Talking Points: Zika Virus (Updated March 10, 2017)

Talking Points – Zika Virus

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The following Talking Points can be used in conversations with the media and customers when discussing Zika, a mosquito borne virus. (Updated March 10, 2017)
1. The Centers for Disease Control and Prevention (CDC) is warning women who are pregnant not to travel to destinations where Zika is spread by mosquitoes, but it does not advise against travel for any others. Instead, it advises all other travelers to “practice enhanced precautions” in preventing mosquito bites.
2. While Zika does not pose a major threat to most people, there are precautions all travelers can take to minimize their risk of being bitten by an infected mosquito. There are also precautions bitten travelers should take after they’ve returned home.
3. We provide the facts so our clients can make an informed decision about their travel plans.
Below you will find additional information, supporting material and statistics to help further illustrate each talking point.
1. The Centers for Disease Control and Prevention (CDC) is warning women who are pregnant not to travel to destinations where Zika is spread by mosquitoes, but it does not advise against travel for any others. Instead, it advises all other travelers to “practice enhanced precautions” in preventing mosquito bites.
• On March 10, 2017, the CDC issued new Travel Alerts for several countries in Africa, South Asia and Oceania, as well as updating their Zika Travel Alerts for numerous countries.
o Zika has been found to have been locally transmitted in the Solomon Islands, Maldives, Guinea-Bissau, and Angola.
o Angola and Guinea-Bissau were recently considered to have endemic Zika. However, the rate of transmission means that it is now considered to be an epidemic. • On November 18, 2016, the World Health Organization (WHO) Emergency Committee (EC) on Zika met, and “The Director-General accepted the recommendations of the EC and declared the end of the Public Health Emergency of International Concern (PHEIC). However, Zika virus and associated consequences remains a significant enduring public health challenge.” • The CDC “has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries and U.S. territories where Zika virus transmission by mosquito is ongoing. The alert includes: o Singapore and Maldives in Asia; o Anguilla, Antigua and Barbuda, Aruba, The Bahamas, Barbados, Bonaire, British Virgin Islands, Cayman Islands, Cuba, Curacao, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Montserrat, the Commonwealth of Puerto Rico (a US territory), Saba, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Eustatius, Sint Maarten, Trinidad and Tobago, Turks and Caicos Islands, and the US Virgin Islands in the Caribbean;
o Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama in Central America; o American Samoa, Fiji, Marshall Islands, Micronesia, New Caledonia, Palau, Papua New Guinea, Samoa, Solomon Islands and Tonga in the Pacific Islands; o Argentina, Bolivia, Brazil, Columbia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela in South America; o Angola, Guinea-Bissau and Cape Verde in Africa; and Mexico in North America. • On September 29, the CDC issued a more nuanced advisory for Southeast Asia for the following countries Brunei, Burma (Myanmar), Cambodia, Indonesia, Laos, Malaysia, Maldives, Philippines, Thailand, Timor-Leste (East Timor) and Vietnam, stating: o “Zika virus has been present in areas of Southeast Asia for many years, and several countries have reported occasional cases or small outbreaks of Zika virus infections. Zika virus is considered endemic in some countries, and a large number of local residents are likely to be immune. However, US travelers to endemic areas may not be immune to Zika virus and infections have occurred among travelers to Southeast Asia. Recent variations have been observed in the number of cases reported in Southeast Asia. This can reflect changes in awareness of Zika virus, surveillance and testing for Zika virus, or changes in intensity of Zika virus transmission. Pregnant women traveling to Southeast Asia could become infected with Zika virus. The level of this risk is unknown and likely lower than in areas where Zika virus is newly introduced and spreading widely.” o “Travelers have returned from certain areas of Southeast Asia with Zika virus infection. While our understanding of the complications of Zika virus infection continues to evolve, and pending broader international surveillance efforts for Zika virus infection, we are providing pregnant women and their partners updated recommendations on reducing their risk for travel related Zika virus infection. CDC recommends pregnant women should consider postponing nonessential travel to Southeast Asia countries with reports of Zika virus infection from local transmission or related to travel to those countries, and those countries with adjacent borders where limited information is available to fully evaluate risk of Zika virus infection.” o “The recommendations for testing vary according to whether exposure occurred in an area where Zika virus has been newly introduced and is spreading widely or in an area with endemic Zika virus transmission. Dengue and Japanese encephalitis viruses circulate widely in Southeast Asia and might cause false positive results in blood tests. Because of this and related testing factors, routine serologic testing of asymptomatic pregnant women who have traveled to areas of Southeast Asia without epidemic Zika virus transmission is not recommended. For more information, please visit the Clinical Guidance for Healthcare Providers Caring for Pregnant Women webpage.” • The CDC also notes that African countries Angola. Benin, Burkina-Faso, Cameroon, Central African Republic, Côte d’Ivoire, Egypt, Ethiopia, Gabon, Guinea-Bissau, Kenya, Liberia, Mali, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Tanzania, Togo, Uganda and Zambia; Asian countries Bangladesh, India and Pakistan; and Pacific Islands Easter Island and Vanuatu have endemic Zika. Travel notices have not been issued for these destinations but would be considered if the number of cases rises to the level of an outbreak.
• For pregnant women or women trying to become pregnant, the CDC offers the follow recommendations: o “A pregnant woman can pass Zika virus to her fetus. Infection during pregnancy can cause serious birth defects. CDC recommends special precautions for the following groups: ▪ Women who are pregnant:
▪ Should not travel to destinations where Zika has been locally transmitted by mosquitoes (exceptions are parts of the following countries where elevation exceeds 6,500 feet, including Argentina, Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Papua New Guinea, Peru, Venezuela.
▪ If you must travel, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.
▪ If you have a partner who lives in or has traveled to an area where Zika transmission is ongoing, either use condoms or do not have sex during your pregnancy. ▪ Women who are trying to become pregnant: • Before you or your partner travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection. • See CDC guidance for how long you should wait to get pregnant after travel to the destinations where Zika is locally transmitted by mosquitoes. • You and your partner should strictly follow steps to prevent mosquito bites. ▪ People who have traveled to the destinations and have a pregnant partner should use condoms or not have sex during the pregnancy.
• The CDC reports, “Public health officials have reported that mosquitoes in each of the countries identified below are infected with Zika virus and are spreading it to people (Text PLAN to 855-255-5606 to receive Zika updates for your destination)”:
o Asia
▪ Currently includes: Singapore and Maldives
o Africa
▪ Angola, Cape Verde, Guinea-Bissau
o Mexico ▪ The CDC advises that “Women who are pregnant should not travel to any area of Mexico below 6,500 feet. See map. ▪ As of March 10, 2017, there have been 8,113 confirmed locally-transmitted cases of Zika. ▪ As of March 10, 2017, 25 of Mexico’s 31 states have locally-transmitted cases of Zika, including 1,869 in Veracruz, 1,195 in Yucatán, 805 in Guerrero, 790 in Nuevo Leon, 773 in Chiapas, 492 in Oaxaca, 367 in Quintana Roo (home to Cancun, Playa del Carmen and Riviera Maya), 306 in Tabasco, 280 in Colima, 305 in Morelos, 193 in Hidalgo, 117 in
Puebla, 104 in Tamaulipas, 91 in Jalisco, 86 in Campeche, 65 in Sinaloa, 64 in Nayarit, 62 in Coahuila, 61 in Michoacán, 36 in San Luis Potosi, 24 in Sonora, and one each in the states of Aguascalientes and Zacatecas, according to the Secretaria de Salud. ▪ 367 cases of locally-transmitted cases of Zika by mosquito have been reported in Quintana Roo, which includes Cancun, Playa del Carmen and the Riviera Maya. ▪ There are 4,643 cases in Mexico of pregnant mothers infected with Zika.
▪ “Hotels, restaurants, airports, and other areas frequently visited by tourists have in place mosquito eradication practices and closely follow international guidelines to monitor and control their growth as much as possible,” according to Mexico Tourism.
o The Caribbean Currently includes: Anguilla; Antigua and Barbuda; Aruba; The Bahamas; Barbados; Bonaire; British Virgin Islands; Cayman Islands; Cuba; Curaçao; Dominica; Dominican Republic; Grenada; Guadeloupe; Haiti; Jamaica; Martinique; Montserrat; the Commonwealth of Puerto Rico, a US territory; Saba; Saint Barthelemy (St. Barts); Saint Kitts and Nevis; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Sint Eustatius; Sint Maarten; Trinidad and Tobago; Turks and Caicos; US Virgin Islands
o Central America Currently includes: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama
o The Pacific Islands Currently includes: American Samoa, Fiji, Marshall Islands, Micronesia (Kosrae) New Caledonia, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga
o South America Currently includes: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, Venezuela • “Because Zika virus is primarily spread by mosquitoes, CDC recommends that travelers to (each of the above countries) protect themselves from mosquito bites. The mosquitoes that spread Zika usually do not live at elevations above 6,500 feet (2,000 meters) because of environmental conditions. Travelers whose itineraries are limited to areas above this elevation are at minimal risk of getting Zika from a mosquito.” The CDC continues: o Sexual transmission of Zika virus is also possible, so you should use condoms or not have sex during your trip. o Many people infected with Zika virus do not get sick. Among those who do develop symptoms, sickness is usually mild, with symptoms that last for several days to a week. Guillain-Barré syndrome (GBS) is a rare disorder that can cause muscle weakness and paralysis for a few weeks to several months. CDC research suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS. Most people fully recover from GBS, but some have permanent damage. For more information, see Zika and GBS. o As more information becomes available, this travel notice will be updated. Please check back frequently for the most up-to-date recommendations.
• “Outbreaks (of Zika) have occurred in parts of Africa, Southeast Asia and the Pacific Islands. In May 2015, Brazil reported the first outbreak of Zika virus in the Americas,” according to the CDC.
o A full list of countries that have past or current evidence of Zika virus transmission can be found here.
• A number of travel suppliers have been providing waivers to travelers seeking to cancel or change plans:
o Airlines – “All three of the USA’s biggest airlines are allowing some customers to cancel or postpone their trips if they’re ticketed to fly to areas affected by Zika. American, United and Delta each made the move this week amid rising concerns about the mosquito-borne virus,” reported USA Today. ▪ “American Airlines will refund pregnant customers with a doctor’s note and their traveling companions when traveling to Aruba, Barbados, Belize, Bolivia, Brazil, Colombia, Costa Rica, Curacao, Dominican Republic, Ecuador, El Salvador, Guadeloupe, Guatemala, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Puerto Rico, Saint Martin, U.S. Virgin Islands, and Venezuela.” For complete information, please go here.
▪ Delta customers with current reservations who are concerned about travelling to destinations reported by the CDC to be affected by Zika should call 800-221-1212 (U.S.) or their local Reservations office and speak with a Delta Representative. Customers may qualify for a change to alternate destinations, travel dates or a refund. For more on Delta, please go here. ▪ On United Airlines, “Customers may change their destination or travel date without a change fee or may choose to receive a refund, if their ticket was issued on or before February 29, 2016. The new travel date must be within the validity of the ticket, and additional charges may apply if there is a difference in fare for the new itinerary.” For complete information, please go here. o Cruise Lines ▪ Cruise lines’ policies in regards to Zika are highly variable, and often made on a case-by-case basis. It is recommended that travel agents keep in close contact with their traveler’s chosen cruise line in order to best communicate the right information. o Insurance Companies (A list of many insurance companies’ policies may be found here)
▪ AIG Travel Guard – “As a general matter, under our U.S. policies: Trip Cancellation for concern or fear of travel associated with sickness, epidemic, or pandemic is not covered. Travelers, who contract Zika before traveling, but after purchase of the policy, could be covered for Trip Cancellation benefits. Travelers who purchased Cancel for Any Reason coverage could be entitled to a percentage of their loss, depending on the level of CFAR coverage purchased – please refer to your description of coverage for details. Travelers who contracts Zika while on a covered trip, could be covered for Medical and Trip Interruption/Curtailment benefits if there is a confirmed diagnosis. To learn about the details of coverage for your trip, please remember to refer to your travel insurance plan’s description of coverage. If you are a
customer and have outstanding questions about coverage, please contact our 24/7 call center at 1-800-826-1300. If you are a travel agent or client partner, please call your Travel Guard sales manager.” ▪ Allianz – “The Zika virus has caused concern for travelers headed to affected countries in Latin America and the Caribbean.…. If the customer’s travel supplier allows them to change the dates of their trip, they may also change the dates on their travel insurance policy… The Zika virus became a known event on January 19, 2016. Customers who purchased travel insurance may be eligible for one or more of the following benefits depending on the product they purchased: (1) Should a customer become ill while traveling, coverage for Emergency Medical/Dental expenses and Emergency Medical Transportation may be available. (2) If a customer’s travel insurance policy includes normal pregnancy as a “covered reason” for trip cancellation, customers who became pregnant after the effective date of the policy may be eligible to receive reimbursement for their pre-paid, non-refundable travel deposits if they choose to cancel their trip. (3) Customers who purchased our Cancel Anytime product and meet the requirements of coverage for their product may cancel their trip for almost any unforeseen reason and receive reimbursement for a portion of their non-refundable travel deposits.”
▪ Travelex – “Currently, Travelex Insurance Services’ protection plans are not impacted by these travel alerts. Counties in these regions continue to be eligible destinations. However, should a traveler become ill with the Zika virus, coverage may be available for emergency medical assistance* and expenses, Emergency Medical Evacuation, Trip Cancellation or Trip Interruption. Some travelers may prefer to cancel their trip out of concern for the Zika virus. Plans with Cancel for Any Reason Coverage allow travelers to decide for themselves whether to travel or cancel their trip. Please be aware that the trip must be canceled no less than 2 days prior to the scheduled trip departure date. Please refer to your plan documents regarding eligibility and for full details.” ▪ Travel Insured – “Plans and the coverage available are not impacted by this travel alert. Countries in these regions continue to be eligible destinations. Should travelers become ill with the Zika virus while traveling, coverage may be available for Emergency Medical, Medical Evacuation, Trip Cancellation, or Trip Interruption. Some travelers may prefer to cancel their trip out of concern for the Zika virus. Plans with Cancel For Any Reason Coverage allow travelers to decide for themselves whether to travel or cancel their trip. Please be aware that to qualify for Cancel For Any Reason coverage, the plan must be purchased within 14 days of the initial trip deposit date and the latest opportunity to use the Cancel For Any Reason benefit is 2 days prior to the trip departure. Please refer to all plan documents for complete details of your coverage.” o Tour Operators ▪ “Classic Vacations’ senior director of business operations, Denis Fastert, said the company had not yet seen any decrease in bookings specifically related to Zika but that for clients who don’t have travel insurance, the company will work with air and hotel partners to try to waive cancellation fees, refund as much as possible or offer to rebook them,” Travel Weekly reported.
▪ Funjet Charter Air and Value Flights – “For pregnant women and their traveling companions that want to change their plans, Funjet requires that the traveler provide documentation from their doctor. Travelers can make changes to any existing reservation without fee or penalty from Funjet, but may be required to pay any increase in vacation package cost incurred from that change. If the affected customer and traveling companion requests a cancellation of the reservation, Funjet will provide a travel credit equal to the amount of the cancellation fees. Standard Funjet travel window requirements apply for all travel credits.” Funjet Scheduled Air – “Many air carriers have begun to issue waivers for travel to affected regions including American Airlines, Delta Airlines, Southwest Airlines, Alaska Airlines, Virgin America, and Copa Airlines. Please note the list of airlines issuing waivers may change so please be sure to click here for the most up-to-date information, including specific airline requirements for cancellation. For pregnant women and their traveling companions that want to change their travel plans, air carriers will likely require similar documentation from their doctor. Funjet will waive all reservation change fees but must honor all scheduled airline and hotel policies. Please know that we will make every effort to reduce or eliminate any hotel cancellation penalties.” ▪ “Pleasant Holidays had received some requests last week to change travel plans based on the CDC’s Zika advisory, and the company said it waived its change and cancellation fees for those customers and is prepared to do the same for others,” Travel Weekly reported.
2. While Zika does not pose a major threat to most people, there are precautions all travelers can take to minimize their risk of being bitten by an infected mosquito. There are also precautions bitten travelers should take after they’ve returned home.
• According to CDC Director Tom Frieden, apart from pregnant women, the Zika virus is not a major threat to the rest of the population. In testimony before Congress on February 10, 2016, Frieden said:
o Approximately 80% of the people who contract the virus will have no symptoms at all.
o The rest will only have mild symptoms.
o The virus remains in infected people’s blood for about a week.
• While there is no vaccine or medication to prevent Zika, the CDC offers some tips to travelers on avoiding mosquito bites and what to do if you get bitten:
o What can travelers do to prevent Zika? There is no vaccine or medicine for Zika. You can protect yourself by preventing mosquito bites: ▪ Cover exposed skin by wearing long-sleeved shirts and long pants. ▪ Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE, also called para-menthane-diol [PMD]), IR3535, or 2-undecanone (methyl nonyl ketone). Always use as directed. ▪ Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label. ▪ Most repellents, including DEET, can be used on children older than 2 months. (OLE should not be used on children younger than 3 years.)
▪ Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself. ▪ Stay in places with air conditioning and window and door screens to keep mosquitoes outside. ▪ Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors. ▪ Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs to protect them from mosquito bites. ▪ Because Zika can be spread by sex, if you have sex (vaginal, anal, or oral) while traveling, you should use condoms. o After travel: ▪ Many people infected with Zika virus do not feel sick. If a mosquito bites an infected person while the virus is still in that person’s blood, it can spread the virus by biting another person. If you travel to (countries with locally confirmed cases of Zika, you should take steps to prevent mosquito bites for 3 weeks after your trip, even if you don’t feel sick, so that you don’t spread Zika to uninfected mosquitoes that can spread the virus to other people. ▪ If you have visited an infected area and have a pregnant partner, you should either use condoms or not have sex during the pregnancy. ▪ If you are thinking about pregnancy, talk with your health care provider and wait to become pregnant (see “Women Trying to Become Pregnant” for how long to wait). You also should use condoms after travel to protect your sex partners from Zika even if you are not pregnant or trying to become pregnant. ▪ For more information, see Zika and Sexual Transmission. If you feel sick and think you may have Zika: ▪ Talk to your doctor if you develop a fever with a rash, joint pain, or red eyes. Tell him or her about your travel. ▪ Take acetaminophen (paracetamol) to relieve fever and pain. Do not take aspirin, products containing aspirin, or other nonsteroidal anti-inflammatory drugs, such as ibuprofen. ▪ Get lots of rest and drink plenty of liquids. If you are pregnant: ▪ Talk to a doctor or other health care provider after your trip, even if you don’t feel sick. Pregnant travelers returning from an infected area, or who have had possible sexual exposure, should be offered testing for Zika virus infection. ▪ If you develop a fever with a rash, joint pain, or red eyes, talk to your doctor immediately and tell him or her about your travel or possible sexual exposure. ▪ If you do not have symptoms, testing should be offered if you see a health care provider, up to 12 weeks after you return from travel or your last possible sexual exposure.
• The CDC has updated its recommendations for avoiding the transmission of Zika sexually here. • For women who are thinking about pregnancy and have traveled to an area where mosquito-borne Zika is prevalent, the CDC offers guidance here and advises they wait at least 8 weeks before trying to get pregnant.
3. We provide the facts so our clients can make an informed decision about their travel plans.
• We closely monitor the U.S. Department of State and Centers for Disease Control (CDC) for travel alerts as well as the more severe travel warnings for all destinations, including those that are most popular with our clients.
o Should we become aware of an issue for a specific destination, we alert clients who may be planning to travel there so they can determine for themselves if they still wish to travel.
o We would not send our clients to a particular destination if we believe it to be unsafe. Should we become aware of an issue for a specific destination, we alert clients who may be planning to travel there and provide detailed information on the situation so they can make informed decisions for themselves if they still wish to travel.
o Also, should we become aware of an issue for a specific destination where a client is currently located; we try to immediately contact the client to check on their well-being and work to assist them if they require an alternate travel arrangement.
• We strongly encourage all of our clients, whether they are traveling domestically or internationally, to purchase travel insurance, particularly right at the same time as travel has been booked. Travel insurance offers an additional layer of protection for travelers and can potentially help save a traveler hundreds or thousands of dollars if a medical or travel emergency occurs. Most insurance companies provide special policies that allow travelers to “cancel for any reason.”
• We are advocates for our clients; and they know that by working with a true travel professional, we are there for them before, during, and after their trip should they need us – which gives them peace of mind.
o By working with a trusted travel professional, we can provide providing alternative travel arrangements should the need arise.
o Our business is founded on repeat customers. Therefore, we want to be sure everything goes off without a hitch.