Zika Virus Awareness and Prevention Practices Among University Students in Miami: 2016.

In January 2016, the first case of mosquito-borne Zika infection in the mainland United States was confirmed in Miami, Florida. The first locally acquired case was reported 6 months later. Local public health and school officials began warning students of the outbreak on their return to the classroom in August 2016. In November-December 2016, we conducted a survey of students attending a large public university in Miami to determine how well informed they were about Zika. A multistage sampling design was used to contact teaching assistants and ask them for help in recruiting their students. Eligible students had to be 18 years of age or older and enrolled in at least one three-credit course during fall semester. A 25-item questionnaire based on the World Health Organization Zika Knowledge, Attitudes, and Practice Resource Pack was developed, pretested, and approved by the university's institutional review board before it was made available to eligible students through Blackboard Learn or a survey link. About half (50.4%) of the 139 respondents had heard about Zika prior to 2016. Only one student was unaware of Zika before our survey. Most (47.1%) first learned about Zika through television, 18.8% from family or friends, and 15.2% from the Internet, social media, or university e-mail. Two thirds (66.2%) believed Zika could be prevented, 15.1% thought it might be prevented, and 85.7% had taken some precautions. A high level of awareness of the risk of Zika infection was apparent. Most students reported taking steps to avoid exposure to the Zika virus.

Epidemiology of Pediatric Zika Virus Infections.

BACKGROUND AND OBJECTIVE: In July 2016, local transmission of Zika virus (ZIKV) was announced in Miami-Dade County, Florida. In this report, we describe the epidemiology of pediatric ZIKV infections in locally acquired and travel-associated cases. METHODS: All children aged 1 to 17 years tested for ZIKV between October 1, 2015, and March 29, 2017, were included. SAS 9.4 was used to analyze age, sex, race and/or ethnicity, origin of exposure, onset date, affiliation with a household cluster, clinical symptoms, hospitalizations, viremia, viruria, and antibody detection in specimens. RESULTS: Among 478 confirmed ZIKV cases in Miami-Dade County, 33 (6.9%) occurred in children (1-17 years). Twenty-seven (82.3%) cases were travel-associated. The median age of a pediatric Zika case patient was 11 years. Seventeen (51.5%) case patients were boys, and 23 (69.9%) were Hispanic. Among 31 symptomatic cases, all reported having rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.6%) reported arthralgia. Sixteen (48.5%) cases reported 2 of 4 and 8 (24.2%) reported 3 of 4 main symptoms. CONCLUSIONS: This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.

Frequency and erroneous usage of temporary medical exemptions and knowledge of immunization guidelines among some Miami-Dade County Florida providers.

OBJECTIVE: We assessed knowledge and practices regarding immunization guidelines and the Florida Certificate of Immunization (DH-680) based on FL-DOH and CDC recommendations, to identify the cause of the increasing number of erroneously issued temporary medical exemptions (TME) among selected health care providers in Miami-Dade County Florida. METHODOLOGY: After reviewing immunization certificates from all public schools, a list of physicians who improperly issued 3 or more TMEs, defined as one given to a child who was up to date for their kindergarten and seventh grade requirements, was compiled. The DOH-Miami-Dade developed educational materials and questionnaires, and conducted face-to-face interviews and interventions during site visits to these providers (n=134). Data was analyzed using SAS 9.2. RESULTS: Of the 104 questionnaires completed, 4 (3.85%) had correct answers to all 10 vaccine knowledge and practice related questions, while 10 (9.62%) had 7 or more incorrect answers. Frequently missed questions included: the required doses of varicella vaccine for seventh grade students entering the 2011-12 school year (86, 82.7%) and the proper scenario for issuing a TME (57, 54.8%). CONCLUSIONS: In order to eliminate the improper use of TMEs, long-term efforts are needed to provide immunization-related educational materials and trainings to the medical community regarding vaccinations. These findings also suggest a need for enhanced explanation in multiple languages on the current Florida Immunization Certificate. Due to enhanced surveillance and education, the number of TMEs for kindergarten and seventh grade students was reduced by 12% and 4.9%, respectively, during the 2011 and 2012 school year.