US states are taking charge to enhance preventive measures for any future Zika infections. The first in line is Florida, which has previously handled small outbreaks of dengue transmitted by the same mosquito, Aedes Aegyptii. The state governor, Rick Scott, has said that the Zika outbreak should be handled like any other approaching hurricane, and has also lobbied Washington for more funds.
The governor has not given a number but the state is squeezing money from its usual budget to arrange training of personnel and to set traps for mosquitoes in areas that need extra help. An official hotline providing Zika information has been started, which has received more than 1700 calls since the month of February.
Florida Keys Mosquito Control District (FKMCD), active since 1920s with an annual budget of 15 million dollars, has now deployed four helicopters and 33 inspectors covering 125 square miles. Miami, Dade County, is enforcing standing water violation punishments and residents are being advised to screen windows and get rid of structures that can trap rain water from their properties.
Best prepared are the residents of Harris County, Texas, which includes the city of Houston. Their program has an annual budget of $4.5 million to control disease carriers or vectors such as mosquitoes, rodents and ticks. The program is 50 years old and is often considered one of the best in the country. It has traps set in 268 areas to capture, catalog, and test mosquitoes for pesticide resistance using newly included traps, made especially for Zika vectors.
According to Texas Health Commissioner, John Hellerstedt, the state has the capacity to perform dozens of blood tests each week. Texas is also spending 2 million dollars on public awareness in the form of federal emergency preparedness money.
New York has pledged $21 million to combat the virus over the next three years. In Mississippi, a small team of expert entomologists has started working on the first survey of mosquito population in years.
Virginia took $700,000 from a federal Ebola grant to hire two mosquito biologists, educate the public, and perform testing services for travelers and mosquitoes, along with running door-to-door distribution of information for nearly 450,000 households.
New Orleans is also working on educating neighborhoods and their residents about Zika, along with preparing for hurricane season.
Financial and resource-related disparities make it impossible to have the same level of preparedness for the upcoming mosquito season, as US mosquito control programs are funded by local tax payers.
The outbreak of Zika is pegged to reach the continental United States in upcoming weeks as the temperature rises and mosquitoes multiply. Experts believe that the poorest communities along the Gulf of Mexico, with a history of dengue outbreaks, are the most at risk and in imminent need of resources, to fight the upcoming infections.
President Obama And The Senate
Three months ago, President Obama urged the United States Congress to allot 1.9 billion dollars to vaccine development, transmission control (mosquito control), and faster diagnostic testing and management of individuals infected with Zika virus.
The Senate, as a result, has committed to provide $1.1 billion in emergency funding by a 68-29 vote. They agreed with the president’s proposal to add money to budget deficit rather than cut off other programs.
The Republicans, however, have pushed for a $622 million bill to battle the Zika virus and have proposed to limit the funding to just this year, along with rerouting the money from the Ebola war chest. The house voted 241-184, mainly along party lines, as Democrats stood in opposition to the bill. The proposed amount of money is just one-third of the amount Obama asked for.
After the announcement, Tom Frieden, Director Centers for Disease Control and Prevention (CDC), said that this amount was ‘just not enough’.
Oklahoma representative Tom Cole, however, said that everything that was needed has been done.
The White House, however, has answered that the measure is inadequate and any such bill will be vetoed by President Barack Obama.
The President has urged the public to ask their lawmakers to increase funding. He explained that anyone with a small family or starting a family needs just this kind of ‘insurance’ right now.
Obama, in a recent interview, while stressing the preventive measures for the mosquito-borne infection, stated that the estimated lifetime care for a child born with a Zika-infected brain can cost up to $10 million, while the current proposed investment would cost much less than that, saving millions of dollars in future spending.
Currently, money is restricting Zika control and prevention activities. Dr Anthony Fauci, of the National Institutes of Health (NIH), said that he was re-allotting money from the agency’s malaria, tuberculosis and influenza programs to fund the vaccine program for Zika.
He termed it as ‘stealing money from myself’ when explaining that he needs more money by the end of June to keep the vaccine on schedule. He also said that the real problem would begin if the agency does not get financial help very soon.
As a result of unanswered financial pleas, CDC has shifted $44 million from emergency preparedness grants usually set aside for state and local health departments for crises like hurricanes and flu outbreaks, to the Zika program.
New Zika Cases
Federal health officials last week reported that nearly 279 pregnant women in the US and its territories have been infected with the Zika virus. The new numbers are more than double the ones most recently reported.
The higher numbers have mainly been due to a reporting criterion change implemented by CDC, rather than a spike.
Two new systems have been introduced to monitor cases. The US Zika Pregnancy Registry and the Puerto Rico Zika Active Pregnancy Surveillance System, collectively observe 279 pregnant women in America (157 in the states and 122 pregnant women in US territories).
The current system will now take into account whether pregnant women with any laboratory evidence indicating a possible infection, can recall any symptoms or not. The new methodology is aligned with the scientific recommendations for pregnancy monitoring at at the risk of poor health outcomes associated with Zika.
Before this, CDC reported numbers on the basis of a case definition established with the help of the Council for State and Territorial Epidemiologists (CSTE). The case definition only diagnosed a positive case when a person had symptoms, pregnancy complications, or if results of laboratory tests were consistent with complications of Zika infections.
When new reports indicated that women without symptoms, but with positive laboratory tests of Zika, were giving birth to infants with microcephaly and serious brain defects, the CDC changed its reporting criteria.
As of May 18th, 2016, the total number of Zika cases reported in the US have been 544 and 279 in pregnant women (states and territories combined).
Margaret Honein, leading the CDC pregnancy and birth defects team as a part of Zika response, said that they have learned a lot over the previous few months and CDC is now aware of more than a dozen adverse outcomes among these women. She also stressed that they still do not have the information on all possible outcomes of the Zika infection.
Majority of these women were infected in countries or territories where Zika is being transmitted by the Aedes mosquito while only a small number of women were actually infected in the US. In most of the cases, the cause of transmission was assessed to be unprotected sexual contact with infected partners. However in US territories, locally acquired total cases were reported at 832.
In April, CDC reported that nearly 3,000 pregnant women have been tested as of yet and 0.8 percent of them were diagnosed with Zika infection.
The Zika virus is relatively mild in adults with symptoms like rash, fever, joint pain, muscle pain, headache, and conjunctivitis, with rarely any fatalities occurring. In infants, however, there is a high incidence of microcephaly which can lead to birth defects such as seizures, cognitive deficits, hearing loss, feeding, and vision problems due to underdevelopment of brain.
The first infections detected in Brazil last year have been linked to more than 1,330 cases of microcephaly, characterized with the small heads of infants born to pregnant, infected women.