Zika virus Q&A with state epidemiologist

By Hannah Clere

Art by Savannah Schroering

Editor’s Note: To learn more about the spread of the Zika virus, read Pages 4 and 5 of this Friday’s print edition of The Bagpiper on Sept. 2.

The following is a Q&A with state epidemiologist of the Indiana State Department of Health Pam Pontones

BagpiperHow is the Zika virus spread?

Pam Pontones: Zika virus is mainly spread through mosquito bites.  It can also be spread through unprotected sex, from mother to baby during pregnancy, and less commonly, blood transfusion and laboratory exposure.

BPHow did it get into the United States?

PP: “Most cases of Zika infection in the United States have occurred in travelers who have visited countries with active transmission and have become infected there.  Recently, 28 cases of local infection have been reported in Florida.  Health officials from the Centers for Disease Control and Prevention (CDC) and the Florida Department of Health (FDOH) have actively investigated these cases.  Local transmission can occur in the US when travelers who are infected and have virus in their bloodstream return to the US and then are bitten by local mosquitoes.  These mosquitoes acquire the virus and then can transmit it to other people locally when they bite.”

BP: What do you know about the new vaccine that was tested and that worked on monkeys? Other vaccines?

PP: “Three experimental vaccines have proven effective in mice and rhesus monkeys.  The National Institutes of Health (NIH) launched a human clinical trial of one of these vaccines on August 3, and Inovio Pharmaceuticals launched a human vaccine clinical trial on July 26.  These trials will take time, and further trials will be needed, but they will help inform future vaccine development.”

BP: How long has the Zika virus been around?

PP: “According to the World Health Organization (WHO), Zika virus was first identified in 1947 in monkeys from the Zika forest of Uganda, Africa.  Human cases were first identified in 1952.  A large outbreak of Zika virus infection was reported in the Yap Islands (Federated States of Micronesia, South Pacific) in 2007, and another outbreak was reported in French Polynesia in 2013-14.  The first cases associated with the current outbreak in were identified in Brazil in May, 2015.   By February 2016, the outbreak spread rapidly through South America, Central America, and the Caribbean, following the range of the Aedes aegypti mosquito (see below).  In February, as a result of this rapid spread and association with microcephaly and Guillain-Barre syndrome, the WHO declared that Zika infection to be a public health emergency of international concern (PHEIC).  You can find more details at http://www.who.int/bulletin/online_first/16-171082/en/.”

BP: What other viruses are a current concern, if any?

PP: “In Indiana, other mosquito-borne viruses that the Indiana State Department of Health (ISDH) tracks include Eastern Equine Encephalitis virus, St. Louis Encephalitis virus, LaCrosse Encephalitis virus, and West Nile virus.  Each year, from April-October, ISDH and local health departments conduct mosquito surveillance in all 92 Indiana counties to determine what types of mosquitoes are present and test those mosquitoes to determine what viruses they may be carrying.  ISDH issues bi-weekly bulletins to all local health departments and state partners to keep them informed as well as press releases and website information to inform the public what viruses are circulating and how people can prevent mosquito bites and mosquito breeding.”

BP: What is it that you do involving the Zika virus?

PP: “The ISDH provides information and consultation to health care providers, local health departments, partners, and the public regarding virus transmission, prevention, and testing.  The ISDH Epidemiology Resource Center assists with case surveillance and investigation, tracks case counts and laboratory results, conducts mosquito surveillance (see above), provides recommendations for mosquito abatement, maintains the ISDH Zika website, assists with communications and planning efforts, and reports case counts to the CDC.  The ISDH Preparedness Division maintains our Zika Action Plan and coordinates state planning meetings and advisory groups.  The ISDH Laboratory performs testing on patient samples and sends samples to CDC if needed. The ISDH Maternal and Child Health Division assists with tracking cases of microcephaly or other birth defects, referring those affected to services they need, and sharing information specifically for mothers and babies.  As you can see, this is very much a team effort involving multiple ISDH divisions and partners.”

BP: How are mosquitos being tested?

PP: “The ISDH does not test mosquitoes for Zika virus itself, since Zika virus is not found in Indiana.  The CDC recommends that human surveillance is much more effective, so we focus our efforts on testing and tracking people who may be infected.”

BP: Do you think that this virus is going to be a big problem?

PP: “Indiana does not have as high of a risk as some other states, since the main vector mosquito, Aedes aegypti, is not found in Indiana, Indiana has a defined mosquito seasonality, and Indiana does not have the volume of travelers as some other states.  However, we always want to be prepared as much as possible, especially given the effects of this infection on unborn children.  We have been working diligently to educate Hoosiers about their risks here at home and while traveling to ensure we are prepared for Zika in case we see local transmission here.”

BP: In what areas is this virus most likely to be found?

PP: “Zika virus is most likely to be found in areas where the mosquito vectors are common (see link below).  In addition, those states that have higher volumes of travelers to countries where Zika is common may have more travel-related cases.”

BP: What type of mosquitos carry the Zika virus?

PP: “Mosquitoes of the Aedes genus can carry Zika virus.  In the US, those are Aedes aegypti and Aedes albopictus.”

Visit http://www.cdc.gov/zika/vector/range.html to see estimated range maps of the US for these mosquitoes, as well as other helpful information about these two mosquitoes.  Although the A. aegypti map shows the range extending into southeastern Indiana, this is an estimated range based on a couple of instances where A. aegypti was found in neighboring counties of Ohio and Kentucky.  A. aegypti is not typically found in Indiana based on our mosquito surveillance.  A. albopictus is typically found in the southern 2/3 of Indiana.

BP: How can people protect themselves from mosquito given diseases and viruses?

PP: “The main focus of prevention is avoiding mosquito bites, and there are several ways people can prevent being bitten, especially when traveling to areas where Zika is actively occurring:

  • Use insect repellant containing DEET, picaridin, oil of lemon eucalyptus, or IR3535 as the active ingredients.  Always follow label instructions and reapply as directed.  If using sunscreen, apply sunscreen before applying insect repellant.
  • If possible, wear long sleeves, pants, and a hat to reduce amount of exposed skin.
  • Stay in places with air-conditioning or well-maintained window and door screens.  Sleep under a mosquito bet net if air-conditioning or screened rooms are not available or if sleeping outdoors.
  • Eliminate mosquito breeding areas.  Discard standing water in and around homes and ensure that water is removed weekly from potential breeding grounds, such as tires, buckets, pet bowls, and flower pots. Frequently flush birdbaths and ornamental fountains.  Even a bottle cap can hold enough water to act as a mosquito breeding ground.
  • Repair cracks or gaps in septic tanks and cover open vents or plumbing pipes.”

BP: Is there anything else that you think is important to know? If so, what?

PP: “Zika virus infection is a serious concern for pregnant women and their unborn babies.  Zika virus can be transmitted from mother to baby during pregnancy, and infection in an unborn baby can cause serious birth defects, including microcephaly, a condition in which a baby is born with a head size smaller than normal and possibly an underdeveloped brain.  Pregnant women and their partners should take every precaution to avoid mosquito bites and sexual transmission and they should not travel to areas where Zika virus infection is occurring.”

About one out of five people will show symptoms of Zika virus infection, which include fever, rash, joint pain, and conjunctivitis (pink eye).  These symptoms go away on their own.  There is currently no vaccine or specific treatment available for Zika infection.   Much more information on Zika is available at www.isdh.in.gov/zika or www.cdc.gov/zika.

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