Zika Virus Update. Partner Webinar 05/12/2016

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1 Zika Virus Update Partner Webinar 05/12/2016

2 Today s presenters Patricia Quinlisk, MD, MPH, Medical Director /State Epidemiologist Ann Garvey, DVM, MPH, MA, State Public Health Veterinarian/ Deputy State Epidemiologist Julie Coughlin, MPH Vector-Borne and Influenza Epidemiologist

3 Topics to be Covered Virus Epidemiology Recommendations and Guidance Review Testing Approval Process Result Notification and Case Investigation Plenty of Time for Questions

4 Zika is not new 1947 first discovered in Zika Forest in Uganda Routine Yellow Fever surveillance Captive Rhesus monkey 1948 recovered from mosquito 1952 first human cases detected in Uganda and Tanzania

5 Spread Expands to Asia India, Indonesia, Malaysia, and Pakistan 2007 First human outbreak in Pacific Island of Yap Prior to this outbreak only 14 human documented cases 11,250 people on island- 185 suspected cases Outbreaks on other Pacific Islands French Polynesia, Easter Island, Cook Islands, and New Caledonia Thousands of suspected cases

6 Brazil March 2015: Brazil reports unidentified illness to WHO February to May 2015: Nearly 7,000 illnesses in Brazil Mild illness, no deaths Zika not suspected / no testing February 2016: WHO declares Public Health Emergency of International Concern Virus most similar to the one circulating in the Pacific 2014 World Cup- no participants from Pacific Islands? 2014 Canoe event in Rio- Pacific Islanders competed? Overland from Chile-had case in a returning traveler from Easter Island?

7 Areas with Active Zika Transmission

8 Zika Virus Flavivirus Similar to yellow fever, dengue, West Nile and Japanese encephalitis viruses Human and non-human primates reservoirs Primarily transmitted by Aedes mosquitoes Aedes aegypti - Primary Aedes albopictus DAYTIME BITERS Thrive in tropical and subtropical climates but are poorly adapted to the climate and landscape in Iowa

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10 Illness Zika Virus 20% of infected people are symptomatic Acute fever, maculopapular rash, arthralgia, conjunctivitis Usually mild illness lasting up to a week Hospitalization and case fatality rates low Usually remains in the blood of an infected person for about a week but sometimes longer Once infected, likely to be protected from future infections.

11 Zika Virus Treatment No specific antiviral treatment Supportive care Treat fever with acetaminophen, avoid aspirin and other NSAIDs until dengue is ruled out Protect from further mosquito exposure for three weeks after illness to prevent risk of local transmission

12 Zika Virus: Rare Transmission Blood transfusions Sexual In-utero Maternal-fetal transmission documented throughout pregnancy

13 FDA recommends that donors defer for 4 weeks if: A history of Zika virus infection (wait 4 weeks after the resolution of symptoms) Travel to the United States from an area with active Zika virus transmission and symptoms suggestive of Zika within 2 week of travels Sexual contact with a man who has been diagnosed with Zika virus infection Sexual contact with a man who traveled to or lived in an area with active Zika virus transmission in the 3 months before the sexual contact Living in or traveling to an area with active Zika virus transmission

14 Zika Virus and Sexual Transmission Male Partner (+/- Female Partner) Traveled to a Zika-infected Area: Female is pregnant Abstain or use condoms for duration of pregnancy Female is not pregnant Man symptomatic and/or tests positive for Zika- use condoms or abstain for at least 6 months after symptoms begin Man asymptomatic use condoms or abstain for at least 8 weeks after return Female Partner Traveled (Male Did Not) and Wants to Get Pregnant Wait until at least 8 weeks after symptom onset (or travel if asymptomatic) before attempting conception.

15 Not testing for risk of sexual transmission Testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the duration and pattern of shedding of Zika virus in the male genitourinary tract is limited. Neither serum nor semen testing of men for the purpose of assessing risk for sexual transmission is currently recommended

16 Zika Virus & Pregnancy Maternal-fetal transmission documented throughout pregnancy Association with increased risk for congenital microcephaly and other abnormalities of the brain and eye Microcephaly leads to mild-severe movement and balance challenges hearing and vision problems seizures developmental delay intellectual disability Source: BBC

17 Zika & Breastfeeding Zika virus has been identified in breast milk, but attempts to culture the virus have been unsuccessful. No evidence of Zika virus infection associated with breastfeeding have been reported. Current evidence suggests that the benefits of breastfeeding outweigh the theoretical risks of Zika virus infection transmission through breast milk. CDC encourages mothers with Zika virus infection and mothers living in areas with ongoing Zika virus transmission to breastfeed their infants.

18 Travel Advisories for Pregnant Women CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing If do travel, strictly follow steps to avoid mosquito bites

19 Travel Alert Level 2, Practice Enhanced Precautions Mosquito bite prevention Use of repellant Permethrin on clothing Mosquito nets as appropriate When return: Mosquito prevention for 3 weeks Sexual transmission recommendations on earlier slide Educational Resources available at:

20 Who can be tested? 1. Pregnant women with travel history (2-12 wks) 2. Persons who become ill (fever, rash, arthralgia, or conjunctivitis) within 14 days of travel 3. Persons with possible sexual exposure who become ill 4. Pregnant woman with possible sexual exposure if either she or her male partner developed consistent symptoms 5. Babies with microcephaly or other abnormalities of the brain or eye if mother possibly exposed

21 Test Approval Process Call us in the Center for Acute Disease Epidemiology (CADE) Testing criteria Collect patient information Specimen collection Transporting specimen to State Hygienic Laboratory (SHL) Test request forms (currently a SHL and CDC form are required)

22 Test Request Forms

23 Result Notification Negative result Results are released through standard SHL process Local public health- not notified of everyone being tested in their county due to volume / workload Positive result IDPH calls healthcare provider Results are released through standard SHL process IDPH calls local public health and case entered in IDSS (local public health has access to all case information)

24 Case Investigation Case information is collected from healthcare provider Most information is collected during the test approval process Completed by CADE staff. No follow-up by local public health. Healthcare provider notifies patient (per normal procedures)

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26 Zika Testing in Iowa ~180 approved for testing 5 positives None pregnant Of those tested ~90% female ~78% of females are pregnant

27 Questions.

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