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Zika at the One-year Mark: Cases on a Downward Trend

This month marks the one-year anniversary of the first detected Zika virus case in the Virgin Islands. Since then there’s been more than 1,000 cases, but not a single fatality or birth defect has been reported in the territory as a result of the infection.

Despite that good news, the Department of Health is still cautioning the public to take precautions against getting mosquito bites, since the outbreak is still actively ongoing.

According to Health, the first laboratory confirmed cases were documented in St. Croix this time last year and weekly reported cause counts increased until early November.

The initial cases on St. Thomas were reported about two months after the first St. Croix cases and the numbers rose steadily through early August. The number of cases spiked on St. Thomas in the late summer, likely due to the island’s higher population density and heavy rains, both of which facilitate transmission.

“To date, the weeks with the highest number of confirmed positive cases occurred in August on St. Thomas and November on St. Croix,” said territorial epidemiologist Esther Ellis, who has been tracking the outbreak since it began.

Ellis said that since these peaks there has been an overall decline in the number of cases reported each week. No new cases had been reported in 2017 as of Thursday, but about 100 samples are pending lab results.

Throughout 2016, the U.S. Centers for Disease Control and Prevention recognized the Virgin Islands as a model for Zika response, noting the territory’s proactive efforts to educate the public about the virus.

What’s made Health’s response effort so successful?

“The key difference has been the activation of the Emergency Operations Center to coordinate this complex response. Activating the EOC allowed the DOH to very rapidly ramp up the response to Zika, and be very proactive in our outreach efforts from day one,” Ellis said.

Ellis added the CDC deployed 91 workers to the territory since February 2016, allowing Health “to mount a robust, proactive response to Zika.”

Health was able to quickly launch a comprehensive and proactive response to the outbreak in coordination with the CDC and the Association of State and Territorial Health Officials (ASTHO). Their ongoing efforts include:

– Activating its Emergency Operations Center in February to coordinate all response activities;

– Establishing a Zika Hotline to answer public and media inquiries about Zika;

– Providing weekly surveillance updates with reports of new suspected cases;

– Partnering with a network of clinics and labs across the territory to provide free testing services;

– Providing free Zika Prevention Kits to pregnant women with more than 1,387 kits to date being distributed to multiple sites across the territory;

– Providing free mosquito control services at the homes of pregnant women, as well as free mosquito inspection and treatment for all hospitals, clinics, schools, daycare centers, churches, for public places, and upon request;

– Conducting proactive outreach and education to the community and USVI clinicians, including more than 368 events – 191 on St. Croix and 177 on St. Thomas/St. John;

– Implementing a proactive media outreach strategy to keep the public informed about Zika and Health response activities;

– Distributing educational materials and insect repellent at community events and outreach activities, including the successful Zika Action Day, where more than 10,000 EPA-approved repellents were given out to the public.

Health as a whole has learned a great deal in terms of best practices for managing a response effort, according to epidemiologist Ellis.

“Managing a coordinated response under the Emergency Operations Center, and having the response infrastructure in place, have been critical to sustaining a long-term, ongoing response over the past year,” Ellis said.

Close collaboration between Health and the CDC has also been critical, Ellis said, as has pulling federal, regional and local resources and staff together.

As of now there is no timeline for how long the EOC will be in operation, but its closing will be based on the number of cases, amount of public inquires and other operational needs, Ellis said. Prevention and surveillance will continue to be a key focus regardless of the EOC’s existence.

Health is also making headway on setting up a local lab so that Zika and other mosquito-borne disease samples can be tested in the territory instead of being sent to labs on the mainland. The lab is now in the process of completing proficiency testing and getting certification.

The epidemiological curve is most illustrative of how the outbreak is unfolding. (See Graphic.) To date, there have been 1,037 positives, which include 120 cases in pregnant women.

St. Thomas now has 645 confirmed cases and St. Croix has 199, while St. John stands at 73. Since the first local case was announced last January, a total of 2,194 cases have come back negative and 101 are currently pending results.

Dengue is also currently circulating in the territory. When a person is tested for Zika, they are also screened for dengue and chikungunya. In the last year there have been 35 cases of dengue on St. Thomas, 16 on St. Croix and 2 on St. John.

To deliver Zika results, Health is calling all patients that were tested either at their offices or one of the clinical labs listed below that are offering free testing. All other results get sent to the provider who is then supposed to inform patients of their test results.

Zika can cause unborn babies to be born with an abnormally small head, a condition known as microcephaly, and can lead to other developmental issues. So far no cases of microcephaly have been reported in the territory.

According to data published by the Centers for Disease Control and Prevention, 90 to 99 percent of women infected with Zika during pregnancy will have a normal birth outcome.

More women are being tested for Zika than men because of the developmental issues that Zika can cause to unborn babies. Health has been proactively testing pregnant women for the virus since the outbreak began and has been giving out Zika prevention kits.

Health has not reported any hospitalizations or deaths as a result of Zika. There have also been no cases of Guillain-Barre` Syndrome (GBS), a disorder that’s been linked to Zika that can result in paralysis as the body’s immune system attacks part of the peripheral nervous system.

Zika’s most common symptoms are headache, fever, rash, joint pain and red eyes (conjunctivitis) and pain behind the eyes, which can make it difficult to distinguish from dengue. Conjunctivitis is not caused by dengue, however, so it can be a telltale sign of having Zika.

The most common symptoms experienced by people in the territory who test positive are rash and joint pain. According to the CDC, the rash usually looks like small blotchy red patches or bumps and doesn’t always itch. The rash reportedly starts most often on the face and then spreads to the rest of the body over the course of a couple days. It’s also common for people to report experiencing joint pain in the hands and feet as the infection progresses.

Health is urging anyone experiencing these symptoms to get tested at one of the 12 free testing centers listed below. Once someone contracts Zika, it clears from the blood in one to two weeks and it’s believed that he or she is immune to getting it again.

Despite the growing number of cases around the world, there’s no medicine or vaccine for Zika yet, though doctors are working to develop one. For now people who come down with the virus are encouraged to rest and drink plenty of fluids.

In late July the CDC reported that both women and men can sexually transmit Zika. The Virgin Islands has not reported any sexually transmitted cases, as it’s difficult to tell whether a case was transmitted through sexual contact or through the bite of a mosquito when the disease is circulating locally in the mosquito population as it is here.

According to Health, people can protect themselves and their families from mosquito bites by following these three cautionary measures that start with a D:

– Dress: Wear protective clothing such as long sleeves, long pants and light colors;

– Drain: Get rid of water containers in and around your home;

– Defend: Use repellant on exposed skin and treat clothes with one of several EPA-approved repellants.

Free Zika testing is available for pregnant women regardless of whether they show symptoms, and educational materials are being distributed in English and Spanish. Prevention tool kits with such items as mosquito nets, insect repellent and condoms are being given free to pregnant women at the following locations:

On St. Croix

– Department of Health MCH Clinic

– Department of Health WIC Clinic

– Juan F. Luis Hospital and Medical Center

– Frederiksted Health Center

On St. John

– Health Care Connection

– Myrah Keating Smith Community Health Center

On St. Thomas

– Department of Health MCH Clinic (Pediatric)

– Department of Health Community Health Clinic (Prenatal)

– Roy Lester Schneider Hospital

– East End Medical Center

Local information about Zika virus can be obtained by calling the Department of Health Emergency Operations Center at 340-712-6205. More general information about the virus is available toll free by calling 1-800-CDC-INFO.

Health is also partnering with several labs and clinics throughout the territory to provide free virus testing for anyone who showing symptoms. The department said that if you are turned away from testing or are told to pay for testing then to call Health, since it has agreements in place with several facilities. These places should not be charging for Zika testing:

On St. Croix:

– Acute Alternative Medical Group, 340-772-2883.

– Beeston Hill Clinical Lab, 340-773-4990.

– Clinical Laboratory Inc. (Sunny Isle), 340-778-5369.

– Frederiksted Health Care, Inc., 340-772-0260.

– Gov. Juan F. Luis Hospital & Medical Center, 340-778-6311.

– Primary Care PLLC, 340-718-7788.

On St. John:

– Myrah Keating Smith Community Health Center, 340-693-8900.

On St. Thomas:

– Community Medical Laboratory, 340-776-7444.

– Cranston/Dottin Biomedical Lab, 340-774-6256.

– Doctors Clinical Laboratory, 340-774-2760.

– Havensight Medical Laboratory, 340-774-5515.

– Roy Lester Schneider Hospital, 340-776-8311. 

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