1. Zika Virus Identifying an Emerging Threat
Florida Department of Health in Miami-Dade County
Epidemiology, Disease Control, & Immunization Services

2. What is Zika Virus?
Zika virus is a vector-borne disease that is transmitted to humans through the bites of infected Aedes (aegypti) mosquitoes
Same virus family as dengue and chikungunya (flavivirus)
Zika virus infections have also been documented through intrauterine, intrapartum, sexual, and blood transmission

4. Where in the World is Zika?
Prior to 2015, Zika virus outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands
In May 2015, WHO reported the first local transmission of Zika virus in the Western Hemisphere – indigenous cases in Brazil
As of late 2016, multiple countries and territories worldwide have reported active Zika transmission. Most of those countries are in the Americas, and now include the US (Miami-Dade County)

7. What about Florida and Miami-Dade?
On Friday, July 29, the Florida Department of Health confirmed Florida’s first local transmission of the Zika virus in four individuals in Miami-Dade and Broward Counties. Three locations of interest were investigated based on where these individuals spent a majority of their time.
As of November 7th, 2016:
Infection Type
Infection Count
Travel-Related Infections of Zika
780
Non-Travel Related Infections of Zika
191
Infections Involving Pregnant Women
135
Out of State Cases (not Florida Residents) 20
Undetermined 7
Total
1,133
These counts are updated based on daily count reports from state (from Olga’s office)

8. Where are the vectors in Florida?

9. Clinical Pathology (How does Zika virus affect humans?)
1 in 5 people infected will become symptomatic
Few hospitalizations
Most common signs and symptoms
Fever (often low-grade)
Muscle ache
Rash
Headache
Joint pain
Pain behind the eyes
Red eyes
Vomiting
There is currently no vaccine to prevent Zika or treatment to cure it
Those who do become symptomatic can only manage symptoms
Persons infected with Zika, dengue, or chikungunya virus should protect themselves from further mosquito exposure during and after illness

10. Behind the Concern: Microcephaly
Microcephaly is a condition in which a baby’s head and brain are underdeveloped
In 2014, Brazil reported 147 cases of microcephaly. In 2015, after the introduction of Zika, the country reported over 4,000 cases.
Recent research by CDC has officially linked Zika virus to microcephaly. The research concludes that the newborns of mothers who had a Zika virus infection while pregnant might be at an increased risk of microcephaly and miscarriages, although it does not mean that every woman who has Zika while pregnant will have a child with microcephaly

11. Behind the Concern: Pregnant Women
We protect unborn babies from microcephaly by protecting their mothers from mosquito bites and Zika infection
Mosquito bite prevention is the most important measure that we and pregnant women can take
Pregnant women (in any trimester) should consider cancelling travel plans to areas where Zika virus transmission is currently happening
Women who are trying to become pregnant should consult their health care provider before travelling to these areas
The first and most important thing that a pregnant woman can do if she thinks she is infected with Zika virus is to talk with her health care provider

12. Behind the Concern: Guillain-Barré syndrome
Guillain-Barré syndrome (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
GBS symptoms include:
Tingling sensation in the extremities
Sensation spreads throughout the body
Can sometimes cause paralysis

13. What is being done?

14. State/Local Response Targeting health care providers Hospitals
American Congress of Obstetricians and Gynecologists
Midwives/nurses
Working with internal partners
Birth Defects Registry
Maternal and Child Health
Syndromic surveillance (ESSENCE)
Guillain-Barrè Syndrome
Microcephaly
Zika

15. State/Local Response
The health department has been sampling close contacts and community members within a 150 meter radius, the maximum distance that Aedes aegypti mosquitoes are known to travel, of confirmed local cases
These community surveys are the first systematic assessment of individuals for possible asymptomatic Zika virus infection ever performed.
Educational events and presentations have been held in various locations and with varying external partners throughout the county, including Zoo Miami, FIU, the International Water Expo., and the Department of Parks and Recreation

16. State/Local Response
Testing: all pregnant women in Miami-Dade County and other Florida Counties (These tests are being performed free of charge in a special Zika clinic at the Health Department)
All non-pregnant individuals must still meet testing criteria to be tested for Zika virus, or must be tested through a commercial lab (Quest Diagnostics)
A Zika Hotline was opened to take all community calls related to testing, symptoms, pregnancy, and questions about the local response

17. Mosquito Control
Mosquito Control has been spraying in the affected areas in Miami-Dade County
DOH notifies Mosquito Control upon suspicion of mosquito-borne illness
Appropriate mosquito control measures are implemented
Drain and cover
Investigation of potential breeding habitats
Spraying (larvicide and adulticide)
Mosquito sampling methods
Successful partnership demonstrated previously:
Chikungunya in 2014
510 imported cases identified
12 sporadic local cases
Coordinated DOH – Local Mosquito Control activities
No sustained local transmission

18. What can YOU do to help prevent the transmission of Zika virus?

19. Zika Virus Prevention Sexual transmission Blood transmission
Mosquito-to-Human Transmission
It is important to remember that Zika virus is primarily a vector-borne disease

20. Sexual Transmission Prevention
CURRENT CDC guidelines for WOMEN:
Wait at least 8 weeks after potential exposure to Zika, or after your symptoms first appeared before trying to get pregnant
CURRENT CDC guidelines for MEN:
Wait at least 6 months after potential exposure to Zika, or after your symptoms first appeared to have unprotected sex, or to try and conceive with your female sex partner
**If a male has potential exposure to Zika or has had Zika and his female sex partner is pregnant, it is best to either abstain from sex or to use condoms throughout the duration of the pregnancy.
Zika is still primarily a vector-borne disease
In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.

21. Blood Transmission Prevention
To date, there have been no confirmed blood transfusion-transmission cases in the United States
Zika virus currently poses a low risk to the blood supply in the continental US, but this could change depending on how many people become infected with the virus
The FDA has released recommendations to help prevent blood transfusion transmission of Zika, which includes specific steps for blood collection organizations
These steps include testing all donated blood for Zika virus
In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.

22. Mosquito-to-Human Transmission Prevention: DRAIN & COVER
DRAIN water from any containers where water has collected.
COVER: If you must be outside when mosquitoes are active, cover up. Wear shoes, socks, long pants, and long sleeves.
REPELLENT: Apply mosquito repellent to bare skin and clothing. Always use repellents according to the label. Repellents that contain EPA-registered active ingredients are considered most effective.
In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.

27. Can I get tested for Zika?
To get tested for Zika, you must meet one of the following criteria*:
Pregnant
Mother of an infant or fetus with microcephaly (Testing of both mother and infant is recommended)
Travel to a Zika-affected area + 2 or more symptoms
A suspect locally-acquired case

29. Any Questions?
Great resource for updated information about Zika virus:
Florida Department of Health in Miami-Dade County
Epidemiology, Disease Control, & Immunization Services