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Features from the Field: Laredo

Outreach and Education Lead to Increased Zika Reporting in Laredo

Just north of the Rio Grande Valley is the city of Laredo, Texas, the 3rd most populous city along the United States– Mexico border. Here, public health personnel are working diligently to monitor, detect, and prevent the spread of Zika virus. The City of Laredo Heath Department (CLHD) is taking a multi-faceted approach to address Zika, implementing an integrated mosquito control program, education campaigns for pregnant women and their communities, and targeted outreach to providers and laboratories.

Features from the Field Laredo

Keila Castillo sharing Zika resources during a provider visit

Provider Outreach and Education

Keila Castillo is a field epidemiologist placed through the CDC Zika Response Local Health Department Initiative. Castillo conducts community and clinician outreach in Laredo with the local health department. “It’s useful to be able to talk to clinicians, nurses, and the entire provider office to get everyone on the same page about Zika,” she says. Castillo contacts OB/GYNs, pediatricians, and other maternal and child health practitioners to share information on Zika testing protocols, investigation procedures, and recommendations for follow-up care. She also coordinates with laboratories to refer people for Zika testing who are uninsured or underinsured, a population that represents nearly 40% of CLHD’s constituents.

Recently, Castillo met with a Laredo provider office that was reluctant to prioritize Zika testing for pregnant patients. She met with the clinical staff to gain an understanding of their reservations, clarify the testing protocols, and reiterate the value of robust data for surveillance and monitoring to public health and the community. As a result, the office agreed to follow CDC’s recommended testing guidelines and Castillo saw an increase in testing. This is an example of the impact inperson outreach can make in the fight against Zika and the importance of building capacity at the local level to respond to emergencies.

The importance of testing and reporting results to the health department cannot be understated during an emergency like Zika. This is another area where Castillo’s efforts are making a significant difference. Between April and May 2017, CLHD saw a 156% increase in the number of Zika lab tests reported to the health department.

Epidemiologic Investigations in the Field

When the health department is notified of a positive test result that may indicate Zika, it deploys an interdisciplinary team to investigate the situation while CDC confirms the test results. The team conducting home visits includes an epidemiologist, environmental health specialist, and social worker. Castillo and the other team members inspect the premises for standing water where mosquitoes lay eggs, discuss Zika risk factors prevention options with the family, draw blood for follow-up testing, and provide access to care. This intimate, in-person approach to responding is efficient and allows CLHD to be proactive in reducing local transmission of Zika in Laredo. It also allows the health department to better predict, plan, and prepare for referrals to service and determine where it should focus its efforts.

Protecting Pregnant Women

The Zika outbreak and its effects on pregnant women highlight the need for early prenatal care. Dr. Hector Gonzalez, Health Director of CLHD, reiterated that “any infection during pregnancy is a problem. We want women to start thinking about disease prevention before they get pregnant, so they mitigate risks. Zika is setting the tone for how we look at syphilis, TB, and other infections during pregnancy.”

The CDC Zika Response Local Health Department Initiative provides skilled resources to local health departments to support Zika activities in the field. “The field assignees play a vital role in the response and we appreciate the creative and innovated approach CDC is taking to build capacity at the local level,” said Dr. Gonzalez. “Having a dedicated person to work on Zika has alleviated a lot of the anxiety and complexities that come with this disease,” shared Waldo Lopez, Associate Director of the Healthy Texas Babies program. “With Keila onboard handling Zika, our epidemiology staff can also dedicate their time on other urgent issues that we continue to face in the community, such as malaria, cholera, typhus, and dengue.”

CLHD will continue outreach and education efforts with maternal and child health providers to respond to the Zika emergency and continue to build thoserelations to enable them to work together on the next outbreak that may affect this community.

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