How the Zika Virus Reached Miami—And What You Need to Know Now

It was only a matter of time. The Zika virus, which has been blazing a path through Latin America since last fall, has found its way to the continental U.S.; 14 newly identified infections have come out of Miami’s Wynwood neighborhood, located in the north of the city known for its art galleries and co-working spaces. In light of the news, The CDC has issued its first warning against travel in the continental U.S., cautioning pregnant women against visiting the Wynwood area. The federal agency also recommends that women who have traveled there wait at least eight weeks before trying to get pregnant. Only 1 in 5 people who contract Zika show the flu-like symptoms, yet it is associated with devastating congenital birth defects.

The new cases are believed to have originated from mosquito bites that occurred in a tiny section of the city—officials found “moderately high” levels of Aedes aegypti mosquitoes and their larvae in a one-square-mile area of Miami—but the resulting unease has rippled across the nation, especially among the legions of pregnant women who visit or live in hot, damp regions where the mosquitoes that are capable of transmitting Zika thrive.

“It’s a very perplexing epidemic and you have to prepare for the worst,” says Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases. “It’s conceivable we have smoldering infections in other regions of the country right now. It was predictable that sooner or later, since we have so many travel-related cases, of course, we are going to see a local transmission.”

We spoke with Fauci and emerging diseases expert Andrew Pekosz, Ph.D., a professor of molecular microbiology and immunology at Johns Hopkins Bloomberg School of Public Health, about what’s new and what’s next in the war on Zika.

Why are we so shocked that there are cases in the continental U.S. when Zika has been ravaging other nations for quite some time?
Andrew Pekosz, Ph.D.: There have been a few cases of sexual transmission in the U.S., but if you don’t have the infected mosquitoes—and we hadn’t until now—you get very limited Zika transmission. Now the most effective means of passing along the infection is occurring in the continental U.S. Once this process begins, you can have exponential growth.

Let’s talk about the potential of it spreading beyond this area of Miami. How could it travel from Florida to, say, Texas?
AP: Zika doesn’t spread by mosquitoes flying from one region to another. It starts with a person, and needs somebody who is infected to come to a new location, where a mosquito bites them and transmits it to the next person it bites. Southern Texas has the mosquito population necessary for transmission. So does most of the southern Gulf coast, including Louisiana and Alabama.

If you’re infected, how long can Zika linger in your system?
AP: If you’re a man it can stay in places like saliva and urine and semen for longer periods of time than it remains in women’s bodies. Men who were infected are advised to wait six months before trying to conceive. We still don’t know for sure how long it lasts in a woman’s reproductive tract, but women are advised to wait eight weeks to try to become pregnant.

How many other cases are there in the States?
Anthony Fauci, M.D.: There are over 1,600 travel-related cases in the continental U.S. And up to 400 of these are in Florida. When you have travel-related cases in a location where there are mosquitoes that are known for transmitting the disease, sooner or later you are going to have a locally transmitted case.

How widespread is it going to become?
AF: We don’t know that. We are dealing with a very resilient mosquito. The only way out of this is via mosquito control and elimination, and then to get the general population to protect themselves. It’s a public health matter to clean up the water supply, use insecticides and larvicides. On a personal level, don’t travel to affected areas, and protect yourself from mosquito bites. Make sure at home your windows have screens and wear clothing that covers your body and use insect repellant.

Should every pregnant American woman get tested?
AF: No. If you were not in a high-risk environment or haven’t had sex with somebody who was, the risk is hardly existent. But take precautions not to expose yourself.

Are we absolutely sure that Zika causes birth defects?
AP: Yes, it’s quite clear that Zika in pregnant women leads to microcephaly and other birth defects. There have been several animal models of Zika virus infection where the fetuses have abnormalities consistent with what we see in humans.

How likely is a pregnant woman who contracts Zika to give birth to an affected baby?
AP: We aren’t sure yet. The few papers that have come out have estimated anywhere from 1 to 10 percent. The solid number we do have is that 1 in 5 affected with Zika will show signs. That’s in keeping with what happened in Miami, where 4 people were diagnosed and then a few days later the authorities reported another 10 cases. We can assume the first four were sick, and the other cases came as the result of community-wide testing.

Where are we on a vaccine?
AF: I’m cautiously optimistic. We have a number of candidates stacked up and ready to go into phase 1 clinical trials to determine if they’re safe. If the problem remains serious, we could have a vaccine by 2018.

 

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