FIRST CONFIRMED CASE OF IMPORTED ZIKA VIRUS IN HOUSTON, TEXAS. Preventing Transmission

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1 FIRST CONFIRMED CASE OF IMPORTED ZIKA VIRUS IN HOUSTON, TEXAS Preventing Transmission

2 Objectives Discuss the epidemiology of Zika virus Describe the Zika case investigation of the first confirmed case in Houston, Texas. Discuss how emerging diseases are controlled by timely identification and reporting from clinicians. Articulate the importance of prompt surveillance and patient education in preventing the spread of vector-borne diseases.

3 Zika Virus Introduction Single stranded RNA Virus Family Flaviviridae, Genus Flavivirus Related to dengue, Japanese encephalitis, yellow fever, and West Nile Virus Transmitted to humans by Aedes species mosquitos.

4 Zika Virus Time-line

5 Modes of Transmission

6 Other Modes of Transmission Sexual Blood Transfusion Maternal-fetal Laboratory exposure Theoretical Breast Milk Organ or tissue transplantation

7 Description of Illness 1 in 5 people become ill. Illness is usually mild. SYMPTOMS: Fever Rash Joint pain Conjunctivitis Myalgia Headache Malaise

8 Treatment -No Vaccine -Rest -Fluids -Medicine

9 Prevention Avoid Bites Repellent Long Sleeves/Pants Air Conditioning Screens/Nets Drain Standing Water

10 ZIKA CASE INVESTIGATION On November 16, 2015 a Houston clinician reported to the Houston Health Department, Bureau of Epidemiology two suspected cases of Zika virus. An investigation was conducted to determine the source of infection and prevent the spread of disease.

11 CASE INVESTIGATION CONTINUED Suspect Case #1 Suspect Case #2 59 Year Old Hispanic Female Onset Date: 11/10/15 Travel to Colombia 60 Year Old Hispanic Female Onset Date: 11/13/15 Travel to Colombia

12 CASE INVESTIGATION CONTINUED BOTH SUSPECTED CASES TRAVELED TO SANTA MARTA, COLOMBIA BETWEEN 11/03/15 &11/10/15

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14 CASE INVESTIGATION CONTINUED Suspect Case #1 Symptoms Suspect Case #2 Symptoms Fever Diarrhea Arthralgia Fatigue Muscle pain Rash Pain behind eyes Upset stomach Fever Fatigue Diarrhea Arthralgia Rash Conjunctivitis Headache Pain behind eyes

15 CASE INVESTIGATION CONTINUED Education provided to patients Communication with the State Health Department and CDC Hurdles we had to overcome

16 Blood Sample Blood samples were taken and sent to the Centers for Disease Control and Prevention at Fort Collins for testing.

17 CASE INVESTIGATION TESTING ELISA IgM PRNT Limitations: Cross-reactivity with other Flaviviruses Serology results should be interpreted with caution

18 CASE INVESTIGATION RESULTS Suspect Case #1 Suspect Case #2 Zika IgM ELISA= Positive Dengue = Positive Chikungunya= Negative West Nile = Negative St. Louis Encephalitis= Negative Zika IgM ELISA= Positive Dengue = Negative Chikungunya= Negative West Nile = Negative St. Louis Encephalitis= Negative

19 CASE INVESTIGATION CONCLUSIONS Both cases were imported from Colombia where local transmission is ongoing. Rapid identification of disease and notification by the clinician. Education provided by public health investigator played a pivotal role in preventing transmission to mosquitos in the Houston area. Texas case counts

20 Conclusions Continued Mosquito-based Surveillance Vector Control Outbreaks

21 Strategy to Respond to Zika Develop laboratory testing capacity Investigate cases and their contacts Coordinate with mosquito control surveillance Conduct neighborhood outreach to vulnerable communities Clean-up garbage in neighborhoods Eliminate standing water Maintain situational awareness in the city and region Improve our understanding of the virus and its effects Educate travelers & expecting mothers Mosquito Control (HCPHES)

22 Zika Virus Complications

23 Aruba Barbados Bolivia Bonaire Brazil Colombia Commonwealth of Puerto Rico, US territory Costa Rica Curacao Dominican Republic Ecuador El Salvador French Guiana Guadeloupe Guatemala Guyana Haiti Honduras Jamaica Martinique Mexico Nicaragua Panama Paraguay Saint Martin Saint Vincent and the Grenadines Sint Maarten Suriname Trinidad and Tobago U.S. Virgin Islands Venezuela * As of February 29, 2016

24 Zika Virus Complications Guillain-Barre syndrome (GBS) -Symptoms -Treatment Countries Reporting Cases

25 Birth Defect Microcephaly Number of microcephaly cases reported in the Northeast Region of Brazil by Epidemiological Week (8 November February 2016). Pan American Health Organization / World Health Organization. Zika Epidemiological Update 24 February Washington, D.C.: PAHO/WHO; 2016 Pan American Health Organization PAHO/WHO, 2016

26 Brazil Microcephaly Cases There have been a total of 5,640 microcephaly cases reported by the Ministry of Health of Brazil. So far 583 of these are confirmed cases. The others are being investigated

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29 U.S. Territories Confirmed Zika Cases US Virgin Islands Puerto Rico American Samoa American Samoa Puerto Rico US Virgin Islands Locally acquired cases Travel-associated cases 0 1 0

30 Distribution of Aedes Aedes aegypti Most likely originated in Africa Aedes albopictus Originated in Asia

31 Prevention Continued Mosquitos are container breeders Eliminate all breeding sites in and around your home to prevent disease transmission.

32 Mosquito Fun Facts Where do mosquitos live? How do they spread? Mosquitos have evolved Sip feeders

33 References Centers for Disease Control and Prevention. All Countries and territories with Active Zika Virus Transmission. Centers for Disease Control and Prevention. Zika Virus. Centers for Disease Control and Prevention. Zika Virus-What clinicians need to know power-point. Clinician Outreach and Communication Activity Call January 26, 2016 Centers for Disease Control and Prevention. Memorandum. February 7, Centers for Disease Control and Prevention. Zika Virus disease in the United States, Centers for Disease Control and Prevention. Surveillance and Control of Aedes aegypti and Aedes albopictus in the United States. J.D. Honigberg International, Inc. International Sales and Export Management. Shipping container figure. MedlinePlus. CDC reports link between Zika virus and microcephaly. Pan American Health Organization / World Health Organization. Zika Epidemiological Update 24 February Washington, D.C.: PAHO/WHO; 2016 Pan American Health Organization PAHO/WHO, 2016 World Health Organization. Countries and territories showing historical time-line of Zika virus spread ( ). Parents. Zika Virus: Everything Pregnant Women should know. Zika Figure.

34 References Unicef. What you need to know about the Zika virus. February 12, World Health Organization. Zika Epidemiological Update. 3 March World health Organization. Cumulative Zika Susect and Confirmed cases reported by countries and territories in the Americas World health Organization. Zika Virus. World Health Organization. Weekly Epidemiological Record. 19 February 2016, vol. 91, 7 (pp.73-88). World Health Organization. Suspected and confirmed Zika cases reported by countries and territories in the Americas, World Health Organization. Zika: the origin and spread of a mosquito-borne virus.

35 Thank You For Joining Me Presenter: Amanda Eckert, MPH Surveillance Investigator Houston Health Department Bureau of Epidemiology 8000 North Stadium Drive Houston, TX Phone: Thank you to everyone who helped with this investigation especially: Thomas Johnson Jr., BS, Brenda Thorne, MS, Salma Khuwaja, MD, MPH, DrPH, and Raouf Arafat, MD, MPH.