1. Zika Virus Lisa Engle, MPH Epidemiologist Chesapeake Health Department
February 28, 2017

2. Zika Virus Disease (Zika)
Spread to people primarily through bite of infected mosquitoes (Aedes species)
In our area is the Aedes albopictus (Asian tiger mosquito)
Mosquitoes become infected by feeding on infected persons
Only 1 of 5 infected persons get sick
Incubation period for Zika is likely 3–14 days
Zika virus remains in an infected person’s blood for about 1 week
Fever, rash, joint pain and conjunctivitis are most common symptoms – usually a mild illness
Illness lasts several days to 1 week
No vaccine or medications to prevent or treat
No animal reservoir is known to be involved in Zika transmission in the Americas
Zika virus infection is a relatively mild infection.
Symptoms usually develop a few days to a week after mosquito bite
In fact, only 1 out of 5 infected persons experience symptoms.
The most common symptoms are fever, rash, joint pain and conjunctivitis.
Illness usually lasts a few days to a week.
Currently, there is no vaccine or medications to prevent or treat Zika infection.
Treatment is supportive care: get plenty of rest, drink fluids to prevent dehydration, take medicine such as acetaminophen to reduce fever and pain; do not take aspirin or other non-steroidal anti-inflammatory drugs (until Dengue infection is ruled-out to prevent hemorrhage complications).
Severe disease requiring hospitalization is uncommon and death is rare.
Symptoms tend to last a few days to a week and most patients feel better after this short period of illness.
Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.
Source:
The primary method of transmission of Zika virus is through the bite of an infected Aedes mosquito.
In the current outbreak, A. aegypti (Yellow fever mosquito) appears to be the most efficient mosquito vector, but A. albopictus (Asian tiger mosquito) is also capable of transmitting the virus.
These are the same mosquitoes that transmit/spread dengue and chikungunya viruses.
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.
Aggressive daytime biters. However, they can also bite at night.
Zika virus can also be spread (rarely) from mother to child
A mother already infected with Zika virus near the time of delivery can pass on the virus to her newborn around the time of birth, but this is rare.
It is possible that Zika virus could be passed from mother to fetus during pregnancy. This mode of transmission is being investigated.
To date, there are no reports of infants getting Zika virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.
In addition, there have been reports of Zika virus transmission through blood transfusion and sexual contact.
Source: CDC

3. Estimated range of Aedes aegypti and Aedes albopictus in the United States, 2016
Because the mosquitoes that spread the virus are found around the world, it is likely that outbreaks will spread to new countries. There have been 43 reported mosquito-borne transmission cases of Zika virus in the continental U.S. (specifically Florida). For a map of where the mosquitoes that could spread Zika virus are located in the U.S., see
For a map of active transmission in Florida:
These maps DO NOT show:
Exact locations or numbers of mosquitoes living in an area
Risk or likelihood that these mosquitoes will spread viruses
These maps show:
CDC’s best estimate of the potential range of Aedes aegypti and Aedes albopictus in the United States
Areas where mosquitoes are or have been previously found
Source: CDC:

4. Transmission of Zika Transmitted from mother to child
During pregnancy or at time of delivery
Transmitted by blood or sexual contact
Spread through blood transfusion and sexual contact has been reported
Blood collection centers in the United States to screen all donated blood for Zika
Virus has been found to persist for several weeks in saliva and urine but it is not known if Zika can be spread from those body fluids
Zika virus can also be spread (rarely) from mother to child
A mother already infected with Zika virus near the time of delivery can pass on the virus to her newborn around the time of birth, but this is rare.
It is possible that Zika virus could be passed from mother to fetus during pregnancy. This mode of transmission is being investigated.
To date, there are no reports of infants getting Zika virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.
In addition, there have been reports of Zika virus transmission through blood transfusion and sexual contact.
Virus has been found to persist for several weeks in saliva and blood.

5. Zika and Microcephaly
CDC studies continue an association with microcephaly
Defined as having smaller than normal head or brain circumference, as compared to babies of same sex and age
AP Photo/Felipe Dana
Source:
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.
Prognosis varies depending on severity of microcephaly
Brazil reporting increase in number of babies with microcephaly and some have had lab-confirmed Zika
FYI additional info from CDC Key Messages (8/23/16):
Does Zika virus infection in pregnant women cause birth defects, such as microcephaly?
Brazil has been having a significant outbreak of Zika virus since May Officials in Brazil have also noted an increase in the number of babies with congenital microcephaly (a birth defect in which the size of a baby’s head is smaller than expected for age and sex) during that time. Congenital microcephaly is often a sign of the brain not developing normally during pregnancy. Health authorities in Brazil, with assistance from the Pan American Health Organization, CDC, and other agencies, have been investigating the possible association between Zika virus infection and microcephaly.
Additional studies are needed to determine the degree to which Zika might be linked with microcephaly. More lab testing and other studies are planned to learn more about the risks of Zika virus infection during pregnancy.
Because of the possible association between Zika infection and microcephaly, pregnant women should take steps to prevent mosquito bites.
How is microcephaly diagnosed prenatally? Microcephaly can be diagnosed during pregnancy with ultrasound. Microcephaly is most easily diagnosed by ultrasound late in the 2nd trimester or early in the third trimester of pregnancy.
How early can microcephaly be diagnosed during pregnancy? Microcephaly might be detected as early as weeks of gestation. However, detection by prenatal ultrasound can be challenging at this gestational age due to fetal position and fetal motion artifact. The optimal time to perform ultrasound screening for fetal microcephaly is not known. In the absence of microcephaly, the presence of intracranial calcifications before 22 weeks gestation might suggest a risk for the future development of microcephaly.
FYI Source: WHO sit rep report on Feb 5, 2016 ( : Seven countries have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome concomitantly with a Zika virus outbreak. (this might include past outbreaks, not just in current outbreak in Americas).
For most recent WHO situation report:
Sources for defining microcephaly: and

6. Zika Prevention Strategies: Avoid Mosquito Bites
Personal Protection
Choose an EPA-registered insect repellent and follow label directions
Products containing DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products provide longer-lasting protection
Cover exposed skin by wearing long sleeves, pants, and hats
Source:
Use Environmental Protection Agency (EPA)-registered insect repellents.
When used as directed, these insect repellents are proven safe and effective even for pregnant and breastfeeding women.
Always follow the product label instructions.
Reapply insect repellent as directed. Do not spray repellent on the skin under clothing.
If you are also using sunscreen, apply sunscreen before applying insect repellent.
Treat clothing and gear with permethrin or buy permethrin-treated items.
Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.
If treating items yourself, follow the product instructions carefully.
Do NOT use permethrin products directly on skin. They are intended to treat clothing.
Wear long-sleeved shirts and long pants.
Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside.
Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
If you have a baby or child : Do not use insect repellent on babies younger than 2 months of age. Dress your child in clothing that covers arms and legs. Cover crib, stroller, and baby carrier with mosquito netting. Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin. Adults: Spray insect repellent onto your hands and then apply to a child’s face.

7. About the Virginia Vector
Asian tiger mosquitoes are found throughout Virginia and are the most common nuisance mosquito in urban and suburban areas
Asian tiger mosquitoes fly and bite during daylight hours when people are likely to be outdoors
Enter homes through unscreened windows or open doors and bite inside day and night
Lay eggs exclusively in containers of water and like shady areas; do not originate from puddles, ditches or natural bodies of water on the ground
Both mosquito vectors for Zika virus transmission are found in Virginia.
In fact, the Asian tiger mosquito is the most common nuisance mosquito in Virginia in urban and suburban areas.
This mosquito species is active during daylight hours when people are likely to be outdoors. They will enter homes and can bite inside during day and night.

8. Common Backyard Mosquito Sources
Adult female Aedes mosquitoes lay eggs in natural and artificial water-holding containers (tree holes, used tires, plastic containers, clogged gutters, etc.)
Once a week, empty standing water sources around home to reduce mosquito breeding sites
Image from:
Thorough inspection of residential and commercial properties to find and eliminate, dump, or treat the containers of water that these mosquito species lay their eggs in. Effective treatment of a neighborhood often requires a property to property effort.
Source:
CDC: Controlling Mosquitoes at Home:
Image:

9. Should Businesses Worry?

10. Florida Travelers Cautioned
Count of locally acquired Zika infections:
215 (Feb 22, 2017 CDC)

11. Florida Depends on Tourism
Roger Dow, president and CEO of the U.S. Travel Association, explained that tourists spent a record $89 billion in Florida in 2015 and the tourism industry employs 1.2 million jobs in the state

12. Economic Impact
After health officials found Zika in Wynwood, sales in the area slumped 50%
In August, airfare prices to Miami International and Fort Lauderdale-Hollywood International Airports fell 17%
Revenue and tips at R House Restaurant have dropped by 75% which led to cutting hours and laying off a quarter of the staff
At a September 14 City Commission meeting, Miami Beach Mayor Philip Levine, said the Loews Miami Beach Hotel had had more than 700 room cancellations

13. A credit analyst at Standard & Poor warned that Miami-Dade’s AA bond rating could eventually be threatened

14. Florida’s Zika Image Problem
A poll conducted August 18-24, 2016 by the Kaiser Family Foundation found 48% of Americans would be uncomfortable traveling to Zika infection areas within the U.S., including Miami
Florida officials have tried to balance informing the public, fighting Zika and luring tourists
Keep the public informed
Travel related and local acquired cases
Mosquito pools testing positive
Fight Zika with an aggressive aerial pesticide spraying
Luring tourists back to their area
Miami arts district offered free two-hour parking Memorial Day

15. Business Prevention Strategy
Avoid mosquitoes
Personal interventions
If job requires a great deal of outdoor exposure, should business provide repellant?
Environment
Landscape that repels mosquitoes
During mosquito season, routinely spray

16. Costs of prevention for Zika ? Who pays?
Symptomatic

17. The All Natural Mosquito Repellant
Can be planted or used fresh to repel pests
May be used in companion planting for pest control in agricultural and garden situations

18. Basil Catnip Thyme Marigold Rosemary Lemon Grass Lemon Balm
Garlic Lantana Tea Tree Lavender Geranium Eucalyptus Peppermint

19. Questions?

20. References and Resources
Besnard M, et al. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February Euro Surveill  2014;19(13):
Duffy MR, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med  2009;360:2536–
Foy BD, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis  2011;17(5):880–
Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15(9)1347–
Kusana S, et al. Two cases of Zika fever imported from French Polynesia to Japan, December to January Euro Surveill  2014;19(4):
Kwong JC, et al. Case report: Zika virus infection acquired during brief travel to Indonesia. Am J Trop Med Hyg  2013;89(3):516‒
Lanciotti RS, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, Emerg Infect Dis  2008;14(8):1232‒
Musso D, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November to February Euro Surveill 2014;19(14):
Oehler E, et al. Zika virus infection complicated by Guillain-Barre syndrome – case report, French Polynesia, December Euro Surveill  2014;19(9):
Petersen LR, et al. Zika Virus. NEJM 2016; 374:
Rabe IB, et al. Interim Guidance for Interpretation of Zika Virus Antibody Test Results. MMWR 2016;
Tappe D, et al. First case of laboratory-confirmed Zika virus infection imported into Europe, November Euro Surveill  2014;19(4):
CDC:
PAHO:
WHO:
VDH:
Media Sources:
For an extensive list of publications and major findings, please refer to the VDH Zika Literature Review in the Disease Control Manual.