RIO 2016 OLYMPICS 05 – 21 AUGUST 2016
Updated: 06 July 2016
RIO 2016 OLYMPICS 05 – 21 AUGUST 2016
Health advice for travellers to the Rio Olympic Games, 2016
Amidst concerns about Zika virus transmission, and risk to participants, the WHO convened a meeting of the Emergency Committee (EC) convened under the International Health Regulations (2005 on 14 June 2016. After review of available information provided by Brazil and advisors specializing in arboviruses, the international spread of infectious diseases, travel medicine, mass gatherings and bioethics, the Committee concluded that there is a very low risk of further international spread of Zika virus as a result of the Olympic and Paralympic Games. The WHO reported that the risk to participants and spectators is minimal, as the intensity of autochthonous transmission of arboviruses, such dengue and Zika viruses, will be minimal during the Brazilian winter (July). Further, Brazilian authorities are intensifying vector-control measures in and around the venues for the Games which should further reduce the risk of transmission.
However, travellers to Brazil should take appropriate advice as follows:
Before travelling to Brazil, travellers should engage with travel medicine providers at least 3-4 weeks prior to departure, in order to ensure adequate time for immunisations and preparation. Travellers to Brazil should be up to date with routine immunisations. In addition they should receive: 1) the influenza vaccine (the currently available formulation for the southern hemisphere is adequate); 2) the hepatitis A vaccine and 3) the yellow fever vaccine (if itinerary includes yellow fever endemic areas). Malaria prophylaxis may be required if the itinerary includes areas with known malaria risks (primarily the north-western areas of Brazil; Rio de Janeiro has no malaria risk). Travellers should ensure purchase of effective anti-mosquito preparations and protective clothing to avoid mosquito bites.
Whilst in Brazil, To avoid mosquito-borne illnesses, travellers should prevent mosquito bites through: 1) wearing of clothing that covers as much of the body as possible; 2) applying insect repellent containing DEET (diethyltoluamide) or IR 3535 or Icaridin to skin or clothing; 3) use mesh screens or netting materials on windows, or closing doors and windows while indoors and 4) sleep under mosquito nets especially during the day when Aedes mosquitoes are most active. Travellers should also practice safe sex or abstain from sex during their stay. To avoid food-and water-borne diseases, travellers should frequently wash hands before handling and consuming food, ensure that food has been thoroughly cooked, drink safe water, avoid uncooked food except for fruits and vegetables that can be peeled or shelled.
Upon return home, travellers should be observe themselves for symptoms of illness especially fever, and seek health care if they are concerned. To prevent onward transmission of Zika virus, and because 80% of persons with Zika infection are asymptomatic, the WHO advises that all returning travellers should practice safer sex, including through the correct and consistent use of condoms, or abstaining from sex, for at least 8 weeks. If men experienced symptoms of Zika (rash, fever, arthralgia, myalgia or conjunctivitis) then they should adopt safer sexual practices or consider abstaining for at least 6 months. Male partners who have travelled to a Zika-area, and who with their partners are planning a pregnancy, should avoid conception within 6 months after return if the male partner has been symptomatic for Zika, or within 8 weeks if asymptomatic.
The NICD offers the following test for ZVD: 1) RT-PCR testing (clotted blood/serum) and 2) virus culture (clotted blood/serum) which are useful during the transient viraemic stage of infection (1 – 5 days post onset); and 3) paired serological testing (clotted blood/serum taken up to 14 days apart). A haemagglutination inhibition test (HAI), ZIKV specific IgM ELISA and a viral neutralisation test are available. Serology is limited by cross-reactivity with other flaviviruses, including dengue and yellow fever, therefore paired serological testing is essential. Specimens submitted for Zika will also be tested for dengue and chikunguna because of overlapping clinical presentations. Serology for ZIKV may not provide conclusive results.
On request, the NICD will offer testing for Zika to returned travellers from a Zika-endemic area who present with rash, fever, headache or arthralgia within 14 days of return, and to asymptomatic pregnant women with a recent ravel history to an active Zika transmission area. Clinicians requesting testing should complete the Zika case investigation form (www.nicd.ac.za) and submit the specimen to the Arbovirus Reference laboratory, Centre for Emerging and Zoonotic Diseases, National Institute for Communicable Diseases for testing. Clinicians should call or email the laboratory to notify them of incoming specimens at 011 386 6391 / 011 386 6353 / 082 908 8045 or firstname.lastname@example.org; email@example.comSamples should be kept cold (on ice or cold packs) during transport. Testing will not be done after hours.
CDC travel advisory for yellow fever and malaria endemic areas in Brazil at http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country/brazil#seldyfm707.
Posted: 06 July 2016