The Texas Department of State Health Services (DSHS) and Cameron County Department of Health and Human Services announced the first case of Zika virus disease likely transmitted by a mosquito in Texas. DSHS is supporting Cameron County's response to the case and to the ongoing risk of Zika in the community.
DSHS is again asking health care professionals to consider Zika virus infection in their patients and order the appropriate testing. DSHS recommends testing all pregnant women who have traveled to areas with active Zika transmission during their pregnancy. DSHS also recommends testing pregnant women who have two or more of the typical Zika symptoms in Cameron, Hidalgo, Starr, Webb, Willacy, or Zapata counties without travel history, and anyone with at least three symptoms statewide. Physicians can find additional information at www.texaszika.org/healthcareprof.htm.
The patient is a Cameron County resident who is not pregnant and who was confirmed last week by lab test to have been infected. She reported no recent travel to Mexico or anywhere else with ongoing Zika virus transmission and no other risk factors. Laboratory testing found genetic material from the Zika virus in the patient's urine, but a blood test was negative, indicating that the virus can no longer be spread from her by a mosquito. There are no other cases of suspected local transmission at this time, but health officials continue to conduct disease surveillance activities as part of the state's ongoing Zika response.
"We knew it was only a matter of time before we saw a Zika case spread by a mosquito in Texas," said John Hellerstedt, MD, DSHS commissioner. "We still don't believe the virus will become widespread in Texas, but there could be more cases, so people need to protect themselves from mosquito bites, especially in parts of the state that stay relatively warm in the fall and winter."
Cameron County, DSHS, and the Centers for Disease Control and Prevention are working together to investigate and respond to the case. Further investigation will be necessary to attempt to pinpoint how and where the infection occurred, and health officials are also responding in a number of other ways. DSHS has activated the State Medical Operations Center to support the response and is providing expertise, personnel, and equipment for activities from disease investigation to mosquito surveillance to public education.
With DSHS support, Cameron County and the City of Brownsville have conducted an environmental assessment at the patient's home and have been trapping and testing mosquitoes to learn more about activity in the area. Brownsville has recently sprayed for mosquitoes in the area and will continue to take action to reduce the mosquito population.
Due to the risk of birth defects associated with Zika, pregnant women should avoid traveling to Mexico and should avoid sexual contact or use condoms with partners who have traveled there. Other precautions include:
- Using Environmental Protection Agency-approved insect repellent.
- Wearing long pants and long-sleeved shirts that cover exposed skin.
- Using air conditioning or window and door screens that are in good repair to keep mosquitoes out of homes.
- Removing standing water in and around homes, including water in trash cans, toys, tires, flower pots, and any other container that can hold water.
Zika virus is transmitted to people primarily through the bite of an infected mosquito, though sexual transmission can occur. The four most common symptoms are fever, itchy rash, joint pain, and eye redness. While symptoms are usually minor, Zika can also cause severe birth defects, including microcephaly and other poor birth outcomes in some women infected during pregnancy.
Texas has had 257 confirmed cases of Zika virus disease. Until now, all cases had been associated with travel, including two infants born to women who had traveled during their pregnancy and two people who had sexual contact with infected travelers.
In response to the possible local transmission of Zika and risk to the local community, the Texas Health and Human Services Commission (HHSC) is reinstating the Medicaid benefit for mosquito repellent due to the first reported case of Zika virus disease likely transmitted by a mosquito in Texas.
Texas quickly made the decision to bring back the benefit, which had ended Oct. 31, given the possibility of local transmission and risk of Zika in the local community. The benefit began Nov. 29 and will be in place through December, as the state collects more information about the case and scope of transmission in Texas.
"We will do all that we can to protect Texans and slow the spread of the Zika virus," said HHSC Executive Commissioner Charles Smith. "Insect repellent is the best way to protect yourself, and we want it to be widely available."
Eligible Texas women can go to participating pharmacies to pick up mosquito repellent, as Texas Medicaid has a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant. The benefit includes two cans per month per eligible beneficiary. Women are encouraged to call the pharmacy ahead of time because supply can vary by location.
Women eligible for the Medicaid, Children's Health Insurance Program (CHIP), and CHIP-Perinate programs are covered. Women covered under the Healthy Texas Women and Children with Special Health Care Needs programs also can receive the benefit.
The following Zika-related items also are covered under current Texas Medicaid benefits:
- Family planning services,
- Diagnostic testing,
- Targeted case management,
- Physical therapy,
- Long-term services and support,
- Acetaminophen and oral electrolytes for Zika symptoms, and
- Potential coverage for additional ultrasounds for pregnant women.
Additional information is available at www.texaszika.org.
Accountable care made big strides this year, and TMA has set the stage for members to get ahead of the curve while demystifying the paradigm shift. Applications are now open for TMA's 2017 Accountable Care Leadership Program. Participants will earn more than 95 hours of continuing medical education.
The makes it easier for physicians to succeed under future accountable care regulations. Past participants describe it as "the clearest information I've ever received on MACRA and MIPS" with "great insight into where health care is headed and how it will likely get there."
Over the course of 10 months, program participants learn about risk-based payment initiatives, clinic-based balanced scorecards, and the development of accountable care organizations (ACOs) and patient-centered medical homes. Strategies for effective negotiation, conflict management, and stakeholder reliance are also part of the curriculum.
ACOs across the nation have brought in more than $1.2 billion in Medicaid savings since 2012. Learn how you can add on to these savings and influence how value based care will affect your practice and your patients by joining TMA's Accountable Care Leadership Program.
Apply early as the 2017 leadership class will be limited to 30 participants. The application deadline is Jan. 6. For complete coursework details, program requirements, and participation fees, visit the TMA website.
Your patients and your profession need you to be a lobbyist for a day. Mark your calendar now to join the Party of Medicine in Austin for First Tuesdays at the Capitol during the 85th Texas Legislature on Feb. 7, March 7, April 4, and/or May 2, 2017. The March 7 event is designated the official TMA Alliance First Tuesday, and the April 4 event is dedicated to medical students and residents. Registration is now open.
TMA's comprehensive 2017 legislative agenda advocates what's best for patients and their physicians, from preserving physicians' right to bill for services to improving Medicaid payment rates and reducing red tape and hassles.
If you're traveling to Austin from out of town for First Tuesdays, reserve your room for the Monday before each event at the Doubletree Suites by Hilton Hotel by calling (800) 445-8667. Don't forget to mention you are attending TMA's First Tuesdays at the Capitol event for the special room block rate of $219 for February, March, and April and $209 for May. Hotel rooms in Austin are in demand during legislative sessions, so make your reservations now.
You also can reserve a room online, but make sure to enter the correct group code for your stay (February: FTC; March: TAT; April: CAP; and May: TUE). For more information or to register, visit the TMA website, or call (800) 880-1300, ext. 1363.