2017 SCAAP Summer Conference. Lilian Peake, MD, MPH

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1 2017 SCAAP Summer Conference Lilian Peake, MD, MPH

2 1. Mosquito-borne Diseases 2. Challenges to Preventing and Controlling Mosquito-borne Diseases 3. Effects of Zika Virus on Child Health None

3 Accelerating emergence and incidence of mosquito-borne diseases Many have or will likely become endemic throughout the Western Hemisphere 3 Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

4 Dengue Virus Yellow Fever West Nile Virus Zika Virus Chikungunya Virus s 1700s 1800s 1900s 2000s Emergence of Arboviruses in the Western Hemisphere Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

5 Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

6 Percent world population living in urban setting 1950: 29% 2007: 49% 2030: 60% Increase largely due to 3X increase in Asia and Africa Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

7 Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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9 Enzootic Culex spp mosquitoes West Nile virus Japanese encephalitis Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

10 Aedes spp mosquitoes Haemogogus spp mosquitoes Enzootic Urban Epidemic Aedes aegypti +/- Aedes albopictus Dengue Yellow fever Chikungunya Zika Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

11 Shortens time from infection to infectiousness (extrinsic incubation period) Increases viral replication in mosquitoes, making them more infectious Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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13 Incidence per 100,000 population Average Annual Incidence of WNV Neuroinvasive Disease US, Year Source: Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

14 Average Annual Incidence of WNV Neuroinvasive Disease by County, US, Source: Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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16 Number Cases Dengue Incidence in the Americas, Source: Pan American Health Organization (PAHO) Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

17 Dengue Serotypes in the Americas, Source: Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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19 Cases, Suspected and Confirmed (thousands) Countries and Territories with Local Transmission Chikungunya Virus in the Americas Countries Cases countries 1,427,005 cases 222 deaths Dec 2013 May 2013 Source: PAHO report posted to Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

20 Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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22 Number of Countries with Zika Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

23 Source: Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

24 Reported Zika Virus Cases, Continental United States As of July 12, 2017 Category Number Travel related* 5,381 Local transmission 224 Other routes 48 * Includes cases in travelers and their contacts with presumed sexual or in utero transmission Source: Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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27 1. No proven control measure for Aedes aegypti (dengue, yellow fever, chikungunya, Zika) 2. Insecticide resistance unknown, in some areas likely widespread 3. Eroding technical capacities at all levels; shrinking entomologic workforce 4. Surveillance infrastructure diminishing 5. Patchwork of vector control units across the US Largely underprepared Focus on Culex mosquitoes, not for Aedes aegypti Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

28 Number Cases Number of Cases of WNV Neuroinvasive Disease, by Calendar Week of Onset and Report, and Vector Index, Dallas County, Reported Onset Vector Index Aerial spraying Vector Index June July August Sept Oct Adapted from JAMA 2013;310: Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

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30 Cugola, Fernanda R., and coworkers. "The Brazilian Zika virus strain causes birth defects in experimental models." Nature (2016): Honein, Margaret A., et al. "Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy." JAMA (2017): Johansson, Michael A., et al. "Zika and the risk of microcephaly." New England Journal of Medicine (2016): 1-4. Panchaud, Alice, et al. "Emerging role of Zika virus in adverse fetal and neonatal outcomes." Clinical microbiology reviews 29.3 (2016): Rasmussen, Sonja A., et al. "Zika virus and birth defects reviewing the evidence for causality." New England Journal of Medicine (2016):

31 Microcephaly Decreased brain tissue and brain damage Damage to eyes including vision Damage to ears including hearing Joint problems

32 Substantial family-identified health care service needs Chronic conditions Functional limitations Health care use

33 I eventually stopped working to care and coordinate my daughter s weekly therapy appointments and monthly doctor visits. She has struggled with meeting developmental milestones, but at age 2 began to show more improvement. After 6 years of intense physical therapy, she began walking independently. A Family Connection Parent of a child with microcephaly and Chromsome deletion

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35 Surveillance and investigation of human cases Working with local governments on vector control Information about Zika in English and Spanish

36 Prepared text4baby messages to alert pregnant women of areas in the event of local Zika Pregnancy Registry Women or infants who screen positive for Zika virus Including infant s 2 month, 6 month, and 12 month pediatric visits Enhanced surveillance of microcephaly cases Contract with partners to take advantage of community expertise

37 Dissemination of information to Latino/Hispanic population Contact with families for the Zika Pregnancy Registry Refer families to appropriate resources

38 Support with statewide education and planning for the Early Intervention community with Zika virus Available to provide pediatric neurology expertise to physicians

39 Provide increased developmental screenings Follow up of all infants in Zika Pregnancy Registry Provide statewide education to Early Intervention community

40 Clinical validation of brain anomalies found Surveillance data from autopsies Support with research on Neural Tube Defects

41 AAP Children and Disasters Zika CDC Zika Healthcare Providers Infants and Children

42 We are working in many areas to try to continue to make SC a healthy place to grow up. We want to hear from you. Please share any concerns, issues, or recommendations with members of the DHEC Pediatric Advisory Council to bring to our attention. Contact: Lucy Gibson (gibsonh@dhec.sc.gov) We could not make progress without you and look forward to continuing to work together!

43 Lilian Peake, MD, MPH Director, Public Health