It’s Here: Florida Confirms Local Zika Cases

(Editor's note: This article was updated on Aug. 1 with new information.)

July 29, 2016 -- Ten more people in Florida have tested positive for the Zika virus, and their infections don’t appear to be related to travel, Florida Gov. Rick Scott said on Monday.

That brings the total of locally transmitted infections in South Florida to 14.

The new cases were identified by a door-to-door community search. Six people didn’t have any symptoms of infection.

Scott has requested more help from the CDC as the state tries to tamp down the spread of the virus.

Many of the 14 cases seem to be linked to the  same small, 1-square-mile area just north of downtown Miami. On Monday, Scott said they were concerned that people were still being infected there.

Zika prevention kits are being distributed in the affected areas, which include Miami’s Wynwood neighborhood, a trendy arts district. Wynwood has also been called “Little San Juan” because of its high percentage of Puerto Rican residents.

In a press call on Friday, CDC Director Tom Frieden, MD, said disease detectives homed in on this district because at least two of the four people who were initially infected worked in the area, though they lived in two different counties.  It’s likely the people were infected at work, Frieden said.

On Monday, following the announcement of the new cases, the CDC cautioned pregnant women not to travel to the identified area. They also advised pregnant women who live or work in the area to protect themselves from mosquito bites and use condoms during sex. 

The CDC also advised pregnant women who are frequently in the neighborhood to be tested for Zika during their first or second trimesters. And they advised men and women who’ve traveled to the area to wait at least 8 weeks before trying to get pregnant.

The British government went even further, however. On Monday, they advised pregnant women to consider avoiding travel to Florida until after they deliver.

Friday's announcement came a day after the FDA asked that blood donations be halted in Miami-Dade and Broward counties. On Friday, Scott said he had directed the state’s Department of Health to establish new blood screening tests.

The finding raises the possibility that there may be a jump in Zika cases in areas where mosquitoes are transmitting the virus, and it comes just weeks after Congress left for the summer without acting on a bill that would have freed up $1.1 billion to help local health departments stanch such an outbreak.

“We’ve been dreading that this day would come,” said Edward McCabe, MD, medical director of the March of Dimes. “We’re very concerned about this.”

Studies indicate Zika poses the biggest threat of birth defects when babies are infected during the early weeks of pregnancy, when organs and tissues are still forming. And evidence is accumulating, McCabe said, that the virus can also cause a spectrum of brain and neurologic problems which may not be immediately detectable. “We keep hearing that microcephaly is the tip of the iceberg,” he said.

Still, public health officials say the development is no reason to panic.

Scott said people who live in the area and want to be tested for Zika should contact their local health department. He further urged residents to take precautions to prevent mosquito bites, including eliminating standing water and wearing insect repellent. He urged pregnant women to contact their doctors.

Since the Zika outbreak began last year, 64 countries have reported evidence of mosquito-borne transmission, according to the WHO. In Brazil, the hardest-hit nation, more than 1,700 cases of a Zika-linked birth defect called microcephaly have been confirmed in newborns.

Health officials had predicted that small pockets along the Gulf Coast would be the first to see the virus take up residence in mainland mosquito populations. So far, Zika is following much the same pattern as outbreaks of a similar illness, dengue fever.

Florida was expected to be a hot zone, and the state has been closely monitoring Zika cases there. The state has both species of mosquitoes known to carry the virus, and it has them year-round.

The first case appeared in Miami-Dade County, which has reported more travel-related Zika cases than any other county in the U.S. As of July 28, they had 96 Zika cases, according to the Florida Department of Health.

The Miami area is also densely populated with pockets of poverty where people live without some of the comforts that keep Zika mosquitoes at bay, like air conditioning and window screens.

In the event of a local transmission, the CDC’s response plan calls for:

  • A rapid investigation, where investigators track down the contacts of the sick person to see if any others are also infected
  • Alerting the local blood center, which may need to begin testing blood from area donors
  • Activating one of the CDC’s Emergency Response Teams (CERTs), which would travel to the area to assist state and county officials
  • Intensifying the hunt for other cases of Zika in the area
  • Communicating with the public about protection and prevention, especially for pregnant women
  • Trapping and testing mosquitoes for Zika
  • Reporting the case to international authorities like the World Health Organization

If no other cases are found, the CDC’s plan calls for public health officials to maintain this level of response for 45 days, which is the time it takes for the virus to die out in mosquitoes.

If more cases are found, some worry it could deal a significant blow to the state’s economy, which relies heavily on tourism.

“If this is a more sustained thing, I think the big issue will be the impact on the Florida economy,” said Michael Farzan, PhD, a professor of immunology and microbial science at The Scripps Research Institute in Jupiter, FL. In an April letter to the New York Times, Farzan predicted the first locally transmitted Zika infection would happen in Miami. Tourism is the state’s greatest source of income, and locally transmitted cases could mean tourists, especially pregnant women, would stay away.

“That’s where it’s really going to hurt us. That’s why the inaction at the state and federal level is so frustrating.”

The Florida Department of Health has urged residents to protect themselves by draining any places that could collect standing water inside or outside their homes. They further advised people to wear protective clothing, including long pants and long sleeves, and to use EPA-approved insect repellents and mosquito netting.

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