1. HCPHES Responding to Zika: Planned Response Activities
Mac McClendon
Director Office of Public Health Preparedness & Response/EMC
Harris County Public Health & Environmental Services
March 23, 2016

2. HCPHES & Harris County
HCPHES serves as the county health department for Harris County (TX) with over 700 public health professionals
Third most populous county in nation with estimated population of 4.34 million
Spread over 1,778 square miles (larger than the state of Rhode Island)
Geographically, politically, and socio- demographically diverse and growing
Home to world’s largest medical center

3. Zika Virus in the Continental United States
Local transmission of Zika virus by mosquitoes has not been reported in the continental United States
With current outbreaks in the Americas, cases among U.S. travelers will most likely increase
Imported cases may result in virus introduction and local spread in some areas of U.S. with appropriate vectors and environmental conditions
Aedes aegypti and Aedes albopictus

4. Modes of Transmission Bite of infected mosquito Mother to child
Aedes albopictus
Aedes aegypti
Bite of infected mosquito
Mother to child
Sexual contact
Blood transfusion
Laboratory exposure
Theoretical
Organ or tissue transplant
Breast milk: Zika virus RNA detected

5. Zika Virus Rates 1 in 5 people infected with Zika virus become ill
All age groups can be affected
Transmitted by same mosquito species that carry Dengue and Chikungunya viruses
No severe disease, hospitalizations, or deaths

6. HCPHES Approach to Fighting Aedes
Understand Aedes vector predominance in Texas (85) & Harris County (56)
Recognize need to shift from primarily Culex-based program to incorporation of Aedes mosquito as a targeted vector
Appreciate importance of public education, personal protection, and source reduction as major tenets in fight against Aedes
Assure “One Health” and health equity lens are applied to evolving multidisciplinary response
Aedes albopictus
Aedes aegypti

7. Role of Health Equity, One Health, & MDT
Multi-Disciplinary Teams (MDT)
An internal team whose purpose is to conduct targeted mosquito, epidemiological, environmental assessments of household perimeters & proximate areas to determine need for interventions
Health Equity
One Health
MDT

8. HCPHES Planned Zika Response Activities
Level 4 - Normal Conditions: No cases of locally acquired Zika in Harris County
Level 3 - Increased Readiness: One case of locally acquired Zika in Harris County
Level 2 - High Readiness: A few or cluster of cases of locally acquired Zika within Harris County
Level 1 - Maximum Readiness: Widespread cases of locally acquired Zika throughout Harris County
Vector Surveillance and Control
Utilize mosquito surveillance using (limited) historical data on Aedes combined with (expanded) surveillance including incorporation of predictive modeling within the 268 operational areas
Generate GIS maps indicating key metrics such as mosquito population density levels of Aedes, Zika confirmed mosquito samples, local cases of human infections, and sources of breeding, etc.
Conduct necessary staff trainings for inspectors, larvicide applicators, and other MC support personnel
Acquire testing materials and laboratory equipment for mosquito virology laboratory for Zika
Work with partners and community members on key issues around reducing mosquito habitats

9. HCPHES Planned Zika Response Activities
Communications, Education and Engagement
Conduct disease prevention education, personal protection, and source reduction campaigns
Utilize media and other community partners to provide credible information to the public
Distribute insect repellent and other prevention modalities to local communities when feasible and appropriate
Create messaging in languages most appropriate for affected communities, working with area consulates, etc.
Conduct door to door education and outreach in targeted communities
Engage federal, state, and local stakeholders to coordinate efforts

10. HCPHES Planned Zika Response Activities
Epidemiology Surveillance & Testing
Health Care Provider/Clinician Outreach
Environmental Health
Veterinary Public Health
Legal Review and Authority
Preparedness and Response

11. HCPHES Operations/Response:
Multi-Disciplinary Team (MDT) activated with one symptomatic, confirmed Zika case
Provides education on Zika virus and prevention/protection measures
Conducts assessments of the case, contacts and environment within a 200 meter radius of the case’s residence
3-5 people on each team
Team Lead: Epidemiology

12. HCPHES Operations/Response: MDT assessments
Epidemiological assessment
Active surveillance for symptoms
Contact investigations
Serologic testing
Environmental assessment
Search for mosquito breeding sources (e.g. standing water in tires, flowerpots, gutters, fountains, unmaintained pools)
Address nuisance issues
Mosquito assessment
Adult mosquito sampling within and around affected area
Samples submitted for viral diagnostic testing

13. Communication, Education, and Outreach
Strategies and Tactics
Media
Social Media
Website
Advertising of Campaign Message
Community Engagement

14. Communicating to the Public
Stay on message
Be sensitive to their circumstances – financial, cultural, environmental – and listen to their concerns
Use plain language – not scientific terms or acronyms
Use interpreters when needed
Be engaging – do demonstrations to ensure they understand
Provide resources, educational materials
Make sure to follow-up
Media inquiries? Contact OCEE

15. Prevent the Bite…Day & Night Personal Protection
Wear an EPA-registered insect repellent that contains one of the following:
DEET, picaridin, IR3535, oil of lemon eucalyptus;
use according to the label
Cover up. Wear long-sleeved shirts, long pants, and socks
Place mosquito netting over infant carriers, cribs, and strollers

16. Prevent the Bite…Day & Night Mosquito-Proof your Property
Remove/empty containers that can hold water such as tires, flower pots, birdbaths, and toys; Keep rain gutters free of debris
Install or repair screens on windows and doors
Sweep up lawn clippings and leaves; Don’t feed the storm drain
Eliminate mosquito breeding sources inside your home, too

17. Questions?
For the latest on Zika Virus and Mosquito Control in Harris County, visit: