1. Applying Primary Prevention Principles to Combatting Zika Virus

2. Zika Virus Information Zika virus disease (Zika) is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. Around 80% of people are asymptomatic and may not realize they have been infected. Data Source: Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Vector-Borne Diseases (DVBD). http://www.cdc.gov/zika/about/index.htmlhttp://www.cdc.gov/zika/about/index.html 2

3. What we know about Zika No vaccine currently exists to prevent Zika virus disease (Zika). Zika can be prevented by avoiding mosquito bites. Mosquitoes that spread Zika virus bite mostly during the daytime. Mosquitoes that spread Zika virus also spread dengue and chikungunya viruses. Zika can cause birth defects if a mother is infected during pregnancy. Sexual transmission of Zika can be prevented by using condoms or not having sex. Data Source: Data Source:Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Vector-Borne Diseases (DVBD). http://www.cdc.gov/zika/prevention/index.htmlhttp://www.cdc.gov/zika/prevention/index.html 3

4. Zika virus: Public Health Threat Emergence unpredicted Serious risk for fetus –Microcephaly –Other birth defects –Poor pregnancy outcomes Guillain-Barré syndrome 4

5. Transmission of Zika Through Mosquito Bites  These mosquitoes typically lay eggs in and near standing water in things like buckets, bowls, animal dishes, flower pots and vases. They prefer to bite people, and live indoors and outdoors near people. From Mother to Child  A mother already infected with Zika virus can pass on the virus to her newborn. Data Source: Data Source:Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Vector-Borne Diseases (DVBD). http://www.cdc.gov/zika/transmission/index.htmlhttp://www.cdc.gov/zika/transmission/index.html 5

6. Transmission of Zika Through Sexual Contact  Zika virus can be spread by a man to his sex partners.  In known cases of sexual transmission, the men developed Zika virus symptoms. From these cases, we know the virus can be spread when the man has symptoms, before symptoms start and after symptoms resolve. From Blood Transfusions  As of February, 1, 2016, there have not been any confirmed blood transfusion transmission cases in the United States. Data Source: Data Source:Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Vector-Borne Diseases (DVBD). http://www.cdc.gov/zika/transmission/index.htmlhttp://www.cdc.gov/zika/transmission/index.html 6

7. Zika Transmission Routes 7

8. Case Counts (4/11/2016) US States: 346 travel-associated 0 locally transmitted Including: 32 pregnant women 1 case of Guillain-Barré syndrome 7 sexually transmitted Tennessee: 2 travel-associated cases as of April 11, 2016 8

9. Local Transmission 9

10. Strategy for Tackling the Problem Step 1: Define the problem and population Problem: Zika Virus Population: Who should you target? And why? Step 2: Set a goal– what are you going to change? Awareness/knowledge Behaviors/habits Policies Step 3: Create a “how to” approach Create Objective Identify Partners and Resources Implementation Learn from the project to inform future improvement

11. What populations should you target now (no local transmission)? Travelers to countries with ongoing Zika Virus transmission –Vacationers/Tourists/Visitors from countries with ongoing transmission Partners could include: travel agencies and airports College/high students in field trips or study abroad programs Partners could include: colleges and universities, high schools and travel agencies Mission groups Partners could include: religious institutions and non-profits Migrants Partners could include: non-profits that work with refugee populations and churches

12. What populations should you target if there is local transmission? High Risk Individuals like: –Homeless Partners could include: churches and non-profit advocacy groups –Pregnant women Partners could include OB/GYN and other healthcare workers/organizations –Low income individuals in urban areas Partners could include: non-profits who work with low income populations, religious organizations, and community centers Continue Targeting the General Public Partners could include: housing authorities, local elected officials

13. The “how to” approach for 3 bundles of change Increasing awareness/knowledge Changing behaviors/habits Changing policies around mosquito control

14. Awareness/Knowledge Step 1: Objective –Provide education and increase knowledge of Zika Virus and prevention measures/personal protection messages –Population: General public, travelers, mission groups, migrants, pregnant women, low income individuals Step 2: Identify partners and resources –Collaborate –Leverage your partners

15. Increasing Awareness/Knowledge: Step 3- Implementation Distribute educational materials Housing authorities, senior centers, parks/recreation facilities, rest stops, convenience centers, bus terminals, churches, schools/PTAs, low income neighborhoods Include pamphlets with utility bills or other community mailings Use community events to distribute information Encourage partner’s to post links to TDH Zika page on their Facebook, website, any other social media Zika Prevention kit 15

16. Example of Educational Materials 16

17. Zika Prevention Kit The CDC has developed recommendations for a Zika Prevention Kit that you could assemble The Kit includes: –A bed net –Insect Repellent –Permethrin spray –Standing water treatment tabs –A thermometer –Condoms http://www.cdc.gov/zika/prevention/prevention-kit.html 17

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19. Educational App for Learning about Zika The Caribbean Public Health Agency (CARPHA) developed the app “Zap-a-‘quito” Zap-a-’quito provides information about where mosquitos breed, how to stop breeding, and other facts about mosquitoes and the diseases they can carry When the user zaps a mosquito, the app states facts about the mosquito, the player has to answer questions and get them right before moving to the next level This game is a user-friendly way to learn about vector-borne illnesses and raise awareness among children (adults enjoy it too) The game is recommended for ages 3 and older The game is free and available on the Google Play store (only available on android devices)

20. Behaviors/Habits Step 1: Objective –Provide information and outreach to assist in environmental changes to reduce breeding grounds –Population: You know your communities better than anyone, think about where there are tire dumps, untidy yards with containers collecting water, individuals living in houses without AC/screens on the windows Step 2: Identify partners and resources –Collaborate with local health councils, schools, service groups (Rotary, Lion, Kiwanis, 4-H clubs), neighborhood associations, churches, and scouts

21. Changing Behaviors/Habits: Step 3-Implementation Step 3: Implementation –Form community clean up days, this not only is an opportunity to reduce breeding grounds for mosquitos but also to make your community beautiful 21

22. Changing Behaviors/Habits: Step 3-Implementation Con’t Bridgestone/Firestone -Take tires of any brand and recycle them -Community clean-up events must register: http://www.bridgestoneamericas.com/en/corporate-social- responsibility/environment-and-sustainability/tires4ward-request 22

23. Policy Step 1: Objective –Change local ordinances regarding standing water –Population: Local municipalities Step 2: Identify partners and resources –Collaborate with local councils to implement “best practices” for ordinances related to standing water

24. Changing Policy: Step 3- Implementation Step 3: Implementation –Make the collection of standing or flowing water in which mosquitos breed unlawful unless treated –Outline in code methods of treatment –Require permits for fish ponds –Incorporate provisions on enforcement and police cooperation –See Title 13 Chapter 2 in Fayetteville’s Code of Ordinances at http://www.mtas.tennessee.edu/public/municodesweb.nsf?Ope nDatabase http://www.mtas.tennessee.edu/public/municodesweb.nsf?Ope nDatabase 24

25. Improving Your Strategy There’s always room for improvement! When implementing your strategy to combat Zika think about— –Reach: What proportion of the target population participated? –Efficacy: Success of the strategy, what might need to be altered to achieve better results or reach more individuals? –Adoption: Did individuals change their behavior in regards to standing water and prevention methods? By keeping these areas in mind during implementation you can continually improve strategies to combat Zika!