Zika Virus Identifying an Emerging Threat Florida Department of Health in Miami-Dade County Epidemiology, Disease Control, & Immunization Services

What is Zika Virus? Zika virus is a vector-borne disease that is transmitted to humans through the bites of infected Aedes (aegypti) mosquitoes Same virus family as dengue and chikungunya (flavivirus) Zika virus infections have also been documented through intrauterine, intrapartum, sexual, and blood transmission

Where in the World is Zika? Prior to 2015, Zika virus outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands In May 2015, WHO reported the first local transmission of Zika virus in the Western Hemisphere – indigenous cases in Brazil As of late 2016, multiple countries and territories worldwide have reported active Zika transmission. Most of those countries are in the Americas, and now include the US (Miami-Dade County)

What about Florida and Miami-Dade? On Friday, July 29, the Florida Department of Health confirmed Florida’s first local transmission of the Zika virus in four individuals in Miami-Dade and Broward Counties. Three locations of interest were investigated based on where these individuals spent a majority of their time. As of November 7th, 2016: Infection Type Infection Count Travel-Related Infections of Zika 780 Non-Travel Related Infections of Zika 191 Infections Involving Pregnant Women 135 Out of State Cases (not Florida Residents) 20 Undetermined 7 Total 1,133 These counts are updated based on daily count reports from state (from Olga’s office)

Where are the vectors in Florida?

Clinical Pathology (How does Zika virus affect humans?) 1 in 5 people infected will become symptomatic Few hospitalizations Most common signs and symptoms Fever (often low-grade) Muscle ache Rash Headache Joint pain Pain behind the eyes Red eyes Vomiting There is currently no vaccine to prevent Zika or treatment to cure it Those who do become symptomatic can only manage symptoms Persons infected with Zika, dengue, or chikungunya virus should protect themselves from further mosquito exposure during and after illness

Behind the Concern: Microcephaly Microcephaly is a condition in which a baby’s head and brain are underdeveloped In 2014, Brazil reported 147 cases of microcephaly. In 2015, after the introduction of Zika, the country reported over 4,000 cases. Recent research by CDC has officially linked Zika virus to microcephaly. The research concludes that the newborns of mothers who had a Zika virus infection while pregnant might be at an increased risk of microcephaly and miscarriages, although it does not mean that every woman who has Zika while pregnant will have a child with microcephaly

Behind the Concern: Pregnant Women We protect unborn babies from microcephaly by protecting their mothers from mosquito bites and Zika infection Mosquito bite prevention is the most important measure that we and pregnant women can take Pregnant women (in any trimester) should consider cancelling travel plans to areas where Zika virus transmission is currently happening Women who are trying to become pregnant should consult their health care provider before travelling to these areas The first and most important thing that a pregnant woman can do if she thinks she is infected with Zika virus is to talk with her health care provider

Behind the Concern: Guillain-Barré syndrome Guillain-Barré syndrome (GBS) is an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes, paralysis GBS symptoms include: Tingling sensation in the extremities Sensation spreads throughout the body Can sometimes cause paralysis

What is being done?

State/Local Response Targeting health care providers Hospitals American Congress of Obstetricians and Gynecologists Midwives/nurses Working with internal partners Birth Defects Registry Maternal and Child Health Syndromic surveillance (ESSENCE) Guillain-Barrè Syndrome Microcephaly Zika

State/Local Response The health department has been sampling close contacts and community members within a 150 meter radius, the maximum distance that Aedes aegypti mosquitoes are known to travel, of confirmed local cases These community surveys are the first systematic assessment of individuals for possible asymptomatic Zika virus infection ever performed. Educational events and presentations have been held in various locations and with varying external partners throughout the county, including Zoo Miami, FIU, the International Water Expo., and the Department of Parks and Recreation

State/Local Response Testing: all pregnant women in Miami-Dade County and other Florida Counties (These tests are being performed free of charge in a special Zika clinic at the Health Department) All non-pregnant individuals must still meet testing criteria to be tested for Zika virus, or must be tested through a commercial lab (Quest Diagnostics) A Zika Hotline was opened to take all community calls related to testing, symptoms, pregnancy, and questions about the local response

Mosquito Control Mosquito Control has been spraying in the affected areas in Miami-Dade County DOH notifies Mosquito Control upon suspicion of mosquito-borne illness Appropriate mosquito control measures are implemented Drain and cover Investigation of potential breeding habitats Spraying (larvicide and adulticide) Mosquito sampling methods Successful partnership demonstrated previously: Chikungunya in 2014 510 imported cases identified 12 sporadic local cases Coordinated DOH – Local Mosquito Control activities No sustained local transmission

What can YOU do to help prevent the transmission of Zika virus?

Zika Virus Prevention Sexual transmission Blood transmission Mosquito-to-Human Transmission It is important to remember that Zika virus is primarily a vector-borne disease

Sexual Transmission Prevention CURRENT CDC guidelines for WOMEN: Wait at least 8 weeks after potential exposure to Zika, or after your symptoms first appeared before trying to get pregnant CURRENT CDC guidelines for MEN: Wait at least 6 months after potential exposure to Zika, or after your symptoms first appeared to have unprotected sex, or to try and conceive with your female sex partner **If a male has potential exposure to Zika or has had Zika and his female sex partner is pregnant, it is best to either abstain from sex or to use condoms throughout the duration of the pregnancy. Zika is still primarily a vector-borne disease In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.

Blood Transmission Prevention To date, there have been no confirmed blood transfusion-transmission cases in the United States Zika virus currently poses a low risk to the blood supply in the continental US, but this could change depending on how many people become infected with the virus The FDA has released recommendations to help prevent blood transfusion transmission of Zika, which includes specific steps for blood collection organizations These steps include testing all donated blood for Zika virus In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.

Mosquito-to-Human Transmission Prevention: DRAIN & COVER DRAIN water from any containers where water has collected. COVER: 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 that contain EPA-registered active ingredients are considered most effective. In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.

Can I get tested for Zika? To get tested for Zika, you must meet one of the following criteria*: Pregnant Mother of an infant or fetus with microcephaly (Testing of both mother and infant is recommended) Travel to a Zika-affected area + 2 or more symptoms A suspect locally-acquired case

Any Questions? Great resource for updated information about Zika virus: http://www.floridahealth.gov/diseases-and-conditions/zika-virus/ http://www.cdc.gov/zika/ Florida Department of Health in Miami-Dade County Epidemiology, Disease Control, & Immunization Services 305-324-2400