The State of Zika – A CDC Update on Miami

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On August 1 and 4, 2016 the Centers for Disease Control in Atlanta held an open conference call to update new information and guidance related to the Zika Virus.

Part of this message included the update that the Centers for Disease Control and Prevention (CDC) has awarded more than $16 million to 40 states and territories to establish, enhance, and maintain information-gathering systems to rapidly detect microcephaly–a serious birth defect of the brain–and other adverse outcomes caused by Zika virus infection. These awards are a stopgap diverted from other public health resources until Zika funds are provided by Congress.

The funding will also help states and territories ensure that infants and their families are referred to appropriate health and social services. Finally, the awards will enable states and territories to monitor the health and developmental outcomes of children affected by Zika.

“It is critical to identify infants with birth defects related to Zika virus so we can support them and their families. This CDC funding provides real-time data about the Zika epidemic as it unfolds in the United States and territories and will help those most devastated by this virus.”

CDC Director Tom Frieden, M.D., M.P.H.

Based on the confirmation of local Zika transmission in Florida, CDC has also updated its Interim Zika Response Plan (CONUS and HI) and has released the Zika Community Action Response Toolkit (Z-CART) to help states with risk communication and community engagement when local transmission is identified.

For more information about Zika: http://www.cdc.gov/zika/.

Zika and Communicable Illness PlanningKey summary points as outlined by CDC Director Thomas Frieden:

  • An area north of downtown Miami had active transmission of the Zika virus. New assessments of mosquito populations and new test results from this past weekend by Florida public health officials have found persistent mosquito populations and additional Zika infections in the same area.
  • This suggests that there’s a risk of continued active transmission of Zika in that area.  As a result, CDC and Florida are issuing travel and testing recommendations for people who traveled to or live in the Florida designated areas on or after June 15th, 2016.  That date is the earliest known date that one of the individuals who became infected with Zika could have become infected, as far as the information we have as of today.
  • At the request of Governor Scott of Florida, CDC is sending a CDC Emergency Response Team or CERT team to Florida to join staff already on the ground there.
  • These experts include individuals with extensive experience in Zika, in addressing pregnancy and birth defects, in mosquito control, laboratory science and community engagement.
  • We advise pregnant women to avoid travel to this area and pregnant women who live or work in this area and their partners to make every effort to avoid mosquito bites and prevent sexual transmission of Zika.  This advice applies to anyone who lives in or has traveled to this area any time after June 15th.
  • We are learning something new about Zika every day.  We make decisions to update our recommendations and guidance on a day-by-day basis.  What we know about Zika is scary.  Zika can cause microcephaly, and this is the first time we’ve seen a devastating birth defect result from a mosquito bite and it causes microcephaly even among women who don’t appear to have had any symptoms of Zika infection.
  • We don’t know the long-term impact Zika may have on children born to infected mothers who don’t have obvious signs of microcephaly, and these effects may only become apparent months or years in the future.
  • We don’t yet have ideal ways to control the particular mosquitoes that spread Zika. We need better methods and tools for mosquito control.

In Miami, aggressive mosquito control measures don’t seem to be working as well as the CDC would have liked.

  1. It’s possible that the mosquitoes there are resistant to the insecticides that have been used.
  2. It’s possible that there are what we call cryptic breeding places or small amounts of standing water where mosquitoes continue to hatch.
  3. It’s possible simply that this is a very difficult mosquito to control, particularly in a complex urban environment like the one north of downtown Miami.

CDC will begin resistance testing to determine whether mosquitoes in this area are susceptible to the insecticides being used.  That testing is complex and takes at least a week and sometimes three weeks or more.  So the mosquito control experts in Florida who have extensive experience with mosquito control as well as the CDC’s own mosquito control experts are meeting intensively to outline additional measures that may be taken to reduce mosquito populations.


Based on what is known now about the situation in the community north of downtown Miami, in Florida, the CDC recommends the following:

  • First, that pregnant women not travel to the identified area.
  • Second, that pregnant women and their partners who live in this area make every effort to prevent mosquito bites and prevent sexual transmission of Zika.  This includes applying insect repellent containing Deet to uncovered skin, wearing long-sleeved shirts and pants, using and repairing screens and windows and doors and using air conditioning when available and removing standing water where mosquitoes lay eggs.
  • That pregnant women who traveled to this area on or after June 15th talk with their health care provider to be tested for Zika.
  • That pregnant women without symptoms of Zika who live in or frequently travel to this area be tested for Zika in the first and second trimesters of pregnancy.
  • That male and female sexual partners of pregnant women who live in or have traveled to this area consistently and correctly use condoms or other barriers against infection during sex.
  • For the duration of pregnancy, that all pregnant women throughout the U.S. be assessed for possible Zika virus exposure during each prenatal care visit and tested according to CDC guidance.
  • That women and men who traveled to this area and have left the area wait at least eight weeks before trying for a pregnancy.
  • Men with symptoms of Zika should wait at least six months before trying for a pregnancy.  And that anyone with possible exposure to Zika and symptoms of Zika be tested for the infection.

The next scheduled call is

Date: Tuesday, August 9, 2016

Time: 2-3 pm (ET)

Participate by Phone:

  • U.S. Callers: 888-942-9686
  • International Callers: 517-308-9076

Passcode:4687942

Participate by Webinar: https://www.mymeetings.com/nc/join.php?i=PW8523117&p=3377346&t=c

Presenter(s)

Charlan D. Kroelinger, PhD, MA
Team Lead
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

Erin Berry-Bibee, MD, MPH
Guest Researcher/ Assistant Professor
Division of Reproductive Health
Centers for Disease Control and Prevention
Department of Obstetrics and Gynecology
University of North Carolina Chapel Hill

Titilope Oduyebo, MD, MPH
Medical Officer
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

Overview

CDC’s top priority for the Zika response is to protect pregnant women and their fetuses from the adverse effects of Zika virus infection in pregnancy. As a result, CDC continues to evaluate all available evidence and update recommendations as new information becomes available. CDC has updated its interim guidance for U.S. healthcare providers caring for pregnant women with possible Zika virus exposure based on emerging evidence about laboratory testing for the diagnosis of Zika. A primary strategy to reduce Zika-related pregnancy complications is to prevent pregnancy among women who want to delay or avoid pregnancy. CDC published contraceptive use data for states where mosquito-borne transmission of Zika is possible. During this COCA Call, clinicians will learn about the updated CDC interim guidance for caring for pregnant women with possible Zika virus exposure, and strategies for increasing access to contraceptive methods and services to minimize the number of pregnancies affected by Zika.

Objectives

  • Discuss revised diagnostic testing for Zika virus infection among pregnant women.
  • Discuss clinical management of pregnant women with confirmed or possible Zika virus infection.
  • Review use of a range of contraceptive methods in states, with a focus on highly effective methods.
  • Define strategies for increasing access and availability to highly effective contraception.
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