A relatively new mosquito-borne virus is prompting worldwide concern because of an alarming connection to a neurological birth disorder and its rapid spread across the globe.
World Health Organization Director-General Margaret Chan called it an “extraordinary event” in declaring a public health emergency.
The Zika virus, transmitted by the aggressive Aedes aegypti mosquito, has spread to at least 29 countries. WHO estimates 3 million to 4 million people across the Americas will be infected with the virus in the next year. The Centers for Disease Control and Prevention is warning pregnant women against travel to those areas; health officials in several of those countries are telling female citizens to avoid becoming pregnant, in some cases for up to two years.
“As long as the mosquito keeps reproducing, each and every one of us is losing the battle against the mosquito,” Brazilian President Dilma Rousseff said recently. “We have to mobilize so we do not lose this battle.”
The U.S. Defense Department is offering voluntary relocation to pregnant employees and their beneficiaries who are stationed in affected areas.
“That’s a pandemic in progress,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. “It isn’t as if it’s turning around and dying out, it’s getting worse and worse as the days go by.”
Here are five important things to know about Zika:
1. What is Zika and why is it so serious?
The Zika virus is a flavivirus, part of the same family as yellow fever, West Nile, chikungunya and dengue. But unlike some of those viruses, there is no vaccine to prevent Zika or medicine to treat the infection.
Zika is commanding worldwide attention because of an alarming connection between the virus and microcephaly, a neurological disorder that results in babies being born with abnormally small heads. This causes severe developmental issues and sometimes death.
Since November, Brazil has seen 404 confirmed cases of microcephaly in newborns. Seventeen of those cases have a confirmed link to the Zika virus. To put that in perspective, there were only 146 cases in 2014. So far, 15 babies have died from the condition; five of the death linked to Zika. An additional 56 deaths are under investigation and authorities continue to investigate 3,670 suspected cases.
Other Latin American countries are now seeing cases in newborns as well. On Saturday Colombia reported over 2,000 pregnant women have tested positive for the virus while in the United States one Hawaiian baby was born with microcephaly linked to the Zika virus after his mother returned from Brazil. Several states have confirmed the virus in individuals who traveled to areas where the virus is circulating, including Illinois, where health officials are monitoring two infected pregnant women.
In Florida, the number of travel-related Zika cases stands at 12. No pregnant women are among those infected.
The CDC is asking OB-GYNs to review fetal ultrasounds and do maternal testing for any pregnant woman who has traveled to one of the 29 countries where Zika is currently active.
In most people, symptoms of the virus are mild, including fever, headache, rash and possible pink eye. In fact, 80% of those infected never know they have the disease. That’s especially concerning for pregnant women, as this virus has now been shown to pass through amniotic fluid to the growing baby.
“What we now know,” said Dr. Lyle Petersen, director of the CDC’s Division of Vector-Borne Diseases, “is that fetuses can be infected with the virus. That’s not new for infectious diseases, but it is new for this virus.”
“This is a very remarkable and unusual situation,” agreed Fauci, “because the other flaviviruses don’t do that to our knowledge. You just don’t see that with dengue or West Nile or chikungunya.”
2. How is Zika spread?
The virus is most commonly transmitted when an Aedes mosquito bites a person with an active infection and then spreads the virus by biting others. Those people then become carriers during the time they have symptoms.
On Tuesday, the CDC reported the first case of locally acquired Zika virus in the United States in the latest outbreak, but it was not from a mosquito bite. Instead it was passed via sex.
The case, announced by Dallas County health officials in Texas, involved a patient who had sex with someone who had recently returned from Venezuela infected with the mosquito-borne virus. The patient had not traveled.
“There have been isolated cases of spread through blood transfusion or sexual contact and that’s not very surprising,” CDC Director Tom Frieden told CNN’s Chief Medical Correspondent Dr. Sanjay Gupta. “The virus is in the blood for about a week. How long it would remain in the semen is something that needs to be studied, and we’re working on that now.”
The CDC stressed there was no danger to a developing fetus in the Texas case and said they planned to soon provide guidance on sexual transmission, with a “focus on the male sexual partners of women who are or who may be pregnant.”
Previously, there have been only two documented cases linking Zika to sex. During the 2013 Zika outbreak in French Polynesia, semen and urine samples from a 44-year-old Tahitian man tested positive for Zika even when blood samples did not. Five years before that, in 2008, a Colorado microbiologist named Brian Foy contracted Zika after travel to Senegal; his wife came down with the disease a few days later even though she had not left northern Colorado and was not exposed to any mosquitoes carrying the virus.
In addition, the CDC says there have been documented cases of virus transmission during labor, blood transfusion, and laboratory exposure. While Zika has been found in breast milk, it’s not yet confirmed it can be passed to the baby through nursing.
The CDC’s Frieden says while research continues on sex and other avenues of transmission, the “vast majority of spread” of the Zika virus is going to be from mosquitoes. “The bottom line is mosquitoes are the real culprit here,” said Frieden.
3. Where is the Zika virus now?
The Zika virus is now being locally transmitted in Barbados, Bolivia, Brazil, Cape Verde, Colombia, Costa Rica, Curacao, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, Samoa, Tonga, the U.S. Virgin Islands and Venezuela, according to the CDC and WHO.
Zika has arrived in the United States, but only from travelers returning from these infected areas. The concern, of course, is whether these imported cases could result in locally transmitted cases within the United States.
The Aedes albopictus, or Asian tiger mosquito, which along with Aedes aegypti transmits Zika virus, is present in many areas of the United States.
If mosquitoes in the United States do become carriers, a model created by Toronto researchers found more than 63% of the U.S. population lives in areas where Zika virus might spread during seasonally warm months. A little over 7% of Americans live in areas where the cold might not kill off the mosquito in the winter, leaving them vulnerable year round.
4. What can you do to protect yourself against Zika?
With no treatment or vaccine available, the only protection against Zika is to avoid travel to areas with an active infestation. If you do travel to a country where Zika is present, the CDC advises strict adherence to mosquito protection measures: Use an EPA-approved repellent over sunscreen, wear long pants and long-sleeved shirts thick enough to block a mosquito bite, and sleep in air-conditioned, screened rooms, among others.
If you have Zika, you can keep from spreading it to others by avoiding mosquito bites during the first week of your illness, says the CDC. The female Aedes aegypti, the primary carrier of Zika, is an aggressive biter, preferring daytime to dusk and indoors to outdoors. Keeping screens on windows and doors is critical to preventing entry to homes and hotel rooms.
5. What’s being done to stop Zika?
Researchers are hard at work in laboratories around the world trying to create a Zika vaccine. A clinical trial for a Zika virus vaccine could begin this year, according to Fauci.
“While in development, it’s important to understand we won’t have a vaccine this year or even in the next few years, although we may be able to have a clinical trial start this calendar year,” he said.
Until those efforts bear fruit, health officials are implementing traditional mosquito control techniques such as spraying pesticides and emptying standing water receptacles where mosquitoes breed. The CDC is encouraging local homeowners, hotel owners and visitors to countries with Zika outbreaks to join in by also eliminating any standing water they see, such as in outdoor buckets and flowerpots.
Studies show local control is only marginally effective, since it’s so hard to get to all possible breeding areas. And since Aedes aegypti has evolved to live near humans and “can replicate in flower vases and other tiny sources of water,” said microbiologist Foy, the mosquitoes are particularly difficult to find and eradicate.
Another prevention effort is OX513A, a genetically modified male Aedes aegypti, dubbed by critics as the “mutant mosquito” or “Robo-Frankenstein mosquito.” The creation of British company Oxitec, OX513A is designed to stop the spread of Zika by passing along a gene that makes his offspring die. Since females only mate once, in theory this slows the growth of the population. Each OX513A carries a fluorescent marker, so he can be tracked by scientists.
Key West, Florida, residents gave the genetically modified male his monster nicknames while protesting a trial release of the mosquito in 2012 as a way to combat an outbreak of dengue fever in South Florida. That effort is under review by the Food and Drug Administration.
But field trials in Brazil in 2011 were hugely successful, according to Oxitec, eliminating up to 99% of the target population. A new release of males in the Pedra Branca area of Brazil in 2014 was 92% successful, according to the company. The mosquito has also been tested in the Cayman Islands, Malaysia and Panama.
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