{"id":144,"date":"2017-02-15T21:04:03","date_gmt":"2017-02-15T21:04:03","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/clinicians\/?page_id=144"},"modified":"2017-02-15T21:04:03","modified_gmt":"2017-02-15T21:04:03","slug":"zika-and-tickborne-illnesses-update-2016","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/clinicians\/zika-and-tickborne-illnesses-update-2016\/","title":{"rendered":"ZIKA AND TICKBORNE ILLNESSES UPDATE &#8211; 2016"},"content":{"rendered":"<p style=\"text-align: center;\"><span style=\"font-family: 'times new roman', times; font-size: medium;\">July 6, 2016<\/span><\/p>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\"><span style=\"font-size: small; font-family: 'times new roman', times;\">Dear Colleague:<\/span><\/span><\/p>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\">Now that the weather is warmer, Virginians are spending more time outdoors, increasing their exposure to mosquitoes and mosquito-related diseases, as well as ticks and tickborne diseases, including Lyme disease. This letter is provided as an update on Zika in Virginia and also includes important reminders about tickborne illness in Virginia.<\/span><\/p>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\"><strong>This correspondence includes:<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\"><a href=\"https:\/\/www.vdh.virginia.gov\/zika-and-tickborne-illnesses-update-2016\/#a1\">Zika virus updates<\/a>. Visit our <a href=\"http:\/\/www.zikava.org\/\">Zika Website<\/a>\u00a0for the most recent information.<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\"><a href=\"https:\/\/www.vdh.virginia.gov\/zika-and-tickborne-illnesses-update-2016\/#a2\">Tickborne illness epidemiology in Virginia<\/a>.<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\"><a href=\"https:\/\/www.vdh.virginia.gov\/zika-and-tickborne-illnesses-update-2016\/#a3\">Recommended actions for healthcare providers to prevent and manage tickborne illnesses<\/a>.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\"><strong><a id=\"a1\"><\/a>Zika Updates<\/strong> <\/span><br \/>\n<span style=\"font-family: 'times new roman', times; font-size: medium;\">Information about Zika virus disease continues to evolve as we learn more about the condition. Please check the <a href=\"http:\/\/www.zikava.org\/\">VDH Zika Website<\/a>\u00a0regularly for the most up to date information.<\/span><\/p>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Zika virus testing in infants: recommendations for testing within two days of birth<\/span>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">When <a href=\"http:\/\/www.cdc.gov\/mmwr\/volumes\/65\/wr\/mm6507e1.htm?s_cid=mm6507e1_w.htm\">evaluating infants born to mothers with Zika positive\/equivocal<\/a>\u00a0lab results, please perform rRT-PCR and IgM serology testing within two days of birth on serum specimens collected from the umbilical cord or directly from the infant.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Maternal Health \u2013 Pediatric Provider Communications<\/span>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">For providers caring for Zika Pregnancy Registry-eligible women, please ensure that appropriate clinical records are passed on to other relevant maternity and pediatric providers in a timely way, ideally immediately before or upon birth of the infant in order to ensure appropriate clinical evaluation of the infant at birth.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Symptomatic person with a negative rRT-PCR test: recommendations for additional serology testing\u00a0<\/span>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">The CDC recommends that for symptomatic patients, all specimens negative for Zika RNA via rRT-PCR be submitted for serology testing. Providers who request molecular testing for Zika virus infection from a commercial testing laboratory are advised to retain and store a serum sample for subsequent Zika IgM ELISA testing if the rRT-PCR is negative. Serology testing for Zika virus is currently only available through public health, and approval of testing is required. Providers can contact their local health department to request public health testing at DCLS.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\"><strong><a id=\"a2\"><\/a>Background Information on\u00a0<a href=\"https:\/\/www.vdh.virginia.gov\/environmental-epidemiology\/tick-borne-disease-prevention-and-control\/\">Tickborne Illnesses<\/a><\/strong><\/span><br \/>\n<span style=\"font-family: 'times new roman', times; font-size: medium;\">Lyme disease activity continues to expand its geographic range in Virginia. In 2015, public health reported 1,539 confirmed and probable cases of Lyme disease in Virginia residents, more than in any previous year. Although Lyme disease is the most commonly reported tickborne illness in Virginia, other tickborne illnesses also warrant attention. Ehrlichiosis is the second most confirmed tickborne disease in Virginia. Ehrlichiosis is carried by the lone star tick, which is the most common cause of tick bites in Virginia; surveys show that ehrlichiosis agents are relatively common in these ticks. Illnesses due to the spotted fever group (SFG) rickettsia, such as Rocky Mountain spotted fever (RMSF) and Tidewater spotted fever caused by Rickettsia parkeri, are uncommon but do remain a concern. For more information, please visit the <a href=\"https:\/\/www.vdh.virginia.gov\/environmental-epidemiology\/tick-borne-disease-prevention-and-control\/\">VDH Tickborne Disease Prevention and Control<\/a>\u00a0web page.<\/span><\/p>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\"><strong>Updated CDC MMWR on Tickborne Rickettsial Diseases<\/strong><\/span><br \/>\n<span style=\"font-family: 'times new roman', times; font-size: medium;\">I\u2019d like to highlight a May 2016 CDC MMWR Report entitled: \u201c<em><a href=\"http:\/\/www.cdc.gov\/mmwr\/volumes\/65\/rr\/pdfs\/rr6502.pdf\">Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis &#8211; US.<\/a><\/em>\u201d This document updates the CDC\u2019s 2006 recommendations and can assist providers with the following:<\/span><\/p>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Recognizing key epidemiologic features and clinical manifestations of tickborne rickettsial diseases;<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Recognizing appropriate treatment, including that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children;<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Understanding that early empiric therapy can prevent severe disease and death;<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Understanding appropriate laboratory diagnostic tests, including their uses and limitations.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\"><strong><a id=\"a3\"><\/a>Actions for Healthcare Providers<\/strong><\/span><br \/>\n<span style=\"font-family: 'times new roman', times; font-size: medium;\">Given the impact of tickborne illnesses in Virginia, please consider the following actions this tick season:<\/span><\/p>\n<ul>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Report cases of the following tickborne illnesses to your <a href=\"https:\/\/www.vdh.virginia.gov\/local-health-districts\/\">local health department<\/a>\u00a0promptly: Ehrlichiosis\/Anaplasmosis, Lyme disease, and Spotted Fever Rickettsiosis.\u00a0<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Remind patients to take preventive steps, including recognizing and avoiding tick habitats, using insect repellent in likely tick habitats, removing attached ticks promptly, and creating tick-safe zones in the yard.\u00a0<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Ask about tick exposure when evaluating patients with febrile illness with or without a rash.<\/span><\/li>\n<li><span style=\"font-family: 'times new roman', times; font-size: medium;\">Familiarize yourself with the laboratory assays available to diagnose tickborne illness. To learn more, please review the following document\/link entitled, \u201c<a href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/pdf\/RecommendedLaboratoryAssaysforSelectTickborneDiseases.pdf\">Recommended Laboratory Assays for Select Tickborne Diseases<\/a>.\u201d Specific information on Lyme disease lab testing is available on the <a href=\"http:\/\/www.cdc.gov\/lyme\/diagnosistesting\/LabTest\/TwoStep\/\">CDC web page<\/a>.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\">Should you have any questions about Zika virus disease or tickborne illnesses in Virginia you may contact your <a href=\"https:\/\/www.vdh.virginia.gov\/local-health-districts\/\">local health department<\/a>. Questions may also be directed to David Gaines, PhD, State Public Health Entomologist, in the VDH Office of Epidemiology. He can be reached by telephone at (804) 864-8192 or by email at <a href=\"mailto:david.gaines@vdh.virginia.gov\">david.gaines@vdh.virginia.gov<\/a>. View VDH\u2019s animated videos on tick bite prevention at <a href=\"http:\/\/www.tickfreesummer.com\/\">http:\/\/www.tickfreesummer.com<\/a>\u00a0and share them widely.<\/span><\/p>\n<p><span style=\"font-family: 'times new roman', times; font-size: medium;\">Working together we can make it more likely that people in Virginia will have a safe, \u201cZika-free\u201d and \u201ctick-free\u201d summer. Thank you for all you do.<\/span><\/p>\n<p><span style=\"font-size: medium;\"><span style=\"font-size: small; font-family: 'times new roman', times;\">Sincerely,<\/span><\/span><\/p>\n<p><span style=\"font-size: medium;\"><span style=\"font-size: small; font-family: 'times new roman', times;\">Marissa J. Levine, MD, MPH, FAAFP<\/span><\/span><\/p>\n<p><span style=\"font-size: medium;\"><span style=\"font-size: small; font-family: 'times new roman', times;\">State Health Commissioner<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>July 6, 2016 Dear Colleague: Now that the weather is warmer, Virginians are spending more time outdoors, increasing their exposure to mosquitoes and mosquito-related diseases, as well as ticks and tickborne diseases, including Lyme disease. 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