Travel-Associated Mosquito-Borne Diseases in Ohio. Infectious Disease Reporting 11/1/2016. Mosquito-Borne Diseases

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1 Travel-Associated Mosquito-Borne Diseases in Ohio Kim Machesky, MPH Ohio Association of Occupational Health Nurses November 5, 2016 Infectious Disease Reporting Authority defined in Ohio Administrative Code Last updated September 16, 2016 Mosquito-Borne Diseases Travel-associated: Chikungunya virus infection Dengue Malaria Yellow fever Zika virus infection Endemic to Ohio: Eastern equine encephalitis virus LaCrosse virus disease St. Louis encephalitis virus disease West Nile virus infection Endemic elsewhere in the continental United States: Powassan virus disease Western equine encephalitis virus disease 1

2 Aedes abserratus Aedes albopictus Aedes atropalpus Aedes aurifer Aedes canadensis Aedes cantator Aedes cinereus Aedes dorsalis Aedes dupreei Aedes excrucians Aedes fitchii Aedes flavescens Aedes grossbecki Aedes hendersoni Aedes implicatus Aedes intrudens Aedes japonicus Aedes mitchellae Aedes riparius Aedes sollicitans Aedes sticticus Aedes stimulans Aedes thibaulti Aedes tormentor Aedes triseriatus Aedes trivittatus Aedes vexans Anopheles barberi Anopheles crucians Anopheles earlei Anopheles perplexens Anopheles punctipennis Anopheles quadrimaculatus Anopheles walkeri Culex erraticus Culex pipiens Culex restuans Culex salinarius Culex tarsalis Culex territans Culex inornata Culiseta melanura Culiseta minnesotae Culiseta morsitans Coquillettidia perturbans Orthopodomyia alba Orthopodomyia signifera Psorophora ciliata Psorophora columbiae Psorophora cyanescens Psorophora discolor Psorophora ferox Psorophora horrida Psorophora howardi Psorophora mathesoni Toxorhynchites rutilus Uranotaenia sapphirina Wyeomyia smithii 58 Species of Mosquitoes in Ohio Aedes abserratus Anopheles punctipennis Malaria Aedes albopictus DEN, CHIK, Anopheles quadrimaculatus Malaria Aedes atropalpus YF, ZIKA Anopheles walkeri Aedes aurifer Culex erraticus Aedes canadensis Culex pipiens WNV, SLE Aedes cantator Culex restuans Aedes cinereus Culex salinarius Aedes dorsalis Culex tarsalis Aedes dupreei Culex territans Aedes excrucians Culex inornata Aedes fitchii Culiseta melanura EEE Aedes flavescens Culiseta minnesotae Aedes grossbecki Culiseta morsitans Aedes hendersoni Coquillettidia perturbans Aedes implicatus Orthopodomyia alba Aedes intrudens Orthopodomyia signifera Aedes japonicus Psorophora ciliata Aedes mitchellae Psorophora columbiae Aedes riparius Psorophora cyanescens Aedes sollicitans Psorophora discolor Aedes sticticus Psorophora ferox Aedes stimulans Psorophora horrida Aedes thibaulti Psorophora howardi Aedes tormentor Psorophora mathesoni Aedes triseriatus LAC Toxorhynchites rutilus Aedes trivittatus Uranotaenia sapphirina Aedes vexans Wyeomyia smithii Anopheles barberi Anopheles crucians Anopheles earlei Anopheles perplexens 58 Species of Mosquitoes in Ohio Case Investigations Lab Testing Clinical Travel & Activities Other Risk Factors Further Transmission Factors Environmental Assessment 2

3 Chikungunya Virus Causative Agent: Chikungunya virus (Togavirus) Incubation Period: 1-12 days Symptoms: Fever, polyarthralgia, headache, myalgia, arthritis, conjunctivitis, nausea, vomiting, rash Demographic Trends: Neonates, adults < 65 years, immunocompromised people Vector: Aedes aegypti, Aedes albopictus mosquitoes Reservoir: Humans, maybe non-human primates Amplifying Hosts: Humans Habitat: Containers Chikungunya Virus 3

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5 As of October * 2016 data as of 10/25/2016 Chikungunya Virus Country of Exposure Cases Cases Cases* Bolivia Cook Islands Dominica Dominican Republic El Salvador Grenada Guatemala Haiti Honduras India Jamaica Mexico Nicaragua Puerto Rico U.S. Virgin Islands Total * 2016 data from ODH as of 10/28/16. Chikungunya, Ohio * Incidence Compared to Aedes albopictus Distribution Aedes albopictus identification from ODH mosquito surveillance in Dengue Virus Causative Agent: Dengue virus (Flavivirus), 4 serotypes Incubation Period: 3-14 days Symptoms: Fever, headache, myalgia, arthralgia, retro-orbital pain, nausea, vomiting, rash Demographic Trends: Previous dengue infection, older children, adults Vector: Aedes aegypti, Aedes albopictus mosquitoes Reservoir: Humans, maybe non-human primates Amplifying Hosts: Humans Habitat: Containers 5

6 Dengue Virus Americas & the Caribbean Asia & Oceania Africa & the Middle East 6

7 Dengue Virus Geographic Area Travel- Associated Locally- Acquired Travel- Associated Locally- Acquired Ohio * 0* Continental United States ** 47** U.S. Territories ** 205** Caribbean 29,282 67,213*** Central America 407, ,520*** South America 1,992,837 1,776,037*** * 2016 data from ODH as of 10/31/2016. ** 2016 data from CDC as of 10/07/2016. *** 2016 data from PAHO as of 10/14/2016. Malaria Causative Agent: Plasmodium parasites (P. falciparum, P. malariae, P. ovale, P. vivax, P. knowlesi) Incubation Period: 7-30 days Symptoms: Fever, chills, sweating, headaches, nausea vomiting, body aches, malaise Demographic Trends: Pregnant women, children, visiting friends/relatives travelers Vector: Anopheles mosquitoes Reservoir: Humans, non-human primates (P. knowlesi) and Prevention. Amplifying Hosts: Humans, non-human primates (P. knowlesi) Habitat: Ponds/marches with vegetation, slow-moving streams with vegetation (An. punctipennis) Image from Centers of Disease Control 7

8 Malaria Geographic Area Cases Deaths Cases Deaths Cases Deaths Ohio * 0* United States 1, ** 10** 217** 4** Worldwide 198 million 584, million 438,000 N/A N/A * 2016 data from ODH as of 10/13/2016. ** data from CDC very incomplete, but as of 10/27/

9 Malaria Ohio Cases Country of Exposure * Africa Ghana 8 5 Kenya 2 4 Liberia 4 3 Nigeria 2 8 Sierra Leone 4 7 Uganda 1 8 Other** Asia 2 1 Caribbean 1 1 TOTAL * 2016 data from ODH as of 10/28/2016. ** Other African countries include: Burkina Faso, Cameroon, Chad, Congo (Democratic Republic of the), Cote d Ivoire, Ethiopia, Madagascar, Mali, Niger, Senegal, Sudan, Tanzania, Togo, and Zambia. Malaria Chemoprophylaxis Based on travel plans, medical history, age, drug allergies, pregnancy status, other factors Some must be started before travel, some need to be continued for weeks after travel Not recommended to purchase outside of the U.S. Must continue personal protective measures Yellow Fever Virus Causative Agent: Yellow fever virus (Flavivirus) Incubation Period: 3-6 days Symptoms: Fever, chills, severe headache, back pain, general body aches, nausea, vomiting, fatigue, weakness Demographic Trends: Infants and children (Africa), young men occupationally exposed (South America) Vector: Aedes aegypti and Aedes albopictus mosquitoes (urban), Haemagogus species mosquitoes (sylvatic) Reservoir: Humans (urban), non-human primates (sylvatic) Amplifying Hosts: Humans (urban), non-human primates (sylvatic) Habitat: Containers Image from the Centers for Disease Control & Prevention 9

10 Yellow Fever Virus Africa South America 10

11 Yellow Fever Virus No cases of yellow fever in the U.S. in at least the past 10 years 72 cases worldwide in % of people in 44 countries at risk vaccinated in 2015 Current outbreak in Angola Started December ,306 suspected cases with 376 deaths* 884 lab-confirmed cases with 121 deaths (all provinces)* Nearly 17 million people have been vaccinated Current outbreak in Democratic Republic of the Congo 2,970 cases (all provinces)** Nearly 10 million doses of vaccine shipped * Data from WHO as of 10/13/2016. ** Data from WHO as of 10/19/2016. Yellow Fever Virus Vaccination International Certificate of Vaccination (ICV) Required to gain entry into many countries 1 Image from the World Health Organization. Certificate is valid for 10 years beginning 10 days after date of vaccination Yellow fever vaccination clinics 2 1. CDC s Travel Health: 2. CDC s Yellow Fever Vaccine Clinics: Zika Virus Causative Agent: Zika virus (Flavivirus) Incubation Period: 3-14 days (likely) Symptoms: Fever, rash, arthralgia, conjunctivitis, myalgia, headache Demographic Trends: Pregnant women, fetuses, older adults Vector: Aedes aegypti, Aedes albopictus mosquitoes Reservoir: Humans, non-human primates Amplifying Hosts: Humans Habitat: Containers 11

12 Zika Virus Concerns with Zika virus infection: Maternal infection during pregnancy Fetal loss (miscarriage, stillbirth) Microcephaly (smaller than expected head circumference) Other birth defects: absent/poorly developed brain structures, eye defects, hearing deficits, impaired growth Guillain-Barré syndrome Image from the Centers for Disease Control and Prevention Zika Virus Countries with endemic Zika virus (past infections, continue to report some new infections): AFRICA: Angola, Benin, Burkina-Faso, Cameroon, Central African Republic, Côte d Ivoire, Egypt, Ethiopia, Gabon, Guinea-Bissau, Kenya, Liberia, Mali, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Tanzania, Togo, Uganda, Zimbabwe. ASIA: Bangladesh, India, Pakistan. SOUTHEAST ASIA: Brunei, Burma (Myanmar), Cambodia, Indonesia, Laos, Malaysia, Maldives, Philippines, Thailand, Timor-Leste, Vietnam. PACIFIC ISLANDS: Easter Island, Vanuatu. 12

13 Zika Virus Geographic Area Travel- Associated Cases Sexually Transmitted Cases 2016 Lab- Acquired Cases Locally- Acquired Cases Ohio* U.S. states* 3, U.S. territories* ,627 Central America, South America, Caribbean** 246 ** N/A 164,215 confirmed; 512,345 suspected * Data from ODH and CDC as of 10/26/2016. ** Data from PAHO as of 10/20/2016. With local transmission of Zika virus it is not possible to determine whether infection occurred due to mosquito-borne or sexual transmission. Zika Virus Country of Exposure 2016 Cases* Caribbean Islands 55 Dominican Republic 10 Haiti 10 Jamaica 4 Puerto Rico 19 St. Lucia 6 Virgin Islands, U.S. 3 Other** 3 Central America 8 South America 4 Southeast Asia 2 Sexually acquired from traveler 1 TOTAL 70 * 2016 data from ODH as of 10/25/2016. ** Other Caribbean islands include: Aruba, Grenada, and St. Martin (Netherlands Antilles). Zika Virus, Ohio 2016* Incidence Compared to Aedes albopictus Distribution Aedes albopictus identification from 2016 ODH mosquito surveillance. 13

14 Zika Virus Pregnancy Infections & Birth Outcomes Pregnant women with any lab evidence of possible Zika virus infection Live born infants with birth defects Pregnancy losses with birth defects Ohio U.S. States U.S. Territories 5 953* 2,027* 0 23* N/A 0 5* N/A * Data from CDC as of 10/20/2016. Poor birth outcomes reported include: microcephaly, calcium deposits in brain, excessive fluid in brain cavities, absent/poorly formed brain structures, abnormal eye development, nerve damage, muscle/bone damage (club foot, inflexible joints), hearing loss. Preventing Travel-Associated Mosquito-borne Diseases 1. Check latest travel notices Pregnant women should not travel to areas with active Zika virus transmission Men and women trying to conceive should consider postponing nonessential travel to areas with active Zika virus transmission 2. Visit a healthcare provider Chemoprophylaxis (malaria) Vaccination (yellow fever) CDC s Travel Notices: Preventing Travel-Associated Mosquito-borne Diseases 3. Avoid mosquitoes Insect repellents Mosquito netting Long sleeves and pants, light-colored clothing Permethrin-treated clothing Air conditioning Window/door screens EPA s Search Tool: find-insect-repellent-right-you 14

15 Preventing Travel-Associated Mosquito-borne Diseases 4. Prevent mosquito bites for 3 weeks after return (during mosquito season) Insect repellents Long sleeves and pants, light-colored clothing Air conditioning Window/door screens Remove mosquito breeding habitats 5. Prevent sexual transmission (Zika virus) Preventing Travel-Associated Mosquito-borne Diseases 6. Defer donating blood or tissue products Timeframe depends on locations of travel and mosquito-borne disease diagnosis 7. See a healthcare provider if symptoms develop Prompt diagnosis and treatment may be critical Resources CDC Travelers Health: CDC Yellow Book: CDC Travel Notices: wwwnc.cdc.gov/travel/notices ODH Mosquito Information: World Health Organization: 15

16 Questions? Ohio Department of Health Bureau of Infectious Diseases Zoonotic Disease Program Phone: (614) Web: 16