Transcript for CDC Media Availability: Support for Utah investigation of Zika

KATHY HARBEN: Good afternoon everyone, and thank you for joining us for this CDC Media Availability. We understand there is a lot of interest in Utah’s report of the new case of Zika.  We are holding this call so CDC experts can answer questions about what the new report means in terms of family contact, infection control, mosquito control and any changes in current guidance. CDC is not releasing new or additional information today.  The purpose of today's availability is to provide additional context about what this case means based on what we currently know.  We’ll continue to provide updates from this case from our perspective as new information is available.  Joining us on the call today are Satish Pillai, he's our incident Deputy Incident Manager with our CDC's Zika response.  Denise Jamieson, Chief of the Women's health and Fertility Branch, Division of Reproductive Health and CDC National Center of Chronic Disease Prevention And Health Promotion.  Michael Bell is Deputy Director of CDC's Division of Health Care Quality Promotion.  Ingrid Rabe with CDC's Division of Vector Borne Diseases and Doctor Robert Wirtz is an Entomologist here at the CDC.  Dr. Pillai will begin with brief remarks and then we'll take your questions. 

SATISH PILLAI: Good afternoon, Utah health officials confirmed today a new case of Zika in Utah.  This person is associated with the family of the patient who died in late June. Based on what we know now, the person has not recently traveled to an area of Zika and has not had sex with someone affected with the Zika or a returning traveler.  In addition, there is no evidence at this time that mosquito that are commonly known to spread are present in Utah.  A CDC emergency response team or (CERT) is in Utah at the request of the Utah Department of Health.  The team includes experts in infection control, virology, mosquito control and disease investigation and health communication.  The investigation in Utah includes additional interviews with, and laboratory testing of, family members and healthcare workers who may have had contact with the person who died and trapping of mosquitos and assessing the risk of local spread by mosquitos. As of July 13, 2016, 1306 cases of Zika have been reported in continental US and Hawaii.  None of these have been the result of local spread by mosquitos.  These cases include 14 believed to be the results of sexual transmission and one was a result of a lab exposure.  We don't have all the answers right now but we'll continue to update what we know,when we know it.  At this point, we look forward to taking your questions, thank you. 

OPERATOR: Thank you.  We will now begin our question and answer question, if you would like to ask a question, press star one, one moment while we wait for the first question.  Our first question comes from Mike Stobbe with the Associated Press. 

MIKE STOBBE: Thank you for taking the question. First, could you make sure I have the complete list? There’s been evidence of Zika infection found in what bodily fluid?  Semen, vaginal fluid, urine, blood, saliva or tears anything else?   Can you say what type of care or how intense the care was with the family contact was given to the deceased or how many people were caring for the patient at home or at the hospital. 

SATISH PILLAI:  I can begin and I can turn over to my colleague, Dr. Rabe for additional comments regarding bodily fluids that we know that Zika has been recovered in-as you pointed out, blood, semen, saliva and urine.  The question of the -- and the question of the type of fear that this is an important element in our investigation.  the person was caring for the elderly patient before death were trying to determine if the contact between the very sick elderly patient and the person plays a role in how the person got sick.  We don't have all those answers right now but we'll continue to share the information as it becomes available.  I want to make sure if Ingrid have any additions to the bodily fluids that I described as having covered it in the past if she wants to supplement that with any information. 

INGRID RABE: Thank you very much. So just in addition to that as was mentioned was the genital tract swabs that have been found positive and other public report goes, there is also a report of detection of virus in breastmilk as well as detection of viral Aqueous fluids from the inside of the eye in a  patient to had uveitis. 

MIKE STOBBE: Does that mean tears? 

INGRID GRABE: No, that's actually internal. 

MIKE STOBBE: How many people are you interviewing other than care givers? 

SATISH PILLAI: This investigation is ongoing of our team in the field are continuing to evaluate the numbers of individuals that maybe involved with stratifying and attempting to target the investigation. 

MIKE STOBBE: Thank you.

KATHY HARBEN: Next question please.

OPERATOR: Thank you.  Next question comes from Brady Dennis with the Washington Post. 

BRADY DENNIS: thank you for the call, I have two different questions, one is the deceased person, are you able to share if this person died at the health care hospital or at home, and also the other person infected, did that person shows symptoms of the Zika virus, is that partly how he was diagnosed in many people do not so I was wonder if he had hour symptoms? 

SATISH PILLAI:  Regarding the care and location of the where the index patient passed away, we of course, defer to our colleagues at the Utah department of Health for details such as that. Regarding the symptoms of other individual who acquired Zika, as is common with Zika, They developed mild symptoms and rapidly recovered which is the typical time course and presentation and recovery that you would expect with Zika virus. 

KATHY HARBEN: Next question, please.

OPERATOR: One moment. Helen Branswell with STAT, your line is open. 

HELEN BRANSWELL: Thank you very much.  I was struck by your observation of your press release, the person who died had more than 100,000 times the viral level that is normally seen with Zika.  I am wondering what you are thinking on that and why he was so viremic whether that would change your thinking of the potential for transmission in a close contact setting like that.  Would one have to worry at that point that maybe the virus would be in the skin, for instance? 

SATISH PILLAI:  I am going to start and i am going to turn over to my laboratory and infection control colleague.  I think what you highlighted is an important aspect of this.  This is a very unique situation with these elevated viral loads that we have previously seen.  The family contacted carrying for the individuals whose sick and later died.  however, we are still, there is a lot we don't know about the Zika virus, we are still doing a lot of investigation to understand whether Zika can be spread from person to person through contact of a sick person.  That’s under investigation.  The facts remain that Zika is spread primarily through the bites of the infected Aedes species mosquito. A pregnant woman can pass Zika virus to her fetus or at the time of birth or a person who’s infected can pass it to their sex partner.  That’s what we know and what we believe of the primary mode of transmission. But I would like to allow my colleague to weigh in as well. 

MIKE BELL: So this is Mike Bell. From the infection control perspective, I think it is early to make a clear statement about what we think could have happened. Certainly a high viral load is something we take very seriously, and as you just heard it is no something about which we have a very long experience.  We are not at a point today to describe any specific action that might have led to transmission.  That’s the point of occurrence of investigation under way in Utah.  As soon as we know something new, we'll certainly use that information to assess risks to both family members and others. And health care personnel. But currently, nothing we can say other than recognizing a high viral load could be a different situation than we would ordinarily see. 

HELEN BRANSWELL:  can I ask a follow-up questions, please.  When the man in Utah died, the way that his death was framed was- He had Zika but he had another severe illness and it was not clear whether he died from Zika or died with Zika or how much Zika contributed to his death.  When you see a viral load like that does that have to answer the question?

MIKE BELL: So you are asking sort of a chicken or the egg question.  Someone who is extremely ill and debilitated from another disease process could have a diminished immune system that does not fight the virus as well and that might allow more virus to proliferate in the bloodstream.  On the other hand someone with a high viral load could be sick with the viral infection.  I personally cannot tell you which way that went.  But, it is certainly worth thinking about. 

HELEN BRANSWELL:  Thank you.

KATHY HARBEN: Next question, please. 

OPERATOR: Next question comes from Dr Jon LaPook with CBS News. 

DR. JON LAPOOK: Hi, it’s kind of a follow-up on exactly that line of questioning, I’m wondering the chicken and egg – was the patient immune compromised from some non-zika condition first and that led to a higher viral load or is it almost a sepsis-like thing happens from Zika, I don't remember seeing that in the literature that it could cause a sepsis like picture which would then lead to an overwhelmingly high viremia.  Can you tell us a little bit of the underline illness that the deceased man had? 

SATISH PILLAI:  No, at this point, these are all avenues that's under investigation. 

DR. JON LAPOOK: Okay. 

SATISH PILLAI: The department of health and Utah can provide more details of the individual case. 

DR. JON LAPOOK: Okay. 

KATHY HARBEN: Next question please. 

OPERATOR: Next comes from Kimberly Leonard with U.S. News and World Report. 

KIMBERLY LEONARD: Hi, thank you for taking my question.  I am wondering whether the possibility that the virus has become airborne is being considered or is that just off the table given the way that we know it already transmits. 

MIKE BELL:  So in our line of work, nothing is truly off the table.  The table is vast.  We never want to under estimate possibilities, however, it would be extremely unlikely for something like that to occur.  In the absence of something like a medical procedure that could create a mechanical error for example -- this is one of the reasons when we handle viruses and other pathogens in the laboratory, we use special precautions because within these things in machines that travel very high velocity and if the test tube breaks, and that could create a special risk.  In contrast a human being behaves differently, and so what we see with this virus is as you heard already the predominant mode of transmission is through the bite of an infectious mosquito.  Right now, we’re accessing very carefully to see whether any other form of transmission could be happening it is a little bit early to be saying it specifically. 

KIMBERLY LEONARD:  I am sorry, who's speaking? 

MIKE BELL: This is Doctor Mike Bell. 

KIMBERLY LEONARD: Thank you, Doctor Bell. 

KATHY HARBEN: Next question, please. 

OPERATOR: Next question comes from Robert King with Washington Examiner. 

ROBERT KING: Hi, Thanks for taking my question, I have a question about the mosquito in Utah, you said you were testing mosquitos in the area but the two mosquitos that primarily spread Zika (the Aedes Egypti and the Aedes Albipictus) aren’t in Utah, do you believe that more mosquitos are now potentially spreading the virus or could spread the virus? 

BOB WIRTZ: This is Bob Wirtz.  No, we don't believe that.  Right now as you mentioned the Aedes Egypti and the Aedes Albipictus are currently not found in the area. We have two CDC Entomologists who are assisting the Salt Lake City Mosquito Abatement District and Mosquito Collections -- they are collecting quite low numbers different species of mosquitos – primarily culex mosquitoes that preferably feed on birds. As Mike mentioned, we never take anything off the table, right now we feel that transmission by Aedes mosquitos is highly unlikely. 

ROBERT KING:  What are you looking for in the mosquitos that you are collecting? 

BOB WIRTZ: They are checking for West Nile Virus as well as the Zika virus just to cover all the bases and to make sure that we get as much information as we can from the collecting that we are doing. 

ROBERT KING: Okay. 

KATHY HARBEN: Next question, please. 

OPERATOR: Next question comes from Maryn McKenna with National Geographic. 

MARYN MCKENNA: Thanks for having this call.  I recognize that you said already that you don't have a hypothesis yet for the transmission that is too early.  But, you have known this is going to ignite a lot of concerns in the general public that's paying attention to the Zika.  Is there anything that you can say to temp that down in any way to keep team thinking of anyone who may have been exposed to the Zika is walking around with the infection. 

SATISH PILLAI: I think this goes back to my earlier statement that primary load of transmission for Zika is through the bite of the Aedes Egypti mosquitos.  That has so far being the most common mode of transmission, there are other mechanisms or other modes of transmission such as sex and through pregnant woman passing the virus through pregnancy or what's what we know.  We don't have evidence right now that the Zika can be passed to one person or another person by sneezing or coughing or touching or hugging or sharing utensils.  The person with the mutated Zika that is being reported today was a family contact of an elderly patient who had been infected with the Zika and as we have heard earlier had a high viral load.  While we still don't know exactly how this family contact became sick and we are actively investigating it.  What we do know is that the primary mechanism in transmission are mosquito born.  We feel that should provide some levels of reassurance to the public. 

KATHY HARBEN: Next question, please. 

OPERATOR: Next question comes from Stephanie Soucheray with CIDRAP News.

STEPHANIE SOUCHERAY: Hi, thanks for taking this question. I am wondering what are the current safety guidelines for protecting health care workers in other countries where Zika is more endemic? 

MIKE BELL: This is Mike Bell, you’re asking what the infection control practice is in other countries are? I’m not aware of anything special or different other than what we would recommend here. For instance, I don't know of any country is treating these patients like you asked earlier if it is transmitted there you the air.  this is something we are approaching, most or if not all country are approaching and using standard precautions to make sure that health care personnel don't have any direct contact with blood or bodily fluid, it is through broken skin or needle stick or slashes through the mucous membrane. 

STEPHANIE SOUCHERAY: Thank you. 

KATHY HARBEN:  Next question, please. 

OPERATOR: Next question comes from Julie Steenhuysen with Reuters. Your line is open. 

JULIE STEENHUYSEN: Hi, yes, I have two questions.  First of all, I want to confirm -- so it was not learned that the deceased person had Zika until after his or her death, is that correct?  Is it right to assume that the person that's carrying for this patient did not know that the elderly man had Zika?  I have a follow up. 

SATISH PILLAI: I don't want speculate on what the individual and the timing of when the individual found out the diagnoses of Zika.  The important thing is when you are essentially caring for an individual, health care workers caring for the individual with the virus, the use of standard precautions is appropriate way to help prevent transmission of infection and preventing exposure to blood and bodily fluids. 

JULIE STEENHUYSEN: Okay, a follow up,  Mike, do you think this alters the CDC recommendations for personal protective gear and health care workers in anyway.  You know several times in your press releases you were saying it was surprising.  Clearly, it is.  I am wondering if it means particularly extremely ill patients and you need to do some testing for high viral load and you need to alter PPE instructions. 

MIKE BELL: Currently, we are not altering PPE instructions.  I think what this highlights is the fact that when you have an infection like Zika virus infection where a good percentage of patients don't have symptoms.  It means that as important as ever to stick with good precautions.  Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or bodily fluid exposure. The same thing is true with Zika virus and this is a great example of why we should never take chances but always adhere to careful and standard precautions. 

SATISH PILLAI: I would like to just reemphasize one point, you know, as of July 13th, there have been 1306 cases of Zika reported in the continental United States and Hawaii.  And, of these cases there is no reason to suspect this kind of person to person transmission is the mode of transmission. This is a unique event in that context. I think that needs to also be kept in mind. 

JULIE STEENHUYSEN:  Thank you. 

KATHY HARBEN: I think we have time for one more question. 

OPERATOR: Our last question comes from Jeneen Interlandi with Customer Reports.

JENEEN INTERLANDI: Thanks so much for having the call. Quickly. Most of my questions were answered, you mentioned earlier and I think I saw in an earlier report of a question of whether or not this second infection of this person interacting with the elderly man who was sick whether it had anything to do with him contacting the virus.  Is there a chance that he got it some other way that he did not come from this patient? 

SATISH PILLAI: I think all we are saying with that is that we are having an ongoing investigation, we are considering and as you heard earlier, mosquito trapping is occurring, a detailed hospital investigation is under going.  We don't want to put the blinders on and just go down to one avenue of investigation.  So I think that's the point of that statement. 

JENEEN INTERLANDI:  thank you. 

KATHY HARBEN: Last call if there is another question we can take it if not.  We’ll wrap it up. 

OPERATOR: Yes, we do have a few more.  Okay, Melissa Healy, with the Los Angeles times. Your line is open. 

MELISSA HEALY: Hi there, thanks for taking my question. Can I ask as part of the investigation, is there still the possibility of conducting any post-mortem study of the deceased patient. Will his brain be looked at of investigation of the Zika virus there? Is there any evidence he had Guillain-Barre syndrome? 

MIKE BELL: The details of that and the investigation is ongoing.  I don't have that level of details right now regarding the specifics of elderly individual’s clinical course and regarding the air – we would defer to the Utah Department of Health for those particulars but we are continuing to do the clinical investigations understanding the potential risk factors that may have contributed.  As we get more information we'll share as quickly as we can and we'll see information that shed more light onto this event. 

KATHY HARBEN: We do have time for one more question. 

OPERATOR: Next question comes from Heather Tesoriero with CBS News. 

HEATHER TESORIERO: Hi, two things. One of the viral load of the new Utah patient, was that in a more typical range and the other thing is can you shed some light on the process and the procedure you’ll be undertaking to try to understand the unusual viral load in the deceased patient?

SATISH PILLAI: I think for the ladder, it will require a thorough review of the clinical course getting better understanding of under lining potentials, medical comorbidities – but as you heard earlier in this call by Doctor Bell, there was a chicken or egg situation and understanding whether what or how if there was an under line illness that may have contributed to immunosuppression this or becoming critically ill contributed to the high viral load.  At this point, i don't think we can provide an answer but the goal of the investigation is to reveal the clinical course and the medical records and get a better understanding of how the individual may have come to a developed a high viral load.  And, regarding the initial question, we have no indications to suggest that the individuals who subsequently became ill had the similar type of high viral load that was noted inside the index case.  Most importantly this individual rapidly recovered and which is the typical and clinical course that one may inspect with this Zika virus infection. 

HEATHER TESORIERO: Thank you so much, one quick follow up. Was it – I’m sorry if you’ve already addressed this already but was it known with the deceased patient, was it not discovered that the patient had Zika virus until the patient was deceased or was it known while the patient was known and dying. 

SATISH PILLAI:  I would say this is still in the realm of our active investigation and as we get more of the sequence of events and understanding timing and working with our colleagues at Utah Department of Health, we hope to get you updates regarding this and additional information as quickly as possible.  Again, I think the bottom line here is that this is a unique case of the 1300 cases that we have reported thus far and the continental United States and Hawaii, there is no suggestions of this type of spread to date.  But, Zika continues to surprise us.  and I think above all, we want to make sure that pregnant women are safe and they should not be traveling to some of the locations that is we described previously that have active mosquito born transmissions of Zika which can be found on the CDC website and individuals who may be at risk for sexual transmission of Zika should use condoms correctly and consistently at all times or abstain from sex.  Again, thank you very much for calling in.  I am going to turn it back over to Mrs. Harben. 

KATHY HARBEN: Thank you everyone for joining us.  This concludes today's media availability, we'll post a transcript on the CDC's news room website as soon as possible.  If you have other questions or need additional information, you can call us at 404-629-3286 or you can e-mail us.  Thank you very much. 

OPERATOR: Please disconnect at this time of your conference.