Wednesday, April 05, 2017

CDC Vital Signs - Zika Virus Update

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It may not feel like it yet across much of the country, but here in Florida - spring has already  sprung - with daytime temperatures pushing 90, which in short order will usher in a new mosquito season.

So, with airborne disease threats like influenza slowly receding, in April we begin to turn our attention more towards vector borne diseases, like Zika, Dengue, EEE, West Nile, and Lyme disease. 

As with seasonal influenza, the the severity and type of vector borne threats varies from year to year.  In 2012 we saw a record number of deaths (n=243) from neuroinvasive West Nile Virus infection, while last year was a more moderate season, with 94 fatalties reported nationwide.

The big vector borne story last year, however, was Zika.

Although local transmission in the United States was pretty much limited to South Florida and Southern Texas, the devastating effects of material infection on the developing fetus makes Zika a particularly serious threat. 



And while the same areas are undoubtedly at highest risk of seeing limited transmission again this summer, other areas of the country are not immune from seeing locally acquired cases.

So yesterday the CDC, via an MMWR Vital Signs report, a CDC Telebriefing, and an updated Vital Signs Zika web page, launched a new awareness and information campaign. 

Due to the length of these resources, I'll just be providing links and a brief summary, follow the links to read and/or listen to them in their entirety.  First stop is the MMWR:


CDCMMWR

Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016

Early Release / April 4, 2017 / 66

Megan R. Reynolds, MPH1; Abbey M. Jones, MPH1; Emily E. Petersen, MD2; Ellen H. Lee, MD3; Marion E. Rice, MPH1,4; Andrea Bingham, PhD5; Sascha R. Ellington, MSPH2; Nicole Evert, MS6; Sarah Reagan-Steiner, MD7; Titilope Oduyebo, MD2; Catherine M. Brown, DVM8; Stacey Martin, MSc9; Nina Ahmad, MD10; Julu Bhatnagar, PhD7; Jennifer Macdonald, MPH11; Carolyn Gould, MD9; Anne D. Fine, MD3; Kara D. Polen, MPH1; Heather Lake-Burger, MPH5; Christina L. Hillard, MA1; Noemi Hall, PhD6,12; Mahsa M. Yazdy, PhD8; Karnesha Slaughter, MPH1; Jamie N. Sommer, MS10; Alys Adamski, PhD1; Meghan Raycraft, MPH1; Shannon Fleck-Derderian, MPH4,13; Jyoti Gupta, MPH11; Kimberly Newsome, MPH1; Madelyn Baez-Santiago, PhD1; Sally Slavinski, DVM3; Jennifer L. White, MPH10; Cynthia A. Moore, MD, PhD1; Carrie K. Shapiro-Mendoza, PhD2; Lyle Petersen, MD9; Coleen Boyle, PhD14; Denise J. Jamieson, MD2; Dana Meaney-Delman, MD13; Margaret A. Honein, PhD1; U.S. Zika Pregnancy Registry Collaboration (View author affiliations)

Key Points

• In 2016, a total of 1,297 pregnancies with possible recent Zika virus infection were reported to the U.S. Zika Pregnancy Registry from 44 states.
• Approximately one in 10 pregnancies with laboratory-confirmed Zika virus infection resulted in a fetus or infant with Zika virus–associated birth defects.
• The proportion of fetuses and infants with Zika virus–associated birth defects was highest among those with first trimester Zika virus infections.
• Only 25% of infants from pregnancies with possible recent Zika virus infection reported receiving postnatal neuroimaging.
• Identification and follow-up care of infants born to mothers with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with congenital Zika virus infection can ensure that appropriate intervention services are available to affected infants.
• Additional information is available at https://www.cdc.gov/vitalsigns/.

Accompanying this MMWR release, the CDC published a press release: About 1 in 10 U.S. pregnant women with confirmed Zika infection had a fetus or baby with birth defects in 2016 and held a 35 minute teleconference (audio and transcript links below).

Transcript for CDC Telebriefing: New Vital Signs Report – Possible Zika virus infections in 44 U.S. states: What can healthcare providers do to help protect pregnant women and their babies?  

Press Briefing Transcript

Tuesday, April 4, 2017 at 12:00 pm E.T.
Audio recording[MP3, 6.14 MB]

Please Note:This transcript is not edited and may contain errors.


And lastly, this  month's Vital Signs report - which focuses on the devastating impacts of maternal Zika infection. 


Zika Virus

Protecting Pregnant Women and Babies
 
Overview

Zika virus infection (Zika) during pregnancy can cause damage to the brain, microcephaly, and congenital Zika syndrome, a pattern of conditions in the baby that includes brain abnormalities, eye defects, hearing loss, and limb defects. Pregnant women can protect their babies from these Zika-related health conditions by not traveling to areas with Zika. Men and women who live in or travel to an area with Zika can prevent infection by avoiding mosquito bites and using condoms during sex. Healthcare providers can encourage pregnant women to follow CDC’s Zika prevention recommendations and help affected babies by providing screening and follow-up care.

Healthcare providers can: 
  Educate families on Zika prevention: Encourage pregnant women to avoid travel to areas with Zika. Tell women and men how to protect themselves from mosquito bites and from getting Zika through sex.

Ask about Zika and provide all needed tests and follow-up care: Guidance is updated as more is learned about Zika so check on current recommendations. Babies with possible Zika should get a comprehensive physical exam, neuroimaging, neurologic exam, newborn hearing screening, and Zika laboratory tests (guidance as of August 2016). https://go.usa.gov/xXq2A.

Support babies and families: Develop a coordinated care plan for babies affected by Zika, including ongoing support, follow-up care, and linking to your local health department. Help families monitor their babies’ development.
         (Continue . . . .)




There's a lot of information to wade through here, so if you'd like a short, yet informative summary, Lisa Schnirring's excellent report last night for CIDRAP News (see Zika birth defects noted in 1 in 10 infected US pregnant women) covers all the bases. 

Whether Zika returns with a vengeance this summer, West Nile sees another resurgence, Lyme disease explodes, or perhaps another threat vector borne threat (hint: Yellow Fever is spreading rapidly In Brazil) emerges, prevention is your first line of defense. 

To defend against mosquitoes, the Florida Department of Health reminds you to follow the  5 D's.




And whether it is ticks or mosquitoes that you must contend with, the EPA has developed an easy to use, interactive insect repellent search engine that will that will allow you to input your needs and it will spit out the best repellents to use.


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