1. Zika 101
Updated August 4, 2016, Added content as of September 13, 2016 1

2. What is Zika virus disease (Zika)?
Disease spread primarily through the bite of an infected Aedes aegypti or Ae. albopictus mosquito.
Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. (Only 1 in 5)
However, Zika can cause birth defects and other problems such as stillbirth and miscarriage.
- Zika virus was first discovered in a monkey in the Zika Forest of Uganda in 1947. 2

3. Aedes aegypti (AYE-dees-uh-GYP-tie) mosquito
Can be recognized by white markings on legs and marking in the form of a lyre on the upper surface of its thorax.
Originated in Africa, now found in tropical and subtropical regions around world
Flies anytime of day

4. Aedes albopictus ( ALD-dees AL-bow-PICK-tus ) mosquito
Black and white striped legs and small black and white striped body (Called tiger mosquito)
Flies in daytime

5. Distribution of Mosquitoes

6. Where has Zika virus been found?
Named after a Ugandan forest where first discovered
Before 2015, Zika outbreaks occurred in Africa, Southeast Asia, and the Pacific Islands.
Currently outbreaks are occurring in many countries and territories.
- In December 2015, the Commonwealth of Puerto Rico, a United States territory, reported its first confirmed locally transmitted Zika virus case.
- Cases of local transmission have recently been confirmed in two other US territories, the United States Virgin Islands, and American Samoa. For the most recent case counts, visit CDC’s Cases in the United States webpage.
Cases of local transmission have also been confirmed in two other US territories, the United States Virgin Islands, and American Samoa. For the most recent case counts, visit CDC’s Cases in the United States webpage.
Local transmission of Zika virus has been reported in the United States.
The Florida Department of Health has identified two areas in Miami-Dade County where Zika is being spread by mosquitoes.
CDC is working closely with Florida public health officials to investigate these cases.
CDC and Florida are issuing travel, testing, and other recommendations for people who traveled to or lived in the Florida-designated areas.
At Florida’s request, CDC also sent a CDC Emergency Response Team (CERT) with experts in Zika virus, pregnancy and birth defects, vector control, laboratory science, and risk communication to assist in the response. 6

7. NASA Zika Computer Model

8. How is Zika transmitted?
Zika can be spread through:
Mosquito bites
From a pregnant woman to her fetus
Vaginal Sex with an infected person
Oral Sex with an infected person
Deep Kissing with an infected person
Virus has been detected in saliva
No documented transmission yet
Possibly blood transfusion, organ and tissue transplant, fertility treatment, and breastfeeding
- Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus).
Mosquitoes that spread Zika virus bite during the day and night.
A pregnant woman can pass Zika virus to her fetus during pregnancy or around the time of birth. We are studying how Zika affects pregnancies.
- To date, there are no reports of infants getting Zika through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.
- A man with Zika virus can pass it to his female or male sex partners.
- There is a strong possibility that Zika virus can be spread through blood transfusions. 8

9. Utah Case Baffles Health Officials
New case that was not contracted through mosquito bite or sexual contact.
Care giver for a older man who had been infected while traveling abroad
New case was a “family contact” who helped care for the older man.
The older man has died. Unclear from what cause.
The older man did have an unusually high level of the virus in his body.
Question now is: Can Zika virus be transmitted by sneezing or coughing, or sharing utensils? Was there a needle stick or injury? Was there possible contact with other body fluids like urine?

10. What are the symptoms? The most common symptoms of Zika are: Fever
Rash
Joint pain
Conjunctivitis (red eyes)

11. What are the symptoms?
Other symptoms include:
Muscle pain
Headache

12. How does Zika virus affect people?
Anyone who lives in or travels to an area with Zika and has not already been infected with Zika virus can get it.
Many people with Zika will not have symptoms or will only have mild symptoms.
Only 1 out of 5 adults will have noticeable symptoms. 4 out of 5 no symptoms.
Symptoms last several days to a week.
Severe disease requiring hospitalization is uncommon. 12

13. Adult Symptoms Needing Additional Research
Zika virus may affect learning and memory in adults
A recent mice study suggests adult brain cells critical to learning and memory are vulnerable to infection. Rockefeller University web site
First study researching the affect of Zika virus on the adult brain.
More research is needed to determine if cell damage has long-term biological implications.
New studies suggest adults with weakened immune systems could be affected in ways not yet recognized

14. How does Zika affect pregnancies?
Zika virus can pass from a pregnant woman to her fetus during pregnancy or around the time of birth.
Not known how often this happens.
The mother may NOT show any symptoms, yet can infect her fetus.
- We expect that pregnant women who develop Zika will have similar illness to people who are not pregnant. No evidence exists to suggest that pregnant women are more susceptible or experience more severe disease during pregnancy.
- We do not know if pregnant women are more likely to develop symptoms compared to the general population.
- We do not know if pregnant women are more likely to get Guillain-Barré syndrome. 14

15. How does Zika affect pregnancies?
Zika infection in pregnancy can cause microcephaly and other severe fetal brain defects.
Microcephaly: birth defect in which a baby’s head is smaller than expected when compared to babies of the same sex and age.
No evidence that previous infection will affect future pregnancies.
This is an area that needs further research.
Microcephaly is a severe birth defect that is a sign of a problem with brain development.
Microcephaly can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth.
Recognizing that Zika is a cause of certain birth defects does not mean that every pregnant woman infected with Zika will have a baby with a birth defect. It means that infection with Zika during pregnancy increases the chances for these problems. 15

16. Lara, Feb. 12, 2016. Just under 3 months old

17. As of September 14, 2016
“Five babies have been born in the United States – the most recent in Florida”. Senator Bill Nelson, Democrat of Florida
Supportive care of a microcephalic child = $100 million plus each child
“Zika may cause many more birth defects than previously suspected. Everything we look at with this virus seems to be a bit scarier than we initially thought.” Dr. Anne Schuchat, U.S. Centers for Disease Control and Prevention , Whitehouse briefing, April , 2016

18. More to Zika than initially thought
Catherine Y. Spong, acting director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development
Online journal BMC Medicine
“Zika may involve other serious brain anomalies, fetal loss/stillbirth, eye abnormalities and developmental and motor outcomes. It is likely that microcephaly is one of the severe complications and that more subtle anomalies will be identified once systematic studies are performed.”

19. More to Zika than initially thought
We need a better understanding of Zika virus related eye and hearing abnormalities, as well as neurobehavioral effects such as altered motor function, stiffness, irritability and incessant crying.
It will be essential to follow children after birth to evaluate their neurodevelopment and developmental milestones, including children who show no signs of anomalies.

20. Zika and Microcephaly
As of August 31, 2016 – 4,000 cases of Zika linked microcephaly
Congenital condition associated with incomplete brain development
Leads to a limited life span with mental retardation

21. How does Zika affect fetuses and infants?
Other problems have been detected in fetuses and infants infected with Zika virus before birth.
Miscarriage, stillbirth, absent or poorly developed brain structures, eye defects, hearing deficits, and impaired growth
No reports of infants getting Zika through breastfeeding.

22. Does Zika cause Guillain-Barré (ge-lan ba-ray) syndrome (GBS)?
Research suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS. CDC is continuing to investigate the link between GBS and Zika to learn more.
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. 22

23. Guillain Barre Syndrome
Body’s immune system attacks the peripheral nervous system
Weakness or tingling sensations in legs, spreading to arms and upper body
Can lead to total paralysis
Myelin sheaths are attacked or degraded
Nerves cannot transmit signals
Inappropriate signals - tingling, crawling skin painful sensations

24. How is Zika diagnosed?
Diagnosis of Zika is based on a person’s recent travel history, symptoms, and test results.
A blood or urine test can confirm a Zika infection.

25. How is Zika diagnosed?
Your doctor or other healthcare provider may order tests to look for several types of infections.

26. How is Zika diagnosed?
All pregnant women should be assessed for Zika at each prenatal care visit. They should be asked if they
Traveled to or live in an area with active Zika transmission
Had sex without a condom or other barrier method to prevent infection with a partner who lives in or traveled to an area with active Zika transmission 26

27. How is Zika treated?
There is no specific medicine or vaccine for Zika virus infection.

28. How is Zika treated? Treat the symptoms Rest
Drink fluids to prevent dehydration
Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS).
Aspirin and Ibuprofen affect platelets which can cause bleeding
Take acetaminophen (Tylenol®) to reduce fever and pain.
Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) until dengue can be ruled out to reduce the risk of bleeding.
If you are taking medicine for another medical condition, talk to your doctor or other healthcare provider before taking additional medication. 28

29. Problem with Aspirin and Ibuprofen
Just like Dengue and Chikungunya virus:
The Zika virus affects the platelets which are responsible for blood clotting or stopping bleeding.
Aspirin and Ibuprofen have the same affect.
Both together pushes the patient into what is called “Dengue Shock Syndrome”

30. What to do after getting Zika
Protect yourself from mosquito bites. During the first week of illness, Zika virus can be found in your blood.
The virus can be passed from an infected person to a mosquito through bites.
An infected mosquito can then spread the virus to other people.
Zika virus can stay in blood for about a week, and mosquitoes can bite you and then infect others through bites. 30

31. Preventing Mosquito Bites

32. Preventing Mosquito Bites
Zika is primarily spread through mosquito bites. Protect yourself and others.

33. STEP 1 Keep mosquitoes outside
Preventing Mosquito Bites
STEP 1 Keep mosquitoes outside
Here’s what you can do to help control mosquitoes outside your home:
Use an outdoor insect spray made to kill mosquitoes in areas where they rest.
If you have a septic tank, repair cracks or gaps.
Use an outdoor insect spray made to kill mosquitoes in areas where they rest.
Mosquitoes rest in dark, humid areas like under patio furniture, or under the carport or garage.
If you have a septic tank, repair cracks or gaps. Cover open vent or plumbing pipes. Use wire mesh with holes smaller than an adult mosquito. 33

34. STEP 1 Keep mosquitoes outside
Preventing Mosquito Bites
STEP 1 Keep mosquitoes outside
Here’s what you can do to help control mosquitoes outside your home:
Once a week, empty and scrub, turn over, cover, or throw out items that hold water.
Tightly cover water storage containers.
Use larvicides to kill young mosquitoes in large containers of water that will not be used for drinking.
“Mosquito Dunks” example
Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like tires, buckets, planters, toys, pools, birdbaths, flowerpot saucers, or trash containers. Mosquitoes lay eggs near water.
Tightly cover water storage containers (buckets, cisterns, rain barrels) so that mosquitoes cannot get inside to lay eggs.
For containers without lids, use wire mesh with holes smaller than an adult mosquito.
Use larvicides to kill young mosquitoes in large containers of water that will not be used for drinking and cannot be covered or dumped out. 34

35. STEP 1 Keep mosquitoes outside
Preventing Mosquito Bites
STEP 1 Keep mosquitoes outside
Here’s what you can do to help control mosquitoes inside your home:
Use window and door screens.
Use air conditioning when possible.
Once a week, empty, scrub, turn over, or throw out items that hold water.
Use an indoor insect fogger or indoor insect spray.
When using insecticides, always follow label directions.
Install or repair and use window and door screens. Do not leave doors propped open.
Use air conditioning when possible.
Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like vases and flowerpot saucers. Mosquitoes lay eggs near water.
Kill mosquitoes inside your home. Use an indoor insect fogger* or indoor insect spray* to kill mosquitoes and treat areas where they rest. These products work immediately, and may need to be reapplied. When using insecticides, always follow label directions. Only using insecticide will not keep your home free of mosquitoes.
Mosquitoes rest in dark, humid places like under the sink, in closets, under furniture, or in the laundry room. 35

36. STEP 1 Keep mosquitoes outside
Preventing Mosquito Bites
STEP 1 Keep mosquitoes outside
When traveling:
Stay in places with air conditioning and with window and door screens.
Use a bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

37. STEP 2 Create a barrier between you and mosquitoes
Preventing Mosquito Bites
STEP 2 Create a barrier between you and mosquitoes
Cover up!
Wear long-sleeved shirts and long pants.

38. STEP 2 Create a barrier between you and mosquitoes
Preventing Mosquito Bites
STEP 2 Create a barrier between you and mosquitoes
Treat clothing and gear
Use permethrin* to treat clothing and gear or buy pre-treated items.
See product information to learn how long the protection will last.
Do not use permethrin products directly on skin.
* Permethrin is not effective in Puerto Rico.
The EPA has reviewed scientific studies on the use of permethrin-treated clothing. Based on EPA’s review, there is no evidence of reproductive or developmental effects to mother or child following exposure to permethrin.
Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.
If treating items yourself, follow the product instructions carefully.
Do NOT use permethrin products directly on skin. They are intended to treat clothing. 38

39. STEP 3 Wear insect repellent
Preventing Mosquito Bites
STEP 3 Wear insect repellent
Use Environmental Protection Agency (EPA)-registered insect repellents.
Use a repellent with DEET, picaridin, IR535, or oil of lemon eucalyptus or para- menthane-diol
Recent reports by Consumer Reports say that “natural” bug sprays are NOT effective in combating mosquitoes that carry Zika. Although they smell better, they don’t last as long as picaridin and DEET. 39

40. STEP 3 Wear insect repellent
Preventing Mosquito Bites
STEP 3 Wear insect repellent
Always follow the product label instructions.
Do not spray repellent on the skin under clothing.
If also using sunscreen, apply sunscreen before applying insect repellent.
DEET is safe for pregnant women and young children
No repellent should be used on babies less than 2 months

41. STEP 4 Protect your family
Preventing Mosquito Bites
STEP 4 Protect your family
For babies and children
Dress your child in clothing that covers arms and legs
Cover crib, stroller, and baby carrier with mosquito netting.
Do not use insect repellents on babies younger than 2 months old.
Do not use products containing oil of lemon eucalyptus or para- menthane-diol on children younger than 3 years old.

42. STEP 4 Protect your family
Preventing Mosquito Bites
STEP 4 Protect your family
For babies and children
Cover crib, stroller, and baby carrier with mosquito netting.

43. STEP 4 Protect your family
Preventing Mosquito Bites
STEP 4 Protect your family
For babies and children
Do not apply onto hands, eyes, mouth, and cut or irritated skin.
Adults: Spray onto your hands and then apply to a child’s face.
Remember: Do not use insect repellent on babies younger than 2 months old.

44. STEP 5 Protect your partner
Zika can be passed through sex from a person who has Zika to his or her sex partners.
Sex includes vaginal, anal, and oral sex, and the sharing of sex toys.
Zika can be passed through sex before symptoms start, during, and after symptoms end.
It can be passed even if the infected person does not have symptoms at the time.
Zika virus can remain in semen longer than in other body fluids, including vaginal fluids, urine, and blood.
Zika can be passed through sex from a person who has Zika to his or her sex partners.
Sex includes vaginal, anal, and oral sex, and the sharing of sex toys.
Zika can be passed through sex, even if the infected person does not have symptoms at the time.
It can be passed from a person with Zika before their symptoms start, while they have symptoms, and after their symptoms end.
Although not well documented, the virus may also be passed by a person who carries the virus but never develops symptoms.
Studies are underway to find out how long Zika stays in the semen and vaginal fluids of people who have Zika and how long it can be passed to sex partners. We know that Zika can remain in semen longer than in other body fluids, including vaginal fluids, urine, and blood. . 44

45. STEP 5 Protect your partner
We do not know
If sexually-transmitted Zika virus poses a different risk of birth defects than mosquito-borne transmission
CDC and other public health partners continue to study Zika virus and how it is spread and will share new information as it becomes available
What we do not know
If a man with Zika who never develop symptoms have the virus in their semen or if they can pass Zika through sex.
If Zika can be passed through saliva during kissing.
If sexual transmission of Zika virus poses a different risk of birth defects than mosquito-borne transmission.
CDC and other public health partners continue to study Zika virus and how it is spread and will share new information as it becomes available. This continuing research may help us find out
How common it is for Zika to be passed during sex by a man or woman.
If Zika can be passed through saliva during deep kissing.
If Zika passed to a pregnant woman during sex has a different risk for birth defects than Zika transmitted by a mosquito bite. 45

46. STEP 5 Protect your partner
Not having sex can eliminate the risk of getting Zika from sex.
Condoms* (and other barriers to protect against infection) can reduce the chance of getting Zika from sex if used correctly from start to finish, every time you have vaginal, anal, or oral sex.
*Barriers that protect against infection include male and female condoms and dental dams. For the purposes of this presentation, all barriers will be referred to as condoms.

47. STEP 5 Protect your partner
Pregnant couples in which one or both partners have traveled to or live in an area with Zika should use a condom correctly, from start to finish, every time they have sex or should not have sex for the duration of the pregnancy.

48. STEP 5 Protect your partner
If you live in or travel to an area with Zika:
If you have a pregnant partner, use a condom correctly every time you have vaginal, anal, or oral sex and do not share sex toys OR
Do not have sex during the pregnancy 48

49. STEP 5 Protect your partner
Persons without a pregnant partner who recently traveled to or lived in an area with Zika
If you’ve been diagnosed with Zika or have (or had) symptoms, you can use condoms or not have sex for 6 months after symptoms begin.
If you never developed symptoms, you can use condoms or not have sex for 8 weeks after returning from travel, or while there is Zika in the area. 49

50. STEP 6 Do your homework before traveling
If you are pregnant, do not travel to areas with Zika.
If you must travel, talk to your doctor or other healthcare provider before your trip.
If you are trying to get pregnant, talk to your doctor or other healthcare provider before you travel. 50

51. STEP 6 Do your homework before traveling
If you choose to travel:
Strictly follow steps to prevent mosquito bites to protect yourself and your family.
Even if you do not feel sick, travelers from an area with Zika should take steps to prevent mosquito bites for 3 weeks so they do not spread Zika to uninfected mosquitoes.
Use condoms or do not have sex while traveling to areas with Zika. 51

52. STEP 6 Do your homework before traveling
See the latest travel notices at: wwwnc.cdc.gov/travel/page/zika-travel-information 52

53. Congressional Funding Problem
February, 2016 Request to fund $1.9 billion emergency funding to fight the pending pandemic of the Zika Virus.
In May, a bipartisan coalition of Senators approved $1.1 billion, killed by House
Congressional stalemate and partisan divide:
Republicans – delete funding for Planned Parenthood to provide contraceptive services related to fighting the Zika Virus
Provision to ease the pesticide restrictions
Stop research on fetal brain tissue
Democrats – We will never agree to the elimination of Planned Parenthood funding

54. Congressional Funding Problem
Response to Congressional Stalemate
Bill killed by Senate Democrats three times it has come up for a vote
Public Health Officials
Sept. – we are out of money
Stop Gap Efforts
Obama redirected $600 million from Ebola research
Republicans legislation to redirect $622 million from other programs
$540 million cut from Obama Care, and stripped a House provision to ban the Confederate flag from federal cemeteries

55. Congressional Funding Problem
Bill approved last week of September.
Will provide $1.1 billion to fight the Zika virus
$750 million in cuts and policy changes

56. Where do we stand today? Website Texaszika.org has latest counts
As of August 31, 2016 there are 2,722 reported cases of Zika in the US
624 of the above cases are pregnant women (CDC)
Include Puerto Rico and other territories – 17,000 reported cases
First Texas death – Baby girl died in Harris County August 10, 2016
Second death in US – Utah man first died in June
Website Texaszika.org has latest counts
As of August 31, 2016 – 99 Zika cases in Texas (all travel related)
3 pregnant women, 1 infant, 1 person transmitted by sexual contact
As of Oct. 1, 2016 – 218 cases in Texas, 13 pregnant, 2 infants, 2 sexual
58 Harris County, 16 Bexar, 9 Travis

57. What About the Genetically Engineered Mosquito
Every weekday in the southeastern Brazilian city of Piraciaba (population 5000) more than 100,000 male mosquitoes are released.
They fly off to find mates and pass along the “mosquito assassin gene”
Developed by British company Oxitee, now owned by Intrexon Corp. Nasdaq: XON) a Blacksburg, VA biotech.
Experiment is now over – 82% reduction in wild mosquito larvae
Project extended for a year. Larger area – 60,000 people.
Proposed Florida Keys test on hold due to environmental concerns. 57

58. Advice
If you are a woman who is pregnant, you really should not travel to areas where there may be Zika virus in mosquitoes

59. Original CDC presentation has been updated and modified by Dr
Original CDC presentation has been updated and modified by Dr. Charles Johnson.
For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 59