Anthony Shaya MD, MPH, FACOG

2 Flavivirus: Originally identified in Africa and Southeast Asia First identified in Uganda’s Zika Forest in 1947 Primarily transmitted by Aedes aegypti mosquitos Outbreaks since 2007

3 Primarily transmitted through bites of an infected mosquito (Aedes aegypti, possibly Aedes albopictus) Less commonly… Transmission in the womb and at the time of birth Sexual Transfusion cases (2 recently documented) Lab exposures Detected in breast milk, saliva, and urine but no documented transmission

Courtesy of FDACS 4

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 Female mosquitoes bite  Lay eggs  Adults life cycle about 11 days  Can be passed to larvae

9  Incubation period: 2-14 days  1 in 5 people infected will become symptomatic  Presentation similar (but milder) to other illnesses like dengue and chikungunya Fever (often low- grade) Maculopapular rash Arthralgia Conjunctivitis Myalgia Headache Retro-orbital pain Vomiting Most common signs and symptoms

10 Symptomatic treatment Typically resolves within a week Coinfections with other flaviviruses possible and should be considered Avoid aspirin and similar drugs (NSAIDs) Pregnant women may receive acetaminophen Possible link to Guillain-Barré Syndrome (GBS) and poor pregnancy outcomes No vaccine but research underway

11 US States Locally acquired mosquito-borne cases reported: 29 Travel-associated cases reported: 2,487 Laboratory acquired cases reported: 1 Total: 2,517 Sexually transmitted: 22 Guillain-Barré syndrome: 7 US Territories Locally acquired cases reported: 8,968 Travel-associated cases reported: 43 Total: 9,011 Guillain-Barré syndrome: updated 8/24/20106

As of August 30, Infection TypeInfection Count Travel-Related Infections of Zika 545 Non-Travel Related Infections of Zika 43 (41 Miami & 2 PB) Infections Involving Pregnant Women 75

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14 Commercial testing now available Sample submitted to DOH for testing must be approved by CHD For persons who meet the criteria presented testing is available at Bureau of Public Health Laboratories (Tampa and Jacksonville) Polymerase Chain Reaction (detects Zika virus) Serum, urine and saliva sample collected within 21 days of illness onset Serology (detects antibodies against Zika virus) Serum sample collected ≥ 4 days of illness onset IgM testing available at BPHL Cross-reactivity with related flaviviruses Convalescent specimen may be needed Additional tests may be requested at CDC.

15 DRAIN water from any containers where water has collected. CLOTHING: If you must be outside when mosquitoes are active, cover up. Wear shoes, socks, long pants, and long sleeves. REPELLENT: Apply mosquito repellent to bare skin and clothing. Always use repellents according to the label. Repellents with DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, and IR3535 are effective. Use netting to protect children younger than 2 months. See: Mosquito Bite Protection in Florida

 Spreads like wildfire  Sputters along  Vaccine  Mosquitoe Eradication