1. ACPM Zika Practicum Rotation at Harris County Public Health in Houston, Texas
Sarah Siddiqui, MD, MPH
University of Texas Medical Branch
Internal Medicine/ Preventive Medicine Residency
ACPM Annual Meeting: May 24, 2017

2. Overview Harris County Public Health (HCPH)
Zika in Texas & Harris County
Zika Practicum
1) Department Rotations
2) Practicum Project
Source: HCPH

3. Harris County Public Health (HCPH)
Local health department that serves Harris County, Texas
Harris County is the third most populous county in the nation (estimated population of 4.34 million)
Spread over 1,778 square miles (larger than the state of Rhode Island)
Very diverse & growing population within the county
Map of Harris County, Texas
Source: HCPH

4. Zika in Texas & Harris County
Since 2015: 334 cases of Zika disease in the state of Texas
In November 2016: Evidence of vector-borne local transmission in Cameron County
Reported Cases of Zika Disease in Harris County & Texas,
2015
2016
2017
Total
Harris County 7 75 1 83
Texas 8
314 12
334
Source: Texas Department of State Health Services (DSHS). Data as of May 12, 2017.

5. Zika Practicum Rotation
Time period: March-April 2017
1) Rotated with following departments:
Epidemiology Program (DCCP)
Mosquito & Vector Control Division (MVCD)
Office of Public Health Preparedness & Response (OPHPR)
2) Conducted a retrospective investigation with Epidemiology Program

6. HCPH Zika Response Team
Created in January 2016
Multi-disciplinary Team
One Health Approach
Mosquito & Vector Control Division (MVCD)
Epidemiology Program
Diseases Control & Clinical Prevention Division (DCCP)
Veterinary Public Health (VPH)
Environmental Public Health (EPH)
Additional Areas of Focus:
Emergency Preparedness and Response
Legal Review and Authority
Health Care Provider/Clinical Outreach
Communications and Community Engagement
Source: HCPH

7. Epidemiology Program Surveillance & Testing
Evaluate and monitor surveillance data for travel-related cases of Zika
Identify emergence of locally-acquired Zika cases
Health Care Provider/Clinical Outreach
Disseminate information on Zika through locally-operated Health Alert Network
Work with healthcare partners within the community on clinical scenarios

8. Mosquito & Vector Control Division
Surveillance
Neighborhood Inspections
Spraying Operations
Insecticide resistance testing
Education & outreach among the community
Research
Studying new methods for vector control including improving surveillance and reducing risk of vector exposure
Source: HCPH MVCD

9. MVCD
Source: HCPH MCVD

10. Office of Public Health Preparedness & Response
Coordinate with Harris County partners on HCPH’s Zika activities
Coordinate and train a multi-disciplinary team (MDT) to conduct epidemiological, environmental, and mosquito assessments when a symptomatic confirmed Zika case is reported within Harris County
Zika Alert System
Level 4 - Normal Conditions: No cases of locally acquired Zika in county
Level 3 - Increased Readiness: 1+ cases of locally acquired Zika in 1 geographic area within county
Level 2 - High Readiness: 1+ cases of locally acquired Zika in >1 geographic area within county
Level 1 - Maximum Readiness: Widespread cases of locally acquired Zika throughout county

11. Zika Practicum Project

12. Project: Purpose
To determine the Zika lab testing status of patients who accessed HCPH’s Refugee Health Screening Program (RHSP) and were referred for possible Zika exposure
To assess whether the Zika lab testing performed was according to recommendations by Centers for Disease Control & Prevention (CDC)

13. Project: Background
Texas: second largest refugee resettlement state in the United States
HCPH’s RHSP
Largest program of its kind in Texas
Only screening program for refugees in Harris County
Total number of individuals who accessed RHSP in 2016: 8,737
64% of these individuals’ country of origin was Cuba
In early 2016, implemented Zika referral process at RHSP
Vulnerable refugee population utilizing these services especially those who travel via South America and Central America in order to enter the U.S.
Possible exposure to Zika virus in these areas of active transmission
Source: HCPH Refugee Health Screening Program

14. Algorithm of Zika Referral
RHSP’s Zika Referral Algorithm
Source: HCPH Refugee Health Screening Program

15. Project: Methods Retrospective investigation
Identified individuals who accessed RHSP and had Zika referral submitted due to history of possible exposure from February 17, 2016 thru March 3, 2017
Reviewed medical charts and conducted phone interviews with clinical staff of OB/GYN clinics
Assessed whether Zika lab testing was based on CDC’s recommendations

16. Project: Preliminary Findings
Several missed opportunities of lab testing
Some inappropriate lab testing
Findings support the need to change the Zika referral process
HCPH’s RHSP collaborated with neighboring health departments to implement a process in which RHSP’s clinics directly collect laboratory testing for all Zika referrals
This will:
Provide more consistent care especially among a vulnerable population such as refugees
Avoid missed opportunities of Zika lab testing when recommended

17. Overall Experience
Gain understanding of how a local public health department addresses the challenges and responds to the emerging Zika virus in a large community with diverse population
Recognize the importance of multi-disciplinary and One Health approach to combating Zika virus
Understand the functions of the Epidemiology Program, MCVD, and OPHPR related to Zika response

18. Acknowledgements American College of Preventive Medicine
Centers for Disease Control & Prevention
Harris County Public Health
University of Texas Medical Branch