Council of State and Territorial Epidemiologists Zika Virus in Florida Anna M. Likos, MD, MPH Council of State and Territorial Epidemiologists September 26, 2016

Overview of Events Early July 2016 Adult female resident of Miami-Dade County Adult male resident of Broward County Fever, rash and arthralgia Serum and urine specimens collected Positive for Zika virus infection by rRT-PCR and/or Zika IgM testing 7 close contacts of both: no symptoms 1 had evidence of recent flavivirus infection Mosquito control around cases Investigation and urosurvey of 150m radius

Disease Cluster Cases 3 and 4 had onset of fever, rash and arthralgia on July 9 and July 10 Confirmation by rRT-PCR was obtained approx. 2 weeks after symptom onset Workplaces located within 120 meters of each other in a mixed-use neighborhood Testing of Workplace A – one positive IgM Serum + urine of Workplace B – 3 of 15 symptomatic either rt PCR or IgM 2 of 14 asymptomatic IgM

July 28-30 - Community survey Surrounding 150 m radius 96 households attempted 52 urine specimens collected from 28 households 6 of 52 positive for Zika (all asymptomatic) Surveys at locations bordering 1 square mile area 189 specimens collected One travel associated case was identified No local transmission FQHC clinic 77 urine samples, 3 positive All with exposure to the 6 block area

Miami Beach: Early August Adult male residents of Miami-Dade County Resident 1: Rash, fever and conjunctivitis Presented to Clinic in Wynwood area, but works in Miami Beach Resident 2: Rash, arthralgia, conjunctivitis, retro- orbital pain and fatigue Presented to Urgent Care center Non-Florida residents with travel to Miami Beach CDC travel advisory on August 19

Community Surveys

Testing and Vector Control Free Zika testing in county health department clinics for pregnant women Announced by Governor Scott on August 3 Laboratory capacity Document management Local, state and federal coordination Ground treatment and aerial spraying Pesticide poisoning concerns

Mosquito breeding site inspections

Mosquito breeding site inspections

Trapping mosquitos

Lessons Learned Process management On the ground survey challenges and sampling Communication, communication, communication Local / State / CDC

Questions? Anna M. Likos, MD, MPH State Epidemiologist Deputy Secretary for Health (Interim) Florida Department of Health Anna.Likos@flhealth.gov 850-245-4411