Zika Outbreak Discussion

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Zika Outbreak Discussion May 10, 2016 2016 Zurich Healthcare Customer Symposium

Speakers Krishna Lynch Senior Healthcare Risk Consultant Zurich Clayton Shoup Business Director, Workers Compensation Zurich 2

Background on Zika Zika is a member of the Flaviviridae virus family which also includes dengue, West Nile and yellow fever Originally noted in 1947 in monkeys in Uganda First human case noted in 1952 in Africa Prior to 2015, there were periodic outbreaks in Africa, Southeast Asia and the Pacific Islands In May 2015, Pan American Health Organization (PAHO) declared an alert due to spread in northern Brazil; now common in northern South America, Central America and the Caribbean Primarily transmitted via the bite of the Aedes aegypti species mosquito Transmission as also been noted in utero, via sexual intercourse and is suspected in transfusion "About Zika Virus Disease." Centers for Disease Control and Prevention. U.S. Centers for Disease Control and Prevention, 22 Feb. 2016. Web. 21 Apr. 2016 3

Zika Symptoms Most people will be asymptomatic if infected About 1 in 5 (20%) may experience fever, rash, joint pain and headaches; symptoms normally last for 2-7 days Severe disease and hospitalizations are uncommon; fatalities are rare Treatment is limited to supportive care, rest, fluids, using acetaminophen for fever / pain Vaccines are under development Greatest concern is the connection to microcephaly and secondarily to a limited number of cases of Guillain-Barre syndrome "About Zika Virus Disease." Centers for Disease Control and Prevention. U.S. Centers for Disease Control and Prevention, 22 Feb. 2016. Web. 21 Apr. 2016 4

Control Measures Aedes aegypti species mosquito is a daytime as well as night time biter Mosquito control is the primary control measure Elimination of sources of standing water in the home, business and outdoor environment Use of screens for windows and air conditioning for indoor environment Use of light colored clothing with long sleeves and pants Use of insect sprays (including DEET, picaridin, and IR3535 ) Outdoor clothing that is treated with permethrin 5

Travel Advisory In January 2016, U.S. CDC issued a travel advisory Travelers should use special precautions when traveling in the affected areas Women who are pregnant check with physician prior to travel and advise their physician if travel in the affected areas so pregnancy can be monitored appropriately Men who travel to affected areas should refrain from unprotected sex upon return Protect against mosquito bites after return to minimize chance of transmission via mosquitos Women of child bearing age delay travel or pregnancy 6

Strategies for Business Determine the impact that the spread of Zika may have on their business; those with outdoor aspects may or operations may have greater exposure Take steps to minimize the presence of mosquitos Review travel policies Develop employee education 7

Implications for Healthcare Recognition of cases? Concern about spread to staff? Actions needed to strengthen mosquito control? Implications for blood banks and organ donation? Preparations for more severe reactions (e.g., microcephaly and Guillain-Barre's Syndrome)? Family planning support? 8

Thank you The information in this presentation was compiled from sources believed to be reliable for informational purposes only. All sample policies and procedures herein should serve as a guideline, which you can use to create your own policies and procedures. We trust that you will customize these samples to reflect your own operations and believe that these samples may serve as a helpful platform for this endeavor. Any and all information contained herein is not intended to constitute advice (particularly not legal advice). Accordingly, persons requiring advice should consult independent advisors when developing programs and policies. We do not guarantee the accuracy of this information or any results and further assume no liability in connection with this presentation and sample policies and procedures, including any information, methods or safety suggestions contained herein. We undertake no obligation to publicly update or revise any of this information, whether to reflect new information, future developments, events or circumstances or otherwise. Moreover, Zurich reminds you that this cannot be assumed to contain every acceptable safety and compliance procedure or that additional procedures might not be appropriate under the circumstances. The subject matter of this presentation is not tied to any specific insurance product nor will adopting these policies and procedures ensure coverage under any insurance policy. 9