FIRST CONFIRMED CASE OF IMPORTED ZIKA VIRUS IN

HOUSTON, TEXAS

Preventing Transmission

Objectives

Discuss the epidemiology of Zika virus Describe the Zika case investigation of the first

confirmed case in Houston, Texas. Discuss how emerging diseases are controlled by

timely identification and reporting from clinicians. Articulate the importance of prompt surveillance

and patient education in preventing the spread of vector-borne diseases.

Zika Virus Introduction

Single stranded RNA Virus Family Flaviviridae, Genus Flavivirus Related to dengue, Japanese encephalitis,

yellow fever, and West Nile Virus Transmitted to humans by Aedes species

mosquitos.

Zika Virus Time-line

Modes of Transmission

Other Modes of Transmission

Sexual Blood Transfusion Maternal-fetal

Laboratory exposure

Theoretical Breast Milk

Organ or tissue transplantation

Description of Illness

SYMPTOMS:

Fever

Rash

Joint pain

Conjunctivitis

Myalgia

Headache

Malaise

1 in 5 people become ill.

Illness is usually mild.

Treatment

-No Vaccine

-Rest

-Fluids

-Medicine

Prevention

Avoid Bites

Repellent

Long Sleeves/Pants

Air Conditioning

Screens/Nets

Drain Standing Water

ZIKA CASE INVESTIGATION

On November 16, 2015 a Houston clinician reported to the Houston Health Department, Bureau of Epidemiology two suspected cases of Zika virus.

An investigation was conducted to determine the source of infection and prevent the spread of disease.

CASE INVESTIGATION CONTINUED

Suspect Case #1 Suspect Case #2

59 Year Old Hispanic Female

Onset Date: 11/10/15

Travel to Colombia

60 Year Old Hispanic Female

Onset Date: 11/13/15

Travel to Colombia

CASE INVESTIGATION CONTINUED

BOTH SUSPECTED CASES TRAVELED TO

SANTA MARTA, COLOMBIA BETWEEN

11/03/15 &11/10/15

CASE INVESTIGATION CONTINUED

Suspect Case #1 Symptoms Suspect Case #2 Symptoms

Fever Diarrhea Arthralgia Fatigue Muscle pain Rash Pain behind eyes Upset stomach

Fever Fatigue Diarrhea Arthralgia Rash Conjunctivitis Headache Pain behind eyes

CASE INVESTIGATION CONTINUED

Education provided to patients Communication with the State Health Department

and CDC Hurdles we had to overcome

Blood Sample

Blood samples were taken and sent to the Centers for Disease Control and Prevention at Fort Collins for testing.

CASE INVESTIGATION TESTING

ELISA IgM PRNT Limitations: Cross-reactivity with other

Flaviviruses Serology results should be interpreted with

caution

CASE INVESTIGATION RESULTS

Suspect Case #1 Suspect Case #2

Zika IgM ELISA= Positive Dengue = Positive Chikungunya= Negative West Nile = Negative St. Louis Encephalitis=

Negative

Zika IgM ELISA= Positive Dengue = Negative Chikungunya= Negative West Nile = Negative St. Louis Encephalitis=

Negative

CASE INVESTIGATION CONCLUSIONS

Education provided by public health investigator played a pivotal role in preventing transmission to mosquitos in the Houston area.

Texas case counts

Both cases were imported from Colombia where local transmission is ongoing.

Rapid identification of disease and notification by the clinician .

Conclusions Continued

Mosquito-based Surveillance

Vector Control Outbreaks

Strategy to Respond to Zika

Develop laboratory testing capacity

Investigate cases and their contacts

Coordinate with mosquito control surveillance

Maintain situational awareness in the city and

region Improve our understanding

of the virus and its effects

Conduct neighborhood outreach to vulnerable communities

Clean-up garbage in neighborhoods

Eliminate standing water

Educate travelers & expecting mothers

Mosquito Control (HCPHES)

Zika Virus Complications

Aruba Barbados Bolivia Bonaire Brazil Colombia Commonwealth of Puerto Rico, US territory Costa Rica Curacao Dominican Republic Ecuador El Salvador French Guiana Guadeloupe Guatemala Guyana Haiti Honduras Jamaica Martinique Mexico Nicaragua Panama Paraguay Saint Martin Saint Vincent and the Grenadines Sint Maarten Suriname Trinidad and Tobago U.S. Virgin Islands Venezuela * As of February 29, 2016

Zika Virus Complications

Guillain-Barre syndrome (GBS) -Symptoms -Treatment

Countries Reporting Cases

Birth Defect

Microcephaly Number of microcephaly cases reported in

the Northeast Region of Brazil by Epidemiological Week (8 November 2015 - 13

February 2016).

Pan American Health Organization / World Health Organization. Zika Epidemiological Update – 24 February 2016. Washington, D.C.: PAHO/WHO; 2016 Pan American Health Organization • www.paho.org • © PAHO/WHO, 2016

Brazil Microcephaly Cases

There have been a total of 5,640 microcephaly cases reported by the Ministry of Health of Brazil.

So far 583 of these are confirmed cases. The others are being investigated

0 5 10 15 20 25 30 35 40

American Samoa

Puerto Rico

US Virgin Islands

American Samoa Puerto Rico US Virgin IslandsLocally acquired cases 4 34 1Travel-associated cases 0 1 0

U.S. Territories Confirmed Zika Cases

Distribution of Aedes

Aedes aegypti

Most likely originated in Africa

Aedes albopictus

Originated in Asia

Prevention Continued

Mosquitos are “container breeders”

Eliminate all breeding sites in and around your home to prevent disease transmission.

Mosquito Fun Facts

Where do mosquitos live?

How do they spread? Mosquitos have evolved

“Sip feeders”

References

Centers for Disease Control and Prevention. All Countries and territories with Active Zika Virus Transmission. http://www.cdc.gov/zika/geo/active-countries.html

Centers for Disease Control and Prevention. Zika Virus. http://www.cdc.gov/zika/index.html. Centers for Disease Control and Prevention. Zika Virus-What clinicians need to know power-point. Clinician Outreach and

Communication Activity Call January 26, 2016 Centers for Disease Control and Prevention. Memorandum. February 7, 2016. http://www.cdc.gov/zika/pdfs/denvchikvzikv-testing-

algorithm.pdf. Centers for Disease Control and Prevention. Zika Virus disease in the United States, 2015-2016.

http://www.cdc.gov/zika/geo/united-states.html Centers for Disease Control and Prevention. Surveillance and Control of Aedes aegypti and Aedes albopictus in the United States.

http://www.cdc.gov/chikungunya/resources/vector-control.html J.D. Honigberg International, Inc. International Sales and Export Management. Shipping container figure.

http://www.jdhmedical.com/thermosafechests.html MedlinePlus. CDC reports link between Zika virus and microcephaly.

https://www.nlm.nih.gov/medlineplus/news/fullstory_157174.html Pan American Health Organization / World Health Organization. Zika Epidemiological Update – 24 February 2016. Washington,

D.C.: PAHO/WHO; 2016 Pan American Health Organization • www.paho.org • © PAHO/WHO, 2016 World Health Organization. Countries and territories showing historical time-line of Zika virus spread (1947-2016).

http://www.who.int/emergencies/zika-virus/zika_timeline.pdf?ua=1 Parents. Zika Virus: Everything Pregnant Women should know. Zika Figure. http://www.parents.com/pregnancy/complications/birth-

defects/zika-virus-everything-pregnant-women-should-know/

References

Unicef. What you need to know about the Zika virus. February 12, 2016. https://blogs.unicef.org/blog/what-you-need-to-know-about-the-zika-virus/

World Health Organization. Zika Epidemiological Update. 3 March 2016. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11599&Itemid=41691&lang=en

World health Organization. Cumulative Zika Susect and Confirmed cases reported by countries and territories in the Americas 2015-2016. http://ais.paho.org/phip/viz/ed_zika_cases.asp.

World health Organization. Zika Virus. http://www.who.int/mediacentre/factsheets/zika/en/ World Health Organization. Weekly Epidemiological Record. 19 February 2016, vol. 91, 7 (pp.73-88).

http://www.who.int/wer/2016/wer9107/en/ World Health Organization. Suspected and confirmed Zika cases reported by countries and territories in the Americas, 2015-2016.

http://ais.paho.org/phip/viz/ed_zika_epicurve.asp World Health Organization. Zika: the origin and spread of a mosquito-borne virus. http://www.who.int/bulletin/online_first/16-

171082/en/

Thank You For Joining Me

Presenter: Amanda Eckert, MPH

Surveillance Investigator Houston Health Department

Bureau of Epidemiology 8000 North Stadium Drive

Houston, TX 77054 Phone: 832-393-4318

Thank you to everyone who helped with this investigation especially: Thomas Johnson Jr., BS, Brenda Thorne, MS, Salma Khuwaja, MD, MPH, DrPH, and Raouf Arafat, MD, MPH.