2. 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. 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
Local Zika
Transmission
confirmed in
Florida
7. 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
8. Symptoms of Zika virus
• 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 Modified from CDC Zika 101 presentation
9. 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
10. 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
11. 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.
12. 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.
13. 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.
15. 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.
16. There has been no local transmission of Zika by mosquitoes in Fairfax County or anywhere in
Virginia
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
19. Egg to adult in 7 to
10 days during
summer months.
1. Egg
2. Larva
3. Pupa
4. Adult
Males: Nectar only
Females: Nectar
and blood
On average, mosquitoes live for about a month as flying, biting adults.
20. 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.
21. 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
23. 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
24. 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
25. 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
28. 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
29.
30.
31. Flood water
Ditches
Root-ball poolsWoodland poolsSalt marshes
Permanent swamps Polluted water Grass tussocks
Pooling streamsPonds with vegetation
Swimming pools
Stormwater management
structures
32. 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
34. Follow label instructions
Active Ingredients:
DEET, Picaridin, IR3535, or
Oil of Lemon Eucalyptus
Reapply insect repellent as
directed
Apply sunscreen before
repellent
CDC
35. 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
37. 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
38. 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
49 countries/territories currently reporting active zika virus transmission
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.