||Vector present or possible in the state
- The governing officials should appoint a senior representative to coordinate Zika response efforts.
- Pre-identify an incident manager.
- Secure surveillance and control resources necessary to enable emergency response if needed.
- Ensure coordination with state public health officials so vector control and human surveillance activities can be linked.
-Review state and local mosquito control programs and assess capacity and capability.
-Review (or, develop as needed) the state vector-borne disease preparedness and response plan, and tailor as appropriate for Zika.
- Review plans with relevant response partners, identify gaps in preparedness, and develop a plan for improvement.
-Prepare a communication campaign for pregnant women, travelers, healthcare providers, and the public to raise awareness of Zika virus. Include messaging on the risk for sexual transmission, and steps persons can take to prevent it.
- Update scripts for state call centers to include Zika messaging.
-Enhance surveillance for travel-associated Zika cases and possible sexual transmission from travel cases.
- Reach out to clinicians in the state and provide guidance for management and testing of possible cases.
- Review state and commercial laboratory capacity to rapidly test specimens for Zika virus.
-Plan preparedness and mitigation activities to reduce the likelihood of transmission from mosquitoes, including: reduction of habitat/potential breeding sites, initiate community clean-up efforts, initiate public information campaigns encouraging yard clean up, use of insecticides, encouraging placement of window screens etc.
- Review (and as necessary, conduct) mosquito surveillance activities to assess whether historic maps of Aedes aegypti and Aedes albopictus distribution are accurate.
Pregnant Women Outreach
- Plan enhanced surveillance for suspected Zika virus infections, including for pregnant women through OB/GYN clinics, etc).
-Identify resources that could be used for interventions for pregnant women (products to develop Zika Prevention Kits for pregnant women, resources for communications campaigns, etc).
- Prepare a registry to collect information on Zika cases during pregnancy that could be used for future monitoring and follow-up of birth outcomes. This will be used to report cases to the National Zika Birth Registry.
- Reach out to local blood collection centers, and consult with them on blood safety contingency plans.
(Aedes aegypti or Aedes albopictus mosquito seasonal biting activity)
Continued Preparation, plus
-Explore focused community interventions to disrupt breeding grounds, such as tire collections and waste removal in at-risk areas. Leverage partnerships with local governments and non-profits for support.
Organize regular meetings between the pre-identified Incident Manager and state vector preparedness and response partners to discuss plans and progress.
- Initiate a communications campaign, with primary messaging focusing on awareness, personal protection against mosquitoes, and residential source reduction.
- Deploy messages encouraging travelers returning from areas with Zika transmission to take precautions upon return (actively take steps to prevent mosquito bites for at least 3 weeks) to reduce the risk of spread to local mosquito populations.
-Rapidly follow up on suspected cases through laboratory testing. Take a complete patient history; establish lack of travel, no transfusion or tissue transplantation, no sexual exposure to a traveler. Assess patient’s geographic area of risk for exposure (i.e., Where were they likely exposed? Home? Other place?)
-When travel-associated cases or cases among their sexual contacts are identified, counsel them to take precautions to avoid exposure to local mosquito populations (stay indoors in screened, air-conditioned rooms, use of personal repellents, consider mosquito reduction activities around home).
-Encourage healthcare providers to immediately reports results for any positive or equivocal cases.
Confirmed Local Transmission by Mosquitoes
(single case, or cases clustered in a single household/community in a county or jurisdiction)
Response as in category 1 plus:
- Activate the state incident management structure.
- Determine if there is a need for assistance from a CDC field team (e.g., Epi Aid or rapid response team) to provide on the ground technical, risk communication, vector control and/ or logistical support.
- As appropriate, issue press release/media statement and intensify visible activities in the county to increase attention to Zika virus transmission risk and personal protection measures (flyers, community leaders, social media).
-Monitor local news stories and social media postings to determine if information is accurate, identify messaging gaps, and make adjustments to communications as needed.
- Intensify surveillance for human cases in a 150-yard radius (or other boundary, as deemed appropriate) around home or other likely sites of exposure). Consider conducting household and door-to-door surveillance for clinically compatible cases.
- Recommend cases stay in air-conditioned/screened accommodations and use personal precautions to reduce mosquito bites.
- Enhance local surveillance for human cases (consider local clinician outreach, syndromic surveillance in nearby hospitals, etc).
- If not previously done, conduct a rapid insecticide resistance study for local mosquito populations.
- Conduct intensified larval and adult mosquito control in a 150-yard radius (or other boundary, as deemed appropriate) around case-patient home, including residential habitat reduction (trash cleanup, etc.) and outdoor space spraying. Although likely not needed in most areas, in areas where A/C and screens aren’t widely available, consider offering homeowners Indoor Residual Spraying (IRS).
- Deploy targeted communications, surveillance, and monitoring programs for pregnant women in the county/jurisdiction.
- Deploy the registry of Zika cases during pregnancy for monitoring and follow-up of birth outcomes.
- Notify local blood collection agencies for awareness.
- Review CDC toolkit for investigation of transfusion-transmitted infection.
||Widespread Local Transmission by Mosquitoes
(multiple locations within a county/jurisdiction)
Response as in category 2 plus:
- Determine the geographic boundaries that will be used for aggressive response efforts (county/jurisdiction, health department coverage area, zip code, etc).
- County/jurisdiction designated as an area of “active Zika transmission”.
-State should notify CDC (770-488-7100).
-Incident Manager should provide regular situation updates to keep public and partners informed of evolving situation.
- Intensify county-wide (or jurisdiction-wide) outreach (newspaper, radio, social media, call centers).
- Intensify county-wide (or jurisdiction-wide) surveillance for human cases (consider clinician outreach, syndromic surveillance in hospitals, etc.).
- Intensify and expand vector control efforts. Control plans should be tailored to local needs, but might include ground application, aerial spraying, or a combination of the two, and should include both adult and larval mosquito control methods, repeating applications as necessary to achieve adequate control.
-For areas where A/C and screens aren’t widely available, consider adding Indoor Residual Spraying (IRS) to vulnerable homes.
- Monitor effectiveness of vector control efforts through mosquito trapping surveillance.
-Advise pregnant women to consider postponing travel to the county/jurisdiction.
- Advise men in the county/jurisdiction to use condoms or abstain from sexual contact with pregnant women.
- Implement intervention plans for high risk populations (pregnant women). Options to consider include mosquito-proofing homes through installation of screens and provision of air-conditioning if necessary, as well as household vector control, and distribution of Zika Prevention Kits (ZPK’s).
- Initiate testing of asymptomatic pregnant women.
- Consider retrospective enhanced surveillance in health facilities to establish the earliest known date of local human infection for future counseling/ testing of asymptomatic pregnant women.
- Blood centers with collections in county/jurisdiction should follow FDA guidance for an area of active transmission, including outsourcing blood if laboratory screening or pathogen reduction is unavailable.
-Blood centers in other areas and states should follow FDA guidance for deferring blood donations for people who have a recent travel history to this county/jurisdiction.
||Local Transmission by Mosquitoes in Multiple Counties
Response as in category 3, plus:
- Expand response activities regionally or state-wide.