Zika Action Plan Pre Summit Webinar

Transcript

Coordinator: Welcome and thank you for standing by. At this time, all participants are in a listen only mode until the question and answer session of today’s conference. At that time, you may press star followed by the number 1 to ask a question.

I would like to inform all parties that today’s conference is being recorded. If you have any objections, you may disconnect at this time. Please continue to stand by. The conference will begin momentarily.

Coordinator: You are live in the conference at this time.

Dr. Anne Schuchat: Operator, could you begin the call for us?

Coordinator: Yes, you are live in the conference and you may begin when ready.

Dr. Anne Schuchat: Thank you so much. Good afternoon. This is Anne Schuchat and I really want to welcome everybody to the Zika Action Plan Summit planning call. We’re really glad that you could join us today as we talk about CDC’s recommendations for preparing and responding to the emergence of the Zika virus.

I’m pleased to be here with you today to update you on CDC’s response so far. During the Webinar, we plan to provide you with information on guidelines for a phased response to Zika and considerations as you continue working on your Zika action plans.

We’ll also share details about the Zika action plan Summit itself. Recently the White House invited governors and other leaderships from states to attend the first April 1st Zika action plan summit being hosted at the CDC in Atlanta.

The summit will provide state and senior health officials with information and tools to improve Zika preparedness and response in jurisdictions. The summit will also provide participants with the latest Zika science including modes of transmission and implications for pregnant women.

One housekeeping note – there’s going to be an opportunity to ask questions through the operator at the end of our presentation during a question and answer session.

If you prefer, please feel free to send a question throughout the session using the Q&A tab on your Live Meeting toolbar. We’ll do our best to answer as many questions as we can get to.

What is CDC doing? This winter, CDC began to focus intensively on the Zika virus which had been spreading in the Americas. We dispatched teams to Brazil and elsewhere to work with counterparts on understanding the virus and issued our first travel guidance on January 15th.

On January 22nd, CDC activated its emergency operations center and because emerging data was pointing to clusters of microcephaly and other problems associated with Zika virus, on February 1st the World Health Organization declared a public health emergency of international concern.

On the 8th of February, we elevated our EOC activation to level one, the highest level of response reserved for very critical emergencies. And as you know, on February 8th, the President announced the request for over $1.8 billion in emergency funds.

Zika virus was first discovered in 1947 in a monkey but it has been – probably we have learned more about this virus in the last two or three months than we have in its first 70 years.

Zika is spread primarily through the bite of an Aedes mosquito infected with the virus and most people probably don’t know they have the virus. Symptoms are typically quite mild and last for several days to a week.

The greatest risk is to pregnant women and their infants and we have emerging data about that risk and that is really why the focus of state and local preparedness is so urgent.

Once a pregnant woman is infected with the virus through a mosquito bite or potentially through sexual contact with a male who’s been infected or who has persistent virus, she can pass the virus on to the fetus and there can be a variety of potential complications to the fetus or potentially to the child.

So far, Zika virus and pregnancy has been linked to fetal loss, to congenital infections including microcephaly, eye problems and impaired growth. We don’t have evidence right now that women who deliver a baby who has complications from Zika virus or who loses a pregnancy to Zika virus has any risk for future pregnancies related to her Zika infection.

But we do think that infection during pregnancy can be a real problem. There are many questions right now and we’re working very hard to get answers, but we don’t know for sure if a pregnant woman is exposed to Zika virus, how likely it is that she’ll be infected.

If she’s infected, we don’t know how likely it is that her pregnancy will have problems or that her fetus will have problems. We don’t know if the fetus is infected, how likely it is that there’ll be birth defects or even longer-term developmental problems.

This is a critical set of questions that CDC and our counterparts around the world are actively trying to understand. Identifying a new viral cause of a major birth defect is extremely rare.

We know that certain maternal viruses like rubella and CMV can cause birth defects. The association between microcephaly and Zika is the first association between maternal infection and birth, in fact, to be detected in more than 50 years and we are literally learning more every week.

But the evidence for a causal relationship between Zika virus and microcephaly or other adverse pregnancy outcomes gets stronger by the day. CDC and other scientists are working to collect information about women infected with Zika during pregnancy and their infants to learn more about the impact of Zika during pregnancy.

The information collected will direct public health efforts intended to mitigate the impact of Zika and guide recommendations for the evaluation, testing and management of women infected with Zika during pregnancy.

We’re also very busy in developing and disseminating clinical guidelines that address the issues for pregnant women, infants and children who have possible Zika virus infections.

We’ll be continuing to issue guidance and update guidance as new information becomes available. Before 2015, Zika outbreaks had occurred in Africa, Southeast Asia and the Pacific Islands.

Currently, there are outbreaks occurring in many countries and territories in the Americas. And, as you know, it was last May that Brazil reported the detection of Zika virus and since then, more than 30 countries or territories are reporting it.

I want to caution you before you pay too much attention to the numbers on this next slide, the numbers shown come from (ArboNET). We have made Zika virus reportable and the state and local authorities are doing a great job of reporting cases but these numbers will be reflecting individuals who have been tested, results that our lab confirmed, that get reported and get updated once a week.

And see individuals from the territories are reporting frequently but these numbers will lag behind the actual trajectory of disease and they will only be laboratory confirmed cases.

That said, as of March 9th, 367 cases of Zika virus have been reported to (ArboNET) which is the national arboviral surveillance system managed by CDC and state health departments.

To date, there has been no local mosquito-borne transmission of Zika virus in the US mainland. One-hundred-ninety-three travel associated cases have been reported so far in 31 states and the District of Columbia.

Seventeen of those were pregnant travelers, three were sexually transmitted and one was a congenital transmission. So far, 174 cases of Zika virus have been reported to (ArboNET) from three US territories including 159 cases from Puerto Rico.

The numbers increase every week and we believe this trajectory will continue to increase substantially, particularly in the territories. So what is CDC doing? We’re focused on supporting state, local, tribal and territorial response efforts.

We’re just at the beginning of the response and its rapidly evolving. The priorities shift as we learn more every day but right now we’re working intensively with public health partners and state health departments to monitor the spread of Zika and report cases for public health surveillance, to increase lab capacity for testing and identification of Zika infections, to assist with the development of new or improved tests for the detection of the virus or past infections and working with partners to improve mosquito control efforts.

As you know, we’ve been providing recommendations for prevention and promoting effective health communication strategies. We are very keen to focus on support to state, local, tribal and territorial response efforts.

That is what the Zika action plan summit is all about and I’m pleased now to introduce our next speaker, Dr. Jennifer McQuiston, who is the deputy incident manager for the Zika response. She’s going to discuss guidelines for jurisdictions developing Zika risk-based action plans.

Dr. Jennifer McQuiston: Good afternoon. It’s a pleasure to be here to speak with everybody today. As Dr. Schuchat mentioned, I’m going to be talking about some new guidelines that we have recently shared with states for the development of their own state and local risk-based Zika action plans.

And these are recommendations that states might take into account in consider as they begin to work on their own plans. These guidelines are posted on the CDC Web site and the link is here and they’ve also been shared with state preparedness directors, partners and state health officials yesterday.

When states are beginning to work on their plans, probably a very common question that comes up is what should we do at what time? And the guidelines that we have been working on developing really look at Zika in a phased response.

A lot of states already have (vector) response plans and we know that some states have experienced, not only with the West Nile virus response, but also with chikungunya and dengue outbreaks.

But the Zika response requires some new considerations that are likely not covered in those other response plans including the need to really focus on pregnant women, protecting them from mosquito exposures and also how to incorporate sexual transmission messaging and risk reduction measures in the response plan.

The plan that was shared with states yesterday provides guidance for a phased jurisdictional response based on escalating risk for Zika. This means that states and counties and local jurisdictions might wish to base their response in a very defined geographic area if there’s not widespread transmission of Zika within the state.

And the phased response plan gives states and localities ways to do this. This is intended to serve as the support tool for states as they develop their plans. It is just meant to be guidance and it’s not meant to be policy.

In order for states and local jurisdictions to think about implementing a phased response, though, there are a few key actions that would really be important. The first is that plans that are already in place are reviewed and you prepare them in the context of a Zika response.

And it’s important to do this in advance of Zika transition actually being reported in your state. The vector control piece of the phased plan requires a comprehensive multistep approach and this means that states and jurisdictions should be thinking about how to monitor for Aedes species mosquitoes in their areas, both at the larval and adult stages and think about how to control them and then also how to implement a more urgent response in the event that Zika transmission begins to occur.

A phased response plan also requires that states have a very strong surveillance and diagnostic testing program in order to very quickly diagnose, report and respond to suspected Zika cases.

The phased response plan breaks down a response into four different categories of risk. There’s a preparation phase and this is the time period that’s really now.

It’s pre-mosquito season and that’s meant for states where an Aedes aegypti or an Aedes albopictus mosquito is present or possible in a jurisdiction. The second category is during mosquito season and this means that you’re actually expecting mosquito biting activity and breeding activity from those mosquito species.

The third phase is confirmed local transmission. This would be the first single case or few cases clustered in a single household or community block in a county or jurisdiction.

And then the fourth category of risk is widespread local transmission within a county or jurisdiction. This means that there are multiple locations with Zika virus cases and that there does not appear to be a clear chain of connection between them.

There is actually a fifth category of risk that we’re not going to talk about here and that would be widespread transmission in multiple counties in a region of the states, and that is just because the same recommendations are in effect but they’re scaled in a much greater level.

In each risk category, there are response activities that follow these different targeted areas and we’re going to talk about each of them. In the preparation phase, as states are beginning to think about what they might do in the event of Zika transmission locally, it’s important to think about who’s going to provide the leadership at the state and local levels.

And that would include appointing a senior representative to coordinate response efforts in deciding who will be an incident manager during an emergency.

It’s important that a lot of state and localities coordinate between state public health officials and vector control officials because, in many cases, those are organized differently and they’re not always working in tandem.

But in a situation like this, it’s very, very important for the infectious disease officials in a state to be talking with the maternal child health officials in the state and also to be coordinating with their vector control officials.

This is a good time to review any plans the state already has, what the situation looks like for your state and local mosquito control programs, what capacity they have, what their staffing needs are.

This is also a good time to review the processes that you may need for rapid hiring more contracting of services. For example, if your state or local area does not have a vector control program, what contracts would need to be put in place in order to make sure that that capacity is arranged?

Also in the preparation phase, and he state that has Aedes aegypti and Aedes albopictus will likely need to be thinking about how to communicate messages to the residents of their states and jurisdictions.

And this is a good time to begin to prepare a communication campaign. Pregnant women are one of the most important groups for us to focus on for communications.

The truly are the most vulnerable population and why we’re treating Zika and the possibility of it in the United States with such urgency. But also travelers returning from countries that have active Zika virus transmission and healthcare providers to know what to look for and how to test patients, all of those have communication needs that can be prepared in advance.

It’s important to note here that unlike other vector-borne diseases like chikungunya or West Nile virus, it’s really important to include messaging on sexual transmission and steps for prevention for Zika.

In the preparation phase, enhancing surveillance for travel associated Zika cases is also important. Not only does this give providers a chance to be recognizing what Zika could look like and how to report it, identifying travel associated cases early and making sure that they’re following recommendations to protect themselves from mosquito bites, may actually help prevent local spread of the virus.

This is also a good time to review your laboratory capacity and to determine if your state is able and ready to test specimens for Zika. For vector control, reviewing and conducting mosquito surveillance activities to assess historic distribution maps is important, but it’s also important to note that many of those maps are outdated.

And so as you’re preparing for the beginning of mosquito season, you might be thinking about how to do surveillance as mosquitoes start to come out so that those maps can be updated.

This is also a good time to begin planning activities that, from the start of a mosquito season, might help bring population numbers down and then hopefully reduce the likelihood of transmission in the future.

For pregnant women, this is a good time to plan how you might enhance surveillance for Zika in this very vulnerable population. It’s also a good time to identify resources that pregnant women might need in the event of local transmission.

And at CDC, working with many of our partners, we have been distributing something called Zika prevention kits in Puerto Rico and some of the other territories that gives pregnant women tools they can use to protect themselves, such as repellents, larvacides that they can use around the homes, condoms to prevent sexual transmission.

So these are the sorts of things that identifying resources in advance and planning for their distribution could be very helpful. We do know that blood safety is a concern with Zika and in Puerto Rico, local blood collections have stopped and they are outsourcing blood according to FDA recommendations.

So within the mainland United States, it’s important to think that if local Zika virus transmission is happening, there were also be blood safety issues to think about.

So consulting with your local blood collection centers now on their blood safety plans is important so that everyone understands what that response pattern will look like.

Once mosquito season starts, and here in Georgia, I think we’re almost there – it’s about 80 degrees here today – it’s important for the partners that are going to be working on the Zika response to begin organizing regular meetings and providing updates.

In addition to this, giving everybody information that can be helpful for – to guide their efforts, this is also a great chance to connect with CDC and other partners and find out what they’re doing.

From a communications perspective, you don’t need to wait for a Zika outbreak to have a communications campaign preparing people, and so messaging for awareness, how they can protect themselves against mosquitoes and really getting people engaged and thinking about how they can reduce residential sources of water they could contribute to Aedes breeding sites is important.

From the surveillance perspective, it’s important during mosquito season to rapidly follow up on suspected cases through laboratory testing and to encourage healthcare providers to immediately report those results.

While this needs to be happening even during pre-mosquito season and during mosquito season, it’s especially critical because those people need to be contacted and counseled about what they should be doing to protect themselves against mosquito bites.

During this time, as well, vector control mainly focuses on reducing residential sources of water where the mosquitoes can breed and organizing community interventions to disrupt those breeding grounds, so community cleanups, removal of any discarded tires. These are all things that are great to do during mosquito season.

In the event of the first confirmed local transmission case, that would activate the state incident management structure and would result in a connection to CDC and partners to see if additional resources might be needed.

If a state wanted to call an Epi- Aid), this is the time that would happen. Surveillance would include intensifying the – looking for human cases around this first confirmed case.

Ideally you’re finding human cases very, very quickly before they become widespread within a county. The only way to know that is to really be intensifying surveillance around that first case.

Vector controls, and a situation like this, if you really only have a localized case were a few cases in a household, vector control might include conducting intensified larval and adult mosquito control it that house or building and in a protective radius around it.

And that would include both residential habitat reduction, reducing water sources. It would include both larvacide and (adulticide) mosquito chemicals, outdoor space spraying.

There are a lot of things that can be done in an intensive way around a case patient’s home. In addition, a county may consider additional interventions, whether they wanted to do more widespread spraying through truck-mounted sprayers or even aerial sprays.

The decision about when to move to more widespread spraying is a very local decision and it depends on a lot of factors. But thinking about them in advance and building them into a plan is a great idea.

The first confirmed case of local transmission, it is very likely that pregnant women in that county are going to be very worried. So communicating clearly and early, specifically targeting your messages to pregnant women about what they can do to protect themselves, about where they should go for help is important.

Letting your local blood collection agencies know that you’ve had a single confirmed case is important and that way they’re ready and prepared in the event that transmission becomes more widespread.

Widespread local transmission is the fourth risk category and this is really when you have multiple cases in a county and multiple different areas that don’t seem to be all linked in time and space.

States and jurisdictions should really know in advance how they might respond, what their geographic counties might be for aggressive response efforts.

It’s envisioned it could be at the county level, it might be at the ZIP Code level. It might be at a level that’s contained within the health department’s access area, however states decide to do it.

It just needs to be communicated so that the response efforts are understood and that the blood safety centers know or blood collection centers know. This is the time you’re going to intensify your communication and outreach to the citizens, letting them know what they need to know to the communication plans you developed in the preparation phase.

And intensifying surveillance for human cases beyond those first cases, really working with your hospitals and clinics. In this phase, vector control needs to become intense and it needs to be expanded to include much wider areas.

And this is where your truck-mounted spraying or your aerial spraying might need to be implemented, depending on your state and county decisions and needs.

Once you have widespread local transmission and you’re doing much more urgent sector control, it also becomes very important to monitor the effectiveness of your control efforts, and so mosquito trapping surveillance is one way to do this.

I’ve gone through – oh, wait, we have a little bit more. Widespread local transmission – pregnant women outreach. We talked about this a little bit. Again, this isn’t necessarily guidance that every state or local jurisdiction would follow, but in the event that there’s widespread local transmission at a county or jurisdiction level, messaging about whether pregnant women might want to consider changing travel plans could be considered.

Again, that is a very local (need) and decision. Implementing your intervention plans is important. Pregnant women might need special intervention plans.

If they live in homes without air-conditioning or screening, they might need help actually mosquito proofing their homes so that they have a safe environment for the duration of their pregnancy.

You might also consider looking retrospectively for pregnant women who may have had Zika virus to see if any cases were missed so that they can be followed appropriately.

At the point of widespread local transmission, blood safety centers must begin following FDA guidance, and this means that local collection of blood will stop and that they will either need to outsource blood or they could to local collections if and when blood tests become available. Those are still in the research phase and they are not widely available at this time.

And with that, I’m going to turn it over to Christine Kosmos, who heads our state coordination task force. Stop review.

Christine Kosmos: CDC has been activated for a Zika response. We’ve been working very closely with our state and local partners to assist you with your planning and readiness for Zika.

Now at this point, I want to take a little break and do a quick poll to get a snapshot of where state and locals are in their planning process. This will help us finalize our reparations for the Zika action planning summit here at CDC on April 1st.

So (Demetrius), can we go to the poll? So hopefully you can see this on your screen and it asks you to just describe your jurisdiction’s Zika planning efforts to date.

So the responses are , hasn’t started yet, you’ve met but you don’t have – or you haven’t met but you have plans to do so, your jurisdiction has been meeting and developing your response plan, your jurisdiction already has a draft Zika plan or you’re not sure what your jurisdiction’s activity has been so far.

So we’ll give you a couple of seconds to answer that. Okay, just a couple more seconds. All right, I think we’ll close the poll. So essentially what this shows is that states and locals are already meeting and many of you already have a draft action plan in the works which is excellent news.

And since the EOC has been activated here at CDC, we provided a lot of technical assistance to our state and local partners. Specifically, we’ve had a lot of outreach to state and local lab directors, epidemiologists, NCH directors, preparedness directors, professional partner organizations, just to name a few.

In addition to that, CDC has provided a lot of guidance through MMWRs. We’ve published eleven MMWRs related to Zika. We’ve issued eight travel advisories. We’ve issued more than 20 plans for state and local use.

Some of them for state and planning. Some of them are lab related guidance. Many of them are for clinicians and healthcare providers. You have a lot of communication and risk communication tools on our Web site.

We have Zika posters and fact sheets. And we’ve also convened more than 40 calls including two national calls into call specifically for clinicians to provide state and locals with the technical assistance that you need.

So in the next few minutes, I want to bring all of this together because we’ve been dealing with a lot of areas subject matter experts, but this is really our opportunity to pull it all together and provide states and tribes and locals with a coordinated, one-stop shop approach to Zika planning and preparedness and provide your planning teams with CDC’s best available advice on how to approach Zika preparedness within state, local and tribal regions.

So in the next few minutes, I’m going to familiarize you with a few of the CDC resources that can really assist you with your planning. So first am going to walk you through the actual Zika action planning template that Jenny just walked through, just to familiarize you with it and show you how it works, so can you click on the link, (Kate) and the planning template form?

So on your screen, you’ll see the actual planning template that Jenny walked through. So it’s by phase, so you’ll see there are the specific actions that Jenny talked about broken out into the preparedness with all the specific guidance documents.

Then it goes into mosquito season, confirm local transmission, widespread local transmission, et cetera. And you’ll see in the left column, that’s the CDC advice and recommendation and it gives you, on the left – or the right-hand side, opportunity to write some of your jurisdictional action steps.

Now we’re hoping that you use this planning template and other resources that we’re providing today to really drill down into your specific plans and bring those particular gaps or areas that you want further assistance to the summit on April 1st.

Now, (Kate), can we go to the Zika Web site? So in addition to that, and sort of continuing in the vein of the one-stop shop, I want to just walk through the CDC Zika Web site which is a lot of information specifically for Zika.

It includes the latest guidance documents, MMWRs. You’ll see the MMWRs on the right-hand side, also the tools and the templates and the resources for state and local, as well as some public facing documents.

There’re Zika FAQs, scientific publications. And please consider this to be one of the best sources of information to assist in your planning and response. And then finally, just – I want to mention that the last thing that we’re offering to you or the last thing in this seminar, that we’re offering to you, is that our CDC entomologists are finalizing a vector control and surveillance strategy for the US.

We’re going to be sending it out to you very soon to assist in your planning, so more to come on that. So to summarize, we are asking you today, and this is kind of your checklist, to assign a lead Zika preparedness coordinator in your team, for those of you that have not yet started, to assess your jurisdictional risk, and there’s information included in the planning template that assists you in determining your jurisdictional risk.

Review the existing CDC guidance and resources that we have here and that I just walked through today, including the (ZAP) planning template which we just walked through, as a way to document some of your activities as well is to document some of the areas where you might need some additional technical assistance.

And want to have that draft plan, where you identify some of the gaps in preparedness and response, we’re going to ask you to bring that back to the summit on April 1st.

And speaking of the summit, I’m going to turn it back over to Sara Zigler who is going to give you some information about the summit.

Sara Zigler: Thank you, Chris. I’m excited to be able to share information with you all about the Zika Action Plan Summit that will take place on April 1st at CDC. I’m going to provide you a brief overview of the summit and how we think you might be able to best make the summit work for you and your jurisdiction.

The summit will include three tracks – a Zika science plenary, leadership planning for state and local government leaders and readiness action planning for state and local scientific and technical staff.

The first two parts will be streamed via live Webcast and archived on the (ZAP) Web site, which is www.CDC.gov/zap. The science plenary will include who is at risk, how to identify and diagnose cases and preventing and responding to mosquito-borne illnesses.

The leadership planning track will include information on crisis and emergency risk communication and the Zika response and how to manage policy to increase public understanding of Zika.

In addition, in the readiness action planning track, state and local scientific and technical participants will have an opportunity for action planning which will include specialized technical assistance.

So how might you engage in the summit? There are two ways for our state and local partners to engage in the summit – in person, as part of a jurisdiction team or virtually, through the live Webcast of the summit on April 1st.

The live Webcast will be archived for viewing after the summit as well. Please go to our will Web site, www.CDC.gov/zap, to find out more information. CDC encourages participation in person from states and jurisdictions that are most likely to have Aedes aegypti mosquitoes circulating and/or high regional travel volume with returning travelers from countries with local Zika transmission.

There is a listing of those state jurisdictions on the Web site. CDC will be providing financial support for state and local participants that attend the summit. I just want to clarify – CDC will be providing financial support for state and local participants that attend the Zika Action Plan Summit.

Everyone must register for the meeting so that we can make the necessary arrangements. Registration for this summit closes on Tuesday, March 15th. For those of you are contemplating in-person participation, we recommend that you consider a team composition that includes individuals from a variety of disciplines that contribute to your jurisdiction’s planning for Zika virus response.

You may consider state and local leaders such as governors, public information officers, a mayor, county commissioners or some scientific and technical staff such as your state health officer, your state epidemiologist, state veterinarian or vector control lead, your state preparedness director, a maternal and child health director, local health and environmental health officials.

We strongly urge state jurisdictions to include local health representation in their team composition. We’re planning for a Zika Action Plan Summit that is focused on providing content that will meet the needs of our state, local and tribal partners.

We would appreciate some of your feedback now through two quick rapid polls. We have two questions for you about what might be your priorities for receiving technical assistance from CDC and the other US government partners that will be involved in the summit.

Please select the best option from the two lists that you’ll see in this poll. We’ll do poll number one and leave this open for a few seconds I let everyone respond. And then we will go to a second question with different options for you to select from.

Please identify your jurisdiction’s priority technical assistance (TA) need from this first list. We appreciate that all of you are giving us your feedback so we can consider that as we make the final planning arrangements for the Zika Action Plan Summit.

Thank you all very much. We’re going to begin closing out this poll. And now for the second question – please identify your jurisdiction’s priority technical assistance needs from this list.

Again, we appreciate this feedback as we will consider it as we make final arrangements for the Zika Action Plan Summit’s curriculum. We’ll give it just a couple more seconds and then we’ll begin to close out this poll.

Thank you all very much for giving us your feedback. We have concluded the presentation section of this Webinar. We’re now going to wor- go to questions and answers.

While the operator is opening up the line to receive questions from the phone, we did receive one question in written form that we well answer. The question was too how to define widespread transmission for the purposes of blood safety. I’m going to turn this answer over to Jenny McQuiston.

Jennifer McQuiston: Hi, thanks for this question. So we – CDC, in concert with our state health officials who we consulted on the development of these guidelines, we kind of played with the idea of whether a certain number would be something that we would want to put out there as the designation for widespread transmission. And we talked about five or more cases possibly meeting that definition. But we decided not to actually put it in the guidance because in some cases…

Coordinator: To ask a question on the phone, please press Star 1 and record your name when prompted. Again, to ask a question on the phones, please press Star 1 now.

Jennifer McQuiston: That your county might be having a widespread transmission concern. So this is really something that we’re hoping that states and local jurisdictions think about and know what they’re trigger point is for widespread transmission. And I think that five or more cases would certainly qualify.

Woman: And operator, we’ll go to the phone if there are any questions.

Coordinator: Yes, and again, as a reminder, to ask a question my phone, please press Star 1 and record your name when prompted. One moment, please, for the first question. The first question comes from (Phil Wong). Your line is open.

(Phil Wong): Yes, hi. This is (Phil Wong). I’m with the City of Austin Health and Human Services Department and (this) follows up on the first written question, I think. And you talked about widespread transmission definitions for blood transmission concerns.

Also, I mean, in terms of how the geographic, what, area, you’re talk- going to be talking about, and I actually missed the end of the question with some of the question’s query procedures that – you know, our blood bank – I just got off the phone with our blood bank and they are very concerned regarding, you know, if our city gets designated or county gets designated as having the widespread transmission, what the implications would be for collecting blood.

Woman: Thanks for that question. We know that these are questions and issues that states and local jurisdictions are definitely going to be thinking about and making decisions about.

And we wanted to roll out the idea of a phased in jurisdictional response because every county and jurisdiction might have a different comfort level and what they feel they want to define as their geographic boundaries for that response.

Some counties may want to do it within the boundaries of their county lines. Some may want to combine counties if they feel like there’s a risk for transmission on a border, for example.

Some counties may be very large and feel like they can contain this jurisdiction only within a ZIP Code designation, so it really is left up to the state and local health departments, the boundaries that they want to set for what an active response would be, what your area of active transmission would be defined as, and correspondingly then, what your area of blood safety concerns would be contained within.

(Phil Wong): Okay, thank you.

Coordinator: The next question comes from (Tom Daly). Your line is open.

(Tom Daly): Hi. I was just looking for some clarification on the financial support that you mentioned it to the affected states. Is that – with that the 100% of the travel costs or a certain share?

Woman: It is CDC’s intention to support the travel expenses for the state and local representatives with consideration for space capacity that we have within our facilities and other factors.

We have a lot of interest for the Zika Action Plan Summit and so when you contact us through the Web site, you will receive a call back and we will communicate with you and find out more about your interest in attending the summit and work with you to identify the number of people that can be supported from CDC.

(Tom Daly): Okay, great. Thank you.

Coordinator: The next question comes from (Scott Lindquist). Your line is open.

(Scott Lindquist): Hi, this is (Scott Lindquist) calling from Washington state. I guess we’re looking for some advice on what our priority is in the state that we clearly do not have this mosquito. Our biggest issues have been around travelers.

So in our action plan, which we’ve drafted, we do have mosquito control districts. We do have (radication) plans, but quite frankly, it’s very unusual for us to see this mosquito at all and probably is not going to be seen in Washington. Any advice for us?

Dr. Anne Schuchat: Yes, hi. This is Anne Schuchat. Thanks for that question. You know, I think the first thing to stress is that this is – this virus is new to the Americas and the mosquito vector, Aedes aegypti, if not, you know, we’re not thinking it’s going to be a problem in Washington state.

So, you know, the prediction is that you’re going to have to deal with transmission from – they you’re going to have a lot of travelers and that you may have sexual transmission and that you’re going to have communication, laboratory, healthcare of affected babies and communication kinds of concerns and likely, not mosquito types of concerns.

But because this is a new condition, we think it’s important to think about things and not wait until you have a problem or wait until we see mosquitoes everywhere.

Certainly we are most concerned about the southern states where we know the vector is common and we also know that the Aedes albopictus can be a vector for this virus and the geographic that might be broader.

I think that the idea that 40 million people travel to Zika affected areas each year and beyond pregnancy, we now have sexual transmission to think about. We feel like every state is going to have some people with Zika infections that are complex and will need to be able to message and manage those.

But I think this – the whole focus on the summit and the planning is to know who the right counterparts are into think ahead to be ready for what’s likely and then to have at least thought about what’s unlikely.

Jennifer McQuiston: And this is Jennifer McQuiston. I will just add that if you visit the Web site and look at the phased risk-based plan, it outlines some state risk assessments that can be helpful for states in determining what level of plan you want to create and what you want to focus on.

And so the first risk assessment is that all states will likely need to provide public information, particularly to pregnant women because even if you’re in a state without Aedes aegypti, you’re pregnant women are going to be concerned and want messaging.

And then to assess returning travelers who may have contracted Zika virus infection and manage any risk for sexual transmission. The second state risk assessment would be for states with Aedes albapictus mosquitoes and those dates should presume that transmission as possible and be ready to prevent, detect and respond to cases of Zika.

And then the third state risk assessment would be states with known Aedes aegypti mosquitoes, and those states we think need to develop plans that more intensively monitor for cases, both in returning travelers and also possible local transmission, and then to prepare and respond vigorously to stop clusters of Zika before they become widespread.

So those are the sort of three risk-based assessments that we’ve put out there. I have an additional question that’s command – how will guidance change regarding travel when local transmission is occurring in a locality within the continental United States? I don’t think that the risk – the phased risk-based plan necessarily gets into the details of whether travel restrictions would be required or recommended.

I do think that pregnant women should now when there is a local area of transmission where active transmission is happening so that they can make their own decisions about travel. And so I think a lot of that is going to depend on messaging properly so that people are informed and can make their own decisions.

Woman: Maybe I could just supplement that a little bit. I think that we have – you know, you all in the state and local health departments know how many possible scenarios there are, you know, in terms of a back – a home or a block that has the mosquitoes in cases versus large numbers of infected mosquitoes with the virus and then possibly some human cases that have been detected.

You know, we also know that the way people live and travel in the community in the continental US is quite different than in Puerto Rico or much of South America in terms of screens and air-conditioning and, you know, air-conditioned malls and air-conditioned doctor’s offices and so forth.

So I think the issue of exactly what might be local – even widespread transmission in the continental US might not look the same as in Puerto Rico or Brazil.

And so the local and state planning really needs to customize (for) what we might see. Obviously, there are some neighborhoods that might be at great risk in the continental US and I think that’s the type of scenario that we should be thinking of.

One of the factors that we want people to plan on is mosquito (unintelligible) and that can help you understand hotspots and where we’ll need to be making sure we have control.

Woman: This is a great time to add that during the summit, on April 1st, there is actually going to be a track where we’re inviting states and localities to share their personal experiences in managing vector-borne outbreaks associated with Aedes aegypti. So we will hopefully have state and local representatives they can talk about what they’ve done in similar situations that can help inform the local decision.

Woman: Operator, we’ll go back for a couple more phone questions.

Coordinator: Thank you. The next question comes from Zach Thompson. Your line is open.

Zach Thompson: Zach Thompson, director of Dallas County Health and Human Services. I’m joined here with our health authority, Dr. Christopher Perkins. I want to commend you for the summit call today and I participated on a similar call earlier this week on Tuesday, March 8th.

I guess my question I want to reiterate how important it is and how critical local health departments will be to participate in person at the summit. We’re on the front lines.

As you know, Dallas County had the second sexually-transmitted case of Zika. Also, we’ve been involved in day-to-day planning, so I’m hoping that you could pass on to Dr. Frieden, the importance of local health departments being a part of the state team since we’re actually on the front line, have to deal with the municipalities, have to deal with the elected officials. And so any summit that does not include local health departments will definitely have a big gap. So thanks a lot.

Woman: Thanks very much for that comment and I just want to reassure you that we are addressing local health department engagement in the summit in two ways. First, by encouraging our state jurisdictions to include (local) representation, and also, by working proactively with the states from the local health departments that we have heard from to ensure that the representa- composition of any team is reflective of the needs of that jurisdiction. We understand your concerns and we’re trying to be very responsive to that.

Coordinator: The next question comes from (Laquanda Nesbitt). Your line is open.

(Laquanda Nesbitt): Hi. My question has been asked and answered. Thank you.

Coordinator: And so the next question is from (Mary McIntyre). Your line is open.

(Mary McIntyre): Yes, this is Mary McIntyre, Alabama Department of Public Health. I have several people here in the room with me. But we wanted to know is, we’re focusing on the composition of the team and what you’re looking at as far as the maximum number of people that would be allowed to come from any state. If we are trying to actually address state, local and partners in this effort, what is the number that we should be aiming for?

Woman: Thanks so much for the question. What we would, one, want to remind you, that for any team members that are not able to travel in person to CDC, that we will have live Webcasts of the large majority of the summit.

In addition to that, when you contact us through the Web site, you will get a call back from a member of our ZAP registration planning team who will work with you to identify the number of individuals we can support on the team.

Because of the large interest for this meeting, it is not a one-size-fits-all answer for this situation for the ZAP planning Summit and so we’ll work with you individually to address that question and we encourage you to contact us as soon as possible so we can get those plans underway.

(Mary McIntyre): Thank you. We have. We’ve contacted you.

Woman: So we had one additional question that came in on email and we’re going to ask Dr. Matt Kuehnert who works with lead safety here at CDC to answer it.

Dr. Matt Kuehnert: The question was, is there specific guidance on planning for blood supply interruption in the case of widespread local transmission? And we would – that’s a great question.

We would encourage state and local health departments to reach out to blood centers that locally collect in their area. We’ve already heard from Texas that blood centers are reaching out to you.

And we can certainly help in that regard and discuss that in the summit. What I will say now is that there is a plan to have blood donor screening tests available in April and by FDA guidance, the – what blood centers have to follow is that if there isn’t a screening test available, then in an area of local transmission, they essentially need to outsource until the screening test is available.

In addition, but centers may not, depending on the situation, choose to screen and want to outsource. So it’s going to be a blood center by blood center decision. Not all blood centers are the American Red Cross. There’re smaller blood centers as many of you know.

So I think it’s important to reach out to them and speak to them about what their plans are to best understand what their scenarios are and what can be done to assist them.

Woman: Operator, we have time for one more question before will complete the meeting.

Coordinator: Very good, and the next question comes from (Kim Stein). Your line is open.

(Kim Stein): Hi. I’m calling from the Michigan Department of Health and my question has to do with human case surveillance. We’re curious to know if – or if and when some of the Southern tier states, where, you know, (HSI) is, you know, present, when the states may begin screening people want travelers for Zika virus in order to detect local transmission. The current guidelines don’t permit us (screening) the people have not traveled out of the United States yet.

Jennifer McQuiston: I’m sorry, this is Jennifer. I think we’re trying to understand the question. The call came through and it broke up a little bit for us. Is the question when states and the southern part of the United States will begin to test symptomatic people who have not traveled?

(Kim Stein): Yes. I mean, you mentioned in Georgia, for instance, you know, mosquito season is upon you. So in other words, how will we know when that virus has reached the continental United States?

Marc Fisher: This is Marc Fisher with the epidemiology team here and that’s a very good question. It’s very difficult to identify the, you know, first local transmission in a given area. So right now, as you mentioned, the testing recommendations are for symptomatic persons who have a specific exposure that is through travel or a sexual contact of somebody who has traveled. And the only testing for asymptomatic people would be for pregnant women who have travelled.

The identification of the first local transmission in an area is really going to come from a combination of information that’s going to come from recognition of an unusual cluster of illness, of people with fever and rash or from mosquito surveillance or issues regarding possibly blood transmission. There’s not going to be a way to, during mosquito season, to test every person who has a symptomatic illness and has not traveled to identify the first case.

(Kim Stein): To know if there’s any test available for mosquitoes at this time for Zika.

Woman: So there are tests that can be applied to testing mosquito pools but at this time we’re not recommending it necessarily as a strategy for all states. But these are great questions that I think we can begin to talk about at the summit and be able to make sure that we’ve got technical expertise available for states that would wish to test mosquito pools that they have the guidance that they need.

Woman: We are reaching the end of our Webinar time. We would appreciate, for those of you that have participated in the Webinar, to give us some feedback. We have two more questions that are coming up they were welcome to answer for us, and on those questions, as you give us your feedback, we also have an email address where you’re welcome to send any comments or questions to us about any of the contents that we covered today.

It will help inform our preparations for the Zika Action Plan Summit in the coming weeks. We’re looking forward to you all participating with us in that summit virtually or in person depending on what’s most appropriate for your jurisdiction.

Woman: So the first question is that you understand the purpose of the Zika Action Plan Summit and then we have one more question after that. You can provide feedback to us at ZAPSummit@cdc.gov.

Again, that email address is ZAPSummit@cdc.gov. For additional information about registering for the Zika Action Plan Summit, please go to our Web site, www.CDC.gov/zap.

There’s a link there where you can click on it to submit a registration request to us and then we will get in touch with you to have a conversation at a designated time to find out more information about your jurisdiction’s interest and then be able to follow up with you to make arrangements for you to engage either virtually or in person at the Zika Action Plan Summit.

Next question, close out the poll. This last question is, how valuable was this Webinar to you? Thank you all very much for participating in this Webinar and we look forward to continuing to work with you in the coming weeks as we prepare for our Zika action plans.

Coordinator: And that does conclude today’s conference. Thank you for your participation. You may disconnect at this time.