Zika in 2016 Cynthia Goldstein, MPH, REHS Environmental Health Administrator - POLK Presentation to Code Enforcement August 10, 2016

What is Public Health? Public health is the science of protecting and improving the health of families and communities by promotion of healthy lifestyles disease and injury prevention detection and control of infectious diseases 2

Major Infectious Diseases over Time Infectious diseases that have impacted the world’s population over history Cholera Scurvy Plagues Poor sanitation and enteric diseases Smallpox Malaria Yellow Fever Tuberculosis Rabies HIV/AIDS 3

Modern Day threats Emerging Infectious Diseases H1N1 flu and other flu illnesses Ebola Zika Chronic Diseases – modern day perils impacted by our lifestyles Tobacco Healthy foods Physical Activity Conditions such as obesity, diabetes, hypertension, cancer, heart and lung disease 4

Local Public Health System 5

DOOR TO DOOR ZIKA OUTREACH Florida Department of Health (DOH) Polk County Health Department Summer D2D Zika Outreach

Objectives 9 After this training, you will be able to: Relay general information regarding Zika Describe your role in the local response to Zika. Talk to the public about mosquito bite prevention Effectively explain and demonstrate how to protect yourself from mosquito bites Identify and eliminate mosquito breeding grounds

General Information about Zika Virus 10 Flavivirus Originally identified in Africa and Southeast Asia First identified in Uganda’s Zika Forest in 1947 Transmission Mosquito – Aedes aegypti, possibly Aedes albopictus Transmission in the womb and at the time of birth Sexual - several cases documented Transfusion-acquired cases documented Lab exposures Detected in breast milk, saliva, and urine but no documented transmission Outbreaks since 2007

Sexual Transmission 11 Zika is still primarily a mosquito-borne disease What we know: There is evidence that the Zika virus can be sexually transmitted by a man to his sex partners The virus is present in semen longer than in blood What we do not know: We do not know how long the virus is present in semen in men who have had Zika We do not know if a woman can transmit Zika virus to her sex partners

Zika Fever Symptoms 12 Incubation period: 2-14 days 1 in 5 people infected will become symptomatic Few hospitalizations Fever (often low-grade) Rash Joint pain Red eyes Muscle ache Headache Pain behind the eyes Vomiting Most common signs and symptoms

Zika Fever (continued) 13 Presentation similar (but milder) to other illnesses like dengue and chikungunya Symptomatic treatment Avoid aspirin and similar drugs (Non- Steroidal Anti-Inflammatory Drugs) No vaccine but research underway Poor pregnancy outcomes Linked to Guillain-Barré Syndrome (GBS)

Zika Virus Link to Microcephaly 14

FAQ’s: Pregnant Women 15 Pregnant and nursing women can use EPA-approved mosquito repellent according to label instructions Sexual transmission precautions if a sexual partner is potentially exposed Information to collect for suspect Zika fever cases: Symptoms and onset date Travel history (throughout pregnancy) How far along in pregnancy? Refer to obstetrician for follow up Consider Zika virus testing

How to protect from mosquito bites 17

Mosquito Repellents 18 How often to reapply? What precautions should I follow when using repellents? Can repellent be used on children? Can pregnant or nursing women use insect repellent?

Applying mosquito repellent 21 Spray Pump Aerosol Liquids or creams Wipes Clothing with permethrin Netting

Identify and eliminate mosquito breeding grounds 22 Water Mosquito life cycle Places you will find enough water to breed mosquitos

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Mosquito Life Cycle from CDC.gov 24

Water is where mosquitos breed 25

Your role in the local response to Zika 26 Door to door (D2D) outreach Provide educational information about bite prevention Distribute insect repellent Assist with Drain and Cover activities.

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28 DRAIN standing water to stop mosquitoes from multiplying  Drain water from garbage cans, house gutters, buckets, pool covers, coolers, toys, flower pots or any other containers where sprinkler or rain water has collected.  Discard old tires, drums, bottles, cans, pots and pans, broken appliances and other items that aren't being used.  Empty and clean birdbaths and pet's water bowls at least once or twice a week.  Protect boats and vehicles from rain with tarps that don’t accumulate water.  Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use.

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What do they need to know? 31 What is in it for them? WIIFM Do a mental check when visiting Screens Open Doors Air conditioning Standing water Pregnant or woman of childbearing age? Customizing the message

Picture courtesy of IFAS 32

Available Resources 33 DOH Zika virus webpage: CDC Zika virus webpage: Handouts review Florida: Mosquito Bite Protection in Florida CDC: Zika: The Basics of the Virus and How to Protect Against It Zika: What Can be Done Protect your Pregnancy Keep mosquitos out of your septic tank

Summary Questions 34 Identify what you will and will not do during Door to Door (D2D) activities for Zika. Yes or No on each option. Provide educational information about bite prevention Provide medical care Distribute insect repellent Assist with Drain and Cover activities. How often should outdoor containers holding water be dumped and cleaned? Pick one. Daily Weekly Hourly Monthly

Summary Questions 35 List 2 ways to protect yourself from mosquito bites. Use mosquito repellent Cover with long sleeves and long pants Do mosquitos breed and multiply in air or water? Air Water Are these statements True or False? Zika is a bacteria. Zika is primarily spread by mosquito bites. Pregnant women can safety use mosquito repellent.

More Information 36 For more information on Zika virus, Florida residents and visitors can call State Zika Hotline at: Contact Nicole Riley, DOH-Polk Communications for specific fliers at ext Contact Jenn Brandow, Preparedness Planner/Polk / Hardee MRC at ext