HCPHES Responding to Zika: Planned Response Activities Mac McClendon Director Office of Public Health Preparedness & Response/EMC Harris County Public Health & Environmental Services March 23, 2016

HCPHES & Harris County HCPHES serves as the county health department for Harris County (TX) with over 700 public health professionals Third most populous county in nation with estimated population of 4.34 million Spread over 1,778 square miles (larger than the state of Rhode Island) Geographically, politically, and socio- demographically diverse and growing Home to world’s largest medical center

Zika Virus in the Continental United States Local transmission of Zika virus by mosquitoes has not been reported in the continental United States With current outbreaks in the Americas, cases among U.S. travelers will most likely increase Imported cases may result in virus introduction and local spread in some areas of U.S. with appropriate vectors and environmental conditions Aedes aegypti and Aedes albopictus

Modes of Transmission Bite of infected mosquito Mother to child Aedes albopictus Aedes aegypti Bite of infected mosquito Mother to child Sexual contact Blood transfusion Laboratory exposure Theoretical Organ or tissue transplant Breast milk: Zika virus RNA detected

Zika Virus Rates 1 in 5 people infected with Zika virus become ill All age groups can be affected Transmitted by same mosquito species that carry Dengue and Chikungunya viruses No severe disease, hospitalizations, or deaths

HCPHES Approach to Fighting Aedes Understand Aedes vector predominance in Texas (85) & Harris County (56) Recognize need to shift from primarily Culex-based program to incorporation of Aedes mosquito as a targeted vector Appreciate importance of public education, personal protection, and source reduction as major tenets in fight against Aedes Assure “One Health” and health equity lens are applied to evolving multidisciplinary response Aedes albopictus Aedes aegypti

Role of Health Equity, One Health, & MDT Multi-Disciplinary Teams (MDT) An internal team whose purpose is to conduct targeted mosquito, epidemiological, environmental assessments of household perimeters & proximate areas to determine need for interventions Health Equity One Health MDT

HCPHES Planned Zika Response Activities Level 4 - Normal Conditions: No cases of locally acquired Zika in Harris County Level 3 - Increased Readiness: One case of locally acquired Zika in Harris County Level 2 - High Readiness: A few or cluster of cases of locally acquired Zika within Harris County Level 1 - Maximum Readiness: Widespread cases of locally acquired Zika throughout Harris County Vector Surveillance and Control Utilize mosquito surveillance using (limited) historical data on Aedes combined with (expanded) surveillance including incorporation of predictive modeling within the 268 operational areas Generate GIS maps indicating key metrics such as mosquito population density levels of Aedes, Zika confirmed mosquito samples, local cases of human infections, and sources of breeding, etc. Conduct necessary staff trainings for inspectors, larvicide applicators, and other MC support personnel Acquire testing materials and laboratory equipment for mosquito virology laboratory for Zika Work with partners and community members on key issues around reducing mosquito habitats

HCPHES Planned Zika Response Activities Communications, Education and Engagement Conduct disease prevention education, personal protection, and source reduction campaigns Utilize media and other community partners to provide credible information to the public Distribute insect repellent and other prevention modalities to local communities when feasible and appropriate Create messaging in languages most appropriate for affected communities, working with area consulates, etc. Conduct door to door education and outreach in targeted communities Engage federal, state, and local stakeholders to coordinate efforts

HCPHES Planned Zika Response Activities Epidemiology Surveillance & Testing Health Care Provider/Clinician Outreach Environmental Health Veterinary Public Health Legal Review and Authority Preparedness and Response

HCPHES Operations/Response: Multi-Disciplinary Team (MDT) activated with one symptomatic, confirmed Zika case Provides education on Zika virus and prevention/protection measures Conducts assessments of the case, contacts and environment within a 200 meter radius of the case’s residence 3-5 people on each team Team Lead: Epidemiology

HCPHES Operations/Response: MDT assessments Epidemiological assessment Active surveillance for symptoms Contact investigations Serologic testing Environmental assessment Search for mosquito breeding sources (e.g. standing water in tires, flowerpots, gutters, fountains, unmaintained pools) Address nuisance issues Mosquito assessment Adult mosquito sampling within and around affected area Samples submitted for viral diagnostic testing

Communication, Education, and Outreach Strategies and Tactics Media Social Media Website Advertising of Campaign Message Community Engagement

Communicating to the Public Stay on message Be sensitive to their circumstances – financial, cultural, environmental – and listen to their concerns Use plain language – not scientific terms or acronyms Use interpreters when needed Be engaging – do demonstrations to ensure they understand Provide resources, educational materials Make sure to follow-up Media inquiries? Contact OCEE

Prevent the Bite…Day & Night Personal Protection Wear an EPA-registered insect repellent that contains one of the following: DEET, picaridin, IR3535, oil of lemon eucalyptus; use according to the label Cover up. Wear long-sleeved shirts, long pants, and socks Place mosquito netting over infant carriers, cribs, and strollers

Prevent the Bite…Day & Night Mosquito-Proof your Property Remove/empty containers that can hold water such as tires, flower pots, birdbaths, and toys; Keep rain gutters free of debris Install or repair screens on windows and doors Sweep up lawn clippings and leaves; Don’t feed the storm drain Eliminate mosquito breeding sources inside your home, too

Questions? For the latest on Zika Virus and Mosquito Control in Harris County, visit:www.hcphes.org/zika