Timely detection, investigation, and reporting of Zika virus cases is a fundamental cornerstone to Zika virus response. Preventive Medicine (PM) Departments should have a plan that incorporates response actions, communication, surveillance, laboratory testing, vector control, pregnant woman outreach, and blood safety.
Navy Installation Command and Marine Corps Installation Command have released Zika Action Plans to guide Zika preparedness and response at the installation level. PM personnel should familiarize themselves with their installation’s plan and incorporate timely detection and investigation activities into that plan. PM personnel should also be aware of installation and local community vector control activities and whether the local area has vectors capable of spreading Zika. The extent of PM activities will differ depending on multiple factors, including Aedes mosquito prevalence and whether local transmission has been established.
If a Zika case is suspected, the PHEO as well as the cognizant NEPMU should be notified. MTFs should also remain aware of state reporting requirements for Zika. General Navy guidance on medical event reporting can be found on NMCPHC’s Medical Event Reporting webpage. Probable and confirmed Zika cases (see case definitions below) should be reported via Disease Reporting System-internet (DRSi) as “Any Other Unusual Condition Not Specified.” The report should include information on travel/deployment history, laboratory testing, and pregnancy status. For information on obtaining a DRSi account, visit NMCPHC’s DRSi webpage.
Case Definitions for Zika Reporting:
Probable: Positive IgM
Confirmed: Positive PCR or confirmatory PRNT
Zika Travel Notices (CDC) : Updated travel notices for countries affected by Zika virus.
Zika Diagnostic Testing (NIDDL): Information on Zika virus testing criteria and specimen submission guidelines. Zika diagnostic testing is now available in the Navy through the Naval Infectious Diseases Diagnostic Laboratory (NIDDL) or the Naval Health Research Center (NHRC). This may provide faster results than sending samples to the CDC for testing, though diagnostic testing is still available through CDC or state laboratories. Zika virus infection cannot be easily confirmed through Zika-specific laboratory testing alone, as there is cross-reactivity with other flaviviruses like dengue. PCR testing avoids this cross-reactivity. False positives are also possible in patients who have been vaccinated against yellow fever and/or Japanese encephalitis.
Interim Guidelines for Prevention of Sexual Transmission of Zika Virus (CDC): Provides recommendations for men and women who have lived in or traveled to areas with active Zika transmission and their sex partners. Includes guidance for persons exposed to Zika who are planning to conceive.
Zika Virus Webpage (CDC): provides a number of resources about Zika virus including information on Zika-affected areas, transmission, prevention, fact sheets, and clinical guidelines for pregnant woman and for testing of infants.
CDC Zika Action Plan Summit On 1 April 2016, the CDC held a Zika Action Plan (ZAP) Summit for state and local health departments to provide information and tools for improving Zika preparedness and response and developing Zika action plans. The recording and slides for presentations from the summit are now available. Topics include preparing and responding to Zika virus, control of mosquito-borne illnesses, and risk communication.
NMCPHC hosts monthly disease surveillance trainings on the last Tuesday of every month that are designed to provide refresher training to local public health staff. Contact the DRSi helpdesk for more information, or visit the Monthly Disease Surveillance Training page for recordings and slides for past presentations. Zika-related topics include: “Zika Virus” (February 2016), “Zika Field Investigation” (February 2017), and “Aedes Mosquito Management” (May 2017).
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Information for Installation and Operational Vector Control and Pest Management
The best way to prevent Zika virus infection is to avoid and prevent mosquito bites. Installation vector surveillance activities play an integral role in managing and controlling the vector population. Vector surveillance measures for dengue and chikungunya-transmitting mosquitoes are also effective for Zika vectors, as these diseases are transmitted primarily by the Aedes mosquitoes which often bite during daytime hours.
Per OPNAVINST 6250.4C, all installations should have a pest management plan that includes an emergency vector control plan. These plans should be reviewed and updated annually. Contact your cognizant NEPMU or NECE if you need assistance.
The distribution range in the US for mosquitoes capable of transmitting Zika virus is primarily in the southeast and south central states, Hawaii, and in some parts of the southwestern states. There are also a number of installations located outside the US where Zika vectors could occur. Installations in these areas should consider whether they have the capability to conduct surveillance for and identify Aedes aegypti and Aedes albopictus mosquitoes. For installations at risk for these species or where these species are already present, pest management plans should include Aedes-specific surveillance and subsequent control mechanisms.
Training on Aedes surveillance and control techniques is available. Contact your cognizant NEPMU or NECE for more information. Additionally, an Aedes mosquito and surveillance video developed by NECE is available on the Navy Entomology MilSuite page (CAC enabled)
Aedes Surveillance and Control Plan for US Navy and Marine Corps Installations (NMCPHC) : General guidance concerning surveillance and control of Aedes spp. mosquitoes – the primary vectors for dengue, chikungunya virus, and Zika virus.
Strategy for the Control of Zika Virus-Transmitting Mosquitoes on Military Installations and Housing Areas (AFPMB) : General guidance on how to conduct surveillance and submit mosquito samples for Zika testing. Contact your cognizant NEPMU or NECE for more information.
Indoor Residual Sprays for Malaria & Dengue Prevention During Military Operations (NECE): Information and procedures for conducting indoor residual spraying against Anopheles and Aedes aegypti mosquitoes, which readily bite indoors.
Mosquito Info Door Hanger (NMCPHC): Aedes mosquito control door hanger that can be customized with local contact information before printing and distributing.
Mosquito Control Pamphlet (NMCPHC): Aedes mosquito control pamphlet that can be customized with local contact information before printing and distributing.
CDC Bottle Bioassay for Detecting Insecticide Resistance: Guidelines on how to perform and interpret the CDC bottle bioassay. The Navy Installation Zika Action Plan recommends that, in the case of confirmed local transmission, MTF staff be trained on CDC bottle bioassay techniques and what triggers are required to initiate testing.
Analysis of Mosquito Surveillance Data for Program Evaluation: This report is an analysis of mosquito trapping techniques and policy implementation at one Navy location in response to potential Zika transmission. The report shows how local data could be used to improve mosquito control efforts.
Information for Healthcare Providers
Healthcare providers should consider Zika in patients with acute onset of fever also presenting with rash, arthralgia, or conjunctivitis, particularly if there is an epidemiologic link to a Zika-affected area or a confirmed Zika case. Providers should notify the PHEO and Preventive Medicine department of any cases for whom clinical specimens will be submitted for Zika testing, as this information is being tracked and collated for reporting up to the SECNAV level.
Zika Virus Information for Department of Defense Medical Personnel (ASD(HA) Memorandum): Guidance for DoD medical and force health protection personnel regarding prevention, diagnoses, and treatment of Zika virus infection.
Zika Diagnostic Testing (NIDDL): Information on Zika virus testing criteria and specimen submission guidelines. Zika diagnostic testing is now available in the Navy through the Naval Infectious Diseases Diagnostic Laboratory (NIDDL) or the Naval Health Research Center (NHRC). This may provide faster results than sending samples to the CDC for testing, though diagnostic testing is still available through CDC or state laboratories. Zika virus infection cannot be easily confirmed through laboratory testing, as there is cross-reactivity with other flaviviruses such as dengue virus. PCR testing avoids this cross-reactivity. False positives are also possible in patients who have been vaccinated against yellow fever and/or Japanese encephalitis.
Interim Guidelines for Interpretation of Zika Virus Antibody Test Results (CDC): Provides recommendations for Zika virus antibody testing and interpretation of results. This guidance updates the timing of IgM antibody testing and the thresholds for the plaque reduction neutralization test (PRNT).
Guidelines for Healthcare Providers Caring for Pregnant Women During a Zika Virus Outbreak (CDC) : Recommendations for the testing and management of infants born to mothers with possible Zika virus infection during pregnancy.
Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Exposure (CDC): Provides recommendations for men and women who have lived in or traveled to areas with active Zika transmission and their sex partners. Includes guidance for persons exposed to Zika who are planning to conceive.
Information for Navy and Marine Corps Personnel and Their Families
The vast majority of Zika virus infections occur from the bite of an infected mosquito. Navy and Marine Corps personnel and their families are at risk for Zika virus infection when traveling to and residing in areas experiencing ongoing Zika virus transmission. In collaboration with civilian public health authorities, the Navy and Marine Corps are working to institute measures to significantly reduce the chances of Zika spread on Navy and Marine Corps installations through mosquito control programs. An effective control strategy also relies in the vigilance of Navy and Marine Corps personnel and their families, which includes taking the following steps:
NAVADMIN: Zika Virus Risk Mitigation : Information for Commanders on travel precautions and mitigation measures for Zika virus.
MARADMIN: Zika Virus Force Health Protection : Guidance for Marine Corps personnel deploying to, operating in, or redeploying from Zika virus affected areas.
Navy-factsheet-DoD-repellent: List of topical repellents including military-approved repellents.
Find the Insect Repellent that is Right for You (EPA): Additional EPA-approved insect repellents that are commercially available.
Is Your Uniform Protecting You? (NECE) : Basic facts about permethrin-treated uniforms.
Navy NWU Type II and Type III Peremthrin Treatment Guidance
Protecting Yourself and Home from Mosquitoes (NECE) : Basic steps from NECE on how to protect against mosquitoes.
FAQ: Zika and Pregnancy (PAHO) : Questions and answers about Zika and pregnancy, for the general public.
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