ZIKA VIRUS. Facts & Figures

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1 ZIKA VIRUS Facts & Figures ISSUED APRIL 27, 2017 Zika Virus has become a signifi cant point of concern in our communities. As with any illness or disease, it is important to know the facts, so you can better protect yourself and your families. To help you, Gila County Health & Emergency Management has created Zika Virus Facts & Figures. This brief Q&A covers frequently asked questions and identifi es available support and resources. This document will be continually updated as new information and data arise. Visit readygila.com/zika to download the latest copy. VIRUS DATA & HISTORY What is Zika Virus? Zika Virus is a virus transmitted primarily by a bite from the Aedes aegypti mosquito. In April 2017, a second mosquito, the Asian tiger mosquito, Aedes albopictus, was found to have traces of Zika virus genetic material, but not the live virus. Zika can also be transmitted via sexual contact. While illness resulting from Zika Virus is typically minor, it can be severe for those carrying an unborn child. Zika has been linked to birth defects in pregnant women, most notably microcephaly (a condition where the brain and skull do not fully develop, resulting in numerous physical and intellectual abnormalities). Additionally, in rare cases, Zika has been correlated with Guillain-Barré Syndrome, a disorder in which the body s immune system attacks part of the peripheral nervous system. This can result in long-term nerve damage and/or paralysis. Where did Zika Virus come from? According to the World Health Organization (WHO), Zika Virus was first discovered in Uganda in From the 1960s through the 1990s, it was largely confined to Africa and Asia and attributed only to minor illness. Zika s first large outbreak in 2007 marked its move across the Pacific, and linked it to more aggressive effects. Since then, it has been traveling steadily and has now been reported in every U.S. state except Alaska. If it s been around for 70 years, why are people just becoming alarmed now? Zika Virus became a worldwide concern in 2015, when global Zika spread evoked alarm. Zika Virus is now considered in epidemic status in more than 45 countries, including many in Southeast Asia and South America, as well as Puerto Rico. As of April 2017, 1 in 5 residents of Puerto Rico are estimated to be infected. In the U.S., Zika is also spreading quickly, with local mosquito-borne transmission found in south Florida (Miami-Dade County), including Miami Beach, a popular tourist destination. On November 28, 2016, the first case of mosquito-spread Zika was reported in Texas. Zika Virus is expected to continue to spread and affect large numbers of individuals in every area of the U.S. To protect yourself and your families, it is important to consult your physician before traveling to areas that have Zika and to stay abreast of travel advisories.

2 TRANSMISSION How is Zika Virus spread? Zika Virus is most often transmitted via bite from the Aedes aegypti mosquito. In addition, it has recently been confirmed that Zika can be passed through sexual contact (including oral sex) with an infected person. Is an infected person contagious? A person with Zika Virus is not necessarily contagious to others. Zika is not airborne; an infected person cannot spread Zika by coughing or touching common items without hand-washing. Some symptoms of Zika, such as conjunctivitis ( pink eye ), are extremely contagious. If pink eye is present with Zika symptoms, it is typically contagious for 24 hours after medication begins. Additionally, an infected person can transmit Zika Virus to another person through sexual activity. See page 3 for protection recommendations. What is the treatment for Zika Virus? There is no treatment for Zika Virus. People who are symptomatic and test positive are advised to rest, drink plenty of water, take acetaminophen to reduce fever, and follow other doctor-prescribed care. SYMPTOMS What are Zika Virus symptoms? How long does the illness last? In general, symptoms of Zika are mild to none. In fact, 80% of people who contract Zika Virus are asymptomatic. Of those who do exhibit symptoms, such symptoms are typically contained to: 1) low-grade fever or chills, 2) headaches, 3) Arthralgia (joint pain, particularly in the joints of the hands and feet), 4) muscle pain or weakness, 5) maculopapular skin rash, and 6) conjunctivitis, all within 3 12 days of exposure. Symptoms last approximately 4 7 days. While pregnant women do not experience symptoms any worse than others, their exposure to Zika can be very dangerous. Pregnant women who have tested positive for Zika have been found to deliver babies with severe birth defects, most notably microcephaly. Also, in rare cases (.3% of U.S. cases,.15% of U.S. Territory cases), Zika Virus is believed to have resulted in Guillain-Barré Syndrome, both in males and females. TESTING How is Zika diagnosed? Zika Virus can be confirmed by blood, urine, CSF, amniotic fluid, or serum test or a combination. Your doctor will determine what type of testing is warranted. New tests are continually being developed for better accuracy. Does Gila County test for Zika? No, but all suspect cases should be reported to the health department by calling We refer people who believe they may be infected from travel or exposure to an individual who has tested positive for Zika to either their primary care physician or the Arizona state laboratory in Phoenix for testing. 2 Gila County Health & Emergency Management Zika Virus Facts & Figures April 27, 2017

3 SUPPORT What resources are available if I test positive? The CDC has established the U.S. Zika Pregnancy Registry, which tracks the health of fetuses and babies born to pregnant women who test positive for Zika Virus, whether or not they exhibit symptoms. This will assist in connecting you with needed support while bringing new research to light. Your obstetrician, pediatrician, or health department can assist you in joining. To learn more, call (770) or ZikaPregnancy@cdc.gov. Additionally, in April 2017, the CDC and the March of Dimes launched ZikaCare Connect (ZCC) (zikacareconnect.org) to help families affected by Zika find specialty physicians (obstetrics, pediatric neurology, etc.) and local support. It is currently targeted to the 10 top Zika locations in the U.S. (which does not include Arizona). ZCC was developed and funded by the CDC, and the website is hosted and maintained by the March of Dimes. The ZCC Helpline (toll-free) is available Monday through Friday, 9am 5pm EST, for questions and referrals to healthcare providers. EDUCATION & PREVENTION Who s at risk? Are pregnant women more susceptible? There is no population (age, color, pregnancy status, etc.) that is more susceptible to Zika Virus than any other. Is there an immunization against Zika? There are currently no vaccines that protect against or medicines that treat Zika Virus, though some are in development. Gila County cautions against Internet claims of the availability of a vaccine. The CDC, WHO, and FDA are the ultimate authorities on efficacy, testing, and approval of a vaccine. How can I protect myself and my family against Zika Virus? First, limit or avoid travel to high-zika areas. See cdc.gov for the latest maps. Second, be aggressive in precautions against mosquito exposure. 1) Use DEET mosquito repellent when outdoors, 2) wear long sleeves and long pants, especially clothing treated with permethrin, 3) add mosquito netting around beds or patio areas, 4) ensure all window and doors screens are intact, and 5) eliminate any standing water where mosquitoes could breed. This includes wading pools, gutters, flowerpots, old tires, toys, and other areas where rain may collect, as well as confined spaces under leaky faucets. When applying insect repellent, do not spray under clothing. If using along with sunscreen, apply your sunscreen first. Are mosquito sprays safe to use during pregnancy? According to the CDC, insect repellents containing DEET (up to 30% concentration), picaridin (20%), or the biopesticide IR3535 (20%) are considered safe for use during pregnancy, provided that they are used modestly and registered with the EPA (see epa.gov/insect-repellents). Shirts and pants treated with permethrin are also considered safe. Note that safety testing has been limited. Overapplication is not recommended. How should pregnant women and those considering getting pregnant protect themselves? Do not travel to areas with Zika. If your sexual partner travels, always use a condom during sexual activity (including oral or anal sex). If you or your sex partner is exposed to, or infected by, Zika and you are trying to get pregnant avoid sex for at least 8 weeks after symptoms present (if you are female) and at least 6 months after symptoms present (if you are male). Talk with your doctor before you begin trying again. 3 Gila County Health & Emergency Management Zika Virus Facts & Figures April 27, 2017

4 What are the sexual contact guidelines for those who have contracted Zika, if you are not pregnant and not trying to get pregnant? The CDC recommends that couples with possible Zika exposure, who are not pregnant and are not planning to become pregnant, but who want to minimize their risk for sexual transmission, use a condom or abstain from sex per the guidelines above. Once I get Zika Virus, will I be immune? It is believed that, like many other viruses, once exposed to Zika, a person may develop antibodies to prevent him/ her from contracting Zika again in the future. Further research is needed to confirm this hypothesis. Are Zika Prevention Kits available in Gila County? Gila County has educational materials at readygila.com/zika as well as in print at our Globe and Payson offices. We also currently have free packets from the state of Arizona, which include Zika resources, including insect repellent, a bug swatter, and a graphic of mosquito breeding sites around homes. We encourage residents to create kits for their families. Tools in this kit could include: bed nets, standing water treatment tabs, DEET insect repellent, permethrin spray (for outdoor spraying), condoms, citronella candles, and mosquito swatters, as well as educational materials. KEY STATISTICS If I get Zika Virus, will my baby have birth defects? It is not a certainty that every woman infected with Zika will deliver a child with birth defects. However, the results of limited studies are noteworthy. The April 2017 issue of CDC s Vital Signs published the following: Of nearly 1,000 pregnant women with evidence of Zika who completed their pregnancies in 2016, 5% with possible Zika had birth defects, 10% with confirmed Zika had birth defects, and 15% with confirmed Zika in the first trimester had birth defects. This compares with a 3% average birth defect rate for all babies born in the U.S. (CDC statistic). Microcephaly, specifically, occurs in approximately 7 per 10,000 live births (.07%) in the absence of Zika virus, according to a January 2016 study published in JAMA. Birth defects are the leading cause of infant mortality, accounting for 20% of infant deaths. Is there a trimester that contracting Zika is more dangerous than others? In limited studies, there was more concern that a fetus in the first trimester may be at increased risk because they are the least developed. See result of study in previous bullet. Pregnant women themselves exhibit symptoms no worse than the average Zika patient, and some may be asymptomatic. What is the current prevalence in the U.S. and Arizona? As of April 21, 2017 ArboNET reports a total of 5,238 reported Zika cases in the U.S. (99.2% attributed to vector bite;.8% sexually transmitted). The total for all U.S. Territories was 36,569 cases. There were 57 cases in Arizona, most of which are considered travel cases. While most Zika cases stem from foreign travel, the mosquito that spreads Zika has been confirmed in southern Florida and Texas. There have been zero fatalities. Will Zika become an epidemic in the U.S.? Unfortunately, it is likely that U.S. Zika will grow. The mosquito that spreads Zika has now been found in south Florida and Texas. While public health officials are actively educating residents, spraying for mosquitoes, and working to eliminate mosquito breeding grounds, these efforts may not be enough. The southeast is an ideal climate for mosquito breeding. Additionally, travel continues to high Zika areas across the globe. Thus, Zika Virus is expected to continue to spread and affect large numbers of individuals in every area of the U.S. 4 Gila County Health & Emergency Management Zika Virus Facts & Figures April 27, 2017

5 GENERAL QUESTIONS What is Gila County doing to protect and inform residents? Our environmental specialists and sanitarians are monitoring high-risk areas, and we are actively fighting Zika by testing, trapping, and spraying for mosquitoes. Gila County is also working with homeowners and landlords to abate and treat standing water to eliminate potential mosquito breeding grounds. We also maintain a web page at readygila.com/ zika. There, visitors can find the latest information, statistics, and advisories. In addition, we are developing a number of resources to further educate and prepare our community families. These will be available on our website as well as in our Globe and Payson offices. What is the CDC doing to combat Zika Virus? U.S. and worldwide health organizations are committing significant resources to control Zika. In December 2016, the CDC announced that it will award $184MM to states, territories, localities, and universities to protect Americans from Zika virus infection and associated health outcomes. This represents part of the $350MM it received under the Zika Response and Preparedness Appropriations Act of The new awards will bolster U.S. preparedness efforts and laboratory capacity, while helping establish vector-borne regional centers of excellence at four universities and the premier vector control unit in Puerto Rico. Additionally, the CDC has developed numerous educational resources for consumers and 100,000 Zika testing kits, which are free to qualified laboratories. Visit What Zika Virus support does Gila County offer for pregnant women? Our clinics can provide for free pregnancy testing for residents who need it. We are also currently developing some free Zika Virus educational materials that will be available during their visit. What Can Gila County residents do to stay informed? Gila County offers a mass notifications system whereby residents can stay abreast of all pending emergencies including those related to Zika Virus. To sign up, visit: Also, you can receive Zika updates from the CDC with its new text messaging service. Text PLAN to to subscribe. Publication information Gila County Health & Zika Virus Facts & Figures is published by the Gila County Emergency Management Health & Emergency Management division of Gila County, AZ, 5515 S. Apache Ave., Suite 400 and continually updated as new information and data arise. Globe, AZ For the latest Zika Virus Facts & Figures or to get on our (928) distribution list envhealth@gilacountyaz.gov readygila.com/zika 5 Gila County Health & Emergency Management Zika Virus Facts & Figures April 27, 2017