1. Local Health Departments: Preparing for and Preventing Zika March 23, 2016

2. Florida Department of Health (DOH) Jennifer Jackson, MPH and David Overfield 2 Zika Virus Response 2016

3. Zika Virus 3 Flavivirus: Testing has potential for cross-reactivity with other flaviviruses Originally identified in Africa and Southeast Asia First identified in Uganda’s Zika Forest in 1947 Transmission Mosquito – Aedes aegypti, possibly Aedes albopictus Vertical transmission (mother to baby) Sexual Transfusion cases (2 recently documented) Lab exposures Detected in breast milk, saliva, and urine but no documented transmission

4. Zika Fever Symptoms 4 Incubation period: 2-14 days 1 in 5 people infected will become symptomatic Few hospitalizations Fever (often low-grade) Rash Joint pain Red eyes Muscle ache Headache Pain behind the eyes Vomiting Most common signs and symptoms

5. Zika Fever (continued) 5 Rule out other illnesses like dengue and chikungunya No vaccine but research underway Linked to poor pregnancy outcomes Linked to Guillain-Barré Syndrome (GBS) http://www.who.int/emergencies/zika- virus/situation-report/4-march-2016/en/

6. CDC Travel Alert/HAN Travel Alert Level 2-Practice Enhanced Precautions Pregnant women in any trimester should postpone travel Women trying to become pregnant should consult healthcare provider before travel Avoid mosquito bites http://www.cdc.gov/media/releases/2016/s0315-zika- virus-travel.html http://www.cdc.gov/media/releases/2016/s0315-zika- virus-travel.html http://wwwnc.cdc.gov/travel/notices http://emergency.cdc.gov/han/han00385.asp 6

7. Executive Order Number 16-29 7 Public Health Emergency in 12 counties (duration and geographic boundaries can change) Authorizes Commissioner of Agriculture to issue mosquito declaration in those counties. Designates DOH as lead state agency to coordinate emergency response activities among various state agencies and local governments Directs Department of Environmental Protection and Fish and Wildlife Conservation Commission to support Department of Agriculture and Consumer Services in developing extensive mosquito control plans

8. Emergency Rules Noticed 8 Noticed February 5, 2016 64DER16-1 (64D-3.029) Diseases or Conditions to be Reported Requires immediate reporting to DOH of suspected or confirmed cases of the Zika virus by physicians, hospitals, and laboratories

9. Specific DOH-Orange Zika Response 9 Ongoing collaboration with Florida Hospital and Orlando Health Hospital Systems Past collaborations (H1N1, MERS) Some healthcare providers and OB/GYN offices lack capabilities to draw and/or ship specimens Currently teaming up with Florida Hospital High Risk OB unit Collaboration with our internal partners (DOH-Orange Family Planning and Prenatal Health) Underinsured population

10. Example Intake Form (Florida Hospital) 10

11. Example Intake Form (Orlando Health) 11

12. Example – Intake Form (DOH-Orange) 12

13. Zika Case Management of Pregnant Women 13 Consider Zika virus testing for all pregnant women with history of travel to an affected country This includes both symptomatic and asymptomatic pregnant women Testing and care for pregnant women who many not have insurance or are under-insured

14. Local Mosquito Control Activities 14 Key partnership with local mosquito control districts DOH notifies mosquito control upon suspicion of mosquito-borne illness (Zika, Dengue, Chik) Appropriate mosquito control measures are implemented almost immediately Successful partnership demonstrated previously Chikungunya 2014 510 imported cases identified 12 sporadic local cases Coordinated DOH – Local mosquito control activities No sustained local transmission

15. Suspected Zika Fever Case Investigation 15 Mosquito Control Sick person Case reported Response Interview Public Health care provider Laboratory County Health Department Case finding Outreach/education Alerts/advisories Testing Approval Department of Health State Office CDC State Laboratory 15 Subject Matter Experts Policy Guidance Case Consultation Weekly reports Publish statewide data Publish nationwide data

16. Lessons Learned 16 Have the conversation now Establish rapport Identify gaps in the process Have surveillance in place Timely specimen collection/lab work Proactive Understanding the federal guidelines but also the needs of YOUR community

17. Environmental Health Activities to Abate Neighborhood Mosquito Breeding Sites 17 Responsible under State statute to investigate and address sanitary nuisances which include “the creation, maintenance, or causing of any condition capable of breeding flies, mosquitos or other arthropods capable of transmitting diseases

18. The Process 18 Complaint received (usually a vacant house) If mosquito larva are found, notice to abate is sent to the owner, tenant and bank If no one responds to the first notice, we issue a notice of intended action which contains language allowing us to remove, cause to remove or prevent the continuing of a sanitary nuisance If the sanitary nuisance is still not corrected, we abate the condition ex. dump the container or place larvicide in the pool and repeat as necessary We place a lien on the property at the County Records office that includes the cost of treatment and applicable fines

19. Some Additional Points 19 Our Sanitary Nuisance investigator is a Public Health Applicator License Holder – issued by the Department of Agriculture and Consumer Services, Bureau of Licensing and Enforcement When investigating a home for mosquito larva, an informational door hanger is left on the home and the homes on either side When applying a lien for the cost of abatement through the County Records office, it can take considerable time to be satisfied

20. Available Resources 20 DOH Zika virus webpage: www.floridahealth.gov/zikawww.floridahealth.gov/zika DOH Zika Virus Information Hotline 1-855-622-6735 CDC Zika virus webpage: http://www.cdc.gov/zika/http://www.cdc.gov/zika/ CDC Zika virus preparedness: http://www.cdc.gov/zika/public-health-partners/tips.html http://www.cdc.gov/zika/public-health-partners/tips.html

21. More Information 21 Jennifer T. Jackson, MPH (Epidemiologist – Orange County) Jennifer.Jackson@FLHealth.gov 407-858-1400 x1133 David Overfield (Environmental Administrator – Orange County) David.Overfield@FLHealth.gov 407-858-1479 x2285

22. Zika: Mission Mosquito Bi-City-County Health District Shaun May, MPH, RS Environmental Health Director March 2016

23. Vector Control Review Objectives Surveillance – Texas Department of Agriculture; Texas Tech University, and City of Amarillo Outreach – website, press releases, media, community events. Education, Education, Education… Seasonal Operations – larvicide vs. adulticide Complaint response – investigation and abatement

24. Surveillance Local response Playas and private property Over 100 sites within City OFIs & Collaboration Communication/Data Sharing Increased# of sites Service integration Updated species maps

25. Outreach Prevention through Education The media can be your friend… Zika Home Care Kit (courtesy of Tarrant County Public Health) Community events/workshops Public Health network meetings

26. Seasonal Operations Larvicide (spraying) 8 staff, 8 hrs/day, 2-3 days a week during peek operations Daytime operations 90% of total mosquito control activities Over 100 sites Most lethal method April thru October

27. Seasonal Operations Adulticide (fogging) 2 staff, 2-4 hrs/day, 2-3 days a week during peak operations (overtime pay) Nighttime operations Weather dependant Complaint based Less lethal method

29. Other Considerations Budget - $35K in chemicals; $50K in staff; general fund Safety is vital – chemical use and storage; vehicle ops Equipment maintenance and operation Private property nuisance abatement Prevention is paramount; Extermination is essential We need updated species distribution maps; 85 species identified in Texas Consider your soil type and topography

31. Questions? Contact Info for Shaun May: Shaun.May@amarillo.gov (806) 378-9473

32. Thank you for joining us. Please take a minute to answer questions about this webinar: https://www.surveymonkey.com/r/NEHAZika https://www.surveymonkey.com/r/NEHAZika Questions? Contact: Christl Tate ctate@neha.org