Threat of Zika Virus Still Looms in Southern States

On October 12, 2017, the Florida Department of Health (DOH) confirmed a case of locally-transmitted Zika virus in the state. This new case adds to the growing total of travel-related and undetermined cases in Florida, bringing the grand total to 188 statewide cases. The Manatee County case is believed to be an isolated case and the Centers for Disease Control and Prevention (CDC) state there is no evidence to support active and ongoing transmission of the Zika virus.

According to the Florida DOH, this case involves a couple who had traveled to Cuba. One partner acquired the Zika virus in Cuba and returned home. Once home, a mosquito bit the infected partner and then bit the uninfected partner, transferring the virus to the other partner.

This incident underscores the need for individuals who have traveled to Zika-endemic areas to take the necessary steps to avoid being bitten by mosquitoes for at least 3 weeks when they return to the United States, according to the Florida DOH. This will help stave off the chance of spreading the virus to the community and an individual’s loved ones and friends. Precautions should be made on a personal level and in the environment. The mosquitoes that transmit the Zika virus can breed in as little as a teaspoon of water, and so the Florida DOH is reminding residents to “drain all sources of standing water to keep mosquitoes from multiplying.” In addition, residents and visitors should remain vigilant about using insect repellent throughout the day and night to prevent bites.

Those who are at risk of a Zika virus infection and who have visited Zika-endemic areas should also take precaution to reduce the chance of sexual transmission by practicing safe sex. The CDC recently issued updated guidance on preventing sexual transmission of Zika which details how the virus can be passed through multiple modes of sexual intercourse, including vaginal, anal, and oral routes, and through the sharing of sex toys. It is important to note that the virus is not only transmitted through heterosexual sex and indeed some investigators warn that men who have sex with men are at risk of seeing a Zika epidemic among their community. As such, the CDC has issued guidance for the LGBTQ community on how they can protect themselves. Regardless of sexual orientation, all individuals should refrain from sharing sex toys and should use male and female condoms and dental dams (for oral sex) to prevent the transmission of the virus.

The CDC wants couples to know that “Zika can be passed through sex, even in a committed relationship.” In addition, “the timeframes that men and women can pass Zika through sex are different because the Zika virus can stay in semen longer than in other body fluids.” Individuals should also be aware that the virus can be spread from person to person even if an individual does not show any symptoms or after their symptoms have ended. More information on the symptoms of the virus were discussed during a recent Science Ask Me Anything (AMA) on the Zika virus posted on Reddit and hosted by Captain Gary Brunette, MD, MS, Travelers’ Health Branch Chief at CDC, Jeff Nemhauser, MD, Chief Medical Officer with CDC’s Travelers’ Health Branch, and Ali Walker, PhD, MPH, Epidemiologist with CDC Travelers’ Health Branch:

"It’s true that many people infected with Zika have no symptoms or only mild symptoms -- so may not know they are infected. Men and women traveling in an area with risk of Zika should consider using condoms every time they have sex or not have sex while traveling. If you traveled to an area with risk of Zika, then you should consider using condoms or not having sex for at least 6 months after your return.

Testing semen is not recommended to determine how likely a person is to pass Zika virus through sex. Because Zika virus can remain in semen longer than blood, you might have a negative blood test, but still carry Zika. Testing semen for Zika virus is not currently available outside of the research setting, and testing is not recommended for asymptomatic men."

More research is still being published on the effects of the virus on adults; however, a new research letter just published in JAMA has found that "increased Guillain-Barré syndrome (GBS) incidence has been reported in countries affected by Zika virus."

Pregnant women continue to be the population at highest risk of a Zika virus infection as the virus can pass from the mother to her unborn child and cause severe birth defects. More information on the birth defects caused by the Zika virus was also shared during the Science AMA:

"Additional clinical findings possibly associated with congenital Zika virus infection have been reported, including eye problems in infants (without microcephaly or other brain anomalies) who were born to mothers with Zika virus infection. In addition, there have been reports of infants with Zika at birth who were born with a normal head size, but experienced slowed head growth after birth, and went on to develop microcephaly. The full spectrum of poor outcomes caused by Zika virus infection during pregnancy remains unknown; scientists continue to study other potential health problems that Zika virus infection during pregnancy may cause."

Couples who are at risk for Zika should practice safe sex with condoms or abstain from sex for the duration of the pregnancy. For those couples who are at risk and trying to conceive, the CDC provides helpful tips on how to stay safe.

Healthcare providers should continue to screen pregnant women in the United States for the Zika virus during their prenatal visits, according to the CDC. The Florida DOH shared that in Florida, “all county health departments offer free Zika risk assessment and testing to pregnant women.”

Although the Northern hemisphere has now moved into the fall season, many southern states (Florida, Alabama, Mississippi, Louisiana, Arizona, New Mexico, Texas, and California) will still boast temperatures conducive to mosquito survival. Therefore, it is important that individuals remain vigilant about mosquito control and prevention throughout the fall and even the winter. In fact, on October 17, 2017, US Senator Bill Nelson issued a letter to CDC Director Brenda Fitzgerald imploring the organization to prioritize Zika prevention efforts in Florida, stating, “The Zika outbreak isn’t over and continues to pose a serious public health threat to Floridians who are already struggling to recover from Hurricane Irma. Last year, I fought for, and Congress ultimately approved, $1.1 billion in funding to respond to the Zika outbreak. It is critical that we build upon this investment to ensure the resources and personnel are in place to stop the spread of this virus."