Zika Virus Disease and Prevention
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View the Health Department's Zika virus presentation, which was presented July 22, 2016 on Facebook Live.
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Zika Virus Disease and Prevention
- 1. ZIKA VIRUS DISEASE AND PREVENTION Fairfax County Health Department
- 2. PRESENTATION OUTLINE • Zika Virus • Epidemiology • Clinical Information • Pregnancy Registry • Prevention Strategies • Mosquito Bite Prevention and Control • Mosquito Biology • Zika Response Activities • Controlling Mosquitoes at Home • Preventing Mosquito Bites
- 3. TIMELINE OF MAJOR ZIKA EVENTS 1947 2007 2013-14 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 1st case in Puerto Rico 2015-16 outbreak in Americas: 1st case of local transmission in Brazil 1st case in VA traveler confirmed WHO declares Public Health Emergency of International Concern 1947: Zika 1st isolated 2015 2016 2007: Yap Outbreak 2013–14: Fr. Polynesia outbreak
- 4. ALL COUNTRIES AND TERRITORIES WITH ACTIVE ZIKA VIRUS TRANSMISSION (AS OF 07/14/2016) 4 http://www.cdc.gov/zika/geo/active-countries.html
- 5. TRANSMISSION OF ZIKA VIRUS • Bite of an infected Aedes aegypti or Ae. albopictus mosquito • Pregnant woman infected with Zika, can pass Zika virus to her fetus during pregnancy or around time of birth • Sexual transmission • Strong possibility passed through blood transfusions
- 6. • The most common symptoms of Zika are: • Fever • Rash • Joint pain • Conjunctivitis (red eyes) • Timeframe from exposure to symptoms is 3-14 days • No vaccine or medications to prevent or treat SYMPTOMS OF ZIKA VIRUS Modified from CDC Zika 101 presentation
- 7. ZIKA VIRUS CLINICAL DISEASE COURSE AND OUTCOMES: ADULTS AND CHILDREN • Clinical illness usually mild • Most people infected do not show any signs of illness • When symptoms do occur, last several days to a week • Severe disease requiring hospitalization is rare • Death is rare • Guillain-Barré syndrome reported in patients following suspected Zika virus infection • Once a person has been infected, he or she is likely to be protected from future infections
- 8. GUILLAIN-BARRÉ SYNDROME (GBS) AND ZIKA • GBS is rare disorder where person’s own immune system damages nerve cells, causing muscle weakness and sometimes paralysis • Symptoms can last a few weeks or several months • Most people fully recover, but some have permanent damage and, in rare cases, have died • GBS is very likely triggered by Zika in a small proportion of infections, much as it is after a variety of other infections. • CDC investigating the link between Zika and GBS
- 9. HOW DOES ZIKA AFFECT PREGNANT WOMEN? • Zika virus is a cause of microcephaly and other severe fetal brain defects. • Defined by having a smaller than normal head or brain circumference • Prognosis varies depending on severity of microcephaly • Brazil reporting increase in number of babies with microcephaly and some have had lab-confirmed Zika Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and Birth Defects–Reviewing the Evidence for Causality. New EnglJ Med. 2016 Apr 13.
- 10. U.S. ZIKA PREGNANCY REGISTRY • Purpose of registry: • To monitor pregnancy and infant outcomes following Zika virus infection • Who is included: • Pregnant women with lab evidence of Zika virus infection • exposed infants born to these women; • Infants with laboratory evidence of congenital Zika virus infection and their mothers.
- 11. ZIKA PREVENTION STRATEGIES: TRAVELERS TO ZIKA-AFFECTED AREA Pregnant or considering becoming pregnant? • CDC recommends women who are pregnant should not travel to any area where Zika virus is spreading. • If your male partner travels to these areas, either use condoms correctly from start to finish, every time you have vaginal, anal, and oral (mouth-to-penis) sex, OR do not have sex during the pregnancy.
- 12. Zika Prevention Strategies: Sexual Transmission http://www.cdc.gov/zika/pregnancy/thinking-about-pregnancy.html
- 13. ZIKA PREVENTION STRATEGIES: TRAVELERS TO ZIKA-AFFECTED AREA For all other travelers: • Pack to prevent (insect repellent, long-sleeved shirts, long pants, bed net, condoms) • Avoid mosquito bites • Sleep indoors in rooms with screened windows or air-conditioning, or use bed net if sleeping in rooms exposed to outdoors • Even if you do not feel sick, travelers returning to the United States from an area with Zika should take steps to prevent mosquito bites for 3 weeks so they do not spread Zika to local mosquitoes that could spread the virus to other people. • Visit CDC’s Travelers Health website to see if the country you plan to visit has any travel health notices (http://wwwnc.cdc.gov/travel/page/zika-travel-information)
- 14. SURVEILLANCE IN FAIRFAX COUNTY • There has been no local transmission of Zika in Fairfax County or in the continental USA • Communicable Disease/Epidemiology Unit conducting human surveillance • Disease Carrying Insects Program conducting mosquito surveillance • If either of these indicate an area at high risk for Zika transmission—Health Department will conduct educational outreach and begin mosquito control activities, which may include: • Removal of mosquito breeding sites • Conducting pesticide treatments
- 15. MOSQUITO BITE PREVENTION AND CONTROL Fairfax County Health Department, Disease Carrying Insects Program
- 16. CONTROLLING ZIKA IS EVERYONE’S JOB. • Prevent mosquito bites • Eliminate container habitats around your yard and common areas Fairfax wants you… to help fight Zika A healthier community starts with you.
- 17. MOSQUITO LIFE CYCLE 7 to 10 days during summer months. 1. Egg 2. Larva 3. Pupa 4. Adult • Males: Nectar only • Females: Nectar and blood
- 18. MOSQUITOES THAT SPREAD ZIKA: AEDES Yellow fever mosquito (Aedes aegypti) Asian tiger mosquito (Aedes albopictus) Dengue Zika Chikungunya Yellow Fever CDC CDC Rare in Virginia Common in Virginia The Asian Tiger mosquito has the greatest potential to spread Zika virus in Fairfax County.
- 19. ASIAN TIGER MOSQUITO BIOLOGY • Lay eggs and develop only in containers • Feed on humans and other animals • Short flight range • Less than150 meters • Urban/sub-urban • Active during daytime • Peak @ dawn and dusk • Rest in vegetation CDC CDC
- 20. ZIKA PREPARATION IN FAIRFAX COUNTY • Education • Outreach materials • Community-based activities • PSAs • Yard inspections • Mosquito Surveillance • Collect adult mosquitoes and test for Zika virus • Larval collections
- 21. ASIAN TIGER MOSQUITO CONTROL • Source reduction (Tip and Toss) • Eliminate larval habitats, especially containers • Larvicides • Control larvae when standing water cannot be emptied • Adulticides • Barrier treatments to control adult mosquitoes
- 22. VECTOR CONTROL FOR ZIKA VIRUS TRAVEL-ASSOCIATED CASE • Infected during travel to Zika-affected area and returned to Fairfax County • Conduct site visit to case property and perform the following, as necessary: • Educate • Source reduction • Larvicide • Collect mosquitoes • Adult mosquito control
- 23. VECTOR CONTROL FOR ZIKA VIRUS LOCAL TRANSMISSION BY MOSQUITOES Patient is symptomatic and lab-positive for Zika without recent travel history to Zika-affected area OR Adult mosquitoes collected during surveillance test positive for Zika virus THEN Perform outreach, source reduction, larviciding, and adult mosquito control at case property as previously described, and on additional properties in the surrounding area
- 25. DO YOUR PART FROM THE START! • Neighborhood cleanups: reduce container habitats • Everyone’s yard • Common areas • Streams where trash accumulates • Share what you know
- 26. ELIMINATE STANDING WATER • Check yard weekly • Tip, Pour, and Toss • Throw away containers • Store containers so they don’t hold water • Use larvicide if can’t empty water
- 27. TIP AND TOSS STANDING WATER. ELIMINATE CONTAINERS.
- 29. Flood water Ditches Root-ball poolsWoodland poolsSalt marshes Permanent swamps Polluted water Grass tussocks Pooling streamsPonds with vegetation Swimming pools Stormwater management structures THESE HABITATS DO NOT PRODUCE ASIAN TIGER MOSQUITOES
- 30. TREAT YOUR YARD WITH INSECTICIDE • Follow label instructions • Make sure product states that it controls mosquitoes • Use products that work for few weeks after application (“residual”) • Focus treatment on areas of dense vegetation
- 31. DRESS TO PROTECT: COVER UP • Long-sleeved shirt • Long pants • Socks and shoes • Light colors • Loose fit • Permethrin-treated clothing
- 32. USE AN EPA-REGISTERED REPELLENT • Follow label instructions • Active Ingredients: • DEET, Picaridin, IR3535, or Oil of Lemon Eucalyptus • Reapply insect repellent as directed • Apply sunscreen before repellent CDC
- 33. MOSQUITO BITE PREVENTION FOR CHILDREN • Repellents • Follow label instructions • DEET: Children older than 2 months • Oil of Lemon Eucalyptus: Children older than 3 years • Adults: Apply to hands and then apply to a child’s face • Avoid hands, eyes, mouth, and cut or irritated skin • Cover crib, stroller, baby carrier
- 34. USE PERMETHRIN ON CLOTHING • Follow label instructions • Permethrin is the active ingredient • Apply to clothing, NEVER to skin • Pre-treated clothing or DIY
- 35. AVOID MOSQUITO BITES • Peak biting times: dawn and dusk • Asian tiger mosquitoes bite all day • Use air conditioning • Repair doors and window screens • Mosquitoes that spread Zika sometimes enter homes
- 36. UPDATED INFORMATION ABOUT ZIKA • Pan American Health Organization (PAHO): www.paho.org/zika • Centers for Disease Control and Prevention (CDC): www.cdc.gov/zika • Virginia Department of Health (VDH): http://www.vdh.virginia.gov/epidemiology/zika-virus-update/ • Fairfax County Health Department (FCHD) http://www.fairfaxcounty.gov/hd/westnile/zika-virus.htm
Notes de l'éditeur
- Zika virus was first discovered in 1947 in a monkey in the Zika Forest of Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations. Before 2007, at least 14 cases of Zika had been documented, although other cases were likely to have occurred and were not reported. Because the symptoms of Zika are similar to those of many other diseases, such as Dengue and Chikungunya, many cases may not have been recognized. In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. On February 1, 2016, the World Health Organization (WHO) declared Zika virus a Public Health Emergency of International Concern (PHEIC). Local transmission has been reported in many other countries and territories. Zika virus will likely continue to spread to new areas. Multiple things could highlight, including any of the following: 1947: Zika first isolated from a monkey in Uganda (Zika forest) Before 2007: only sporadic human cases reported from Africa and Southeast Asia 2007: 1st outbreak reported on Yap Island (Federated States of Micronesia) 2013-2014: Outbreak in French Polynesia (>28,000 suspected cases) May 2015: Pan American Health Organization issued an alert regarding 1st confirmed Zika case in Brazil May 2015-current: local transmission reported in several other countries and territories Dec 2015: Puerto Rico reported 1st Jan 22, 2016: CDC actives Emergency Operations Center (EOC) Jan 26, 2016: 1st imported case in Virginia identified (onset was 12/2/15) Feb 1, 2016: WHO declares Zika a public health emergency of international concern
- 49 countries/territories currently reporting active zika virus transmission
- Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. The illness is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people. Once a person has been infected, he or she is likely to be protected from future infections.
- Source: http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly. Babies with microcephaly can have a range of other problems, depending on how severe their microcephaly is. It was been linked with seizures, developmental delay, intellectual disability, problems with movement and balance, feeding problems, hearing loss and vision problems. Difficult birth defect to monitor because of inconsistent definition and use of terminology Adverse Outcomes and Zika Virus A range of other problems have been reported:Eye abnormalities Hearing impairment Seizures Swallowing impairment Hypertonicity and posturing Contractures, including club foot and curving of the joints Severe irritability Developmental delay Growth abnormalities, including intrauterine growth restriction and disproportionate growth (head size alone affected) Karwowski MP, Nelson JM, Staples JE, et al. Zika Virus Disease: A CDC Update for Pediatric Health Care Providers. Pediatrics.2016;137(5):e20160621
- http://www.bt.cdc.gov/coca/ppt/2016/04_12_16_zikaclinicalguidelines_fb.pdf More information is available on the U.S. Zika Pregnancy Registry website at www.cdc.gov/zika/hc-providers/registry.html To contact CDC Registry staff, call the CDC Emergency Operations Center watch desk at 770-488-7100 and ask for the Zika Pregnancy Hotline or email ZIKApregnancy@cdc.gov
- -Interrupt the cycle -eggs singly laid versus rafts -talk about complete metamorphosis
- -talk about egg laying and drying needed for development -talk about getting indoors
- Engaging stakeholders (April, May) Zika 101 for county employees Website with updated outreach materials
- Zika action plan calls for increasing mosquito control in response to local cases of Zika Adult mosquito control, in the form of barrier sprays, will be considered as part of an integrated approach that uses other methods, such as source reduction.
- -Conduct site visit to case property -During the epidemiological investigation, the patient will already have received advice about avoiding mosquito bites. -When vector control specialists investigate the property, we will also give the residents hard copies of educational materials, and request that they stay indoors during our inspection to avoid mosquito bites. -Tip and toss all standing water, eliminate larval sources -Standing water than cannot be eliminated treated with larvicide -Set BG-sentinel mosquito trap to determine adult Asian Tiger mosquito abundance. This trap specifically targets Asian Tiger mosquitoes. Make observations about adult mosquito activity on property. -If warranted based on thresholds (# of mosquitoes found), barrier application may be used on case property
- -Asian tiger mosquitoes typically do not fly more than a few hundred feet from their larval source when looking for hosts. If we can eliminate any potential container habitats that would harbor larvae, and kill many of the adult mosquitoes case property and additional nearby properties, we can reduce the risk of expansion of the virus outward from the case property.
- Mosquitoes prefer to rest in shaded, high-humidity places Thick bushes, ivy, azaleas, boxwoods, etc.
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