From Ebola to Zika - What Do Providers Need to Know?
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http://bit.ly/1p7TV5f Panelists will discuss how the military, CDC and hospital providers are responding to the potential threat from the Zika virus.
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From Ebola to Zika - What Do Providers Need to Know?
- 1. From Ebola to Zika: What Do Providers Need to Know? WEBINAR SERIES SPONSORED BYSPONSORED BY
- 2. HOUSEKEEPING WEBINAR SERIES From Ebola to Zika: What Do Providers Need to Know? S P O N S O R ED BY
- 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
- 17. Additional Issues: – Pre-travel information – Blood transfusion – Counseling and support
- 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
- 36. Zika Preparedness Presented by: John Braden M.D., Baptist Health South Florida Medical Director, Emergency Preparedness & Security Department
- 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
- 38. Patient Base
- 39. Hurricane Season (June 1 – November 30) Impact in the Area •Watch •Levels •Warning
- 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
- 41. Communicable Diseases of Urgent Public Health Concern •Zika •Ebola •Dengue •Influenza •Chikungunya
- 42. Emergency Response Teams (ERT) Classes & Training
- 43. •300 Participants •Area Command •Incident Command •Ocean Reef Clinic •Family Re-unification Centers (SWS) BHSF Annual Exercise
- 44. Partners
- 47. THANKS ALSO TO OUR PANELISTS: EXPECT A FOLLOW-UP EMAIL within two weeks with links to presentation materials and information about how to offer feedback. FOR MORE INFORMATION about upcoming webinars, please visit ModernHealthcare.com/webinars 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