Zika Virus Update. Florida Department of Health (DOH) Patrick Jenkins, MPH Director of Communicable Diseases DOH-Broward

Transcription

1 Zika Virus Update Florida Department of Health (DOH) Patrick Jenkins, MPH Director of Communicable Diseases 2016 DOH-Broward 1

2 Zika Virus Flavivirus: teslng has potenlal for cross-reaclvity with other flaviviruses Originally idenlfied in Africa and Southeast Asia First idenlfied in Uganda s Zika Forest in 1947 Outbreaks since

3 Zika Fever Transmission Primarily transmiyed through bites of an infected mosquito (Aedes aegyp*, possibly Aedes albopictus) Less commonly Transmission during pregnancy and at the Lme of birth Sexual Transfusion cases (2 recently documented) Lab exposures Detected in breast milk, saliva, and urine but no documented transmission 3

4 ESTIMATED range of Aedes aegyp* and Aedes albopictus in the United States, 2016 Maps 4 As of April 26, 2016 Courtesy of CDC.

5 Countries and Territories with AcLve Zika Transmission 5 As of April 18, 2016 Courtesy of CDC.

6 6 Countries and Territories with Zika Virus AMERICAS Aruba Barbados Belize Bolivia Bonaire Brazil Colombia Commonwealth of Puerto Rico, US territory Costa Rica Cuba Curacao Dominica Dominican Republic Ecuador El Salvador French Guiana Guadeloupe Transmission Guatemala Guyana HaiL Honduras Jamaica MarLnique Mexico Nicaragua Panama Paraguay Saint Lucia Saint MarLn Saint Maarten Saint Vincent and the Grenadines Suriname Trinidad and Tobago U.S. Virgin Islands Venezuela

7 Countries and Territories with Zika Virus Transmission OCEANIA/PACIFIC ISLANDS American Samoa Fiji Kosrae, Federated States of Micronesia Marshall Islands New Caledonia Samoa Tonga AFRICA Cape Verde 7

8 Zika Cases in the United States, US States Travel-associated Zika virus disease cases reported: 426 Locally acquired vector-borne cases reported: 0 Total: 426 Pregnant: 36 Sexually transmiyed: 8 Guillain-Barré syndrome: 1 US Territories Travel-associated cases reported: 3 Locally acquired cases reported: 596 Total: 599 Pregnant: 56 Guillain-Barré syndrome: 5 8 As of April 27, 2016 Courtesy of CDC.

9 Zika virus disease in the United States, As of April 27, 2016 Courtesy of CDC.

10 10 Florida Zika Cases as of April 27,2016 County Number of Cases Alachua 4 Brevard 2 Broward 15 Clay 1 Collier 1 Hillsborough 3 Lee 4 Miami-Dade 39 Orange 5 Osceola 4 Palm Beach 5 Polk 3 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* Total 94 5

11 Zika Fever Clinical PresentaLon IncubaLon period: 2-14 days 1 in 5 people infected will become symptomalc PresentaLon similar (but milder) to other illnesses like dengue and chikungunya Most common signs and symptoms Fever (ojen low-grade) Maculopapular rash Arthralgia ConjuncLviLs Myalgia Headache Retro-orbital pain VomiLng 11

12 Zika Fever (conlnued) SymptomaLc treatment Typically resolves within a week Avoid aspirin and similar drugs (NSAIDs) Possible link to Guillain-Barré Syndrome (GBS) Link to poor pregnancy outcomes No vaccine but research underway 12

13 Laboratory TesLng 13 No commercial teslng available (FDA approves AEU). Sample submiyed to DOH for teslng must be approved by CHD Polymerase Chain ReacLon Serum and urine sample collected within 21 days of illness onset Serology (detects anlbodies against Zika virus) Serum sample collected 4 days of illness onset Convalescent specimen may be needed AddiLonal tests may be requested at CDC.

14 CDC Travel Alert/HAN Travel Alert Level 2-PracLce Enhanced PrecauLons Pregnant women in any trimester should postpone travel Women trying to become pregnant should consult healthcare provider before travel Avoid mosquito bites hyp:// zika-virus-travel.html hyp://wwwnc.cdc.gov/travel/nolces hyp://emergency.cdc.gov/han/han00385.asp 14

15 ExecuLve Order Number Directs State Health Officer (SHO) and Surgeon General to declare Public Health Emergency in 4 counles (duralon and geographic boundaries can change) Authorizes Commissioner of Agriculture to issue mosquito declaralon in same 4 counles Designates DOH as lead state agency to coordinate emergency response aclviles among various state agencies and local governments 15 Directs Department of Environmental ProtecLon and Fish and Wildlife ConservaLon Commission to support Department of Agriculture and Consumer Services in developing extensive mosquito control plans

16 DeclaraLon of Public Health Emergency NoLfies Commissioner of Agriculture of threat to public health from Zika virus transmission to humans from bite of infected Aedes mosquito. Directs meelngs be convened in the impacted counles to discuss mosquito control best praclces and outreach to communiles with high risk or vulnerable populalons County Health Officers for affected counles develop outreach program for local medical professionals to increase awareness and access to diagnoslc tools 16

17 ReporLng Zika InfecLons Florida AdministraLve Code Emergency Rule 64DER16-1 (2/5/16) Persons suspected of having Zika fever should be reported immediately upon inilal suspicion to the CHD: 1. All persons, including pregnant women, with two or more of the following signs/symptoms: fever, maculopapular rash, arthralgia or conjunclvils (GBS could follow) and a history of travel to an area with Zika virus aclvity in the two weeks prior to illness onset. 2. Mother of an infant or fetus with microcephaly or intracranial calcificalons or poor fetal outcome diagnosed ajer the first trimester and have history of travel to an area with Zika virus aclvity during pregnancy. (TesLng of both the mother and infant is recommended.) 17

18 ReporLng Zika InfecLons Report immediately, conlnued: 3. Currently pregnant women who (while pregnant) experienced two or more of the following signs/ symptoms: fever, maculopapular rash, arthralgia, or conjunclvils (GBS could follow) during or in the two weeks following travel to an area reporlng Zika virus aclvity. Travel could have occurred at any point in the pregnancy. 18

19 ReporLng Zika InfecLons 19 Report immediately, conlnued: 4. Persons suspected of having locally acquired the infeclon. For example, A symptomalc person without history of travel who lives in the same household as a person who traveled to an area reporlng Zika virus aclvity. (Mosquito transmission.) A symptomalc person without history of travel that had sexual contact with a confirmed case; or An ultrasound indicalng microcephaly of the fetus in pregnant woman that is asymptomalc and had sexual contact with a partner that had travel history to an area with aclve Zika virus circulalon.

20 Required Health Status Monitoring Florida AdministraLve Code Emergency Rule 64DER16-2 (2/5/16) requires providers to report health status updates to DOH for suspected and confirmed Zika InfecLons. Report health status updates of hospitalized suspected or confirmed Zika fever cases to your CHD every 24 hours unll discharge. Report health status updates of non-hospitalized suspected or confirmed Zika fever cases to your CHD every 72 hours unll symptoms resolve. 20

21 Human Case InvesLgaLon Healthcare provider suspects Zika Virus in a palent Healthcare provider consults with CHD epidemiologist to determine if teslng is required CHD facilitates sample colleclon and sending specimens to DOH labs or CDC CHD interviews the palent CHD reports the case to DOH and nolfies Mosquito Control CHD EH conducts assessment and goes door to door with mosquito proteclon informalon DOH reports the case to CDC and includes it in the weekly report 21

22 Other DOH Response AcLviLes TargeLng health care providers Hospitals American Congress of Obstetricians and Gynecologists Midwives/nurses Working with internal partners Birth Defects Registry Maternal and Child Health Syndromic surveillance Guillain-Barrè Syndrome Microcephaly 22

23 Other DOH Response AcLviLes Response similar to dengue/chikungunya Inform local mosquito control officials of suspect cases Inform Arbovirus Surveillance Coordinator on suspicion of locally acquired cases Provide public informalon on disease, transmission, prevenlon, proteclve aclons 23

24 Local Public Health AcLons Community Outreach DistribuLng mosquito proteclon fliers/palm cards through: Community partners Libraries Day care centers Supermarkets Corner stores Houses of worship Health fairs and community events CHD outreach staff to local businesses Municipality social media and websites Homeowners AssociaLons 24

25 Mosquito Bite PrevenLon 25 DRAIN water from any containers where water has collected. CLOTHING: If you must be outside when mosquitoes are aclve, cover up. Wear shoes, socks, long pants, and long sleeves. REPELLENT: Apply mosquito repellent to bare skin and clothing. Always use repellents according to the label. Repellents with DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, and IR3535 are effeclve. Use nerng to protect children younger than 2 months. See: Mosquito Bite ProtecLon in Florida

26 Mosquito Bite ProtecLon Mosquito bite proteclon page 1 26

27 Mosquito Bite ProtecLon Mosquito bite proteclon page 2 27

28 28 Mosquito Bite ProtecLon

29 29 Mosquito Bite ProtecLon

30 30 Mosquito Bite ProtecLon

31 31 Mosquito Bite ProtecLon

32 Local Public Health AcLons Healthcare provider outreach ing, mailing or delivering informalon packets/ posters/palm cards/fliers to: Hospitals All Broward County physicians All urgent care centers EMS providers FQHCs Clinics in retail pharmacies Volunteer clinics MeeLngs with each of 17 acute care hospitals Individual consultalon with physicians 24/7 32

33 Local Public Health AcLons Environmental Health assessments CoordinaLon with Emergency Management CoordinaLon with Broward County Mosquito Control 33

34 34 Available Resources DOH: Guidance for Physicians and Healthcare Providers InformaLon for Clinicians InformaLon for Obstetricians Mosquito Bite ProtecLon in FL and for Overseas Travelers CDC: Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of ReproducLve Age with Possible Zika Virus Exposure United States, 2016 Interim Guidelines for the EvaluaLon and TesLng of Infants with Possible Congenital Zika Virus InfecLon United States, 2016 Interim Guidelines for PrevenLon of Sexual Transmission of Zika Virus United States, 2016

35 DOH-Broward Epidemiology (24/7) Patrick Jenkins, Communicable Disease Director