Zika Virus: What the Healthy Start Community Needs to Know. Ask the Expert Webinar June 29, 2016

Transcription

1 Zika Virus: What the Healthy Start Community Needs to Know Ask the Expert Webinar June 29, 2016

2 Webinar Agenda I. Welcome II. General Overview about Zika and Preventive Measures, focused on the pregnant population III. Public Health Response IV. HRSA/MCHB Response V. Actions Steps for Healthy Start VI. Local HS Response VII.Discussion with our presenters

3 Your Presenters CAPT. David de la Cruz Deputy Director, Division of Healthy Start and Perinatal Services Irogue Igbinosa, MD Centers for Disease Control and Prevention Aaron Lopata, MD MCHB, Chief Medical Officer CDR Maria Benke Division of Healthy Start and Perinatal Services Columbus Public Health My Baby & Me Healthy Start

4 Objectives Hear an overview of Zika and preventive measures specifically for pregnant women Have an awareness of the public health response to Zika Share resources that Healthy Start grantees may use to educate themselves and program participants about Zika

5 Welcome CAPT. David de la Cruz Deputy Director Division of Healthy Start and Perinatal Services

6 Irogue Igbinosa, MD Centers for Disease Control and Prevention

7 Centers for Disease Control and Prevention Zika Virus: What Healthy Start Grantees Need to Know Irogue Igbinosa, MD Clinical Team, Zika Pregnancy and Birth Defects Task Force Centers for Disease Control and Prevention June 29, 2016

8 First time in history Never before in history has there been a situation where a bite from a mosquito could result in a devastating malformation. Dr. Tom Frieden, CDC Director Fortune, April 13, 2016 the last time an infectious pathogen (rubella virus) caused an epidemic of congenital defects was more than 50 years ago New England Journal of Medicine, April 13, 2016

9 Zika: The Basics

10 What is Zika Virus? Disease spread primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. abopictus) Aggressive daytime biters, live indoors and outdoors Can also bite at night Aedes aegypti mosquito Closely related to other flaviviruses Aedes albopictus mosquito

11 How is Zika transmitted? Zika can be transmitted through Mosquito bites From a pregnant woman infected with Zika to her fetus Sexual contact with an infected male Possible blood transfusion

12 What are the symptoms? The most common symptoms of Zika are Fever Rash Joint pain Conjunctivitis (red eyes) Many people infected with Zika virus won t have symptoms or will only have mild symptoms.

13 Where is Zika now? 48 countries and territories worldwide, including 39 countries and territories in the Americas, reporting active Zika virus transmission

14 Status of Zika Virus in the United States Local vector-borne transmission of Zika virus has not been reported in the continental United States As of June 22, 2016

15 Zika: Pregnancy and Microcephaly

16 Zika Infection in Pregnancy Pregnant women can be infected through A mosquito bite Sex with an infected male partner If infected around conception Zika might present risk to fetus If infected during pregnancy Zika can be passed to the fetus during pregnancy or around the time of birth

17 What Else Do We Know About Zika in Pregnant Women? Limited information demonstrates No evidence of increased risk for Zika in pregnant women No evidence of more severe symptoms in pregnant women Infection can occur in any trimester Proportion of pregnant women who will become infected not fully known

18 Zika Can Cause Microcephaly

19 Infants Born With Microcephaly Note scattered intracranial calcifications Note large ventricles and volume loss CT scan images courtesy of Dr. Erin Staples Typical newborn head CT scan

20 Zika May Cause Other Problems Linked to miscarriage and stillbirth Not enough evidence yet to say Zika virus is the cause Besides microcephaly, fetuses infected with Zika virus before birth may have other health and developmental problems after birth: Seizures Developmental delay Intellectual disability Problems with movement and balance Feeding problems, such as difficulty swallowing Hearing loss Vision problems Karwowski MP, Nelson JM, Staples JE, et al. Zika Virus Disease: A CDC Update for Pediatric Health Care Providers. Pediatrics. 2016;137(5):e

21 US Zika Pregnancy Registry Purpose of registry: To monitor pregnancy and infant outcomes following Zika virus infection during pregnancy and to inform clinical guidance and public health response How it works: The registry is a supplemental surveillance effort coordinated by CDC and dependent on the voluntary collaboration of the state, tribal, local, and territorial health departments

22 Number of Pregnant Women Who May Be Affected Puerto Rico US Virgin Islands 265 * ** 216 American Samoa Pregnant women with any laboratory evidence of possible Zika virus infection in the US 50 states and DC Pregnant women with any laboratory evidence of possible Zika virus infection in US territories *Includes aggregated data reported to the US Zika Pregnancy Registry as of June 16, 2016 **Includes aggregated data from the US territories reported to the US Zika Pregnancy and data from Puerto Rico reported to the Zika Active Pregnancy Surveillance as of June 16, 2016

23 Reporting Poor Outcomes Starting June 16, 2016, CDC began reporting poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection for US states and the District of Columbia (DC). As of June 16, 2016, in US states and DC, there were 265 pregnant women reported to the US Zika Pregnancy Registry 4 liveborn infants with birth defects 4 pregnancy losses with birth defects

24 CDC Recommendations: Prevention

25 Traveling to Areas with Active Zika Transmission Pregnant women should not travel to areas with Zika If a pregnant woman must travel, she should Talk with her healthcare provider before she goes Strictly follow steps to prevent mosquito bites during the trip Take steps to prevent sexual transmission Talk with her healthcare provider after she returns, even if she doesn t feel sick

26 Living in or Traveling to Areas with Active Zika Transmission * *Mosquitoes may be resistant to permethrin in some areas.

27 Women and Their Partners Thinking about Pregnancy WOMEN MEN Recent travel to an area with Zika or sex without a condom with an infected male Zika virus disease No Zika virus disease Wait at least 8 weeks after symptom onset Wait at least 8 weeks after exposure Wait at least 6 months after symptom onset Wait at least 8 weeks after exposure Residence in an area with Zika Zika virus disease No Zika virus disease Wait at least 8 weeks after symptom onset Talk with health care provider Wait at least 6 months after symptom onset Talk with health care provider

28 Clinical Tool PRECONCEPTION COUNSELING For Women and Men Living in Areas with Ongoing Spread of Zika Virus Who Are Interested in Conceiving This guide descriles recommendations for counseling women and men living in areas with Zika who want to become pregiant and hav.a not experienced clinical illness consistent wtth Zka virus disease. This material ilcludes recommendations from CDC's updated guidance 1, key questions to ask patients, and sarn~e scripts for discussing recommendations and preconception issues. Because a lot of content is outlined for discussion, questions are included throughout the sample script to make sure patients understand what th&}' are being told. Recommendation Key Issue Questions to Ask Sample Script Assess pregnancy intentions Introduce importance of pregnancy plamilg Have you been thinking about having a baby? Would you like to become pregnant in the next year? ke you currently using any form of birth control? tt you are thinking of having a baby, I would like to help you have a healthy and safe pregnancy. Wtth the Zika virus outbreak, ~anning pregnancy is more important than ever. Preparilg and plaming for a healthy pregnancy means getting as healthy as you can before becoming pregnant, and also taking the time now to learn about how best to care for yourseh during pregnancy. Assess risk of Zika virus exposure Environment Do you have air conditioring in your home? At work? Do you have window and door screens in your home? flt work? Do you have a bed net? Would you consider using one? Do you live in an area with a Jot of mosquitoes? The best way to prevent Zka is to prevent mosqutto bites. To protect yourseh at home and work, use air condttioning n possible. Install window and door screens and repar any holes to help keep mosquttoes outside. Sleep l.llder a bed ne~ n air condttioning or screened rooms are not available. Silce you live in an area where Zika is spreading, you are at risk of getting Zika. It is important that we discuss the timing of your pregnancy, and ways to prevent infection when you are pregnant. Knowledge check: What are some ways to protect yourseh at home and work? Link to Preconception Counseling Clinical Tool

29 Resources *Free materials available in English and Spanish

30 Thank you! More information on Zika: Questions about CDC s work related to Zika and unintended pregnancy: contact CDC-INFO at or More information for consumers and providers on preventing unintended pregnancy: For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

31 Questions?

32 Aaron Lopata, MD MCHB, Chief Medical Officer

33 THREE Primary Pillars of MCHB s Response to & Preparation for Zika I. OUTREACH & EDUCATION to our (MCHB s) population: Women, Children, and Families II. Provide clinical guidance for healthcare providers OB-GYNs Pediatricians, family practitioners, and all primary care providers who care for children/newborns III. Ensure all children born with birth defects or developmental delay have access to highquality, specialized care

34 I. OUTREACH & EDUCATION Focused on: 1. PREVENTION ZIKA INFECTION Via mosquito bites Via sexual transmission 2. PREVENTION of UNPLANNED PREGNANCIES education regarding use of contraceptives, Eduction regarding controceptive options 3. Provide guidance to pregnant women on when to see their health care provider & get tested for Zika infection

35 II. CLINICAL GUIDANCE RE: ZIKA for HEALTH PROFESSIONALS For healthcare providers caring for women: Recommendations For Testing Pregnant Women With Possible Zika Virus Exposure Preconception Counseling Recommendations For Women With Possible Exposure to Zika Virus For healthcare providers caring for newborns & children Recommendations for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection Evaluation and Management of Infants and Children Aged <18 Years with Possible Acute Zika Virus Disease

36 III. Ensure newborns with special health care needs receive high-quality care MCHB DEVELOPING & COMPILING: Guidelines & Best Practices for the Managing/Providing Comprehensive Care for Infants born w/ birth defects and/or diagnosed with developmental delay secondary to Congenital Zika Virus Infection Purpose: To ensure that all health providers caring for newborns and infants w/ special health care needs (SHCN) have processes in place to provide: Comprehensive care & support- e.g. primary care, psychological, developmental, educational, and social services- for children w/ SHCNs and their families

37 Questions?

38 CDR Maria Benke Division of Healthy Start and Perinatal Services

39 What You Can Do Connect with, and support, your state s Zika prevention activities. Educate yourself and staff about Zika. Help educate the your clients and your community about how to prevent Zika infection. Share travel notices and other travel-related guidance. Visit for more information.

40 What Pregnant Women Should Know Source: CDC website

41 Zika Virus Website

42 Integrate Zika Action into HS Staff Training Community Action Networks Client Education

43 Work with Partners to Assist State and Local Health Departments Healthcare Partners & Provider Practices

44 What are you doing around Zika? Discussion

45 Questions?

46 Local Healthy Start Response: Columbus Public Health

47 Zika Elizabeth Koch, MD, MPH&TM Director, Office of Outbreak Response Leslie didonato, B.S. Ed. Director, Office of Emergency Preparedness

48 ZIKA Structuring a Response Implemented ICS at Columbus Public Health on 2/8/16 Activation of the Infectious Disease Emergency Response Plan and structure Creation of Zika-specific Annex to the Vector Control Plan Columbus Public Health

49 ZIKA What We Are Doing Vector Control & Surveillance Active Case Finding & Disease Investigation Webinars & Educational Sessions Coordinated messaging Columbus Public Health

50 ZIKA Facilitating Testing All travelers with symptoms who have visited a Zika-affected area in the past 12 weeks. Pregnant women who traveled to a Zikaaffected area in the past 12 weeks or had unprotected sex with a male who may have Zika. Centers for Disease Control & Prevention & Ohio Department of Health Laboratory Columbus Public Health

51 ZIKA Mosquitoes in the US Columbus Public Health

52 ZIKA Public Education Launching an educational campaign to help eliminate standing water Prevention of mosquito bites Columbus Public Health

53 Surveillance Continuing surveillance of Culex mosquitos known to spread West Nile Virus Aedes trapping sites added to monitor Aedes populations Aedes Vs. Culex Columbus Public Health

54 What Our Community Is Doing Drain standing water Treat areas where they can t drain water Get rid of scrap tires Protect ourselves from mosquito bites Columbus Public Health

55 Questions?

56 Wrap Up and Reminders Check out the info sent with registration. Websites