1. Supervisory Epidemiologist
Zika Virus
Preetha Iyengar, MD
Supervisory Epidemiologist
District of Columbia
Department of Health

2. Background Mosquito-borne flavivirus 1947: First identified in Uganda
2007: First major outbreak in Yap (Micronesia)
2013: Outbreak in French Polynesia
2014: Cases in Pacific Islands
2015: Outbreak in Brazil
2016: In >20 countries in the Americas

3. Areas with Zika Transmission

4. Zika Virus in the US NO local transmission 35 travel-associated cases
1 from sexual transmission
9 by local transmission in US territories

5. How do you get Zika? Spread through the bite of an infected mosquito
Same mosquitoes that spread dengue, chikungunya, and yellow fever
Aedes spp.
Mother-to-child during pregnancy or delivery
Possible association between infection during pregnancy and microcephaly in babies
Sexual transmission
No reports through breastfeeding

6. Symptoms of Zika Infection
About 1 in 5 people (20%) have symptoms
Most common symptoms: fever, rash, joint pain, or red eyes (conjunctivitis)
Other symptoms could include muscle pain and headache
Last days to weeks
Incubation period is unknown
Likely viremic for 1 week after illness

7. Testing Recommendations
Anyone with a travel history and 2/4 symptoms
All pregnant women with a travel history in the last 2-12 weeks
Pregnant women with a history of sexual contact with someone with Zika infections
Infants with microcephaly and a mother with a travel history or history of Zika infection
Testing is currently only performed at the Centers for Disease Control and Prevention

8. District of Columbia Department of Health (DC DOH) Approach
The Department of Health actively develops new protocols to both protect the health of our residents and monitor changes in health trends. In the past we have implemented monitoring and prevention programs for both Chikungunya virus and Ebola virus disease; applying many of the lessons learned from these responses to our current Zika virus surveillance and response program. Our most extensive response and prevention effort to-date was our Ebola response program.
From October 2014 through January 2016 the Center for Policy, Planning and Evaluation: Division of Epidemiology monitored over 1000 recent travelers returning the United States from Ebola-impacted countries in West Africa. This started with an initial risk assessment interview conducted over the phone, followed by daily check-ins with travelers for a 3 week period. This taught us valuable lessons on how to achieve the highest possible response rates, gathering information quickly.
During the Ebola response, we also improved our methods for communicating with the DC medical community, as well as Federal and local partners
Since this response concluded, we have conducted a survey among persons that were monitored during the process to determine the most efficient protocols to contact people during future surveillance efforts. All of these lessons were used in shaping our Zika response program.

9. Emerging Disease Threat Assessment
Background
Chikungunya virus
Ebola Virus
Lesson’s Learned from DCDOH Ebola Response
>1000 travelers monitored
Initial risk assessment interview
Daily communications
Collaboration with:
DC medical community
Federal and local partners
The Department of Health actively develops new protocols to both protect the health of our residents and monitor changes in health trends. In the past we have implemented monitoring and prevention programs for both Chikungunya virus and Ebola virus disease; we are now applying many of the lessons learned from these responses to our current Zika virus surveillance and response program. Our most extensive response and prevention effort to-date was our Ebola response program.
From October 2014 through January 2016 the Center for Policy, Planning and Evaluation: Division of Epidemiology monitored over 1000 recent travelers returning the United States from Ebola-impacted countries in West Africa. This started with an initial risk assessment interview conducted over the phone, followed by daily check-ins with travelers for a 3 week period. This taught us valuable lessons on how to achieve the highest possible response rates, gathering information quickly.
During the Ebola response, we also improved our methods for communicating with the DC medical community, as well as Federal and regional partners, such as Maryland and Virginia
Since this response concluded, we have conducted a survey among persons that were monitored during the process to determine the most efficient protocols to contact people during future surveillance efforts. All of these lessons were used in shaping our Zika response program.

10. DC DOH Approach Coordination with local providers Level of Concern
Health notices
Fact Sheets
Website
Level of Concern
Pregnant Women
Non-Pregnant Women
Men
The DC department of health has been actively coordinating with local providers, a key element in surveillance and control of the Zika virus. As recommendations are constantly changing, we have been active through sending out health notices, creating factsheets about the virus for providers and residents, and updating our website. Through these venues, we have been in communication with doctors, nurses, DC residents, school officials, and many other concerned stakeholders.
Our focus in education has been in helping medical officials and the public understand appropriate levels of concer.
The largest concern with Zika virus is for pregnant women, for all travelers who are not pregnant they have a 1 in 5 chance of developing symptoms milder than the common flu if they are bitten by an infected mosquito. Non-pregnant women thinking of becoming pregnant should consider not traveling as well.
Therefore, if you have any pregnant friends or family members planning travel to an area with ongoing spread of Zika, please advise them not to travel. For everyone else, advise them to avoid exposures to mosquitos and utilize proper safe sex practices when they return.

11. DC DOH Zika Surveillance Program
DCDOH Notified of Case
YES
DC Resident? NO
Coordinate with Regional Partners
Positive Travel
NO Symptoms
Zika Interview Conducted
Positive Travel AND Symptoms NO
Pregnant?
When the Department of Health is first notified of a potential Zika virus exposure we first determine if the individual is a DC resident. If they are not a DC resident we put them in contact with their home health department. Once resident status has been determined, a Zika virus interview is conducted. This is to determine if the person has an appropriate travel history and clinically relevant symptoms. The symptoms we are looking for are: fever, conjunctivitis, joint pain, and a rash. If a person has both traveled and has at least two symptoms, we coordinate with local providers to have blood samples tested for Zika virus at CDC facilities in Colorado. If they do not, testing is not performed. However, if the patient is pregnant and has recently traveled to an area with on-going Zika transmission, they are tested regardless of symptom status. The reason for this difference in policy is the unknown risk to fetal development in pregnant women exposed to Zika virus.
YES
Zika testing not indicated
Zika testing performed at CDC

12. DC DOH Zika Contact Information
DC DOH Website:
Address:
Phone #:
(844)
To stay current on the most recent recommendations, please refer to the DOH Zika website. A link to the website can be found on the main page by clicking the “Staying Informed on Zika Virus” icon.
Other questions can be directed to the main epidemiology address or phone number.