Florida’s Zika ResponseLessons Learned

Cassandra G. Pasley, BSN, JD, DirectorDivision of Children’s Medical Services

Department of Health

National Reproductive Health ConferenceJuly 17, 2018

Disclosure

Nothing to disclose

Objectives

By the end of this presentation, participants will be able to explain the state-wide Zika response enacted in Florida.

Snapshot of Florida

People:• 20.9 million people reside in Florida • 4.1 million are children

• Approximately 1.1 million with special health care needs• Approximately 650,000 with medical complexity

• Approximately 220,000 births per year• Over 30,000 births in Miami-Dade County

• 112.8 million tourists visited Florida in 2016 • 44.6 million travelers passed through Miami International Airport

in 2016424

• Directed State Health Officer to declare public health emergency in counties with travel-related cases

• In February 2016, four counties with travel-related cases• 40 of the 67 counties were ultimately impacted

• Designated DOH as lead state agency to coordinate emergency response activities

• Authorized Commissioner of Agriculture to issue mosquito declaration and directed two other agencies to assist in developing mosquito control plans

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Florida Zika Executive Order No. 16-29, issued February 3, 2016

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Zika Response Partners

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Counties Affected by Zika

Active Zone Travel & Undetermined Travel & Local Travel

2016 2017 2018

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Florida Zika Cases

2016 2017 2018 Total

Local Cases 300 2 0 302

Travel Cases 1122 225 49 1396

Undetermined Cases

49 35 0 84

Total Statewide Cases

1471 262 49 1782

Pregnant Women 299 136 35 470

Babies Born with congenital Zika and Birth Defects

4 3 0 7

As of June 2018:

• 470 Zika positive pregnant women detected in Florida • 92% linked to prenatal care and/or Healthy Start• 85% live-born infants tested for Zika virus

• CHDs and Registry coordinator monitor pregnancy outcomes• Collect prenatal and birth records (84% of birth records collected)

• 9 infants born in Florida with Zika virus• 7 infants had microcephaly or other neurologic complications • 2 infants do not currently have evidence of a birth defect

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Florida Zika Maternal and Newborn Data

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Florida Department of Health Response

• 67 County Health Departments • State Public Health Laboratories• Birth Defects Registry• Maternal and Child Health• Children’s Medical Services

• Early Intervention (IDEA, Part C)• Title XIX/XXI plan for Children w/

Special Needs• Zika Health Care Services Program

• Communications

• Licensed Health Professionals (with boards)

• Preparedness and Response• Disaster Preparedness

(Emergency Support Function 8 Public Health and Medical lead agency)

• Communicable Diseases• Disease Control and Health

Promotion (Not Vector Control)• Environmental Health

• Original Award on January 18, 2017 • U.S. Department of Health and Human Services, Centers for

Medicare and Medicaid Services • Project supported by Funding Opportunity Number CMS-1Q1-17-

001

• $2,991,000 (over 3 years)

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Zika Health Care Services Program Grant

“The contents provided are solely the

responsibility of the authors and do not

necessarily represent the official views of HHS or

any of its agencies.”

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Zika Health Care Services Program Grant

Strategies:• Increase access to contraceptive services for women and

men• Reduce barriers to diagnostic testing, screening, and

counseling for pregnant women and newborns• Increase access to appropriate specialized health care

services for pregnant women, children born to mothers with maternal Zika virus infection, and their families

• Improve provider capacity and capability13

Zika Health Care Services Program Grant

Importance of: • Agile laboratory capacity and capabilities • Free Zika testing for all pregnant women until December

2017, regardless of risk factor or exposure • Maternal and Child Health participation in decisions

regarding emergency response planning• Strong relationships between OB/GYN’s and Pediatricians

and the local county health departments• Creating a platform for health care experts to collaborate

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Lessons Learned and Strategies

Importance of: • Mapping processes

• Zika testing for pregnant women • Zika Investigation (Door to Door) • Linking pregnant women with Zika to prenatal care and coverage • Pregnant women with Zika or potential exposure (Zika Pregnancy

Registry) • Linking an infant born from a woman with a positive Zika test to

appropriate testing and/or care• Establishing eligibility category for Early Steps (early intervention) for

infants with congenital Zika exposure

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Lessons Learned and Strategies

Importance of: • Access to Obstetric and Pediatric champions, along with other

specialists • Adequate health care providers to reduce the timeframe for

LARC insertion in Florida Department of Health in Miami-Dade County for those women who chose this method of contraception

• Federal, state, local, and community partnerships• Effective communication (timely, complete, consistent and

transparent)

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Lessons Learned and Strategies

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Questions