By Ashley Fuoco Antonelli, associate editor
The possibility of Zika transmission in the United States is dominating the media. But reports suggest most U.S. residents don't really know what the virus is, how it could affect them, or what they can do to protect themselves.
According to an Associated Press/NORC Center for Public Affairs Research poll released in April, four in 10 U.S. residents have heard little to nothing about the virus, which according to the latest CDC data has infected 591 individuals in U.S. states and an additional 939 individuals in U.S. territories. CDC said 903 of the 939 Zika cases reported in U.S. territories have been reported in Puerto Rico.
All of the cases in the U.S. states are linked to travel, but federal officials expect that mosquitos will begin spreading the virus in the continental United States within the next few weeks, as temperatures rise and mosquitos emerge.
So what is the Zika virus?
The Zika virus primarily is spread by infected mosquitos. Symptoms of active Zika virus infection include fever, headache and rash. Symptoms usually are mild, and for 80 percent of infected individuals no symptoms appear at all.
The virus poses the largest risk to fetuses. CDC scientists last month confirmed that Zika causes severe brain defects in fetuses, including microcephaly -- a neurological disorder that is characterized by an abnormally small head and potentially fatal developmental issues.
There currently is no vaccine or effective treatment for the virus.
Will Zika be a significant public health threat in the United States?
Public health experts say it's almost certain that U.S. states will see local transmission -- that is, transmission by mosquitos, rather than through person-to-person contact -- of the Zika virus in the coming months. The virus is most likely to appear in southern states due to their mosquito-friendly warm weather and high humidity, but CDC has said the insects could travel as far north as Maine.
Public health experts say they do not anticipate an outbreak equal to or surpassing those seen in South American countries or Puerto Rico.
Lawrence Gostin, director of Georgetown University's O'Neill Institute for National and Global Health Law, told American Health Line that there "will be cases" of Zika in the United States, but that the country "will not have an epidemic of the kind we are experiencing in Latin America."
Citing the United States' response to tropical diseases such as chikungunya and dengue fever, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told USA Today that U.S. Zika cases will likely occur in small clusters that public health officials will be able to contain. Fauci said, "We've been able to put the lid on those mild outbreaks, with mosquito control and elimination."
What is being done to combat Zika in the United States?
For health care providers, CDC has created a website with resources that recommend providers:
- Ask patients about their recent travel history and test those who have traveled to an area with ongoing Zika virus transmission for the virus; and
- Counsel pregnant women with male partners who have been or could be infected with Zika to use condoms or abstain from sex during their pregnancy.
FDA has released guidelines intended to ensure the U.S. blood supply does not become contaminated by Zika. The guidelines recommend that blood banks:
- Decline blood donations from individuals who within the previous four weeks traveled to countries where the Zika virus is active or who within the previous three months had sexual contact with an individual who might have traveled to a Zika-affected area; and
- Update donor questionnaires to inquire about travel within the past month to areas with active Zika transmission, as well as a history of residence in such areas.
The guidelines recommend that prospective blood donors who:
- Exhibit symptoms of Zika infection within two weeks of returning from an area where the virus is active refrain from donating blood until one month after the symptoms have stopped;
- Were confirmed to have Zika refrain from donating blood until one month after they no longer have the virus; and
- Live in U.S. territories affected by Zika consider abstaining from donating blood.
CDC also has issued travel alerts to warn U.S. residents about the risks of visiting areas that currently are experiencing local transmission of the Zika virus, including Cape Verde, Mexico and certain areas of:
- The Caribbean;
- Central America;
- The Pacific Islands; and
- South America.
State and local efforts
CDC also has made more than $85 million available to help states and U.S. territories combat the Zika virus, including:
- $60 million the agency is distributing to city and state health officials to help laboratories bolster their Zika tracking and monitoring capabilities; and
- $25 million to a total of 53 cities, states and U.S. territories that are at risk for Zika transmission to aid health officials in identifying, examining and addressing any potential outbreaks.
Meanwhile, some states and localities have launched Zika prevention initiatives. For example, health officials in Washington, D.C., are distributing kits intended to curb the virus' spread that include:
- Insect repellent; and
- Mosquito dunks, which can be placed in standing water to kill mosquito eggs.
Other states, including Louisiana and New York, are helping with efforts to track Zika-transmitting mosquitoes.
What else can the United States do to combat Zika?
Despite those efforts, some public health experts say the United States isn't prepared to handle a Zika outbreak.
Scott Weaver of the University of Texas Medical Branch has said the United States currently has "nothing at the national level other than advice from ... CDC and most states do not even coordinate their programs at the county level very well."
Gostin told American Health Line, "The [United States] is clearly not well prepared." He noted, "It is a significant problem that states and localities don't all have the powers and funding needed for mosquito control, surveillance and health care. This will cost lives unnecessarily."
Experts cite several additional steps the United States could take to combat the spread of Zika:
1. Bolster travel monitoring programs
Gostin said public health officials and providers should do more to monitor travelers returning from Zika-affected areas and to monitor for mosquitoes that transmit the virus.
2. Standardize testing for pregnant women
Health officials also should test pregnant women for the virus, according to Gostin. He noted, "We need to really be on the lookout. That involves having really good information systems from the CDC. It means training doctors. The last thing we want is a repeat of Ebola, where we saw preventable deaths in the United States and globally."
3. Increase mosquito control efforts
Local communities should increase mosquito control efforts by eliminating standing water and by spraying mosquito control solutions, Gostin said. He told American Health Line, "States need to ensure that they aggressively fight mosquitos. I would declare war on mosquitos, the most dangerous animal in the world."
Similarly, Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, said that communities should remove trash strewn on the side of the road, as that can serve as a breeding ground for the type of mosquito that transmits Zika. He said, "These mosquitoes have adapted very well to our throw-away society," adding, "It's not in the swamps where the mosquitoes that spread malaria live. But that discarded fast food wrapper in the ditch could be a very important source" of Zika-carrying mosquitoes.
Further, Gostin told American Health Line that U.S. residents should protect themselves against Zika-transmitting mosquitos by "cleaning up breeding sites and using insect repellant and screens on windows."
4. Accelerate research -- and consider more drastic interventions
Gostin also has said the United States could take a controversial step and release genetically engineered mosquitoes that could reduce the mosquito population. In addition, Gostin told American Health Line that "NIH must accelerate [research and development] on vaccines and other therapeutics" to address Zika.
The fight over Zika response funding
Of course, all of these initiatives require funding, and appropriating the funding for U.S. Zika response efforts hasn't been easy.
Policymakers are split on how much funding to provide for U.S. Zika response efforts.
The Obama administration in February requested from Congress $1.9 billion, but the House delayed action.
Last week, House lawmakers voted to convene a conference committee to merge its Zika response legislation (HR 5243) with the Senate's proposal (SA 3900). The Senate's proposal, which is included an amendment to a broad appropriations bill (HR 2577), would provide $1.1 billion for Zika response, while the House's proposal would provide $622 million. The White House has signaled a willingness to sign the Senate's proposal, but says President Obama would veto the House measure because it would not provide adequate funding.