1. NC Zika Virus Response Julie Casani, MD, MPH Mike Sprayberry

2. Ongoing Activities for North Carolina
Epidemiology
Health Care Provider Guidance
Blood Safety
Pregnancy and Zika virus
Guidance to Prevent Sexual Transmission
Pregnancy Registry
Mosquito Surveillance / Management
Outreach for communication / public education
Public Health – Emergency Management Partnership

3. Epidemiology (as of July 6, 2016)
North Carolina
Travel-associated cases reported: 18
Locally acquired cases reported: 0

4. Zika Health Care Provider Guidance

5. U.S. Zika Pregnancy Registry
The North Carolina Division of Public Health is currently working with CDC to enroll all pregnant women with positive or indeterminate Zika virus test results in the Pregnancy Registry.
Who is included?
Pregnant women in the United States with laboratory evidence of Zika virus infection (positive or inconclusive test results, regardless of whether they have symptoms).
Prenatally or perinatally exposed infants born to these women.
Infants with laboratory evidence of congenital Zika virus infection are eligible for inclusion in the registry.
Information will be collected from routine medical care of women through pregnancy and infants through the first year of life.
Successful implementation will rely on effective partnership with obstetricians, gynecologists and pediatricians

6. U.S. Zika Pregnancy Registry Provider Guidance

7. Zika Blood Safety: FDA Guidance
The FDA has provided blood establishments that collect Whole Blood and blood components recommendations for donor screening, donor deferral and product management to reduce the risk of transfusion-transmitted Zika virus.
Blood Centers and Operators in North Carolina
American Red Cross
Armed Services Blood Center
Community Blood Centers of the Carolinas
Duke Apheresis Donor Program
REX Blood Services
The Blood Connection, Greenville, South Carolina
Cape Fear Valley Health
University of North Carolina Blood Center
Wake Med Apheresis Donor Program
The Division of Public Health is coordinating with these agencies along with the North Carolina Emergency Management and the N.C. Association of Blood Bankers, to ensure uniformity of action and delivery of guidance.

8. NCSLPH Testing Associated with Zika Virus
CDC EUA MAC ELISA
Verified and implemented 4/01/16
Extensive cross-reactivity with DENV
Positive specimens require PRNT confirmation due to Flavivirus cross reactivity
CDC Trioplex rRT-PCR to detect CHIKV, DENV, and ZIKAV
Verified and Implemented 6/01/16
Serum, CSF, urine*, amniotic fluid*
Dengue virus - currently evaluating commercial IgM assays
Chikungunya virus
CDC MAC ELISA
CDC distribution of reagents discontinued and
SLPH evaluating commercial assays
* May only be tested for Zika alongside a patient-matched serum specimen

9. Short Term Mosquito Survey
Statewide survey of container inhabiting Aedes species mosquitoes has not been accomplished in NC since 1994
The survey is being administered through partnership with Western Carolina University, NC State and East Carolina University.
Collections have begun and data will be available soon.

10. Survey Purpose
This survey is designed to update distribution records of container‐inhabiting Aedes species in selected North Carolina counties.
Particular effort is focused on determining the presence of Aedes albopictus and/or Aedes aegypti within counties that are in metropolitan statistical areas (MSAs), or other areas likely to be at higher risk for transmission of arboviruses by Aedes mosquitoes.
In addition to larval and pupal surveys, a series of ovitrap surveys will be used at key MSAs to establish temporal trends and relative species abundance while increasing the probability of detecting the presence of Aedes aegypti at surveyed locations.

11. Survey Locations

12. Mosquito Survey Map 2016 East Carolina UniversityH E A L L E G S U R R Y S T O K E R O C K I C A S W E G R A N V W A R R E N O R T H G A T E S C U R R I P E R S O V A N C E C A M D E H E R T F W A T A U P A S Q U W I L K E H A L I F Y A D K I F O R S Y A L A M A P E R Q U M I T C H A V E R Y G U I L F O R A N G F R A N K B E R T I C H O W A M A D I S C A L D W Y A N C E A L E X A D A V I E D U R H A N A S H E D G E C T Y R R E I R E D E W A S H I B U R K E D A V I D M A R T I W A K E H A Y W O M C D O W B U N C O C A T A W R A N D O C H A T H W I L S O D A R E S W A I N R O W A N P I T T J O H N S G R A H A L I N C O L E E G R E E N B E A U F H Y D E J A C K S H E N D E R U T H E C A B A R G A S T O S T A N L H A R N E P O L K C L E V E M O N T G M O O R E W A Y N E C H E R O M A C O N T R A N S M E C K L L E N O I C R A V E C L A Y P A M L I U N I O N R I C H M H O K E C U M B E A N S O N S A M P S J O N E S D U P L I S C O T L C A R T E O N S L O R O B E S B L A D E P E N D E C O L U M N E W H B R U N S
East Carolina University
Counties that are white did not respond
Western Carolina University
North Carolina State University (Go Pack! )

13. Mosquito Collection Seymour Johnson AFB
Senior Airman Shaun Mclaughlinwaite, 4th Aerospace Medicine Squadron Public Health technician, prepares mosquito larvae for preservation, identification and shipment April 25, 2016, on Seymour Johnson Air Force Base, North Carolina.
Once prepped, the larvae were shipped to East Carolina University and the United States School of Aerospace Medicine for further examination.
Photo and caption courtesy of Seymour Johnson Air Force Base

14. PHERT Integrated phased response plan for local transmission
Implemented when we have confirmation of a known, or suspected, Zika viremic individual that may be at risk for initiating local mosquito-borne transmission.
Assumption: ongoing mosquito surveillance will not be to the level to inform risk of local transmission at the individual’s residence.
Goal: provide entomologic risk assessment and risk abatement around the viremic individual.
Team: entomologists will skills to assess, identify and abate
Collection and identification of Aedes species
Risk abatement
Recommendations for -cidal actions
It is assumed that there will not be on-going local surveillance for Zika vectors (e.g., Aedes aegypti and Aedes albopictus) at a scale that will be informative for risk assessment at the Zika case residence. Thus the NC PHERT will rapidly identify and analyze entomological risk(s) by determining the presence or absence of Aedes aegypti or Aedes albopictus, measuring Zika virus infection rates and/or parity status in anthropophilic mosquitoes, and calculating container indices. These data will be evaluated in the context of additional environmental (e.g., residential and landscape factors) and epidemiological considerations to provide recommendations for immediate mosquito control activities.

15. Zika Outreach & Education
Worked with the Office of the Governor and NC DHHS to issue a proclamation which declares April as Tick and Mosquito Awareness Month.
Created a Zika tool kit which contains materials that can be used by local health departments, medical providers and the general public. Some of the materials include key messages on prevention of Zika virus, mosquito control, laboratory testing guidance and provider guidance. The kit can be found here:
Updated the Zika virus web page to make it easier for the public to use in order to find personal protection messages and tips on mosquito reduction.
Held a conference call with local health directors and communicable disease nurses to provide updates on Zika provider guidance and updated prevention messages.

16. Funding CDC PHPR Epidemiology and Laboratory Capacity
State contract for mosquito control contract
Support to Local Health Departments for incident management, public education and mosquito control
Epidemiology and Laboratory Capacity
State appropriations
Zika Specialist = Entomologist
Support to Local Health Departments for mosquito control and public education

17. What’s Unique to NC
“High risk” area but unknown prevalence of the vector
Home rule state
A lot of travel to/from the affected areas
Already established partnerships with many of the response agencies/ entities

18. Public Health – Emergency Management Partnership
NC Public Health has ensured that NCEM & all other pertinent State Emergency Response Team partners understand Zika threat from Day 1.
A Zika Virus Response TTX was conducted at the State EOC on 2/11/16.
Zika Virus Conference Calls with Public Health, the State Lab, & NCEM began in 2/16 & continue at this time.
NC Public Health took NCEM Director to the CDC Zika Virus Summit on 4/1/16.
In an effort to reduce risk of transfusion-transmitted Zika Virus, NC Public Health, NC Association of Blood Bankers & NCEM have worked together to ensure FDA Guidance is disseminated widely.
NCEM is prepared to provide Incident Management Team personnel to the NC Public Health EOC if event worsens – serves in an ICS position & as a Liaison with the State EOC – worked well during Ebola Event.
NCEM is prepared to work with County Emergency Managers to provide any resources required; anything from Logistical Support to Speciation Operations.

19. QUESTIONS?