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Nevada State Epidemiologist's Zika Presentation

An Overview of the Evolving Challenge Posed by ZIKV
by

Daniel Mackie

on 13 June 2016

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Transcript of Nevada State Epidemiologist's Zika Presentation

Overview of the Emerging
Zika Virus (ZIKV) Challenge

How did we get here, and where are we going?
Arbovirus (Flavivirus) research:
Yellow Fever
First isolated from a rhesus monkey in 1947.
Uganda Virus Research Institute (UVRI):
37-Meter Tower thru levels of canopy
Yellow Fever Research
Isolated ZIKV in Rhesus Monkey
"Zika's long, strange trip into the limelight"
Science Magazine
Jon Cohen
February 8, 2016

Rhesus 766
How did ZIKV go from a 'virological curiosity'
to a WHO-identified
"Public Health Emergency of International Concern"?
1954: Nigeria
In spite of this eastward migration over 60 years, up to 2007 there were only 14 documented cases of ZIKV illness in humans, and no reported outbreaks.
Two Lineages: African and Asian
Who:
Approx. 7,000 citizens
What:
Asian lineage
73% of residents aged >3= years had recently been infected
18% had clinical illness
185 cases (26% confirmed, 32% probable)
Where:
Federated States of Micronesia in the western Pacific, Yap Island, in 9 out of 10 municipalities

When:
April 2007 through July 2007
Why:
Possibly introduced through a viremic human traveler from the Philippines
How:
Vector primarily identified was
A. hensilli
mosquito
Geographical Extent of ZIKV: 1947 to 2007
French Polynesia
New Calendonia
Cook Islands
Vanuatu/Fiji
Solomon Islands
Easter Island
Easter Island
Zika's Arrival to the Americas:
2014-2015
Zika's Origins and Eastward Migration:
1947 to 2006
Zika in the Pacific:
2007 to 2014
Who:
28,000 sought medical care (symptomatic)
The 1:4 Ratio
Rule-of-Thumb
If 80% had no symptoms, then as many as 140,000 were infected
This represents 51% of the population
What:
Asian lineage
Largest ZIKV outbreak recorded
Related to virus involved on Yap Island
Complications: neurological such as GBS, and physical such as microcephaly
Co-circulation w/ another arbovirus: Dengue
Where:
French Polynesia

When:
October

2013 through May 2014
Why:
Most likely introduced through viremic human travelers
How:
Vector primarily identified was
A. aegypti
mosquito, with
A. polynesiensis
also playing a role.
Intensely researched outbreak
Import to Brazil:
Original Hypothesis:
Football World Cup: June/July 2014
Aquece Rio International Canoe Sprint: Sept. 2014
Current Science:
N.R. Faria et al., Science 10.1126/science.aaf5036 (2016)
"Zika virus in the Americas: Early epidemiological and genetic findings"
"We estimate that the date of the most recent common ancestor of all Brazillian genomes is August 2013 to April 2014."
Nature of the Threat:
Vector-borne via mosquitos
Arbovirus, Flavivirus
Humans act as the
"principal amplyfying host during outbreaks"
(CDC's MMWR for 2/19/16)
"Infection is usually asymptomatic"
Symptoms: generally mild,
Fever
Rash
Arthralgia (aka: joint pain)
Conjunctivitis (aka: red eyes)
Differential Diagnosis:
Who:
As of March 2016
Approximatley 1.5+ million infected
What:
Asian lineage
Over 30,000 cases
Microcephaly: Brazil went from <200/year to nearly 5,000
Guillain-Barre Syndrome (GBS): Over 1,700 and rising
Rare disorder, immune system attacks nerves, muscle weakness, motor coordination issues, paralysis
Can last days/weeks/months
Where:
Brazil (widespread local transmission)
Began in northeastern states, then quickly spread to 22 of Brazil's 27 states
When:
May

2015 through December 2015, with epidemic peak in mid-July 2015
Why:
Most likely introduced through viremic human travelers
How:
Vector primarily identified is
A. aegypti
mosquito, and
A. albopictus
mosquito
http://www.who.int/emergencies/zika-virus/situation-report/en/
ZIKV Vectors
A. aegypti:
Brown and white
Violin shape
Daytime biter
Bites multiple people in one feeding
Rests indoors
A. albopictus:
Black and white
Aka: Asian Tiger
White stripe down back
Leg stripes/bands
Daytime biter
More common in N. America
Modes of Transmission:
Mosquito bites
Mother to Child
Sexual Contact
Blood Transfusion
Travel-associated
versus
Locally acquired
"...clusters of microcephaly cases and other neurological disorders continue to constitute a Public Health Emergency of International Concern (PHEIC), and that there is increasing evidence that there is a causal relationship with Zika virus."
Using Dengue and Chikungunya Data for Nevada as a proxy for ZIKV Estimates:
* Note: 100% of these were travel-associated
We have already seen a few travel-associated human cases of ZIKV here in Nevada, and will continue to see more.
08 MAR 16:
ZIKV Goes to the Big Leagues

CDC's Division of Vector-Borne Diseases (DVBD):
Fort Collins, CO
Remember: Up until 2007 there were only 14 human cases and no reported outbreaks:
Science needs to catch-up:
Correlation of microcephaly
Correlation of GBS
New vectors / new reservoirs
Incubation period
Survivor transmissibility
Sexual transmission
Interplay of Dengue/Chikungunya antibodies with ZIKV
Insecticide involvement
Frequently Asked Questions
(FAQs)
1) Mosquitos in Nevada:
Season is May to October
In 2014 there were eleven different Aedes species in NV
In 2015 there were nine Aedes species
Nevada will employ the
same three-part response strategy
that
both
the WHO/PAHO and CDC are recommending:
1) Detect:

ZIKV, it consequences, and evolution of outbreak:
Disease Surveillance of the human population:
Case Definition
Zika Investigation Line Listing
State Public Health Labs
CDC Labs
2) Prevent:

Reduce vector density, and opportunities for transmission:
Monitor Mosquito Population by trapping and species typing throughout NV
Based on NV Dept. of Agri. data, most Aedes genus are in agricultural /wet/wooded north: Churchill, Elko, Douglas, Eureka, Humboldt, Pershing
A. aegypti & A. albopictus do not currently live in NV
3) Respond:

Partner with healthcare partners, messaging, and coordinate resource mobilization

Full transcript