From Ebola to Zika - What Do Providers Need to Know?
- 1. From Ebola to Zika:
What Do Providers Need to Know?
WEBINAR SERIES
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- 3. NOW SPEAKING
Please use the questions box on your webinar
dashboard to submit questions to our moderator
JACLYN SCHIFF
Moderator
Editorial Programs Manager
Modern Healthcare
WEBINAR SERIES
From Ebola to Zika:
What Do Providers Need to Know?
S P O N S O R ED BY
- 4. During today’s discussion, feel free to submit questions at any time by using the questions box
DR. MICHAEL BELL
Deputy Director
National Center for Emerging
and Zoonotic Infectious Diseases
JOHN BRADEN
Medical Director, Emergency
Preparedness
Baptist Health South Florida
JACLYN SCHIFF
Moderator
Editorial Programs Manager
Modern Healthcare
COL. MICHAEL RAJNIK, USAF
Associate Professor
of Pediatrics
Uniformed Services University
JOHN BRADEN
Medical Director,
Emergency Preparedness
Baptist Health South Florida
TODAY’S PANELISTS
WEBINAR SERIES
From Ebola to Zika:
What Do Providers Need to Know?
S P O N S O R ED BY
- 5. NOW SPEAKING
Please use the questions box on your webinar
dashboard to submit questions to our moderator
DR. MICHAEL BELL
Deputy Director
National Center for
Emerging and Zoonotic
Infectious Diseases
WEBINAR SERIES
From Ebola to Zika:
What Do Providers Need to Know?
S P O N S O R ED BY
- 6. Centers for Disease Control and Prevention
Zika Virus
Update on Interim Zika Virus Clinical Guidance and
Recommendations
Michael Bell, MD
Deputy Director,
Division of Healthcare Quality Promotion,
Centers for Disease Control and Prevention
March 24, 2016
- 7. Zika Virus
Single stranded RNA virus (Genus Flavivirus)
Related to dengue, yellow fever, Japanese
encephalitis, West Nile
Transmitted to humans primarily by Aedes
(Stegomyia) species mosquitoes
• Ae aegypti (more efficient vectors to humans)
• Ae albopictus
Also transmit dengue and chikungunya viruses
Live indoors and outdoors
Aggressive daytime biters; can also bite at night
- 8. Zika Virus in the United States
Local vector-borne transmission of Zika
virus has not been reported in the
continental United States
With current outbreak in the Americas,
cases among U.S. travelers will likely
increase
Imported cases may result in virus
introduction and local transmission in
some areas of U.S.
- 9. Other Possible Modes of Transmission
Maternal-fetal
• Intrauterine
• Perinatal
Sexual Contact
• Pregnant women with male partners who have or are
at risk of Zika virus infection should abstain or use
condoms for the duration of pregnancy
Other
• Blood transfusion
• Organ or tissue transplantation
- 10. Zika Virus Disease Symptoms
Clinical illness usually mild, non-specific
Symptoms last several days to a week
Common symptoms:
• Rash
• Fever
• Joint pain
• Conjunctivitis (red eyes)
Less common:
• Muscle pain
• Headache
Severe disease and fatalities are rare
Guillain-Barré syndrome reported in some patients following
suspected Zika virus infection
Assessment of links between Zika virus and microcephaly and
outcomes ongoing
- 11. Initial Assessment and Treatment
No specific antiviral therapy
Treatment is supportive (i.e., rest, fluids, analgesics, antipyretics)
Suspected Zika virus infections should be evaluated for possible dengue
or chikungunya virus infections
Aspirin and other NSAIDs should be avoided until dengue can be ruled
out to reduce the risk of hemorrhage
Avoid aspirin in children with suspected viral infection due to the
association with Reye’s syndrome
- 12. Reporting Zika Virus Disease Cases
Zika virus disease is a nationally notifiable disease
• Healthcare providers are encouraged to report cases with laboratory
evidence of Zika infection to their state, tribal, local, or territorial
health department
Health departments are requested to report cases with laboratory
evidence of Zika infection to CDC
Timely reporting allows health departments to assess and reduce the risk
of local transmission or mitigate further spread
- 13. Diagnostic tests:
For acute illness (symptoms present for <7 days):
Detect Zika virus RNA by RT-PCR for serum and/or cerebrospinal fluid
If Zika virus RNA is not detected and symptoms have been present for ≥4 days
Zika and dengue virus IgM and neutralizing antibodies
Feb. 2016, FDA issued an Emergency Use Authorization (EUA) for CDC Zika IgM
Antibody Capture Enzyme-Linked Immunosorbent Assay (Zika MAC-ELISA)
CDC distributing test kits via the Laboratory Response Network
More information about laboratory testing can be found at:
http://www.cdc.gov/zika/state-labs/index.html
- 14. Interim recommendations for testing
Pregnant women should be tested:
• History of travel to an area with Zika virus transmission during
pregnancy AND :
• Presence of two or more of the following symptoms (acute onset
of fever, maculopapular rash, arthralgia, or conjunctivitis) during
travel or within 2 weeks of travel
OR
• Presence of fetal microcephaly or intracranial calcification by
ultrasound
- 15. Zika Virus Infection and Pregnancy: Clinical
Management
Positive or inconclusive Zika virus testing results
– Antepartum
• Consider serial ultrasounds every 3–4 weeks
• Referral to maternal-fetal medicine specialist is recommended
– Postpartum
• Histopathologic examination of the placenta and umbilical cord
• Testing of frozen placental tissue and cord tissue for Zika virus RNA
• Testing of cord serum for Zika and dengue virus IgM and neutralizing
antibodies
- 16. Preventing Zika Virus Transmission in Labor and
Delivery and Health Care Settings
Standard Precautions for preventing
transmission in healthcare settings
http://www.cdc.gov/mmwr/volumes/65/wr/mm6511e3er.htm
?s_cid=mm6511e3er_w
- 18. Additional resources
CDC Zika virus information: http://www.cdc.gov/zika/
Zika virus information for clinicians: http://www.cdc.gov/zika/hc-
providers/index.html
Zika virus information for travelers and travel health providers:
http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-
related-to-travel/zika
Travel notices: http://wwwnc.cdc.gov/travel/notices
- 19. NOW SPEAKING
Please use the questions box on your webinar
dashboard to submit questions to our moderator
COL. MICHAEL
RAJNIK, USAF
Associate Professor of Pediatrics
Uniformed Services University
WEBINAR SERIES
From Ebola to Zika:
What Do Providers Need to Know?
S P O N S O R ED BY
- 20. Emerging Infections 2016
Zika Virus: A Military Perspective
Emerging Infections 2016
Zika Virus: A Military Perspective
Michael Rajnik, Col, USAF, MC
Associate Professor of Pediatrics
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
Michael Rajnik, Col, USAF, MC
Associate Professor of Pediatrics
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
- 21. Why is Zika a Concern for the DoD?Why is Zika a Concern for the DoD?
• Force Health Protection
• All services performed, provided, or arranged
by the Services to promote, improve,
conserve, or restore the mental or physical
well-being of personnel.
• We have uniformed and civilian personnel
stationed and deployed all over the world
• We have the largest global health network
• Force Health Protection
• All services performed, provided, or arranged
by the Services to promote, improve,
conserve, or restore the mental or physical
well-being of personnel.
• We have uniformed and civilian personnel
stationed and deployed all over the world
• We have the largest global health network
- 22. The United States Army Yellow Fever
Commission
The United States Army Yellow Fever
Commission
• Mosquito was the
vector of
transmission for
Yellow Fever
• Human Subject
experiments
implementing
volunteers with
informed consent
• Mosquito was the
vector of
transmission for
Yellow Fever
• Human Subject
experiments
implementing
volunteers with
informed consent
- 23. Why is Zika a Concern for the DoD?
Research
Why is Zika a Concern for the DoD?
Research
• Walter Reed Army Institute of Research
Viral Diseases Branch (WRAIR)
• Dengue Virus Research and Immunization
Development
• Working on immunization with
GlaxoSmithKline
• Adjuvanted, Purified, Inactivated Dengue Virus
Vaccine, Types 1-4 (DPIV)
• Investigating Zika Constructs
• Walter Reed Army Institute of Research
Viral Diseases Branch (WRAIR)
• Dengue Virus Research and Immunization
Development
• Working on immunization with
GlaxoSmithKline
• Adjuvanted, Purified, Inactivated Dengue Virus
Vaccine, Types 1-4 (DPIV)
• Investigating Zika Constructs
- 24. Why is Zika a Concern for the DoD?
Research
Why is Zika a Concern for the DoD?
Research
• January 27, 2016
• DoD to assist Health and Human Services in
Zika Virus Research
• Defense Threat Reduction Agency
• United States Army Medical Research Institute
of Infectious Diseases (USAMRIID)
• Hope that infrastructure might be used to
help “fast-track” research efforts similar to
the Ebola Response
• January 27, 2016
• DoD to assist Health and Human Services in
Zika Virus Research
• Defense Threat Reduction Agency
• United States Army Medical Research Institute
of Infectious Diseases (USAMRIID)
• Hope that infrastructure might be used to
help “fast-track” research efforts similar to
the Ebola Response
- 25. Options for Pregnant Women Outside
of the US Affected by Zika Virus
Options for Pregnant Women Outside
of the US Affected by Zika Virus
• The option is up to the local commanders
and or Combatant Commanders
• The option is up to the local commanders
and or Combatant Commanders
- 26. Pregnant Uniformed Service MembersPregnant Uniformed Service Members
• Service Members
• Temporary Duty (TDY)
• May be relocated to an area where no active
transmission is occurring for duration of
pregnancy
• Early Change of Station (PCS)
• Move to next station outside of transmission zone
• Result in a gap in personnel
• Service Members
• Temporary Duty (TDY)
• May be relocated to an area where no active
transmission is occurring for duration of
pregnancy
• Early Change of Station (PCS)
• Move to next station outside of transmission zone
• Result in a gap in personnel
- 27. Pregnant Dependents of Uniformed
Service Members
Pregnant Dependents of Uniformed
Service Members
• Dependents
• Medical Care Travel from a Zika-affected area
• Early Return of Dependents (ERD)
• Will pay for travel and household goods
shipments
• Cannot return to the duty station unless another
tour is authorized
• Travel at the Personal Expense of the Service
Member’s Dependent
• This might impact the Service Member’s
Benefits
• Dependents
• Medical Care Travel from a Zika-affected area
• Early Return of Dependents (ERD)
• Will pay for travel and household goods
shipments
• Cannot return to the duty station unless another
tour is authorized
• Travel at the Personal Expense of the Service
Member’s Dependent
• This might impact the Service Member’s
Benefits
- 28. Pregnant DoD CiviliansPregnant DoD Civilians
• Temporary Duty (TDY)
• Orders back to the US for duration of pregnancy
• May be transitioned to medical care travel for birth
• Dependents may travel at Govt expense of ERD
• Medical Care Travel
• May leave 6 weeks before and stay 6 weeks after
– up to 180 days
• Release from Transportation Agreement
• Duty Status – Maximize Telework
• Priority Placement Program (PPP) eligible
• Temporary Duty (TDY)
• Orders back to the US for duration of pregnancy
• May be transitioned to medical care travel for birth
• Dependents may travel at Govt expense of ERD
• Medical Care Travel
• May leave 6 weeks before and stay 6 weeks after
– up to 180 days
• Release from Transportation Agreement
• Duty Status – Maximize Telework
• Priority Placement Program (PPP) eligible
- 29. Pregnant Dependents of DoD CiviliansPregnant Dependents of DoD Civilians
• Medical Travel
• May leave Zika virus-affected country for 6 weeks
before and 6 weeks after delivery
• Up to 180 days
• ERD
• Command may return permanently if in the best
interest of the Government
• May not rejoin her family
• Travel at own personal expense
• May rejoin with child at own expense
• Medical Travel
• May leave Zika virus-affected country for 6 weeks
before and 6 weeks after delivery
• Up to 180 days
• ERD
• Command may return permanently if in the best
interest of the Government
• May not rejoin her family
• Travel at own personal expense
• May rejoin with child at own expense
- 30. Received Orders but are Pregnant or
Dependents are Pregnant
Received Orders but are Pregnant or
Dependents are Pregnant
• Cancellation of PCS
• Service or Agency may cancel PCS orders or
delay the report date until after birth of child
• Delayed Dependent Travel
• If it is a dependent who is pregnant, travel of
dependents can be delayed until after the birth
of the child
• Cancellation of PCS
• Service or Agency may cancel PCS orders or
delay the report date until after birth of child
• Delayed Dependent Travel
• If it is a dependent who is pregnant, travel of
dependents can be delayed until after the birth
of the child
- 31. Comprehensive Force Health
Protection
Comprehensive Force Health
Protection
• Reduce Mosquito Population, Avoid
Mosquito bites, and Prevent Infection
• Communication
• Mosquito surveillance and Control
• Proper wear of Uniforms/Clothing
• Insect Repellents (Permethrin and DEET)
• Bed Nets
• Screening of Living Quarters
***** DEET and Permethrin-Treated Clothing are
safe in Pregnancy *****
• Reduce Mosquito Population, Avoid
Mosquito bites, and Prevent Infection
• Communication
• Mosquito surveillance and Control
• Proper wear of Uniforms/Clothing
• Insect Repellents (Permethrin and DEET)
• Bed Nets
• Screening of Living Quarters
***** DEET and Permethrin-Treated Clothing are
safe in Pregnancy *****
- 32. The Walter Reed National Military
Medical Center-Bethesda Experience
The Walter Reed National Military
Medical Center-Bethesda Experience
• Large referral center for the National
Capital Region also receiving transfers
from outside of the United States
• Active Infectious Diseases Services (Adult
and Pediatric) with robust Perinatology
support for High-Risk Pregnancies
• Similar facilities in HI, TX, VA, WA, CA
• Large referral center for the National
Capital Region also receiving transfers
from outside of the United States
• Active Infectious Diseases Services (Adult
and Pediatric) with robust Perinatology
support for High-Risk Pregnancies
• Similar facilities in HI, TX, VA, WA, CA
- 33. The Walter Reed National Military
Medical Center-Bethesda Experience
The Walter Reed National Military
Medical Center-Bethesda Experience
• Patients with exposure to Zika endemic areas
and clinical symptoms or pregnancy have been
referred to this system
• History – Travel, Immunizations, Symptoms
• Clinical Assessment of patient
• Sampling for Zika Virus, Dengue and
Chikungunya
• Testing sent to referral area where the patient
lives (State labs in MD, VA or CDC)
• Working on in-house testing
• Navy Infectious Diseases Diagnostic Lab (NIDDL)
• Patients with exposure to Zika endemic areas
and clinical symptoms or pregnancy have been
referred to this system
• History – Travel, Immunizations, Symptoms
• Clinical Assessment of patient
• Sampling for Zika Virus, Dengue and
Chikungunya
• Testing sent to referral area where the patient
lives (State labs in MD, VA or CDC)
• Working on in-house testing
• Navy Infectious Diseases Diagnostic Lab (NIDDL)
- 34. The Walter Reed National Military
Medical Center-Bethesda Experience
The Walter Reed National Military
Medical Center-Bethesda Experience
• Screened
• 27 high-risk patients
• Exposure + symptoms or pregnant
• Pregnant referred to Obstetrics per the CDC
guidelines
• 1 positive Zika, 1 likely Dengue and no
evidence of congenital infections
• Screened
• 27 high-risk patients
• Exposure + symptoms or pregnant
• Pregnant referred to Obstetrics per the CDC
guidelines
• 1 positive Zika, 1 likely Dengue and no
evidence of congenital infections
- 35. NOW SPEAKING
Please use the questions box on your webinar
dashboard to submit questions to our moderator
JOHN BRADEN
Medical Director,
Emergency Preparedness
Baptist Health South Florida
WEBINAR SERIES
From Ebola to Zika:
What Do Providers Need to Know?
S P O N S O R ED BY
- 37. Baptist Health by the Numbers
• 7 Hospitals
•50+ Outpatient Centers, Medical Plazas
and other facilities
•Spans 4 counties
•16,000+ total employees
•347,000 Yearly Emergency Visits
- 40. BHSF Emergency Preparedness & Security Department|
(Est. 2005)
BHSF Board of Community Leaders
President/CEO BHSF
BHSF COO
Medical Staff
BHSF Emergency
Preparedness &
Security Department
Baptist Corporate
Office
Baptist Outpatient
Services
South Miami
Hospital
Baptist Health
Enterprises
Baptist Hospital
West Kendall
Hospital
Mariners Hospital
Doctors Hospital
Homestead
Hospital
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THANK YOU FOR ATTENDING
DR. MICHAEL BELL
Deputy Director
National Center for Emerging
and Zoonotic Infectious Diseases
JACLYN SCHIFF
Moderator
Editorial Programs Manager
Modern Healthcare
COL. MICHAEL RAJNIK, USAF
Associate Professor
of Pediatrics
Uniformed Services University
JOHN BRADEN
Medical Director,
Emergency Preparedness
Baptist Health South Florida
From Ebola to Zika:
What Do Providers Need to Know?WEBINAR SERIES
From Ebola to Zika:
What Do Providers Need to Know?
S P O N S O R ED BY