Lilian Peake, MD, MPH

2017 SCAAP Summer Conference

1. Mosquito-borne Diseases

2. Challenges to Preventing and ControllingMosquito-borne Diseases

3. Effects of Zika Virus on Child Health

None

3

• Accelerating emergence and incidence of mosquito-borne diseases

• Many have or will likely become endemic throughout the Western Hemisphere

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

1999 2013 2015Yellow Fever

West Nile Virus

Dengue Virus

ZikaVirus

Emergence of Arboviruses in the Western Hemisphere

1600s 1700s 1800s 1900s 2000s

ChikungunyaVirus

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Percent world population living in urban setting

•1950: 29%

•2007: 49%

•2030: 60%

Increase largely due to 3X increase in Asia and Africa

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Enzootic

Culex spp mosquitoes• West Nile virus• Japanese encephalitis

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Urban EpidemicEnzootic

Aedes spp mosquitoes

Haemogogusspp

mosquitoes

Aedes aegypti +/-Aedes albopictus• Dengue• Yellow fever• Chikungunya• Zika

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

• Shortens time from infection to infectiousness (extrinsic incubation period)

• Increases viral replication in mosquitoes, making them more infectious

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Average Annual Incidence of WNV Neuroinvasive Disease US, 1999–2015

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Incid

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Year

Source: https://www.cdc.gov/westnile/resources/pdfs/data/5-WNV-Neuro-Incidence-by-Year_for-PDF_1999-2015_07072016.pdf

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Average Annual Incidence of WNV Neuroinvasive Disease by County, US, 1999–2015

Source: www.cdc.gov/westnile/resources/pdfs/data/7-WNV-Neuro-Incidence-by-County-Map_1999-2015_07072016.pdf

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Dengue Incidence in the Americas, 1980-2016

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Source: Pan American Health Organization (PAHO)

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Dengue Serotypes in the Americas, 1990-2014

Source: http://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=6252&Itemid=40734&lang=en

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Chikungunya Virus in the Americas

0

5

10

15

20

25

30

35

40

45

50

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200

400

600

800

1000

1200

1400

1600

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Countries

Cases

Source: PAHO report posted to http://www.paho.org/hq/index.php?option=com_topics&view=article&id=343&Itemid=40931

44 countries1,427,005 cases222 deaths

Dec 2013

May2013

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Number of Countries with Zika

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

http://www.cdc.gov/zika/geo/active-countries.html

Source: https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Reported Zika Virus Cases, Continental United States

Category Number

Travel related* 5,381

Local transmission 224

Other routes 48

* Includes cases in travelers and their contacts with presumed sexual or in utero transmission

Source: https://www.cdc.gov/zika/geo/united-states.html

As of July 12, 2017

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

1. No proven control measure for Aedes aegypti(dengue, yellow fever, chikungunya, Zika)

2. Insecticide resistance unknown, in some areas likely widespread

3. Eroding technical capacities at all levels; shrinking entomologic workforce

4. Surveillance infrastructure diminishing

5. Patchwork of vector control units across the US

• Largely underprepared

• Focus on Culex mosquitoes, not for Aedes aegypti

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

Number of Cases of WNV Neuroinvasive Disease, by Calendar Week of Onset and Report, and Vector Index, Dallas County, 2012

0

10

20

30

40

50

19 21 23 25 27 29 31 33 35 37 39 41 43

Reported

Onset

Vector Index

Adapted from JAMA 2013;310:297-307

Aerial spraying

AugustJulyJune Sept Oct

1.5

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Vector Index

Source: Adapted from presentation by Lyle R. Petersen, MD, MPH, Director, Division of Vector-Borne Diseases, CDC

• Cugola, Fernanda R., and coworkers. "The Brazilian Zika virus strain causes birth defects in experimental models." Nature 534.7606 (2016): 267-271.

• Honein, Margaret A., et al. "Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy." JAMA 317.1 (2017): 59-68.

• Johansson, Michael A., et al. "Zika and the risk of microcephaly." New England Journal of Medicine 375.1 (2016): 1-4.

• Panchaud, Alice, et al. "Emerging role of Zika virus in adverse fetal and neonatal outcomes." Clinical microbiology reviews 29.3 (2016): 659-694.

• Rasmussen, Sonja A., et al. "Zika virus and birth defects—reviewing the evidence for causality." New England Journal of Medicine 374.20 (2016): 1981-1987.

• Microcephaly

• Decreased brain tissue and brain damage

• Damage to eyes including vision

• Damage to ears including hearing

• Joint problems

• Substantial family-identified health care service needs

• Chronic conditions

• Functional limitations

• Health care use

“I eventually stopped working to care and coordinate my daughter’s weekly therapy appointments and monthly doctor visits. She has struggled with meeting developmental milestones, but at age 2 began to show more improvement. After 6 years of intense physical therapy, she began walking independently. “

A Family Connection Parent of a child with microcephaly and Chromsome deletion

• Surveillance and investigation of human cases

• Working with local governments on vector control

• Information about Zika in English and Spanish

• Prepared text4baby messages to alert pregnant women of areas in the event of local

• Zika Pregnancy Registry• Women or infants who screen positive for Zika virus

• Including infant’s 2 month, 6 month, and 12 month pediatric visits

• Enhanced surveillance of microcephaly cases

• Contract with partners to take advantage of community expertise

• Dissemination of information to Latino/Hispanic population

• Contact with families for the Zika Pregnancy Registry

• Refer families to appropriate resources

• Support with statewide education and planning for the Early Intervention community with Zika virus

• Available to provide pediatric neurology expertise to physicians

• Provide increased developmental screenings

• Follow up of all infants in Zika Pregnancy Registry

• Provide statewide education to Early Intervention community

• Clinical validation of brain anomalies found

• Surveillance data from autopsies

• Support with research on Neural Tube Defects

• AAP – Children and Disasters – Zika

• CDC – Zika Healthcare Providers – Infants and Children

• We are working in many areas to try to continue to make SC a healthy place to grow up.

• We want to hear from you. Please share any concerns, issues, or recommendations with members of the DHEC Pediatric Advisory Council to bring to our attention.• Contact: Lucy Gibson (gibsonh@dhec.sc.gov)

• We could not make progress without you and look forward to continuing to work together!

Lilian Peake, MD, MPHDirector, Public Healthpeakelr@dhec.sc.gov