Wednesday, November 22, 2017
Health

Containing Zika: How Tampa Bay health officials scrambled to stop the spread of the virus

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TAMPA — The female firefighter's eyes were red. She had battled a fever, body rash, headache and joint pain in her hands and ankles for five days before visiting a doctor.

Her symptoms rang alarm bells at a Pinellas clinic, which on Aug. 17 alerted the county Health Department about the "non-pregnant female with no travel history." Her blood and urine samples were dispatched the next morning to the nearest state laboratory, in Tampa.

When one urine sample tested positive, epidemiologists didn't wait for the second test needed to establish a true positive. Mosquito control officials on both sides of Tampa Bay were dispatched to spray around her home and workplace and health officials were put on warning.

The Tampa Bay region had its first locally transmitted case of Zika.

It would be four days before Gov. Rick Scott would announce the case to the public, but Health Department epidemiologists in Pinellas and Hillsborough were already on full alert to try to limit the spread of the virus. And it was in Tampa, not Pinellas, where most containment efforts took place, according to Health Department emails obtained by the Tampa Bay Times.

Crucial to devising a containment plan were extensive interviews conducted over at least two days with the Tampa Fire Rescue firefighter, now classified by epidemiologists as a Person Under Investigation.

A timeline of her whereabouts was painstakingly compiled, covering a three-week period when she might have caught and spread the virus. It listed where she dined out. The entries for some days simply stated "Need more details."

Epidemiologists were looking to pinpoint where she had been bitten by mosquitoes, where she had been outdoors for extended periods of time, what sexual contacts she'd had, and whether she had injections, blood transfusions or tattoos in the past six months.

"You're trying to find the source while also trying simultaneously to contain the virus," said Mark Hart, an assistant professor of epidemiology at the University of Florida who teaches health communication. "You'll create a boundary map for where this person lives and works so you can go back in time two weeks and build that map showing where they spent most of that time."

The answers did not make for a simple plan.

The firefighter, whom the Times is not naming because of privacy concerns, lived in Pinellas but worked in Tampa. Her job meant she was often outdoors.

She recalled being around mosquitoes but the date did not fit the two- to 14-day incubation period for Zika based on the first day she started feeling sick.

The plan that officials hatched focused on eradicating mosquito populations around both her home and workplace. After blood and urine tests of her immediate family returned negative, Pinellas epidemiologists concluded that urine testing and surveying of residents in her neighborhood was unnecessary.

"Additional efforts will be focused on the workplace, and Hillsborough will be leading the workplace investigation," a situation report stated. "We will continue to perform active surveillance in the case's neighborhood and work with mosquito control to assist in their mosquito-reduction activities."

Firefighter union leaders and the city of Tampa were contacted to get permission to test her fellow firefighters at Station No. 3 close to Kennedy Boulevard in Tampa.

At least 25 co-workers were identified to be tested and interviewed, records show. Consent forms asking for blood and urine tests were quickly drawn up based on those used in two neighborhoods in Miami-Dade County, where Zika is being spread by mosquitoes.

"We would like to test anyone working at the fire station July 23 to the present," wrote Warren McDougle, a Hillsborough epidemiologist to Tampa Fire Rescue.

In Tampa, county mosquito control technicians conducted backpack spraying, dropped larvicide dunks in standing water and trapped mosquitoes around a 300-yard radius. The Aedes aegypti mosquito known to spread the Zika virus typically travels a maximum of only 150 yards in its lifetime.

Hillsborough Environmental Health Geographic Information Systems, or GIS, also conducted mapping, identifying areas of standing water, treating them with larvicide, and distributing door hangers and palm cards with details about mosquito bite prevention.

New advisories were sent to doctors' offices, emergency rooms, nurses, midwives, and gynecology clinics advising extra caution for women who are pregnant or planning to become pregnant.

Another Health Department agency in the state was also notified because the firefighter traveled there during the virus' incubation period. Extra mosquito spraying was conducted there based on information passed on by Pinellas officials.

In Pinellas, Zika kits that include mosquito repellent, larvicide dunks, mosquito nets and condoms were sent to clinics in mid county, Clearwater, Pinellas Park, St. Petersburg and Tarpon Springs. About 240 packs of wipes with mosquito repellent were distributed to the homeless.

Tuesday marked three weeks since the Pinellas infection was announced. While rarely fatal, Zika has been linked to microcephaly, a birth defect in which a baby's head is smaller than normal and which is often accompanied by developmental issues.

State health officials said this week they have tested 63 people. Results of three tests are still pending while the rest have returned negative. If no other cases are found, the case will be declared a single infection and closed, as happened earlier this year in Palm Beach County.

Still, the lengthy investigation has left residents, especially pregnant women, anxious about the virus. Both U.S. Rep. David Jolly and St. Petersburg Mayor Rick Kriseman said residents deserved more specific details about where the infected resident lived.

"Maybe they could have been better at alleviating concerns, but maybe they have gotten conflicting evidence and don't have an answer," said Hart, the University of Florida epidemiology professor. "As time has gone on, the people in the community probably feel a little bit better about it."

Contact Christopher O'Donnell at [email protected] or (813) 226-3446. Follow @codonnell_Times.

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