Zika Virus Disease: Virginia’s Planning Activities July 27, 2016 Marissa J. Levine MD MPH State Health Commissioner

Zika Virus Disease – Basics Spread to people primarily through bite of infected Aedes mosquitoes Other modes of transmission: sexual, maternal-fetal Common symptoms: Fever, rash, joint pain and conjunctivitis Usually a mild illness, lasting several days to 1 week Most infected persons do not get sick Infection during pregnancy can cause a serious birth defect called microcephaly, and other severe fetal brain defects which have life-long impact. Zika virus infection is primarily spread through the bite of an infected mosquito (Aedes species). Of those that are infected with the virus, 1 out of every 5 will become sick. The most commonly reported symptoms are fever, rash, joint pain and conjunctivitis. The illness is typically mild, lasting approximately 1 week. There are some reports of more lengthy or more serious illness, but those are much less common. 80% of those who are infected will NOT become ill. The treatment for Zika virus infection is what is known as “supportive care”, that is, there are no specific medications to treat the infection. The illness is treated by managing the symptoms, which can include fluids, rest, and medications such as tylenol to reduce fever. There is currently no vaccine to prevent zika virus infection. 2

Estimated range of Aedes albopictus and Aedes aegypti in the US, 2016 3

Virginia’s Preparedness Efforts Virginia Zika Task Force established Human disease surveillance initiated Laboratory testing available Mosquito surveillance initiated Ongoing education and guidance to Virginians Guidance to clinicians - regularly updated 4

Virginia Zika Task Force Input from all Task Groups Office of the Governor Commissioner VDH Virginia Zika Task Force VDEM VDH OEP Governor’s Office Representative Lt. Governor’s Office Representative Clinician Outreach Task Group Communications Task Group Human Surveillance Task Group Maternity Health Task Group Mosquito Control Task Group Blood/Tissue Safety Task Group Others DVS Lead: VDH ORCE Lead: VDH OEPI Lead: VDH OEPI Lead: Virginia Mosquito Control Association Lead: American Red Cross DBHDS Input from all Task Groups DGS DCLS VDH Office of Family Health Services Virginia Blood Services DOE LEGEND: BHDS: Virginia Department of Behavioral Health and Developmental Services DCLS: Division of Consolidated Laboratory Services DCR: Virginia Department of Conservation and Recreation DGS: Virginia Department of General Services DOE: Virginia Department of Education DVS: Virginia Department of Veterans Services OEP: Office of Emergency Preparedness OEPI: Office of Epidemiology ORCE: Office of Risk Communications and Education SCHEV: State Council of Higher Education for Virginia VACO: Virginia Association of Counties VCU Health: Virginia Commonwealth University Medical Center VDEM: Virginia Department of Emergency Management VDH: Virginia Department of Health VDOF: Virginia Department of Forestry VDGIF: Virginia Department of Games and Inland Fisheries VHHA: Virginia Hospital and Healthcare Association VML: Virginia Municipal League SCHEV VDACS VDH OEPI DGS VDGIF VHHA VDOF DCR MSV VACO State agency Private Sector VML Non-governmental organization 5

Testing Virginia Residents for Zika Virus 950 Virginia Residents Approved for Zika Testing between 1/29/2016 and 7/20/2016 Virginia Residents Approved for Testing by Region Case Status Num % Confirmed/Probable case 43 5 Not a case 757 80 Test results pending 128 13 Test declined 22 2 This slide shows the 950 Virginia residents approved for testing as of July 20, 2016. The Northern Region has the majority (59%) of residents, followed (distantly) by Central (17%), Eastern (11%), Northwest (9%), Southwest (4%). Among these 950 Virginia residents, 43 (or 4.5% (rounded to 5% in table)) were classified as confirmed or probable cases based on lab and epi criteria, 757 were classified as not a case, and test results are pending for 128 people. It’s important to mention that case classification is based on lab and clinical criteria (or symptoms). NOT A CASE – majority are asymptomatic! 6

Virginia Jurisdictions and Military Installations having Mosquito Control Capabilities Fort Myers & the Pentagon, Arlington County Fort Belvoir, Fairfax County Langley AFB, Hampton Fort Eustis, Newport News Mosquito control guided by mosquito surveillance & arboviral testing Mosquito control guided by mosquito surveillance only Military installations having mosquito surveillance & control capability Mosquito control programs are mostly found in some of Virginia’s most heavily populated jurisdictions. 7

Public Messaging/Communication http://www.vdh.virginia.gov/ www.ZikaVA.org 8

Zika Messaging Multimedia Approach Leave-Behind Printed Material Clinician Outreach 3 Animated Videos (English & Spanish) TV, Radio and Movie Theaters Airport Signage Social Media Campaign Zika Prevention Kits 9

Zika Table top Exercise June 17, 2016: Mosquito (Vector) Control Zika task force VDH LeadershipTeam 5 local health districts Tabletop Exercise Template Available for other jurisdictions to use http://www.vdh.virginia.gov/emergency-preparedness/training-education/ 10

http://www.virginiawellbeing.com 11 Data Source: Virginia Department of Health Plan for Wellbeing, January 2016 11

Thank you! Summary/Questions? 12