Zika as a reportable condition Testing approval and result notification Zika pregnancy registry Is there a risk of local transmission?

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2 Zika as a reportable condition Testing approval and result notification Zika pregnancy registry Is there a risk of local transmission? Immediate NC surveillance activities Building entomologic capacity

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4 Emergency order signed by the State Health Director on February 1 makes Zika virus infection reportable by clinicians and laboratories in NC National case definition is established North Carolina case report form in use Cases reported to CDC via ArboNET

5 Emphasis on pregnant women who Have a compatible illness and appropriate travel history Have a compatible illness and condomless sex with a male partner who has traveled to an area of ongoing Zika virus transmission and who has had symptoms of Zika virus disease during travel or within 2 weeks of return. Have an appropriate travel history and who have ultrasound findings of fetal microcephaly or intracranial calcifications

6 Testing may also be considered for Asymptomatic pregnant women with an appropriate travel history Any person presenting with signs and symptoms consistent with Zika virus disease within two weeks of travel to an area with ongoing transmission Symptomatic persons who have had condomless sex with a male partner who has traveled to an area of ongoing Zika virus transmission and who has had symptoms of Zika virus disease during travel or within 2 weeks of return.

7 Zika Testing Approval Process If a provider contacts their local health department (LHD) If a provider contacts the Communicable Disease Branch (CDB) LHD completes Zika case report form (CRF) CDB completes Zika case report form (CRF) LHD contacts CDB for approval Patient does not meet CDC testing guidelines Patient meets CDC testing guidelines Patient does not meet CDC testing guidelines Patient meets CDC testing guidelines LHD alerts provider that testing is not approved; no further action needed The LHD: Notes approving staff person s name on CRF Faxes CRF to CDB Alerts provider that testing is approved Provides guidance on specimen collection, completion of laboratory forms CDB alerts provider that testing is not approved; no further action needed CDB faxes CRF to LHD; sends alert to LHD The CDB: Alerts provider that testing is approved Provides guidance on specimen collection, completion of laboratory forms

8 Zika Test Result Notification Process The NC State Laboratory of Public Health (SLPH) receives a Zika test result from CDC SLPH immediately fax POSITIVE results to CDB and all submitters listed on the DASH form SLPH faxes NEGATIVE results in a timely manner to CDB and all submitters listed on the DASH form CDB confirms the result and patient identification CDB confirms the result and patient identification CDB notifies the LHD of the result: If it is the county s first positive result, CDB will call the health director If the health director is unavailable and for all subsequent positive results, CDB will call the CD nurse CDB will fax the lab result to the LHD The county decides if CDB or the county will contact the provider CDB notifies the LHD of the result: CDB contacts the CD nurse CDB will fax the lab result to the LHD CDB reports the positive result to CDC via ArboNET

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10 Will include: pregnant women meeting the suspected, probable, or confirmed CSTE case definition all asymptomatic pregnant women with laboratory evidence of Zika virus infection Distinction Just because a person is included in the registry does not mean the person is a case

11 CDC will work with states to coordinate activities States will determine how reporting and follow-up procedures work in their jurisdiction

12 CDC is working with national organizations to alert providers about the registry (e.g., ACOG) CDC does not plan to release state-specific information Aggregate information from the registry may be released

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14 Same mosquitoes that transmit dengue and chikungunya Widely distributed throughout Americas Aggressive daytime biters

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16 Outbreak Year Vector Gabon 2007 A. albopictus Yap (Federated States of Micronesia) 2007 A. hensilli French Polynesia A. polynesiensis & aegypti Brazil & South America A. aegypti

17 ~ 65 mosquito species present in NC Relative distribution and abundance not quantified Some local mosquitoes transmit infections Disease La Crosse Encephalitis West Nile Encephalitis Eastern Equine Encephalits Mosquito vector Aedes triseriatus Culex spp. Culiseta spp. How do we learn more about our mosquitoes, and how to manage them?

18 Education and community outreach Entomologic surveillance and mapping Set action thresholds Source (habitat) reduction Biological control Public health mosquitocides Larval } Use in compliance with NC Division of Water Quality/National Pollutant Discharge Elimination System rules Adult Monitor for efficacy and resistance Record Keeping

19 Office of the Governor and the DHHS have made it a priority to build capacity DPH is now recruiting for two entomologists Funding will be available to help local health departments provide education and conduct surveillance This is tremendous opportunity that will benefit all people in NC

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21 Education campaign Larval surveillance Ovitrap surveillance

22 March 2016 survey Mosquito education campaign Mosquito surveys Larvicide treatment Vector distribution maps Efficacy of source reduction and larvicide treatment Adulticide treatment CDC Resource /resources/vectorcontrol.html

23 25 County Mosquito Control Activities (N=73) Education Campaign Mosquito Survey Larvicide Mosquito Distribution Map Efficacy of Larvicide Adulticide

24 Partnering with WCU, ECU, and NCSU Goal Determine presence of containerinhabiting mosquitoes in NC, especially Ae. Aegypti and Ae. albopictus Target counties Larval survey Ovitrapping Counties with local resources will speciate larvae Reference labs will hatch eggs and speciate adults, as well as speciate larvae for counties Reference labs will also verify collections of Ae. aegypti and other novel species

25 Mosquito Survey Map 2016 A L L E G A S H E S U R R Y C A S W E S T O K E R O C K I G R A N V W A R R E G A T E S C U R R I P E R S O N O R T H V A N C E C A M D E H E R T F W A T A U W I L K E H A L I F P A S Q U M I T C H A V E R Y Y A D K I F O R S Y G U I L F A L A M A P E R Q U 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 I R E D E M A R T I W A S H I T Y R R E M C D O W B U R K E D A V I D H A Y W O S W A I N B U N C O C A T A W R A N D O C H A T H W A K E W I L S O D A R E R O W A N P I T T G R A H A L I N C O L E E J O H N S G R E E N B E A U F J A C K S H E N D E R U T H E C H E R O M A C O N T R A N S P O L K C L E V E G A S T O C A B A R H Y D E S T A N L H A R N E M O N T G M E C K L M O O R E W A Y N E 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 C A R T E S C O T L 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 B R U N S N E W H Participating Military Base Participating March 2016

26 Updated baseline data Temporal trends Allow for detection of novel species Foundation for sustainable statewide entomologic surveillance program

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28 Vector borne diseases represent approximately 15% of all reported general communicable diseases (VPDs and STIs excluded) in North Carolina Primarily SFGR NC has one of the highest incidence rates of LACE

29 The complex life and transmission cycles of many vector borne conditions requires a thorough understanding of the ecology of the organism to characterize environmental risk factors, identify methods to interrupt disease transmission, and educate the public and providers

30 Vectorborne Program Communicable Disease Branch A Comprehensive Approach to Integrated Mosquito Management in North Carolina Vectorborne Diseases West Nile Virus Zika Virus Dengue Chikunguyna Eastern Equine Encephalitis Staff Entomologists Veterinarians Environmental Health Epidemiologists Communications Activities Entomologic Surveillance Human Surveillance Outreach and Education Testing Building capacity for vector surveillance, control and education Partners Local Health Departments Women s Health Branch* State Laboratory of Public Health NC Department of Agriculture NC Emergency Management Birth Defects Unit* * The Women s Health Branch and Birth Defects Unit would be involved primarily with Zika virus

31 CDB Vector borne disease nurse consultant, also responsible for TATP State public health veterinarian, also responsible for rabies, zoonotic and foodborne SLPH Special serology staff

32 New program will be focused on understanding the ecology of tick and mosquito borne conditions to mitigate their impact on people. The former PHPM program was defined by statutes that were repealed when the staff and funding for the program were abolished The new program will not have specific laws directing its function but will be based on the principles and practice of communicable disease control

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