This e-mail is being sent as part of a temporary series of messages to deliver Zika-related information during peak mosquito season in Indian Country. 
July 28, 2017
MYTHZika Myth of the Week
Myth : I should spray repellent as often as possible to prevent against Zika.

This is a myth and is not correct!

Truth : Using an insect repellent when you are outside is an excellent way to prevent Zika. It is important to use repellents which are registered with the Environmental Protection Agency (EPA). You can find more information about EPA-registered repellent  HERE  and 
However, spraying insect repellent as often as possible is NOT a good idea. Repellent should be applied according to the instructions on the label. Although repellents are safe when used as directed, applying the repellent too often or incorrectly can be harmful. For a repellent to be safe and effective, it needs to be used correctly. 

Help is available if you ever have concerns that you used too much repellent or used it incorrectly. For example, maybe you accidentally sprayed the repellent into your mouth or eyes, or your child swallowed some repellent. You can call Poison Control at 
800-222-1222 for free, confidential help at any time of day or night.
Zika 101Zika101

Learn the TOP FIVE things everyone should know about Zika  HERE
NIHB Resources
Learn more about Tribal Zika Response and Planning at the NIHB Zika Hub

NIHB main website can be accessed HERE

Have questions? Need assistance? Click here to email NIHB staff 

In This Newsletter

INSECTUsing Insect Repellents Safely & Effectively
Using insect repellents is a recommended way to prevent Zika transmission. Since Zika is most commonly spread by mosquitoes - although it's also important to know about
the other types of transmission  - preventing bites is a very important way to prevent the virus from spreading. This can help protect you, your family, and your community. 
Example of using repellents safely: repellent should be sprayed into the parent's hands and then applied to the child's face.
Image courtesy of CDC 

First, it's important to make sure the repellent you select is registered with the Environmental Protection Agency (EPA). You can find more information about these registered products  HERE and  HERE
Safety and usage tips from the EPA can help you use repellents right! This includes the following guidelines: 
  • Follow all label instructions
  • Use repellents on exposed skin and clothing, never UNDER the clothing
  • Do NOT use repellents near eyes and mouth, and use only a small amount around the ears
  • Do NOT use repellents on cuts, wounds, or irritated skin
  • Do NOT spray directly on face - spray on hands and apply to face
  • Do NOT spray in enclosed areas, and avoid breathing in spray
  • Do NOT use near food
  • Some products are flammable and should NOT be used around open flames or cigarettes - see label
  • Do not use on animals unless label says this is okay
  • Keep products away from children - for example, store repellents in a locked cabinet or shed
  • Do NOT apply to children's hands, because children may put hands in mouth or eyes
  • Wash children's skin and clothes with soap and water when returning home
  • Be careful to use the right amount of product - too much may be harmful and too little may be ineffective! 
  • Most repellents are safe for young children, but do NOT use oil of lemon eucalyptus products on children under age three (3)
EPA information about using repellents is available  HERE
TRAVIS Travis' Story: Mistakes with Mosquito Repellent
The National Pesticide Information Center (NPIC) shares the story of a man named Travis. Travis went on a trip to California and was concerned about catching diseases spread by mosquitoes, such as Zika. He sprayed on repellent every morning and reapplied every few hours. Sometimes, he sprayed on the repellent before getting dressed and the repellent was all over his body, under his clothes. After two weeks, Travis realized his skin was itchy and tingling. After almost three weeks, Travis' skin started developing sores and blisters. 
Travis looked online and realized that his skin problems may be related to his repellent usage. He called NPIC and a specialist told him that he was overexposed because he had used the repellent under his clothes, and more often than necessary. Why did Travis make this mistake? He didn't read the entire label on his repellent bottle and didn't use the repellent correctly. 
Overexposure can cause a variety of health problems. However, underexposure, or using too little repellent, may not provide effective protection. It's always important to read the label and follow instructions. 
Travis' story is posted  HERE

Check out other NPIC information and resources  HERE
For help with concerns about overexposure or other possible misuse of insect repellents or other substances, free and confidential help is available at any time of day or night. Contact Poison Control at 800-222-1222 or learn more  HERE
Zika News
whoshouldbetestedWho Should be Tested for Zika? CDC Releases Updated Recommendations for Pregnant Women

Image courtesy of CDC

This week, CDC released updated Zika testing guidelines for pregnant women. This information is intended to help healthcare providers determine whether patients need to be tested for Zika. Guidelines also include other testing details. 

The updated guidance no longer recommends routine testing for pregnant women who do not have Zika symptoms if they were potentially exposed to Zika but were not exposed on an  ongoing basis.  It's important to understand this 
change does NOT mean that Zika exposure is no longer dangerous for pregnant women. Zika's effects are still just as devastating to unborn babies. 
So why the change? One reason for changing test recommendations is due to the concern of 
false positive results. A false positive result means that the test incorrectly shows that a person was infected with Zika when there was actually no infection. A perfect test would give a positive result to everyone who has the disease and a negative result to everyone who does not have the disease. In reality, any test may mistakenly show that a healthy or uninfected person has a disease (this is a false positive ) or may mistakenly show that a sick or infected person does not have a disease (this is a false negative ). A true positive or true negative result is a test result that accurately reflects whether a person actually has the illness. The image below is NOT specific to Zika, but helps to show how false negatives and positives work. 

Image courtesy of CDC

For Zika, the likelihood of false positives is increasing. As shown in the image above, as a disease becomes less common, there is an increase in the percentage of false positives among all positive test results. The benefits of testing may also decrease because fewer true positives in the community are identified. Further, e ven if a Zika test correctly shows positive results, the test cannot tell doctors when the infection occurred. The Zika exposure may have been so far in the past that the virus could not have affected the pregnancy. 

False positives can cause unnecessary stress and anxiety, lead to unnecessary additional lab work or medical care, and influence women's personal or medical decisions based on incorrect or incomplete information. This can also happen for true positives if the test cannot show when the woman was infected.  This means that Zika testing can cause families to worry even when there is no actual cause for concern.  In other words, a Zika test may not be recommended routinely because it may not help a woman make better, more informed decisions. 

Read the updated CDC guidelines  HERE - but please keep in mind that this guidance contains clinical jargon and is intended to advise clinical healthcare providers on Zika testing for pregnant women. 

R ead a Washington Post article summarizing and discussing the recommendations HERE

General CDC testing guidance is found  HERE and  CDC has patient flyers to help explain who should be tested:
To learn more about false negatives and false positives in general, click  HERE  or watch a video  HERE

TEXASTexas Officials Report Possible Local Transmission
Earlier this week, Texas authorities reported a suspected case of local mosquito-borne Zika transmission in Hidalgo County. It is believed that this case was transmitted locally by a mosquito within the last several months because the patient has no known exposure to Zika through travel or sexual activity. If this is correct, this would be the first case of local transmission this year in the United States. This person is no longer able to transmit Zika virus; however, this is a reminder of the importance of being prepared for the possibility of local Zika transmission. 

Read a New York Times article, published this week, about this case  HERE 

Read the announcement on the Texas Health and Human Services website  HERE
Funding Opportunity
ZikaAwardsTribal Zika Response and Planning Mini Awards
Planning to apply for one of NIHB's Tribal Zika Response and Planning Mini Awards ? Don't forget to submit your application by today's deadline. Applications are due TODAY, JULY 28 at 11:59 PM
 Webinars, Trainings, Events
TRAININGSNo new trainings this week, but check out the NIHB Zika webinars and archive HERE

If there are topics you would like to learn more about in the future, please email NIHB HERE