1. Zika info for international travelers
May, 2017

2. transmission bite of infected Aedes aegypti maternal-fetal sex
transfusion
lab
transmission

3. check wwwnc.cdc.gov before you travel
find out if level 1, level 2, level 3
level one: practice usual mosquito bite prevention precautions
level 2: zika virus is present in mosquitos and causing disease from local transmission; local transmission means infected mosquitos are spreading it to people
pregnant or going to get pregnant don’t go
level 3: ebola, malaria, too dangerous for non essential travel
level 1; practice usual precautions
level 2: practice enhanced precautions
level 3; avoid travel

4. global distribution of Zika illness
solid purple areas locally acquired cases of Zika
that means bitten by infected mosquito and became ill
locally acquired infection means
bitten by infected mosquito
and became ill with Zika

5. Case counts U.S. states Jan. 1, 2015-April 19, 2017
5,238 Zika virus disease cases reported
4939 cases were returning travelers
222 cases acquired through local
mosquito-borne transmission Florida
76 cases acquired through sexual transmission, congenital
infection
no new locally acquired cases in Florida 2017

6. case counts U.S. territories
36,575 Zika virus cases reported
143 cases in returning travelers from affected areas
36,432 cases acquired through presumed local mosquito- borne transmission
US territories Puerto Rico, US Virgin Islands, Guam, American Samoa, others

8. all islands Indian Ocean
level 2 alerts for divers
all islands Caribbean
all islands Indian Ocean
South Pacific
level 1 alert
Australia
I looked for dive locations that are Zika-free; not many. Australia has no Zika
as of March 10,2017 ongoing local transmission of Zika in Mexico, Bonaire, Curacao, Aruba, St. Vincents, Dominica, etc. on and on
Indian ocean Maldives, sulawesi, etc

9. Aedes aegypti mosquito
same mosquito that causes chikungunya, dengue, zika, yellow fever
female bites
more aggressive
white markings on legs
prefers humans lives near humans
lives 45 days
doesn’t fly far
gets infected by biting an infected person during the one week viremia

10. Aedes aegypti mosquito
different from other mosquitos;
prefers humans over animals; likes to breed in flower pots, showers, tires, very shallow water in man made containers, all year long in tropical climates
more aggressive
white markings legs
bites any time of day
prefers humans
breeds in standing water

11. for 2 hours after sunrise for 2 hours before sunset

12. transmission of Zika virus
same mosquito that transmits dengue fever, chikungunya, yellow fever,
more aggressive, prefers, biting humans during day, but also bite at night, prefer to live close to people. mosquito become infected on a sick person , then spreads to virus to other people through bites. person infected is viremic for one week after infection;
life span one month;
doesn’t fly far
Aedes mosquito
transmission of Zika virus

13. any kind of sex
virus present in all body secretions
Zika remains in semen for six months

14. transmission through sex
CDC level 2 precautions for Bahamas
use condoms or do not have sex during trip
after travel to The Bahamas, take steps to prevent mosquito
bites for 3 weeks after your trip even if you are not sick
if traveler to Bahamas has pregnant partner, no sex
during the pregnancy
pregnant women should not go
zika can be passed through sex from a person with ZIka through vaginal, anal, oral sex
timeframes that men and women can pass Zika through sex are different bc Zika virus stays in semen longer than in other body fluids
bc most people infected with Zika won’t have symptoms they may not know they have been infected

15. , arthralgias hands and feet
conjunctivitis
, arthralgias hands and feet
20 percent infected
get symptoms
(mild)
fever
pruitic rash
80% don’t know about infection
no symtoms
illness first week after bite of infected Aedes mosquito

16. zika neurotropism microcephaly Guillain-Barre syndrome seizures
meningoencephalitis
first known mosquito borne cause of birth defects
zika likes neurons
infects nerve cells
very bad congenital defects of nervous system
GB syndrome is uncommon, but with Zika infection incidence is 2 to 9.8 times higher than baseline

17. microcephaly
Brazil
Zika has been confirmed as cause of microcephaly by CDC
first known mosquito borne cause of birth defects
normal US risk of microcephaly extremely rare % Zika 14%
controversial
some people claim other cause
insect repellents cause microcephaly, etc

18. congenital Zika syndrome
microcephaly
decreased brain tissue/subcortical calcifications
orbital abnormalities
congenital contractures/clubfoot, etc
hypertonia, hyperreflexia, seizures, etc
as defined by CDC
there are many other brain and spin

19. Congenital Zika Syndrome
WHO
report
Congenital Zika Syndrome
Brazil has 10,867 suspected cases
2,336 confirmed cases by medical personnel

20. outcomes for pregnancies with positive Zika tests in USA
CDC April 11, 2017
outcomes for pregnancies with positive Zika tests in USA
completed pregnancies 1,367
liveborn pregnancies with birth defects 58
pregnancy losses with birth defects 7

21. no excess microcephaly noticed cases in French Polynesia
2013 in one year had over 20,000cases Zika and GB was noticed
2 cases of GB is considered normal but with outbreak at 42 cases in Tahiti
outbreak disappeared very quickly-good news.

22. cause of dengue, chikungunya, yellow fever

23. US distribution of Aedes mosquito
estimate

25. does zika recovery confer immunity?
probably yes

26. info for infected travelers
don’t get pregnant
don’t have unprotected sex
check for standing water around house
get tested
avoid mosquito bites
blood test
urine test

27. South Florida Miami - Dade County no US residents have contracted
March 10, 2017 preparation for spring mosquito season
pesticide
larvicide
on the ground inspections
130 bug traps across county
South Florida hit very hard last summer with
no US residents have contracted
Zika from a local mosquito 2017

28. size of circle estimated monthly average arrivals to US from countries on /CDC Zika advisory; color is Aedes aegypti potential abundance in July 2017
U.S. forecast for summer 2017

29. prevention for travelers
check CDC website
bring good repellent
long pants and sleeves
mosquito nets
AC, screens
check room
showers and toilets for larvae
check for standing water –

30. DEET
vaccine
GMO
prevention

31. vaccine phase 2 trials already going on by NIH
maybe 2020? vaccine available
multiple private companies and governments are researching