health centre immediately upon return.
• Travellers are advised to be aware of the symptoms of Zika Virus infection which are mild fever, conjunctivitis, skin rash and muscle aches. If any travellers develop any symptoms of Zika Virus infection, they are advised to seek medical attention immediately.
• Travellers who have recently returned from Zika-affected countries are advised to monitor their own health and to look out for any symptoms of Zika for at least 14 days. They should seek medical attention if they develop any of the symptoms listed above.

1. 3. With respect to vaccination:

• There is no specific vaccine against Zika virus disease
• Travellers are advised to be up to date with their routine immunisations. This includes their yearly influenza vaccine.
• Additional vaccination against Hepatitis A, typhoid and yellow fever is also advised.
• Travellers are advised to be vaccinated at least 4 weeks before their date of travel
• Vaccinations can be obtained from the Vaccination Centre, Bandar Seri Begawan Health Centre in Ong Sum Ping or the District Health offices during office hours.

Last updated 31 Aug 2016

1. What is Zika?

Zika virus disease is caused by the Zika virus (first identified in 1947), which is spread to people primarily through the bite of an infected mosquito (Aedes aegypti and Aedes albopictus). The infected person may usually show mild symptoms lasting up to a week, and many people (up to 80% of infected individuals) do not have symptoms. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly and other severe brain defects.

2. How do people get infected with Zika?

Zika virus is primarily transmitted to people through the bite of an infected Aedes mosquito, which also transmits chikungunya, dengue and yellow fever. A pregnant woman infected with zika can pass the virus to her fetus during pregnancy or around the time of birth. Also, an infected person can pass the virus to his or her partners through sexual contact.

3. What are the symptoms of zika virus disease?

Zika virus usually causes mild illness. Symptoms most commonly include a mild fever or rash, appearing a few days after a person is bitten by an infected mosquito. Although many will not develop any symptoms at all, others may also suffer from conjunctivitis (red eye), muscle and joint pain, headache and feel tired. The symptoms usually last from 2 to 7 days. There is no known difference in the symptoms of infected pregnant and non-pregnant women.

4. What serious health problems can result from getting Zika?

Many people infected with Zika will have no symptoms or mild symptoms that last several days to a week. However, Zika infection during pregnancy can cause a serious birth defect called microcephaly and other severe fetal brain defects. Current research suggests that Guillain-Barre syndrome (GBS), an uncommon sickness of the nervous system, is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS.

5. How can people prevent Zika?

The best way to prevent Zika is to protect yourself and your family from mosquito bites as it is primary mode of transmission. Women who are pregnant or planning to become pregnant and their sexual partners should take extra care to protect themselves from the bite of mosquitoes that transmit Zika.

• Wear long-sleeved shirts and long pants
• Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
• Use registered repellents according to label instruction.
• Environmental cleanliness is important by taking preventive measures against mosquito breeding sites such as identifying and eliminating potential mosquito breeding sites, by emptying, cleaning or covering containers that can hold even small amounts of water, such as plastic containers, buckets, flower pots and tyres.
• Construction sites are known hotspots for mosquito breeding therefore extra care should be taken by construction workers and construction sites.

6.   How is Zika diagnosed?

It is recommended to consult with your doctor to diagnose Zika if you are symptomatic and having recent travel to one of the affected countries. Your doctor will ask you about recent travel and symptoms you may have, and collect blood or urine to test for Zika or similar viruses, if appropriate.

7.   How can Zika virus disease be treated?

Currently, there is no specific treatment or vaccine for Zika virus. The symptoms of Zika virus disease can be treated with supportive treatment such as common pain and fever medicines, rest and plenty of water. If symptoms worsen, people should seek medical advice.

8.   What should I do if I am travelling to Zika-affected area?

Travelers should stay informed about updated list of countries affected by Zika virus, and consult their local health or travel authorities if they are concerned.

During your trip, follow personal protective measures to prevent mosquito bites such as wearing long covered clothing, applying insect-repellent, and sleeping under mosquito nets or in rooms with air conditioning or screens. They should seek medical attention promptly if they become unwell.

Even if you do not feel sick, you should also protect yourself from mosquito bites till 3 weeks after returning from the trip in order to prevent infecting mosquitoes that could spread the virus to other people.

If you feel sick after your return from your trip, please consult with your doctor or health centre to find out if you need to be tested for the Zika virus.

You should adopt safer sexual practices, e.g. consistent and correct use of condoms during sex, or consider abstinence for at least eight weeks after your return. However, if you are a male partner of a pregnant woman you should practice safer sex practices throughout her pregnancy.

Pregnant women are advised to speak to their doctor prior to travel to areas of ongoing Zika virus transmission; pregnant women whose sexual partners live in or travel to areas with Zika virus transmission should ensure safer sexual practices or abstain from sex for 6 months after his return from an affected country.

9.   Which countries are currently affected?

As of 25 August 2016, 70 countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2007. 53 of these countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2015. Brazil has reported the largest number of cases, estimated at over 1 million infections in 2015.

Sporadic cases of local Zika virus infection have been detected in several countries in Southeast Asia, including Cambodia, Indonesia, Philippines, Malaysia, Vietnam, Lao People’s Democratic Republic and Thailand previously.

As of 31 August 2016, Singapore reported 86 locally transmitted cases of Zika virus.

Please check the WHO website (http://www.who.int/emergencies/zika-virus/situation-report/18-august-2016/en/ for the updated list of affected areas.

10.What should pregnant women who have to travel or have recently traveled to an area with Zika do?

If travel to an area with Zika during pregnancy is essential, it is important to prevent mosquito bites, and follow recommended precautions against getting Zika through sex.

If they must travel to affected areas, they should seek advice from their doctor and undertake strict precautions against mosquito bites. If they are unwell, they should seek medical attention immediately. They should consult their doctor after return to Brunei for advice.

Pregnant women who have recently traveled to an area with Zika should talk to their doctor about their travel, even if they do not feel sick. Pregnant women should see a doctor if they have any Zika symptoms during their trip or within 2 weeks after traveling.

11.Can mothers with Zika infection breastfeed their baby?

Zika virus has been detected in breast milk but there is currently no evidence that the virus is transmitted to babies through breastfeeding.

WHO recommends exclusive breastfeeding for the first 6 months of life.

12.How is the Ministry of Health preparing for the possible occurrence of Zika in Brunei?

The Ministry of Health continues to strengthen our capacity to prevent, detect and control Zika virus infections in Brunei Darussalam.

Prevention of Zika Virus infection

• The Vector Control Unit conducts routine surveillance, environmental inspection and environmental management at known mosquito hotspots; controlling, eradicating mosquito breeding sites through the Integrated Vector Management process complementary to environmental sanitation by members of the public.
• Risk communication & community engagement such as available public information on MOH website (www.moh.gov.bn), MOH Facebook and other social media sites, Talian Darussalam 123; and have issued press statements and press conferences highlighting the key role of community engagement.

Detection of Zika Virus infection

• All clinicians are reminded to assess suspected patients with travel history within the last 12 days to to the affected countries according to case definitions.
• Laboratory testing algorithm for Zika virus infection was developed to confirm the diagnosis.

Control of Zika Virus infection

• Readiness for public health management of Zika virus infection such as epidemiology investigation; surveillance and contact tracing of travel companions and household contacts; and outbreak control standard procedures if there is importation of the disease in the country.
• Since the infection can be acquired through mosquitos which are naturally present in the community, the Ministry urges the public to practice cleanliness of environment; elimination of mosquito breeding grounds and personal protection measures to prevent mosquito bites.