Zika Virus Update - U.S. Travel Association• March 8, 2016 WHO statement on the Zika virus situation, for travel: Pregnant women should be advised not to travel to areas of ongoing

Zika Virus Update

CDCRespondstoZIKA

Zika BriefingDr. CliveM.Brown,MBBS,MPH,MSc,DTM&H(London)Chief,QuarantineandBorderHealthServicesBranchDivision ofGlobalMigrationandQuarantineMarch18,2016

WhatisZika virusdisease(Zika)?§ In1947,yellowfeverresearchers

placedarhesusmacaqueinacageintheZikaForestinEntebbe,Uganda– Zikameans"overgrown"intheLugandalanguage

§ Themonkeydevelopedafever– Researchersisolatedatransmissibleagentfromitsserumin1952– theZikavirus

WhatisZika virusdisease(Zika)?§ Diseasespreadprimarilythroughthe

biteofanAedes mosquitoinfectedwithZika virus.

§ Mostpeoplewon’tevenknowtheyhaveZika.

HowisZikatransmitted?

§ Zika canbetransmittedthrough:– Mosquitobites– Fromapregnantwomantoherfetus

– Sexualcontact– Bloodtransfusion

WherehasZika virusbeenfound?

§ Before2015,ZikaoutbreaksoccurredinAfrica,SoutheastAsia,andthePacificIslands.

§ Currentlyoutbreaksareoccurringinmanycountriesandterritories.

Zikaisprimarilytransmittedthroughmosquitobites.Protectyourself.

Ways to Protect Yourself from Zika

STEP 1KEEP MOSQUITOES OUTSIDE

STEP 3WEAR INSECT REPELLENT

STEP 2CREATE A BARRIER BETWEEN YOU AND MOSQUITOES

STEP 4PROTECT YOUR FAMILY

STEP 5PROTECT YOUR PARTNER

STEP 6DO YOUR HOMEWORK

BEFORE TRAVELING

SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION

Doyourhomework beforetraveling

Seethelatesttravelnoticesat:

wwwnc.cdc.gov/travel/page/zika-travel-information

WhatisCDCdoing?§ CDC’sEmergencyOperationsCenter

– ActivatedJan22,2016– HighestlevelofactivationonFeb8.

§ Workingwithpartnersto:– Educatehealthcareproviders&publicaboutZika.– Posttravelnotices(level2alert,practiceenhanced

precautions)andothertravel-relatedguidance.– Providestateandterritorialhealthlaboratorieswith

diagnostictests.– CreateanddistributeZikaPreventionKitsforaffected

USterritories

• OnFebruary1,2016WHOdeclaredthecurrentZikavirussituationaPublicHealthEmergencyofInternationalConcern(PHEIC)

• Microcephalyandotherneurologicdisorders– needforsurveillanceandresearch• Zikavirustransmission• Longer-termmeasures

• Travel• Thereshouldbenorestrictionsontravelortradewithcountries,areasand/or territorieswith

Zikavirustransmission• TravelerstoareaswithZika virustransmissionshouldbeprovidedwithuptodateadviceon

potentialriskandappropriatemeasurestoreducethepossibilityofexposuretomosquitobites

• StandardWHOrecommendationsregardingdisinsectionofaircraftandairportsshouldbeimplemented

• March8,2016WHOstatementontheZika virussituation,fortravel:§ PregnantwomenshouldbeadvisednottotraveltoareasofongoingZika virusoutbreaks;§ PregnantwomenwhosesexualpartnersliveinortraveltoareaswithZika virusoutbreaksshould

ensuresafesexualpracticesorabstainfromsexforthedurationoftheirpregnancy

WHODeclaration

U.S.Population&Travelers

~310millionpopulation~40millionforeign-born>300 officialportsofentry

Border Crossings per Year

Mode MillionsAir 78

Sea* 26Land 237Total 341

Airport Coverage – North AmericaTravel from Zika Affected Countries

Mode MillionsAir 34Sea 9

Land 173Total 216

San Diego

Atlanta

ChicagoSeattle

Miami

Los Angeles

San Francisco

Honolulu

WashingtonDC

El PasoHouston

NewarkNew York

Boston

San Juan

Minneapolis

DetroitAnchorage

Dallas

U.S. Port of Entry (n= 327)

CDC Quarantine Station (n=20)

U.S.POEandCDCQuarantineStations

RoutineActivitiesatU.S.Airports

• Promptlyidentifyandanalyzepublichealthriskbasedonilltravelerassessment

• Utilizeexistingreportingandresponsemechanisms• Mitigatemorbidityandmortalityforpassengers,crew,

andcommunity• Supportcrisisemergencyriskcommunication

(compassionate,timely,credible)

Close coordination with local public health, emergency first responders, law enforcement, and aviation sector partners is essential

RoutineBorderTools&ActivitiestoPreventIntroductionofCommunicableDiseases• Healthpromotion&healthcommunicationstotravelers

• E-monitors,TravelHealthAlertNotices,CDCTravelers’HealthWebsite

• Guidancetoairlinesandairportpartners• Federalauthorities torestricttravel• Contactinvestigations• RoutineProcedurestoDetectIllTravelers• Training,Planning,Exercising

Preparedness & Response

U.S.AirportEntryScreening• Routineprocedurestoidentifyill travelersison-goinginpartnershipwithCustoms

andBorderProtection(CBP)• CDCisnotconductingentryscreeningonarrivingtravelersforZika• TravelersfromareaswhereZikavirusisspreadingcouldarriveatanyU.S.airport,

includingondomesticflightsfromU.S.territoriesorpreclearanceports.• CDCstaff,incollaborationwithCBP,EMSandlocalhealthofficials,followroutine

protocolsandrespondtosicktravelersanddetermineappropriatemeasures• ThereportingrequirementsforairlinesandcruiseshipsunderCDC’sregulations

(42CFRpart71)coversomeofthemorecommonsymptomsofZika.• CDCwillcontinuetoassessthesituationanddetermineifadditionalmeasuresare

necessaryandcommunicatewithCustomsandBorderProtection.

Disinsection ofCommercialAirplaneso Zika virusspreadsfromplacetoplaceprimarilythroughinfectedtravelers,notmosquitoeso CDCdoesnotrecommend routineuseofinsecticides(disinsection)insidecommercial

conveyancestopreventthespreadofZikaviruso InsecticideuseisnotrequiredforairplanesorshipsarrivingintheUnitedStateso Jurisdictionsshouldcontinuetofollowestablished,routinevectoreffortstocontrolor

eliminatemosquitoesinairportsandseaports

o Airlinesshouldfollowguidancefromcountriesthatrequiredisinsection andfromtheInternationalCivilAviationOrganization

o WHOhaspostedinformationon“Zikavirus:Aircraftdisinsection formosquitocontrol”at:http://www.who.int/ihr/ports_airports/zika-aircraft-disinsection/en/.

SanJuanQuarantineStation

PhiladelphiaQuarantineStation

WhatCanAirlinesdotoHelpAmplifytheMessage

• Consideradoptingfleet-wideapproachtoZikavirusnotifications• Providehealthadvicetopassengersandcrewwithitinerariestolocations

listedinZikavirustravelalertsashavingreportedZika transmission• US-CDC,WHO/PAHO,EuropeanCentreforDiseasePreventionandControl(ECDC)

• Guidancefromrelevantnational,regionalandinternationalhealthauthoritiescanbeusedtodevelophealthadvice

• Provideinformationforspecificriskgroups• Pregnantwomen,womentryingtobecomepregnant

• Updatewhenhealthauthoritiesupdatetheadvicetheyprovide

WhatCanAirlinesdotoHelpAmplifytheMessage

• Messagescanbeprovided:• Pre-travelhealthalertswithitinerariestoaffectedcountries:

• Topassengersaton-linebooking, viaemailprior totravel• Tocrew:onlinevideos,newsletters,emails

• Specifichealthinformation forpregnantwomenandforwomentrying tobecomepregnant.

• Onboard:• Inflightvideos- everyoneorthosewhoselect;• Flyers,magazinearticles• Additionalgoodiesforflightstoaffectedcountries?

Olympics2016Brazil,5-21August&7– 18September

• U.S.OlympicCommittee(USOC)formedaDiseaseAdvisoryGroup• Assistinidentifyingandestablishingbestpracticesregardingthemitigation,

assessment,andmanagementofinfectiousdiseasecenteredontheathletesandstaffparticipatinginOlympicandParalympicGamesandUSOCoperatedfacilities.

• Assistindevelopingeducationalmaterialsforathletes,staff,anddelegationmembers.

• CDCisamemberofadvisorygroup:Capt.MartinS.Cetron,MD,Director,DivisionofGlobalMigrationandQuarantine

• Olympictravelnoticeposted:http://wwwnc.cdc.gov/travel/notices/alert/2016-summer-olympics-rio

TravelRecommendationsfor2016SummerOlympicsinBrazil

• Zika• Womenwhoarepregnantshouldnotgo.• Iftheymustgo,should preventmosquitobites.• Womentryingtobecomepregnantshouldtalktotheirdoctor.• Menwhogoshouldusecondomsornothavesexwithpregnantpartners.

• Othertravelhealthrecommendations• Gettravelvaccines.• Followsafetyandsecurityrecommendations.• Followfoodandwatersafetyguidelines.• Preventmosquitobites(topreventdengueandchikungunya,aswellasZika).• Choosesafetransportationoptions.

• Similarguidelineshavebeenissuedforspringbreaktravelers.http://www.cdc.gov/features/springbreaktravel/index.html

Airlines:ThingstoTakeIntoAccount• Diseaseseverityandpotentialimpactontraveler• Arealltravelersatsamerisk• StatementsbyWHO

§ Emergencycommitteestatements,e.g.PHEIC• StatementsbyNationalGovernments

§ TravelHealthNotices• IntheUScouldconsiderforL2orL3

§ PublishedGuidanceforMonitoringandMovementofPersons• CDCadvisespurchasingtravelhealthandmedicalevacuationinsurance

http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/travel-insurance-travel-health-insurance-medical-evacuation-insurance

CommunicationMaterials

ZikaUpdates:www.cdc.gov/zika

§ CDCEmergencyPartnersNewsletterrequest:[email protected]

§ ZikavirusandpregnancyQ&As:http://www.cdc.gov/zika/pregnancy/question-answers.html

§ Zika keymessageshttp://www.cdc.gov/zika/pdfs/zika-key-messages.pdf

Resources

Formoreinformation,contactCDC1-800-CDC-INFO(232-4636)TTY:1-888-232-6348www.cdc.gov

ThefindingsandconclusionsinthisreportarethoseoftheauthorsanddonotnecessarilyrepresenttheofficialpositionoftheCentersforDiseaseControlandPrevention.