FIRST CONFIRMED CASE OF IMPORTED ZIKA VIRUS IN
HOUSTON, TEXAS
Preventing Transmission
Objectives
Discuss the epidemiology of Zika virus Describe the Zika case investigation of the first
confirmed case in Houston, Texas. Discuss how emerging diseases are controlled by
timely identification and reporting from clinicians. Articulate the importance of prompt surveillance
and patient education in preventing the spread of vector-borne diseases.
Zika Virus Introduction
Single stranded RNA Virus Family Flaviviridae, Genus Flavivirus Related to dengue, Japanese encephalitis,
yellow fever, and West Nile Virus Transmitted to humans by Aedes species
mosquitos.
Zika Virus Time-line
Modes of Transmission
Other Modes of Transmission
Sexual Blood Transfusion Maternal-fetal
Laboratory exposure
Theoretical Breast Milk
Organ or tissue transplantation
Description of Illness
SYMPTOMS:
Fever
Rash
Joint pain
Conjunctivitis
Myalgia
Headache
Malaise
1 in 5 people become ill.
Illness is usually mild.
Treatment
-No Vaccine
-Rest
-Fluids
-Medicine
Prevention
Avoid Bites
Repellent
Long Sleeves/Pants
Air Conditioning
Screens/Nets
Drain Standing Water
ZIKA CASE INVESTIGATION
On November 16, 2015 a Houston clinician reported to the Houston Health Department, Bureau of Epidemiology two suspected cases of Zika virus.
An investigation was conducted to determine the source of infection and prevent the spread of disease.
CASE INVESTIGATION CONTINUED
Suspect Case #1 Suspect Case #2
59 Year Old Hispanic Female
Onset Date: 11/10/15
Travel to Colombia
60 Year Old Hispanic Female
Onset Date: 11/13/15
Travel to Colombia
CASE INVESTIGATION CONTINUED
BOTH SUSPECTED CASES TRAVELED TO
SANTA MARTA, COLOMBIA BETWEEN
11/03/15 &11/10/15
CASE INVESTIGATION CONTINUED
Suspect Case #1 Symptoms Suspect Case #2 Symptoms
Fever Diarrhea Arthralgia Fatigue Muscle pain Rash Pain behind eyes Upset stomach
Fever Fatigue Diarrhea Arthralgia Rash Conjunctivitis Headache Pain behind eyes
CASE INVESTIGATION CONTINUED
Education provided to patients Communication with the State Health Department
and CDC Hurdles we had to overcome
Blood Sample
Blood samples were taken and sent to the Centers for Disease Control and Prevention at Fort Collins for testing.
CASE INVESTIGATION TESTING
ELISA IgM PRNT Limitations: Cross-reactivity with other
Flaviviruses Serology results should be interpreted with
caution
CASE INVESTIGATION RESULTS
Suspect Case #1 Suspect Case #2
Zika IgM ELISA= Positive Dengue = Positive Chikungunya= Negative West Nile = Negative St. Louis Encephalitis=
Negative
Zika IgM ELISA= Positive Dengue = Negative Chikungunya= Negative West Nile = Negative St. Louis Encephalitis=
Negative
CASE INVESTIGATION CONCLUSIONS
Education provided by public health investigator played a pivotal role in preventing transmission to mosquitos in the Houston area.
Texas case counts
Both cases were imported from Colombia where local transmission is ongoing.
Rapid identification of disease and notification by the clinician .
Conclusions Continued
Mosquito-based Surveillance
Vector Control Outbreaks
Strategy to Respond to Zika
Develop laboratory testing capacity
Investigate cases and their contacts
Coordinate with mosquito control surveillance
Maintain situational awareness in the city and
region Improve our understanding
of the virus and its effects
Conduct neighborhood outreach to vulnerable communities
Clean-up garbage in neighborhoods
Eliminate standing water
Educate travelers & expecting mothers
Mosquito Control (HCPHES)
Zika Virus Complications
Aruba Barbados Bolivia Bonaire Brazil Colombia Commonwealth of Puerto Rico, US territory Costa Rica Curacao Dominican Republic Ecuador El Salvador French Guiana Guadeloupe Guatemala Guyana Haiti Honduras Jamaica Martinique Mexico Nicaragua Panama Paraguay Saint Martin Saint Vincent and the Grenadines Sint Maarten Suriname Trinidad and Tobago U.S. Virgin Islands Venezuela * As of February 29, 2016
Zika Virus Complications
Guillain-Barre syndrome (GBS) -Symptoms -Treatment
Countries Reporting Cases
Birth Defect
Microcephaly Number of microcephaly cases reported in
the Northeast Region of Brazil by Epidemiological Week (8 November 2015 - 13
February 2016).
Pan American Health Organization / World Health Organization. Zika Epidemiological Update – 24 February 2016. Washington, D.C.: PAHO/WHO; 2016 Pan American Health Organization • www.paho.org • © PAHO/WHO, 2016
Brazil Microcephaly Cases
There have been a total of 5,640 microcephaly cases reported by the Ministry of Health of Brazil.
So far 583 of these are confirmed cases. The others are being investigated
0 5 10 15 20 25 30 35 40
American Samoa
Puerto Rico
US Virgin Islands
American Samoa Puerto Rico US Virgin IslandsLocally acquired cases 4 34 1Travel-associated cases 0 1 0
U.S. Territories Confirmed Zika Cases
Distribution of Aedes
Aedes aegypti
Most likely originated in Africa
Aedes albopictus
Originated in Asia
Prevention Continued
Mosquitos are “container breeders”
Eliminate all breeding sites in and around your home to prevent disease transmission.
Mosquito Fun Facts
Where do mosquitos live?
How do they spread? Mosquitos have evolved
“Sip feeders”
References
Centers for Disease Control and Prevention. All Countries and territories with Active Zika Virus Transmission. http://www.cdc.gov/zika/geo/active-countries.html
Centers for Disease Control and Prevention. Zika Virus. http://www.cdc.gov/zika/index.html. Centers for Disease Control and Prevention. Zika Virus-What clinicians need to know power-point. Clinician Outreach and
Communication Activity Call January 26, 2016 Centers for Disease Control and Prevention. Memorandum. February 7, 2016. http://www.cdc.gov/zika/pdfs/denvchikvzikv-testing-
algorithm.pdf. Centers for Disease Control and Prevention. Zika Virus disease in the United States, 2015-2016.
http://www.cdc.gov/zika/geo/united-states.html Centers for Disease Control and Prevention. Surveillance and Control of Aedes aegypti and Aedes albopictus in the United States.
http://www.cdc.gov/chikungunya/resources/vector-control.html J.D. Honigberg International, Inc. International Sales and Export Management. Shipping container figure.
http://www.jdhmedical.com/thermosafechests.html MedlinePlus. CDC reports link between Zika virus and microcephaly.
https://www.nlm.nih.gov/medlineplus/news/fullstory_157174.html Pan American Health Organization / World Health Organization. Zika Epidemiological Update – 24 February 2016. Washington,
D.C.: PAHO/WHO; 2016 Pan American Health Organization • www.paho.org • © PAHO/WHO, 2016 World Health Organization. Countries and territories showing historical time-line of Zika virus spread (1947-2016).
http://www.who.int/emergencies/zika-virus/zika_timeline.pdf?ua=1 Parents. Zika Virus: Everything Pregnant Women should know. Zika Figure. http://www.parents.com/pregnancy/complications/birth-
defects/zika-virus-everything-pregnant-women-should-know/
References
Unicef. What you need to know about the Zika virus. February 12, 2016. https://blogs.unicef.org/blog/what-you-need-to-know-about-the-zika-virus/
World Health Organization. Zika Epidemiological Update. 3 March 2016. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11599&Itemid=41691&lang=en
World health Organization. Cumulative Zika Susect and Confirmed cases reported by countries and territories in the Americas 2015-2016. http://ais.paho.org/phip/viz/ed_zika_cases.asp.
World health Organization. Zika Virus. http://www.who.int/mediacentre/factsheets/zika/en/ World Health Organization. Weekly Epidemiological Record. 19 February 2016, vol. 91, 7 (pp.73-88).
http://www.who.int/wer/2016/wer9107/en/ World Health Organization. Suspected and confirmed Zika cases reported by countries and territories in the Americas, 2015-2016.
http://ais.paho.org/phip/viz/ed_zika_epicurve.asp World Health Organization. Zika: the origin and spread of a mosquito-borne virus. http://www.who.int/bulletin/online_first/16-
171082/en/
Thank You For Joining Me
Presenter: Amanda Eckert, MPH
Surveillance Investigator Houston Health Department
Bureau of Epidemiology 8000 North Stadium Drive
Houston, TX 77054 Phone: 832-393-4318
Thank you to everyone who helped with this investigation especially: Thomas Johnson Jr., BS, Brenda Thorne, MS, Salma Khuwaja, MD, MPH, DrPH, and Raouf Arafat, MD, MPH.