1. Zika Virus Update Town Hall June 15, 2016 Dr. Howard Haft, Deputy Secretary for Public Health, DHMH Robin Waddell, Deputy Health Officer – Operations, Cecil County Health Department Fred von Staden, Director, Environmental Health Services, Cecil County Health Department HEALTHY PEOPLE. HEALTHY COMMUNITY. HEALTHY FUTURE.

2.  Zika is transmitted to people primarily through the bite of infected Aedes sp. mosquitoes. The Aedes aegypti is the primary vector.  Aedes albopictus mosquitoes are more widely dispersed in the continental U.S. and can also carry the virus, although it’s less likely. It is also known as Asian Tiger.  ZIKA VIRUS IS NOT CURRENTLY BEING SPREAD BY MOSQUITOES IN THE CONTINENTAL UNITED STATES. What We Know Right Now

3.  There is no vaccine to prevent or medicine to treat Zika virus.  Guidance and recommendations will change as more is learned about Zika virus. virus infection is not currently available What We Know Right Now

4. Aedes aegypti mosquito

5. Aedes albopictus (Asian Tiger) mosquito

6.  Zika infection during a pregnancy is linked to birth defects. This is a concern during any part of a pregnancy. Pregnant women should delay travel to areas with Zika.  The best way to prevent Zika is to prevent mosquito bites. Top Take-away Messages

7.  Most people infected with Zika don’t know they have it. They usually don’t get sick enough to seek medical care and very rarely die.  See a healthcare provider if you develop a fever, rash, joint pain, or red eyes during a trip or within two weeks after traveling to a place with Zika. This also applies if you have had sexual contact with someone who has traveled. Top Take-away Messages

8.  Prior to 2015, Zika virus disease outbreaks occurred in areas of Africa, Southeast Asia, and the Pacific Islands.  First isolated in 1947, the virus was not reported in the Americas until early 2014 when it was identified on Easter Island (Chile).  Mosquitos that spread Zika are aggressive daytime biters, but they can also bite at night. Background of the Virus

9. What is Zika Virus? Zika virus is an arbovirus ( spread by arthropods ) single- stranded, enveloped RNA virus In the Flaviviridae family  Yellow fever  West Nile  Dengue  St. Louis encephalitis A transmission electron micrograph of the Zika virus (CDC)

10. Timeline of Current Outbreak  May 2015 – First confirmed Zika virus infections in Brazil  Dec 2015 -- Posted first regional travel notices for Zika in South America and Mexico. (Currently, outbreaks are occurring in many countries and territories. Additional areas are added weekly.)  Jan 22, 2016 – CDC activated its Emergency Operations Center  Feb 1, 2016 – World Health Organization declared a Public Health Emergency of International Concern (PHEIC)  Feb 8, 2016 – CDC elevated EOC activation to Level 1 (the highest)  Feb 8, 2016 – President Obama announced a request for $1.8 billion in emergency funds for several agencies to accelerate research into a vaccine and educate populations at risk for the disease

11. Maryland U.S.  Currently 691 travel-related cases reported to ArboNET  Of these cases:  206 are pregnant women  11 were sexually transmitted  2 developed Guillain- Barré syndrome Current Situation as of 6/8/2016  Currently 21 reported cases (no further breakdown is available)  All are travel-related * * Travelers returning from affected areas, their sexual contacts, or infants infected in utero

12.  Locally-acquired cases reported: 1,301  Travel-associated cases reported: 4 * Pregnant 166 * Guillain-Barré 7  Includes Puerto Rico, American Samoa, & U.S. Virgin Islands Current Situation in U. S. Territories

13. Modes of Transmission Other Than Mosquitoes  Sexual transmission from a man to his partners  Recommendations for safe sex will vary based on the couple’s situation and concerns. Information is still evolving. Talk to your healthcare provider. Information also available on CDC.gov  Zika virus can be passed from a pregnant woman to her fetus during pregnancy or around the time of delivery  Blood transfusions  Organ or tissue donation (theoretically possible)  Has been isolated in breast milk, but no known cases (It is NOT recommended that women stop breast feeding.)

14.  Most Zika virus infections either do not cause any symptoms or they are mild.  About one in five people infected develop the disease.  Most common symptoms are fever, rash, joint pain, and/or red eyes. Could have muscle pain or headaches. Treatment is supportive.  Symptoms may begin after incubation period of a few days to a week. Most symptoms then resolve within a few days to a week.  Other diseases must be considered when diagnosing. Symptoms and Complications

15.  Serious consequences of what was previously thought to be a benign disease can occur.  CDC scientists have announced that evidence shows Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects.  There is also evidence of multiple neurologic syndromes in adults/adolescents, including Guillain-Barré syndrome.  Long-term consequences have yet to be determined Symptoms and Complications

16.  A blood or urine test can confirm a Zika infection.  Either the local health department or the State health department must approve testing for Zika before it is ordered.  Many factors are considered based on the situation when evaluating a request for testing. Work with your healthcare provider if you have concerns or questions.  There is a recently-approved commercial test available but there are limitations to its use. Doctors are asked to discuss all potential exposures with local health department. Testing

17. Additional Facts  CDC is not able to predict how much the Zika virus will spread in the continental U.S.  Zika is a nationally reportable disease.  CDC continues to work with states to monitor for mosquito-borne diseases, including Zika.  Many areas in the U.S. have the type of mosquitoes that can become infected with and spread Zika virus.  Do not need special PPE as with Ebola.  Based on similar infections, once infected with Zika, you are likely protected from future infections.

18. Estimated Range

19. Zika Virus Transmission Prevention and Health Promotion Administration 6/16

20. For Zika to cause an outbreak in the continental United States, ALL of the following must happen:  People infected with virus enter the United States;  An Aedes mosquito in the U.S. bites the infected person during time period when virus can be found in person’s blood (typically only through first week of infection);  Infected mosquito lives long enough for the virus to multiply and for the mosquito to bite another person; and  This cycle continues multiple times and starts an outbreak.

21.  During the first week of infection, Zika virus can be found in a person’s blood.  Virus can be passed from an infected person to a mosquito through mosquito bites.  The infected mosquito can spread the virus to other people.  To prevent others from getting sick, strictly follow steps to prevent mosquito bites during first week of illness or if you test positive. Prevention

22. Act Now  Mosquitoes that spread Zika breed in containers of water of all sizes.  Empty all containers of standing water, including: - buckets - planters - toys - birdbaths - flowerpots - bottles and bottle caps - tires Prevention and Health Promotion Administration 6/16

23. Act Now  Avoid mosquito bites.  Apply insect repellent, wear lightweight pants and long-sleeved shirts, and keep window screens in good condition.  Mosquito Control technicians are here to help. Please cooperate if you see them on your property. Prevention and Health Promotion Administration 6/16

24. For More Information  View the DHMH Zika Town Hall at: https://youtu.be/1xpcuDHsGK8  Soundcloud for Zika audio PSAs, please visit: https://soundcloud.com/mdagdept  If you have a question about Zika that is not answered by any of the sites listed, you can send your question to: Zika.Questions@maryland.gov Zika.Questions@maryland.gov  For more information, please visit: http://phpa.dhmh.maryland.gov/pages/zika.aspx or cecilcountyhealth.org Please visit these sites often as information is updated frequently DHMH Prevention and Health Promotion Administration 6/16