2017 Zika Update: A Synopsis

In 2015, I put together a panel of diverse public health professionals in order to provide graduate students with guidance on how to best prepare for (and land) a relevant public health job. The majority of the seasoned professionals on the panel (all epidemiologists) mentioned the impact 9/11 had on them being able to get a job, as a result of new positions created with emergency preparedness funding. I graduated shortly after this presentation and was able to secure a High-Consequence Infectious Disease (HCID) position at a local health department in Texas. These surge capacity epidemiologist positions had been made available as a result of the Ebola outbreak. Some of my peers were able to land similar positions around the state of Texas during the same time (or shortly after).

Although these positions were created in response to the Ebola outbreak, the emerging Zika crisis in Brazil became the high-consequence infectious disease of focus for us. Within a few weeks of starting my position, the epidemiology office at my local health department began to receive requests from local media for more information about Zika virus and the risk it posed to community members. Additionally, we were receiving continual updates from the Department of State Health Services, Zoonosis Control Branch concerning laboratory testing, preventive measures, and risk assessments for pregnant women and their partners. I was in charge of consolidating and disseminating this guidance to our local health care providers and community partners. It was also during this time that I  created a short quiz to gauge knowledge of key aspects of the illness and provide answers from relevant sources such as the Centers for Disease Control and Prevention (CDC), the Pan American Health Organization (PAHO), and the World Health Organization (WHO). The survey was tested out in the LinkedIn Global Health group and then later included in a presentation I put together for local health department and county staff. The quiz answers and presentation were updated periodically, as we learned more about Zika virus through conference calls and webinars. By the time I started a new position a year later, the number of Zika virus cases being reported globally had started to decrease.

That’s just a little of my experience with Zika. Now, I will share a brief, global synopsis of Zika.

In 2016, the World Health Organization (WHO) declared Zika virus to be a Public Health Emergency of International Concern due to its association with congenital microcephaly in infants born to women who had been infected during their pregnancy. Additionally, neurological conditions such as Guillain-Barre syndrome (GBS) were also being reported in adults who had been infected with Zika virus. Zika virus is said to be transmitted through the bite of an infected Aedes aegypti mosquito. It is also spread through sexual and congenital transmission.

Since May 2015, more than 750,000 confirmed and suspect Zika virus cases have been reported globally. Cases have been spread throughout more than 60 countries and territories. From May 2015-Dec 2016, there were 707,133 suspect and laboratory confirmed Zika virus cases in the Americas due to local transmission. Twenty-five percent of these cases were laboratory-confirmed. By late 2016, Zika virus transmission had occurred in 48 countries and territories in the Region of the Americas. Peaks were observed at various points during this time period (some regions even experienced more than one):

-January 2016 (Central America)
-February 2016 (Southern Cone, Andean subregions, and non-Latin Carribean)
-June 2016 (Central America and non-Latin Carribean)
-January-July 2016 (Latin Carribean; also the region with the highest number of Zika virus cases)

Zika virus rates in North America were relatively low, with a small peak occurring in October 2016. According to the U.S. Zika Pregnancy Registry (USZPR), 10% of completed pregnancies with confirmed Zika virus infection reported birth defects. Microcephaly was reported in 84% of completed pregnancies with birth defects. Additionally, birth defects were higher during the first trimester of pregnancy. Compared to pre-Zika levels in 2013-2014, 30 times more fetuses/infants were reported to have birth defects in 2015-2016. A similar trend was seen in Brazil when comparing pre-Zika data to data collected from mid-2015 to Jan 30, 2016 (read limitations in both articles).

In November 2016, WHO re-classified Zika virus as a long-term public health challenge  (instead of a Public Health Disease of International Concern). Since December 2016, there has been a significant drop in the number of cases being reported, however, CDC is reminding the public to follow preventive measures as the mosquito season gets closer.

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