BACKGROUND: Emerging infections pose preparedness challenges. In 2014, due to the emergence of chikungunya in the Americas, epidemiologists at the Georgia Department of Public Health (DPH) created guidance documents for public health staff to respond to clinical inquiries. In 2015, Zika virus became a concern for US travelers, especially pregnant women. In December 2015, DPH adapted existing chikungunya guidance documents for Zika response. By January 2016, a database was created and interim guidance disseminated to public health staff in anticipation of suspect Zika cases in Georgia. Important lessons on the need for complete documentation were learned from the 2014 and 2015 Chikungunya and Ebola responses.
METHODS: The DPH 2014 chikungunya guidance documents were updated to reflect Zika-specific protocols and documents were disseminated to public health staff. Five epidemiologists at DPH were immediately trained to triage Zika calls, and secure temporary systems were put into place to document all Zika-related calls and to track patient data for suspect cases until a permanent system could be established. In August 2016 the 2014 Ebola Active Monitoring System in the State Electronic Notifiable Disease Surveillance System (SendSS) was used as a template for the Zika Active Monitoring System (ZAMS). All established data were imported into ZAMS including patient demographics, travel history, clinical information, and laboratory results, all shared securely between state and local public health.
RESULTS: The first travel-related Zika infection in Georgia was identified in early January. Between January 26, 2016 and December 30, 2016, DPH Epidemiology has triaged over 5,000 Zika-related inquires, of which 2,087 were clinical inquiries resulting in 1,405 patients tested--all tracked in ZAMS. The single ZAMS system allows state staff to take on the burden of patient triage for many of the health districts in Georgia while allowing District Epidemiologists to monitor situations in their district in real time. District staff still performing their own triage use ZAMS as their primary system for tracking Zika suspect cases.
CONCLUSIONS: The adaptation of existing documents allowed for a rapid response to a new emerging infection. By creating and disseminating information early, public health staff were better prepared to handle information requests and clinical inquiry calls. Centralized electronic tracking of case patients in ZAMS allowed DPH to respond rapidly to inquiries for additional information requested by physicians, patients, and other stakeholders and to use resources efficiently. Institutional knowledge and building upon lessons learned can improve preparedness and response to emerging infectious diseases.