FactSheet Interim Guidance for Protecting Workers from Occupational Exposure to Zika

The Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) are monitoring the outbreak spreading through Central and , Mexico, and parts of the Caribbean, including U.S. territories. For the most up-to-date information, check the Centers for Disease Control and Prevention (CDC) Zika website frequently. Some U.S. states have mosquitoes that can become infected with and spread Zika virus, and travel- associated Zika virus infections in U.S. states may result in local spread of the virus. Visit the CDC Areas with Zika website to learn where there is current . Workers who are exposed on the job to mosquitoes or the blood or other body fluids of infected individuals may be at risk for occupationally acquired Zika virus infection. This interim guidance provides employers and workers with information and guidance on preventing occupational exposure to the Zika virus. The guidance may be updated as additional information becomes available.

Introduction Zika virus is primarily spread through the bites of infected mosquitoes. Mosquitoes can become infected when they bite infected persons and can then spread the Zika virus to other persons they subsequently bite. Zika virus historically has been found in Africa, , and the Pacific Islands. The first case was identified in the in in 1947.1 In 2015, cases of Zika virus infection emerged in the Americas and the Caribbean. Credit: CDC / James Gathany aegypti mosquitoes, like the one pictured, can become infected Zika virus has the potential to spread anywhere when they bite infected persons and can then spread the Zika virus to that mosquitoes capable of spreading this virus other persons they subsequently bite. are found. Aedes species mosquitoes are a principal (i.e., carrier) of Zika virus in the including dengue, yellow , , U.S. (commonly known as yellow , and West Nile. CDC fever mosquitoes) are typically concentrated provides information about surveillance of in the southern U.S. as well as parts of the Aedes mosquitoes in the U.S. Southwest. Another vector for Zika virus is Zika Virus Infection in Humans (commonly known as Asian Tiger mosquitoes), which are found in much of Current science-based evidence suggests that the southern and eastern part of the U.S. Aedes approximately one out of five infected people mosquitoes can also carry other , develops symptoms of Zika virus, usually beginning 2-7 days after the bite of an infected . Symptoms are usually mild and can 1. Hayes, Edward B. “Zika Virus Outside Africa,” Emerging Infectious Diseases, 15, 9, 1347–1350 (2009). last 2–7 days. The most common symptoms of Zika virus infection are fever, , joint pain Outdoor workers may be at the greatest risk of and red or pink eyes. Other symptoms include exposure to Zika virus. Some workers, including (muscle pain) and headache. These those working with to control symptoms are similar to those of mosquitoes and healthcare workers who may or chikungunya. Neurological and autoimmune be exposed to contaminated blood or other complications are infrequent but have been potentially infectious materials from individuals described in outbreaks in Polynesia and, more infected with Zika virus, may require additional recently, Brazil. protections (e.g., certain types of personal protective equipment, PPE). Employers must During the first week of infection, Zika virus comply with universal precautions for potential can be detected in the blood and is capable bloodborne pathogens (BBP) exposures, as of being spread from an infected person to a described in OSHA’s BBP standard (29 CFR mosquito that feeds on that person. Infected 1910.1030), and any applicable requirements in mosquitoes can then spread the virus to other OSHA’s PPE standards (29 CFR 1910 Subpart I), people through bites. In some instances, having among other OSHA requirements. direct contact with infectious blood or other body fluids (such as through sexual Consult the CDC Zika website for the most up-to- transmission) of an infected person may result in date information to help employers implement transmission of the virus. effective worker protections. Zika virus can be spread from a pregnant woman Outdoor workers to her fetus and has been linked to a serious Recommended employer actions: of the brain called in babies of mothers who had Zika virus while • Inform workers about their risks of exposure pregnant. Other problems have been detected to Zika virus through mosquito bites and train among fetuses and infants infected with Zika them how to protect themselves. Check the virus before birth, such as absent or poorly CDC Zika website to find Zika-affected areas. developed brain structures, defects of the eye, • Provide insect repellents and encourage their hearing deficits, and impaired growth. CDC use according to the guidance below. recommends special precautions for women • Provide workers with, and encourage them who are or may become pregnant. to wear, clothing that covers their hands, arms, legs, and other exposed skin. Consider Control and Prevention providing workers with hats with mosquito In areas affected by Zika virus transmission, netting to protect the face and neck. protect yourself and others from possible • In warm weather, encourage workers to exposure to Zika virus by always taking steps wear lightweight, loose-fitting clothing. This to prevent mosquito bites. There is no type of clothing protects workers against the to prevent Zika virus and there is no specific sun’s harmful rays and provides a barrier to treatment for individuals who become infected. mosquitoes. Always provide workers with adequate water, rest and shade, and monitor Although Zika virus is generally spread by the workers for of heat illness. bites of infected mosquitoes, exposure to an • Get rid of sources of standing water (e.g., infected person’s blood or other body fluids (such tires, buckets, cans, bottles, barrels) whenever as semen through sexual transmission) may possible to reduce or eliminate mosquito also result in transmission. Employers should breeding areas. Train workers about the train workers about their risks of exposure to importance of eliminating areas where Zika virus through mosquito bites and direct can breed at the worksite. contact with infectious blood and other body • If requested by a worker, consider reassigning fluids and how to protect themselves. Employers anyone who indicates she is or may become should also provide information about Zika virus pregnant, or who is male and has a sexual partner infection, including modes of transmission and who is or may become pregnant, to indoor possible links to birth defects, to workers who tasks to reduce their risk of mosquito bites. are pregnant or may become pregnant or whose sexual partners are or may become pregnant.

2 Recommended worker actions: it will protect against mosquito bites. For example, the more DEET a repellent contains, • Use insect repellents according to the the longer time it can protect you from guidance below. mosquito bites, with protection times ranging • Wear clothing that covers hands, arms, legs, and from 1 hour (4.75% DEET) to 5 hours (23.8% other exposed skin. Wear hats with mosquito DEET). Studies suggest that concentrations of netting to protect the face and neck. Wear socks DEET above approximately 50% do not offer that cover the ankles and lower legs. a marked increase in protection time against • In warm weather, wear lightweight, loose- mosquitoes; DEET efficacy tends to plateau at fitting clothing. This type of clothing protects a concentration of approximately 50%. workers against the sun’s harmful rays and • To avoid reaction to DEET or other ingredients provides a barrier to mosquitoes. Drink plenty in insect repellents, read and follow the of water, take rest breaks in shaded areas, and directions on all insect repellents before watch for signs and symptoms of heat illness, use. Spray () on including in coworkers. the outside of clothing, as it is possible for • Get rid of sources of standing water (e.g., mosquitoes to bite through thin clothing. tires, buckets, cans, bottles, barrels) whenever • Do NOT spray insect repellent on skin that is possible to reduce or eliminate mosquito under clothing. breeding areas. • Do NOT apply insect repellent to skin that is • Talk to your supervisor(s) about any outdoor already irritated, or to cuts/lacerations. work assignment(s) if you are or may become • Do NOT spray aerosol or pump products in pregnant, or, for males, if your sexual partner enclosed areas. Do NOT spray a pump or is or may become pregnant. Such workers aerosol product directly on the face. First should be familiar with CDC information on spray it on hands and then carefully spread Zika virus and . it on the face (do not allow insect repellent to • If symptoms develop, seek medical attention contact eyes or mouth). promptly. Discuss any possible exposure • After returning indoors and before eating, use to mosquitoes or infections spread by soap and water to wash skin that has been mosquitoes with a healthcare provider. treated with insect repellent. Reapply repellent Guidance on use of insect repellents for when returning outdoors or after eating. employers and workers: • Outdoor workers may need to use sunscreen in conjunction with insect repellent. Repellents • Always follow label precautions when using that are applied according to label instructions insect repellent. may be used with sunscreen with no reduction • Use insect repellent containing an EPA- in repellent activity. However, limited data show registered active ingredient. All of the a one-third decrease in the sun protection factor EPA-registered active ingredients have (SPF) of sunscreens when DEET-containing demonstrated repellency, but some provide insect repellents are used after a sunscreen longer-lasting protection than others. is applied. Products that combine sunscreen Research suggests that repellents containing and repellent are not recommended, because DEET (N,N-diethyl-m-toluamide) or picaridin sunscreen may need to be reapplied more (KBR 3023) typically provide longer-lasting often and in larger amounts than needed for protection than the other products, and oil the repellent component to provide protection of lemon eucalyptus (p-menthane-3,8-diol) from biting insects. The best option is to use provides longer-lasting protection than other separate products, applying sunscreen first and plant-based repellents. Permethrin is another then applying the repellent. Due to the decrease long-lasting repellent that is intended for in SPF when using a DEET-containing insect application to clothing and gear, but not repellent after applying sunscreen, users may directly to skin. need to reapply the sunscreen more frequently.2 • Choose a repellent that provides protection for the amount of time that you will be outdoors. In general, the more active ingredient (higher 2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, “CDC Health Information for concentration) a repellent contains, the longer International Travel, 2016 (Yellow Book).”

3 • Stop using insect repellent and/or sunscreen if a guidance on biosafety when working with rash or other adverse symptoms develop. Wash arboviruses, including Zika, in Section VIII – F: skin with soap and water. Consult a healthcare Arboviruses and Related Zoonotic . provider or poison control center for further Laboratories should handle Zika virus at BSL‑2, guidance. Be sure to inform the healthcare including limiting access to laboratories and provider or poison control center about the other work areas when work is occurring and insect repellent used (e.g., type, when and conducting certain procedures in biosafety where applied). Take other actions, as described cabinets or other containment equipment. Some in this guidance, to avoid mosquito bites if procedures may require BSL-3 precautions, insect repellent cannot be used. including additional respiratory protection, based on the risk assessment of the proposed Healthcare and laboratory workers work.4 The BMBL guidance also describes Employers and workers in healthcare settings BSLs in Section IV - Laboratory Biosafety Level and laboratories should follow good infection Criteria (PDF). control and biosafety practices (including universal precautions) as appropriate, to Employers must comply with applicable prevent or minimize the risk of transmission requirements in the BBP (29 CFR 1910.1030), PPE of infectious agents (e.g., Zika virus). Always (29 CFR 1910.132), and Respiratory Protection follow universal precautions for potential BBP (29 CFR 1910.134) standards, among other OSHA exposures, as described in OSHA’s BBP standard requirements. (29 CFR 1910.1030). In healthcare, standard Additionally, employers should ensure that workers: precautions can be used to expand the universal precautions required by the BBP standard by • Follow workplace standard operating adding several protections (including expanded procedures (e.g., workplace exposure control PPE) not covered by the BBP standard. Standard plans) and use the engineering controls and precautions include, but are not limited to, work practices available in the workplace to hand hygiene and the use of PPE to avoid prevent exposure to blood or other potentially direct contact with blood and other potentially infectious materials. See 29 CFR 1910.1030. infectious materials, including laboratory • Do NOT bend, recap, or remove contaminated specimens/samples. PPE may include gloves, needles or other contaminated sharps. gowns, masks and eye protection. Properly dispose of these items in closable, puncture-resistant, leakproof, and labeled or Hand hygiene consists of washing with soap color-coded containers. See 29 CFR 1910.1030. and water or using alcohol-based hand rubs • Use sharps with engineered sharps injury 3 containing at least 60 percent alcohol. Soap protection (SESIP) to avoid sharps-related and water are best for hands that are visibly injuries. soiled. Perform hand hygiene before and after • Report all needlesticks, lacerations, and other any contact with a patient, after any contact with exposure incidents to supervisors as soon as potentially infectious material, and before putting possible. on and upon removing PPE, including gloves. Employers should consider enhanced precautions Laboratories should ensure that their facilities in situations where workers are at increased risk and practices meet the appropriate Biosafety of exposure to Zika virus or other hazards. CDC Level (BSL) for the type of work being conducted recommends healthcare workers use standard (including the specific biological agents – in precautions during patient care regardless of this case, Zika virus) in the laboratory. CDC suspected or confirmed Zika infection status.5 has specific Biosafety Guidance for the While there is no evidence of Zika transmission Transportation of Specimens and for Work with through aerosol exposure, minimizing the Zika virus in the Laboratory. The Biosafety in Microbiological and Biomedical Laboratories 4. U.S. Department of Health and Human Services, “Biosafety in (BMBL), 5th Edition also provides detailed Microbiological and Biomedical Laboratories (BMBL), 5th ed.” 5. Healthcare Infection Control Practices Advisory Committee, “2007 Guideline for Isolation Precautions: Preventing 3. U.S. Department of Health and Human Services, Centers Transmission of Infectious Agents in Healthcare Settings,” for Disease Control and Prevention, “Show Me the Science – Centers for Disease Control and Prevention (CDC), U.S. When to Use Hand Sanitizer.” Department of Health and Human Services (HHS).

4 aerosolization of blood or body fluids as much as respirator use does not restrict the worker’s possible during patient care or laboratory tasks ability to operate the vehicle safely. OSHA’s may help prevent workers from being exposed to Safety and Health Topics page on Respiratory other pathogens. Additional protections, including Protection provides general information on engineering controls to ensure containment of respirator use and OSHA standards that may pathogens or enhanced PPE to prevent or reduce apply to the use of other chemicals. exposure, may be necessary during any aerosol- Employers also must comply with any applicable generating procedures or other such tasks. requirements in OSHA’s PPE standards (29 CFR workers 1910 Subpart I), among other OSHA requirements. When working outdoors, follow the same General Guidance for Employers precautions recommended above for general of Workers with Suspected or outdoor workers for protection against Confirmed Zika mosquito bites. Workers performing tasks CDC advises individuals, including workers, related to mosquito control may need additional infected with Zika virus to6: protection, depending on their job tasks. • Get plenty of rest. Workers entering or working around areas with • Drink fluids to prevent dehydration. dense mosquito populations, such as ponds and • Take medicine such as acetaminophen to other locations with standing water, may need reduce fever and pain. enhanced skin protection to prevent mosquito • Avoid taking , ibuprofen, naproxen, or bites. Employers should assess such workers’ other non-steroidal anti-inflammatory drugs risks of mosquito bites, and consider providing because of rare cases of bleeding occurring any additional protective clothing to fully cover with and these medications. workers’ exposed skin. • Talk to a healthcare provider before taking any Workers who mix, load, apply, or perform other medications, including prescriptions, for other tasks involving wide-area (or area) insecticides medical conditions. may need additional protection to prevent or • To help prevent others from getting sick, reduce exposure to hazardous chemicals. avoid mosquito bites during the first week of infection. Wearing clothing that covers skin The EPA regulates pesticide safety use through and using insect repellents can help prevent the Agricultural Worker Protection Standard mosquito bites. (WPS). Although the WPS is a regulation for • To help prevent transmission to partners agricultural pesticides aimed at reducing via sexual contact, abstain from sexual the risk of pesticide poisonings and injuries activity or use during sexual among agricultural workers and pesticide activity during and following infection. For handlers, its requirements may provide a model specific recommendations to prevent sexual for protecting workers using insecticides in transmission, please visit the CDC Zika and mosquito control operations. The EPA WPS Sexual Transmission website. page provides information on pesticide safety training, notification of pesticide applications, Employers should: use of PPE, restricted-entry intervals after • Ensure that supervisors and all potentially pesticide application, decontamination supplies, exposed workers are aware of the symptoms and emergency medical assistance. of Zika. Workers conducting mosquito control operations • Train workers to seek medical evaluation if with insecticides may require respirators, which they develop symptoms of Zika. must be used in accordance with the respirator • Assure that workers receive prompt and selection, medical clearance, fit-testing, and appropriate medical evaluation and follow- other requirements of OSHA’s Respiratory up after a suspected exposure to Zika virus. Protection standard (29 CFR 1910.134). If the exposure falls under OSHA’s BBP Employers should monitor use of respirators by any worker who must drive vehicles (e.g., trucks 6. U.S. Department of Health and Human Services, Centers used for application) to ensure that for Disease Control and Prevention, “Zika Virus – Symptoms, Diagnosis, & Treatment.”

5 standard (29 CFR 1910.1030), employers must Even if they do not feel sick, travelers returning comply with medical evaluation and follow- to the United States from an area with Zika up requirements in the standard. See 29 CFR should take steps to prevent mosquito bites 1910.1030(f). for three weeks so they do not pass Zika to • Consider options for granting sick leave mosquitoes that could spread the virus to other during the infectious period. CDC describes people. CDC provides information on mosquito steps employers and employees can take to bite prevention for travelers (PDF). protect others (PDF) during the first week of Zika virus illness. Additional Resources • Zika Virus. Centers for Disease Control and Paragraph 11(c) of the OSH Act, 29 USC 660(c), Prevention (CDC), U.S. Department of Health prohibits employers from retaliating against and Human Services (HHS). workers for raising concerns about safety and • Zika Travel Information. Centers for Disease health conditions. OSHA encourages workers Control and Prevention (CDC), U.S. Department who suffer such discrimination to submit a of Health and Human Services (HHS). complaint to OSHA. Workers have 30 days from • Mosquito-Borne Diseases. National an alleged reprisal to file their complaints. Institute for Occupational Safety and Health Travel to Zika-affected Areas (NIOSH), Centers for Disease Control and Prevention (CDC), U.S. Department of Health When traveling to or through Zika-affected areas, and Human Services. follow the precautions described above for • Zika Virus Fact Sheet. World Health specific work activities. CDC guidance for travel Organization (WHO). to Zika-affected areas may also help employers • Zika virus infection and : Frequently and workers in travel-related operations, such asked questions. Pan American Health as airlines, airline crew members, and cruise line Organization (PAHO). workers take appropriate protective actions. • Mosquito Bite Prevention for Travelers (PDF). Employers should consider allowing flexibility in Centers for Disease Control and Prevention required travel for workers who are concerned (CDC), U.S. Department of Health and Human about Zika virus exposure. Flexible travel and Services (HHS). leave policies may help control the spread • Zika information repository. Center for of Zika virus, including to workers who are Infectious Disease Research and Policy concerned about reproductive effects potentially (CIDRAP), University of Minnesota. associated with Zika virus infection. • Rodents, Snakes and Insects QuickCard. Occupational Safety and Health Consider delaying travel to Zika-affected areas, Administration (OSHA), U.S. Department of especially for workers who are or may become Labor (DOL). pregnant or whose sexual partners may become • 2007 Guideline for Isolation Precautions: pregnant. CDC recommends that pregnant Preventing Transmission of Infectious Agents women in any trimester not travel to an area in Healthcare Settings (PDF). Healthcare with active Zika virus transmission. CDC has Infection Control Practices Advisory published Zika Travel Information by region, Committee (HICPAC), Centers for Disease which may assist workers and employers in Control and Prevention (CDC), U.S. Department making travel-related decisions or implementing of Health and Human Services (HHS). precautions when traveling. Pregnant women, • Safety and Health Information Bulletin: women who may become pregnant, and men Workplace Precautions Against . with sexual partners who are or may become Occupational Safety and Health Administration pregnant should consult with their healthcare (OSHA), U.S. Department of Labor (DOL). providers about risks associated with Zika virus Provides related guidance for workers and infection during pregnancy. More information employers that is also generally applicable to can also be found on the CDC Zika and Zika virus and other mosquito-borne diseases. Pregnancy website.

6 • West Nile Virus Fact Sheet (PDF*). Centers for Disease Control and Prevention Occupational Safety and Health (CDC), U.S. Department of Health and Human Administration (OSHA), U.S. Department of Services (HHS). Labor (DOL). Provides related guidance for • Heat Stress Topic Page. National Institute workers and employers that is also generally for Occupational Safety and Health (NIOSH), applicable to Zika virus and other mosquito- Centers for Disease Control and Prevention borne diseases. (CDC), U.S. Department of Health and Human • West Nile Virus QuickCard. Occupational Services (HHS). Safety and Health Administration (OSHA), • Fast Facts: Protecting Yourself from U.S. Department of Labor (DOL). Provides Heat Stress (PDF). National Institute for related guidance for outdoor workers that is Occupational Safety and Health (NIOSH), also generally applicable to Zika virus and Centers for Disease Control and Prevention other mosquito-borne diseases. (CDC), U.S. Department of Health and Human • Surveillance and Control of Aedes aegypti and Services (HHS). Aedes albopictus in the United States. Centers • Respirator Topic Page. National Institute for for Disease Control and Prevention (CDC), U.S. Occupational Safety and Health (NIOSH), Department of Health and Human Services Centers for Disease Control and Prevention (HHS). (CDC), U.S. Department of Health and Human • Bloodborne Pathogens and Needlestick Services (HHS). Prevention Safety and Health Topics. • Preventing Transmission of Zika Virus in Labor Occupational Safety and Health Administration and Delivery Settings Through Implementation (OSHA), U.S. Department of Labor (DOL). of Standard Precautions – United States, 2016. • West Nile Virus Prevention. National Institute Centers for Disease Control and Prevention for Occupational Safety and Health (NIOSH), (CDC), U.S. Department of Health and Human Centers for Disease Control and Prevention Services (HHS). (CDC), U.S. Department of Health and Human • Questions and Answers for Healthcare Services (HHS). Provides related guidance for Providers Caring for Pregnant Women and workers and employers that is also generally Women of Reproductive Age with Possible Zika applicable to Zika virus and other mosquito- Virus Exposure. Centers for Disease Control borne diseases. and Prevention (CDC), U.S. Department of • Fast Facts: Protecting Yourself from Ticks Health and Human Services (HHS). and Mosquitoes (PDF). National Institute for *Accessibility Assistance: Contact OSHA’s Directorate of Occupational Safety and Health (NIOSH), Technical Support and Emergency Management at (202) 693- 2300 for assistance accessing PDF materials.

Disclaimer: This document is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace. The Occupational Safety and Health Act requires employers to comply with safety and health standards and regulations promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, the Act’s General Duty Clause, Section 5(a)(1), requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.

This information will be made available to sensory-impaired individuals upon request. The voice phone is (202) 693-1999; teletypewriter (TTY) number: (877) 889-5627. For other requests or questions, contact OSHA at 1-800-321-OSHA (6742). To receive NIOSH documents or more information about occupational safety and health topics, contact NIOSH at 1-800-CDC- INFO (1-800-232-4636), TTY: 1-888-232-6348, web: www.cdc.gov/info, or visit the NIOSH website at www.cdc.gov/niosh.

U.S. Department of Labor

OSHA - DTSEM FS-3855 04/10/2016