1. Amanda Mehl, RN, MPH Lynden Schuyler, MBA, MPH
Boone County Health Department 
1204 Logan Ave.
Belvidere, IL 61008

2. How Scary is Zika?
Dr. Tom Friedan, former CDC director, said the following in an interview in April 2016:
“Never before in history has there been a situation where a bite from a mosquito could result in a devastating malformation. . . The last time an infectious pathogen, rubella virus, caused an epidemic of congenital defects was more than 50 years ago”
New England Journal of Medicine

3. Pregnancy and Birth Defects What have we learned?
CDC, March 1, 2017

4. What’s at Stake?
Zika infection during pregnancy can cause serious birth defects and is associated with other pregnancy problems.
Although Zika is possibly linked to increased likelihood of miscarriage and stillbirth but evidence is insufficient to confirm Zika absolutely.
Several countries that have experienced Zika outbreaks recently have reported increases in people who have Guillain-Barré syndrome (GBS).
CDC Update for Pediatric Health Care Providers. Pediatrics. 2016

5. These Pictures Are From 1990

6. As of July 26, 2017
Total Zika Virus disease cases reported
US and DC = 5,359
US territories = 36,620
Pregnant women with lab evidence of Zika Virus infection
US and DC = 2,047
US territories = 4,285
New symptomatic Zika cases for 2017
US States and DC: 175 (3 in Illinois currently)
One case in US through sexual transmission
US Territories: 532 (all presumed to be locally acquired)
*Source: ArboNET, January 1, 2017 –  July 19, 2017 }
These numbers are fairly static
Centers for Disease Control and Prevention

7. Areas with Risk of Zika Transmission

8. Areas around the world outside of the US and US territories with Zika:
Mexico
The Caribbean:  Anguilla; Antigua and Barbuda; Aruba; The Bahamas; Barbados; Bonaire; British Virgin Islands; Cayman Islands; Cuba; Curaçao; Dominica; Dominican Republic; Grenada; Guadeloupe; Haiti; Jamaica; Martinique; Montserrat; Saba; Saint Barthelemy; Saint Kitts and Nevis; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Saint Eustatius; Saint Maarten; Trinidad and Tobago; Turks and Caicos Islands
Central America:  Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama
South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, Venezuela
The Pacific Islands:  Fiji, Marshall Islands, Micronesia, Palau, Papua New Guinea, Solomon Islands, Tonga
Africa:  Angola, Guinea-Bissau
Asia:  Maldives, Singapore
wwwnc.cdc.gov/travel/notices
CDC as of

9. Territory Covered by the Mosquitos That Carry Zika

10. Illinois’s Zika Experience So Far
1,840 babies have been born to mothers in the US who were infected with the Zika virus.
91 have known birth defects
There were 43 born with microcephaly in 2016; 1 in Chicago which was travel acquired.
Microcephaly (an abnormally small head) is the most obvious birth defect but Zika attacks neural stem cells and can result in abnormal brain development that will not necessarily be obvious at birth
Seizures, developmental delays, joint problems, impaired vision and hearing can also develop
Disruptions in the central nervous system may not be apparent for months or even years.
Key word here is apparent
Illinois Department of Public Health – April 7, 2017

11. Reporting of Zika Virus Disease Cases
Zika virus disease and infection are nationally notifiable
Council of State and Territorial Epidemiologists (CSTE) updated case definitions in July, 2016
Includes non-congenital and congenital infection and disease
Healthcare providers should continue to report suspected cases to their state or local health department CSTE
State health departments should continue to report laboratory- confirmed cases to CDC according to CSTE case definitions
Timely reporting allows health departments to assess and reduce the risk of local transmission or mitigate further spread

12. There are no approved drugs or vaccines against Zika
Symptoms
Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are
Fever*
Rash*
Headache
Joint pain*
Conjunctivitis (red eyes)*
Muscle pain
*A minimum of 1 of these symptoms must be present to meet clinical criteria for testing.
Zika is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital. For this reason, many people might not realize they have been infected. 
See your doctor or other healthcare provider if you have the symptoms described above and have visited an area with risk of Zika, this is especially important if you are pregnant.
There are no approved drugs or vaccines against Zika
CDC, April 2017

13. Transmission Mosquito bite Sexual transmission Travel related
No local transmission so far in 2017
Sexual transmission
Zika can be passed from person to person during vaginal, anal, and oral sex and the sharing of sex toys
Lives in semen for 6 months
Lives in women’s bodies for 8 weeks
Lives in urine 2 weeks
Lives in blood 5 days

15. General Guidelines for Prevention
Prevent mosquito bites
Use EPA registered repellents containing Deet, Picaridin, or oil of eucalyptus.
Keep body covered – long sleeves, long pants
Permethrin-treated clothing
Sleep under netting if window screens are not available
Empty and scrub, turn over, cover, or throw out items that hold water around your home.
Stay indoors
Protect yourself during sex
The use of condoms and dental dams can reduce the chance of getting Zika from sex.
Abstain from having sex
CDC – January 2017

16. Preventing Zika if you Travel
Travel smart – check the CDC website for travel advisories.
Prevent mosquito bites
Use EPA registered repellents containing Deet, Picaridin, or oil of eucalyptus.
Keep body covered – long sleeves, long pants
Permethrin-treated clothing
Sleep under netting if window screens are not available
Empty and scrub, turn over, cover, or throw out items that hold water around your home.
Stay indoors
Protect yourself during sex
The use of condoms and dental dams can reduce the chance of getting Zika from sex.
Abstain from having sex

17. If the Patient is Male Zika can live in semen for 6 months
A man infected with Zika can spread Zika virus during sex with a pregnant woman, and the virus can pass to her fetus.
You should use condoms correctly every time you have sex or do not have sex to prevent sexual transmission.
If your partner is pregnant, use condoms or don’t have sex during the pregnancy.
CDC, January 2017

18. If the Patient is Female of Child-bearing Age
Women with confirmed or suspected Zika virus infections should wait at least 8 weeks until after the first symptoms appeared before trying to conceive
Women and men who have no symptoms but may have been exposed during travel or sexual contact should wait 8 weeks before getting pregnant
Couples who live in or travel to areas with local transmission should talk with their doctors about pregnancy planning during the outbreak, the risks of Zika infection, and how to avoid mosquito bites, acknowledging that conception timing decisions are complex, deeply personal decisions.
CDC, May 2016

19. If the Patient is Pregnant
Health care providers should ask all pregnant women about recent travel.
Pregnant women with a history of travel to an area with Zika virus should consider testing for Zika virus infection in consultation with their state or local health department
Pregnant women who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department.
Testing is not indicated for women without a travel history to an area with Zika virus transmission.
In pregnant women with laboratory evidence of Zika virus infection, serial ultrasound examination should be considered to monitor fetal growth and anatomy and referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended.
There is no specific antiviral treatment for Zika virus; supportive care is recommended.
CDC – January 2017

20. Zika in Pregnancy
Congenital Zika syndrome is a pattern of birth defects found among fetuses and babies infected with Zika virus during pregnancy. Congenital Zika syndrome is described by the following features:
Severe microcephaly where the skull has partially collapsed
Decreased brain tissue with a specific pattern of brain damage
Eye abnormalities
Hearing impairment
Seizures
Swallowing impairment
Developmental delay
Growth abnormalities - Joints with limited range of motion, such as clubfoot
Too much muscle tone restricting body movement soon after birth
CDC Update for Pediatric Health Care Providers. Pediatrics. 2016

21. The Authorization Process
Zika testing through IDPH/CDC must be requested through the local health department.
Client must meet one of the following conditions:
Pregnant female who has traveled to an area of local transmission (symptomatic & asymptomatic)
Non-pregnant persons, including men, who are symptomatic
A minimum of 1 of these * symptoms must be present to meet clinical criteria for testing
Fever*
Rash*
Joint pain*
Conjunctivitis (red eyes)*
Muscle pain
Headache
Client or partner must have recently traveled to an area with active Zika virus transmission unless local transmission has been established
Fetal ultrasound identifying calcifications of the brain or microcephaly (

22. Zika Pregnancy Registry
Obstetric healthcare providers can:
Report information about pregnant women with laboratory evidence of Zika virus to their state, tribal, local, or territorial health department.
Collect pertinent clinical information about pregnant women and their infants on the Pregnancy and Zika Virus Disease Surveillance forms.
Provide the information to state, tribal, local or territorial health departments or directly to CDC registry staff if asked to do so by local health officials.
Notify state, tribal, local, or territorial health department staff or CDC registry staff of adverse events (e.g., spontaneous abortion, termination of pregnancy).
Pediatric healthcare providers can:
Identify and report suspected congenital Zika virus exposure to their state, tribal, local, or territorial health department for possible testing.
Collect pertinent clinical information about infants born to women with laboratory evidence of Zika virus infection or infants with congenital Zika virus infection.
Provide the information to state, tribal, local or territorial health departments or directly to CDC registry staff if asked to do so by local health officials.
Notify state, tribal, local, or territorial health department staff or CDC registry staff of adverse events (e.g., perinatal or infant deaths).

23. Recommendations for Healthcare Providers:
It is critical for pregnant women to prevent Zika during pregnancy to protect their baby from Zika-related health conditions. Healthcare providers can:
Educate families about Zika prevention: Encourage pregnant women to avoid travel to areas with Zika. Tell women and men how to protect themselves from mosquito bites and from getting Zika through sex.
Ask about Zika exposure and provide all needed tests and follow-up care: Guidance is updated as more is learned about Zika, so it’s important to stay current on CDC’s recommendations. Babies with possible Zika should get a comprehensive physical exam, neuroimaging, neurologic exam, newborn hearing screening, and Zika laboratory tests (guidance as of August 2016).
Support babies and families:
Develop a coordinated care plan for babies affected by Zika, including ongoing support, follow-up care, and linking to your local health department. Help families monitor their babies’ development.

24. Medicaid Funding for Zika
$66 million allocated in late 2016; taken from child and family services
Allocations are based on the percent of active and local Zika cases reported by the CDC and the size of the populations in these areas.
Applicants must demonstrate their ability to quickly and efficiently expand existing Zika response efforts and further determine the most effective use and dissemination of funds in their respective jurisdictions.
Funds will be available for health care services related to family planning, diagnostic testing, screening and counseling, medical care, case management and treatment, and improving provider capacity and capability.
CMS.gov November 2016

25. What are We Doing at Boone County?
Beginning , all women of child bearing age were given a short questionnaire at intake assessing for possible exposure.
If they are at risk, they are counseled by one of the clinic nurses and referred for testing.
Extensive outreach to health departments and the provider communities in Boone and all surrounding counties.
Extensive outreach to the Hispanic community
Outreach to business and faith leaders in Boone and Winnebago Counties.
Media coverage to the public at large.