Zika Vir us and Oklahoma Vulne r able Populations Ja n F ig a rt, DHA, RN Asso c ia te Dire c to r, Co mmunity Se rvic e Co unc il
CDC a ntic ipa te s tha t lo c a l summe r tra nsmissio n ma y o c c ur in limite d a re a s o f the c o ntine nta l Unite d Sta te s (CONUS) a nd Ha wa ii whe re c o mpe te nt mo sq uito ve c to rs e xist. Zika Vir us Risk in Oklahoma Be c a use o f the risk o f tra nsmissio n o f Zika virus infe c tio n thro ug h b lo o d tra nsfusio ns, b lo o d sa fe ty inte rve ntio ns a re ne e d e d fo r b o th una ffe c te d a nd a ffe c te d a re a s. With the re c e nt o utb re a ks in the Ame ric a s, the numb e r o f Zika virus infe c tio ns a mo ng tra ve le rs visiting o r re turning to the Unite d Sta te s is like ly to inc re a se . L o c a l tra nsmissio n o f Zika virus in US te rrito rie s a nd a ffilia te d Okla ho ma is no t like ly to ha ve a Pa c ific Isla nd c o untrie s is o ng o ing . susta ine d risk o f Zika virus infe c tio n due Ne ithe r va c c ine s no r pro ve n c linic a l tre a tme nts a re e xpe c te d to e nviro nme nta l c o nditio ns (e .g ., to b e a va ila b le to tre a t o r pre ve nt Zika virus infe c tio ns b e fo re te mpe ra te c lima te , lo we r po pula tio n lo c a l tra nsmissio n b e g ins within the c o ntine nta l US o r Ha wa ii. de nsity, wide spre a d use o f a ir c o nditio ning a nd sc re e ns, a nd T he e ffic a c y o f ve c to r c o ntro l in re d uc ing mo sq uito -b o rne re duc e d mo sq uito ha b ita t) tha t inhib it infe c tio n risks ma y b e limite d , a s ha s b e e n the c a se with huma n-mo sq uito -huma n tra nsmissio n simila r mo sq uito -b o rne viruse s, suc h a s d e ng ue a nd b y Ae . ae g ypti a nd tha t diffe r fro m c hikung unya . mo re tro pic a l a re a s tha t ha ve Sc ie ntific und e rsta nd ing o f Zika virus c o ntinue s to e vo lve , a nd e xpe rie nc e d pro lo ng e d a nd inte nse ne w c ha ra c te ristic s o f the virus a nd ho w it is spre a d to tra nsmissio n. huma ns ma y a rise . Ce nte rs fo r Dise a se Co ntro l a nd Pre ve ntio n. Inte rim CDC Zika Re spo nse Pla n (CONUS a nd Ha wa ii): Initia l Re spo nse to Zika Virus. Atla nta , Ge o rg ia : Aug ust 2016.
CDC g uida nc e is b uilt o n a fo unda tio n o f surve illa nc e fo r huma n-re la te d illne ss, ra the r tha n a c tive surve illa nc e fo r infe c te d mo sq uito e s. Inve stig a tio n o f lo c a l tra nsmissio n Zika Vir us Pote ntial in c luste rs o f de ng ue a nd c hikung unya viruse s ha ve sho wn tha t huma n illne ss surve illa nc e is mo re info rma tive a nd Oklahoma se nsitive tha n ve c to r surve illa nc e . Sing le lo c a l tra nsmissio n c a se s usua lly ha ve no e vide nc e o f furthe r tra nsmissio n. Of 12 lo c a lly a c q uire d c a se s o f c hikung unya re po rte d in F lo rida in I n Okla ho ma , pro lo ng e d a nd inte nse 2014, o nly two a ppe a re d to b e linke d due to the ir lo c a l tra nsmissio n o f Zika virus is unlike ly pro ximity in time a nd spa c e . b ut mo re like ly to o c c ur in summe r Ong o ing lo c a l tra nsmissio n o f de ng ue within CONUS mo nths, a nd in so uthe rn Okla ho ma ha s o c c urre d o nly in So uth F lo rida (F lo rida K e ys) a nd whe re e nviro nme nta l c o nditio ns a re so uthe rnmo st T e xa s, a nd ha s no t e xpa nde d b e yo nd mo re fa vo ra b le . I t is mo re like ly tha t the se a re a s. Okla ho ma c a se s will o rig ina te fro m L tra ve l re la te d c o nta c ts, a nd pe rso n to o c a l tra nsmissio n c a n o nly o c c ur whe n c o mpe te nt pe rso n c o nta c t thro ug h se x with a n Ae . ae g ypti o r Ae . alb o pic tus ve c to r po pula tio ns a re pre se nt within a c o mmunity. Mo sq uito se a so n va rie s infe c te d pe rso n. Risk o f b lo o d b o rne b y jurisdic tio n b ut is typic a lly during the summe r (tra nsfusio n) Zika is le ss like ly in mo nths. Okla ho ma b ut wo uld mo st like ly o c c ur a s a re sult o f tra ve l a nd pe rso n to In mo st sta te s, the te mpe ra te c lima te limits the pe rso n c o nta c ts g iving b lo o d. po te ntia l fo r ye a r-ro und Zika virus tra nsmissio n.
De ng ue a nd c hikung unya viruse s ha ve simila r Zika Vir us and Wome n of tra nsmissio n pa tte rns a s Zika virus. Hundre ds o r tho usa nds o f impo rta tio ns into the c o ntig uo us Unite d Child- be ar ing Age in Sta te s re sult in a limite d numb e r o f sho rt tra nsmissio n Oklahoma c ha ins (usua lly o ne o r two ide ntifie d no n-ho use ho ld c a se s) a nd le ss tha n two sma ll o utb re a ks pe r ye a r. T his e xpe rie nc e indic a te s tha t sing le ide ntifie d c a se s o r sma ll c luste rs o f Zika do no t re pre se nt a b ro a d c o mmunity risk to pre g na nt wo me n. T he re fo re , it is e xpe c te d tha t a dditio na l pe rso na l pro te c tio n I n Okla ho ma , wo me n who a re me a sure s a nd c o mmunity ve c to r c o ntro l will pro vide pre g na nt o r a re thinking o f b e c o ming suffic ie nt pro te c tio n o f pre g na nt wo me n who re side pre g na nt sho uld o b se rve tra ve l wa rning s o utside o f the US. Pre g na nt in, wo rk in, o r tra ve l to the a ffe c te d a re a . wo me n with risk o f tra nsmissio n thro ug h In the unlike ly e ve nt tha t Zika virus tra nsmissio n o c c urs se xua l c o nta c t sho uld use c o ndo ms a t a n inte nsity tha t pre se nts a sig nific a nt o ng o ing risk during pre g na nc y to re duc e the risk o f to pre g na nt wo me n, tra ve l g uida nc e sho uld b e tra nsmissio n. Physic ia ns sho uld b e tra ine d with e a rly indic a tio n a nd issue d, ide a lly b y sta te s, o r b y CDC, fo r pre g na nt tre a tme nt pro to c o ls fo r wo me n o f wo me n to a vo id no n-e sse ntia l tra ve l to the impa c te d c hildb e a ring a g e fo r Zika virus a re a . F o r e xa mple , sig nific a nt risks inc lude o ng o ing de te c tio n a nd tre a tme nt. tra nsmissio n tha t e xte nds fo r >2 we e ks (the a ppro xima te life time o f Ae de s ae g ypti).
Zika Vir us and Wome n At Gr e ate st Risk Po ve rty, urb a n se tting s, no a c c e ssing pre ve ntive me a sure s a nd multiple se xua l pa rtne rs a re fa c to rs in Zika tra nsmissio n during pre g na nc y. I n the US, 2 to 12 I n Okla ho ma , 51% o f a ll b irths a re uninte nde d. Amo ng te e ns o ve r 80% c a se s pe r 10,000 live b irths re sult in mic ro c e pha ly. a re uninte nde d. I nte ntio na lity One third o f wo me n who c o ntra c t Zika during de sc rib e s the la c k o f use o f pre g na nc y ha ve ha d a b irth de fe c t in Bra zil a n a re a o f pre c a utio ns to pre ve nt te e n pre g na nc y. Physic a l b a rrie rs to inte nse c o nc e ntra tio n o f Zika . pre ve nt pre g na nc y (c o ndo ms, a nd va g ina l da ms) a re a lso b e ne fic ia l to re duc e se xua lly tra nsmitte d infe c tio ns. Okla ho ma is 1 st in te e n b irths a mo ng 18 a nd 19 ye a rs o lds a nd 2 nd fo r te e n b irths to g irls 15-19 ye a rs o ld.
Zika Vir us and Vulne r able Populations in Oklahoma I n Okla ho ma , vulne ra b le po pula tio ns suc h a s urb a n a re a s (hig h de nsity), tra ve le rs (risk a re a fo r Zika virus), se x wo rke rs (tra ve le rs c o nta c ts), a nd ho me dwe lle rs witho ut a ir-c o nditio ne rs o r sc re e ns o n the windo ws sho uld ta ke pre c a utio ns inc luding a vo id tra ve l to re stric te d a re a s, use o f to pic a l mo sq uito re pe lle nts, a nd use o f c o ndo ms with se xua l c o nta c t . State gove r nme nt should inve st in r e duc ing pote ntial mosquito habitats and pr ovide r obust e duc ation c ampaigns for he alth c ar e pr ovide r s and the public .
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