Latest update on Zika virus and impact to female and male travelers

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Intelligence-driven medical risk management for
companies with global travelers or operations
ZIKA VIRUS OVERVIEW 28 January 2016

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CURRENT SITUATION: ZIKA VIRUS
Virus Profile
Discovered in Africa in 1947
Transmitted by the Aedes genus mosquito
Causes a mild flu-like illness; 80% of those infected are
asymptomatic
No vaccine, treatment or cure is available
Outbreak in the Americas 2015-2016
New outbreak started in Brazil; 500K – 1.5M cases
estimated in Brazil alone
Rapidly spreading north from South America into Central
America, North America and the Caribbean
See page 6 & 7 for the updated map of impacted countries &
predicted areas of future impact. (Updated JAN 22, 2016)
Consult http://www.cdc.gov/zika/geo/ for regular updates as the
geographic impact changes
Impact on Pregnant Women:
Zika Virus is linked to the fetal deformity called
microcephaly.
Microcephaly is a condition wherein skull & brain
development is stunted in utero.
Testing for microcephaly is not available until late 2nd or
3rd trimester.
CDC issued a travel warning for pregnant women to Central/South America, the
Caribbean and Mexico. Travel to impacted areas should be avoided.
Zika Virus is endemic in yellow-shaded countries.
See page 6 & 7 for a world map and a complete list of countries.

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HEALTH CONCERNS FOR TRAVELERS
Risks for Travelers
All Travelers
• Areas of concern are in Mexico, Central America, South
America and the Caribbean.
• Mosquito precautions represent the best prevention
strategy.
• Special concern: Zika Virus is also sexually
transmitted & transmittable via blood. Male and
female travelers who become infected with the virus
may transmit the disease to their partners via sexual
contact.
• There is also an association between Zika Virus and the
development of Guillain-Barre Syndrome (GBS). GBS is
a potentially fatal syndrome that causes transient and
permanent paralysis. This association is new and little is
known about it.
Female Travelers
• There is believed to be an association between Zika
Virus and microcephaly with a possible association with
late term miscarriage.
• Female travelers who are pregnant or are
considering becoming pregnant should not travel to
effected areas.
• Female travelers who do travel to infected areas should
take appropriate precautions to avoid pregnancy.
• There is also a theoretical risk of transmission of Zika via
breast milk as Zika virus RNA has been detected in the
breast milk of infected women.
Diagnosis & Treatment
• Common symptoms: fever, rash, joint pain and
conjunctivitis.
• Less common symptoms: muscle pain and headache.
• Illness is mild and typically resolves in a few days.
• Lab tests are available to confirm infection but only a
very limited number of labs can perform these tests.
• There is no treatment or cure for the virus. An infected
person will eventually develop natural antibodies to
defeat the virus.
• People who become infected must self-quarantine
and take special precautions to avoid mosquitos.
These individuals are capable of spreading the disease
further including into their local population.
Pan American Health Organization

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PREVENTION STRATEGIES
Personal Prevention
• Use insect repellant that contains 20-30% DEET
(available at many retail locations).
• Wear long sleeve shirts and long sleeve pants.
• Wear insect-resistant clothing treated with
Permethrin (marketed by outdoor clothing
companies and others).
• Avoid open-toed shoes.
• Wear socks that cover your legs to mid-calf.
• Stay indoors between dusk and dawn.
• Daytime transmission is equally likely.
• When outside, avoid shady areas, moist areas and
areas sheltered from the wind.
• All prevention strategies must be used in
combination with one another.
Physical Prevention
• Eliminate areas of standing water inside and
outside.
• Keep doors & windows closed.
• Use heat & air conditioning for environmental
control.
• Consider netting as a physical barrier around beds.
• Spray outside areas with mosquito-killing pesticides
and larvicides. This should be done by a trained
professional.
• Sonic devices have been demonstrated to be
universally ineffective against mosquitos.

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CORPORATE CONSIDERATIONS
Future of Zika
Zika may spread to the United States
It will impact the Southern USA first.
It could impact the entire country if the virus
can be transmitted by Asian Tiger
mosquitos.
Zika is actually transmitted by infected-
person to uninfected-person
Mosquitos are just the transport
mechanism.
Persons who become infected with Zika
Virus should self-quarantine while they are
symptomatic.
However, only 20% of infected people
become symptomatic.
Impact on Corporate Activities
Plan for domestic impact
Secure contracts and pricing with mosquito
control companies for areas around
corporate properties.
Consider engineering controls to remove
untreated and standing water.
Re-think outdoor events.
Re-think travel strategies
Will your company allow female employees
to opt-out of travel to impacted areas?
What if male employees plan to opt-out of
travel because of the potential to transmit
the disease to their partners?
Should business-attire standards during
travel be modified to allow or encourage
mosquito-resistant clothing?

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COUNTRIES IMPACTED BY ZIKA (LIST)
CDC and Pan Health Travel Advisory List
JAN 21, 2016
1. Brazil
2. Columbia
3. El Salvador
4. French Guiana
5. Guatemala
6. Guyana
7. Haiti
8. Honduras
9. Martinique
10. Mexico
11. Panama
12. Paraguay
13. Saint Martin
14. Suriname
15. Venezuela
16. Puerto Rico
17. Barbados
18. Bolivia
19. Ecuador
20. Guadeloupe
21. Cape Verde
22. Samoa
CDC and Pan Health Expanded List
Newly Added JAN 26, 2016
23. U.S. Virgin Islands
24. Dominican Republic
VIGILINT-Predicted Future Country Alerts
Based on available intelligence, VIGILINT believes that
local transmission may be occurring in additional yet-
to-be reported countries. The CDC has not yet issued
travel advisories for these countries.
• Maldives
• Thailand
• Jamaica
• St. Croix

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COUNTRIES IMPACTED BY ZIKA (MAP)
CDC surveillance map, as of 22 JAN 2016.

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