State Health Agencies Prep for Zika

January 29, 2016|9:06 a.m.| Scott Briscoe

Zika virus is the latest health threat gripping the U.S. public. Before we get to the role of state health agencies in monitoring the disease and preparing for its possible spread to the United States, a quick check of some pertinent facts:

  • Zika is not known to spread directly from person to person. Rather it is transmitted to a person via a mosquito bite. A mosquito that has bitten an infected person can then transmit it to other people through bites. UPDATE Feb 3: Zika can be spread through contact with bodily fluids, as documented in the case in Texas. The extent to which person-to-person transmission is a threat is being studied. Mosquitoes remain the main transmission method.
  • Most people exposed to Zika have no symptoms, and those that do generally have mild to moderate flu-like symptoms. While this may be good news for the general public, it presents a challenge to public health workers as the disease is likely to go undiagnosed in the vast majority of people exposed to it. Why is diagnosis of something that causes mild to moderate flu-like symptoms important? Because of the next two points.
  • There is a possible association between Zika and a severe birth defect known as microcephaly. The medical research community is working furiously to either confirm or rule out a link between the two, but there is enough evidence that the CDC advises pregnant women to avoid travel to countries with widespread outbreaks, and women trying to get pregnant should take extra precautions if they travel to those countries.
  • An increase in Guillain Barré syndrome cases has also been reported to coincide with Zika outbreaks. It is unclear if there is a link between the two diseases, and research is ongoing.
  • There have been several cases of Zika virus diagnosed in the United States, but all of them are in individuals who had travelled to infected areas. There has not yet been a known case of local transmission. UPDATE Feb 3: There has now been local transmission through sexual intercourse. There has still not been known transmission from mosquitoes in the United States, however, the CDC says some local transmission is a possibility.

There are several good FAQs that provide more detail about Zika, including the CDC’s Q&A: Zika virus infection and pregnancy.

Infant Zika ScreeningState health agencies have been intensively collaborating about Zika virus with CDC for several weeks, and states are aware of the CDC’s recently released guidelines on monitoring and testing for the virus. For a health agency, Zika is now on the list with other high-priority vector-based (meaning the disease is spread through insect or animal contact) diseases, including West Nile virus, Chikungunya, and Dengue Fever to name a few.

Hawaii is currently managing a rare outbreak of dengue fever that includes local transmission. Hawaii also recently had the first U.S. case of an infant born with microcephaly linked to the presence of Zika (though the disease is believed to have been contracted by the mother in Brazil). Virginia Pressler, MD, director of the Hawaii Department of Health, notes that the public education messaging used by the agency to reduce and then eliminate the dengue fever outbreak also aids in keeping an outbreak of Zika from getting established.

“We are in the midst of a dengue outbreak right now, so we are building on that effort to educate physicians and the public to be aware,” she says. “We have a ‘Fight the Bite’ campaign for dengue that applies equally to Zika and Chikungunya.”

Public health and environmental workers in Hawaii are also working in communities. “We are engaged in active mosquito abatement with spraying by state and county workers to properties and surrounding neighbors within 200 yards of suspected dengue cases,” Pressler says. “We are also engaging entire communities to work with us to address standing water, water catchment systems, and protection against mosquito bites.”

Mississippi State Health Officer Mary Currier, MD, MPH, notes that relationships with health providers are an important function of the state health agency. The Mississippi State Department of Health has a Health Alerts network to communicate important information to providers. The key, she notes, is to keep the messaging precise and succinct.

Mississippi also works to control the mosquito population. "We are engaging in mosquito surveillance with external partners to identify the presence of vectors that could transmit Zika and other arboviruses," Currier says. "We work with viremic cases to prevent transmission events to the local mosquito population and help with mosquito abatement in the immediate vicinity of confirmed cases"

Should local transmission of Zika present itself in the United States, state and local health agencies would likely engage in similar practices.

For now, state health agencies are in preparation and monitoring mode when it comes to Zika. This includes public education and outreach, as evidenced by Georgia’s Zika virus FAQ, and the Florida Department of Health’s press release. States are also doing outreach to medical providers urging them to ask travel-related questions of patients and to contact state or local health departments if Zika may be presented in a patient.

Note: This post was updated with information from the Mississippi State Department of Health on Feb. 2 and with new information on Feb. 3.

Scott Briscoe, CAE, is senior director, communications at ASTHO.