Early in 2015, Brazil experienced an outbreak of the Zika virus. By late in the year, Brazil was also reporting an increase in newborns being born with microcephaly, a congenital condition associated with incomplete brain development and abnormally small head circumference (microcephaly). Although scientists are still trying to discover how the Zika virus, an infection that normally presents with mild symptoms in adults, causes microcephaly in newborn babies of mothers infected with the virus, the sharp increase of cases of microcephaly concentrated in areas that have experienced an outbreak of the Zika virus is suggestive of a causal relationship. Along with microcephaly, Zika is believed to be responsible for a number of health problems in infants including, neurological disorders, developmental delay, brain and spine lesions, and infant mortality.
The Zika virus was first discovered in the Zika forest in 1947, and only 14 cases had ever been recorded in humans prior to 2007. That year, an outbreak occurred on Yap Island in the southwestern Pacific Ocean and infected two-thirds of the island's inhabitants. The typical symptoms of the disease included mild fever, joint pain and swelling, conjunctivitis, and rash. The symptoms are considered to be mild and typically last less than a week, and 4 out of 5 affected individuals will show no symptoms at all. In the most severe cases, Zika has been linked to an increase in Guillain-Barre syndrome, which can cause breathing difficulty or paralysis. The Zika virus reemerged in the South Pacific in 2013 and by 2014 had made its way to the Americas and Brazil.
In 2014 Brazil only had 140 confirmed cases of the Zika virus, but by the end of 2015 it had become an epidemic. The number of people thought to have contracted the Zika virus in Brazil is between 400,000 and 1.4 million people. The virus is usually spread through mosquito bite, although scientists have recently confirmed it can be also be spread through sexual intercourse. The Aedes aegypti species of mosquito is responsible for the current outbreak in Brazil. These mosquitoes thrive throughout much of South America and can be found as far north as the southeastern United States. The Aedes albopictus mosquito also has the potential to transmit the Zika virus and is prevalent in the United States and can be found as far north as the southern tip of New York.
On February 1st the World Health Organization (WHO) declared the current Zika outbreak as a Public Health Emergency of International Concern (PHEIC). This is due in large part to the Zika virus's apparent link to microcephaly after Brazil experienced a sharp rise in microcephaly cases that coincided with the Zika outbreak. In 2014, French Polynesia experienced a similar rise of microcephaly that coincided with an outbreak of the Zika virus. The Centers for Disease Control and Prevention (CDC) recommends women who are pregnant, or planning to become pregnant, avoid traveling to areas experiencing a Zika outbreak and if they do travel to these areas, to strictly follow steps to help prevent mosquito bites such as wearing long sleeves and pants, using insect repellents, and using air conditioning or window and door screens when indoors. Pregnant women who's partners have traveled to an area with a Zika outbreak should avoid having sex, or should use condoms during sex for the remainder of their pregnancy.
On the heels of the WHO declaration, Governor Cuomo announced the New York State Department of Health(NYSDOH) would provide Zika testing "for all pregnant women who traveled to areas where the infection is ongoing, regardless of whether they exhibit symptoms." The NYSDOH will also be monitoring the Aedes albopictus mosquito in the state. Presently, they have been found in Nassau, Suffolk, Westchester, Rockland, and Orange counties as well as New York City. Additional mosquito trappings will be done in Orange, Putnam, Ulster, Dutchess, and Sullivan counties to see if the Aedes albopictus mosquito has spread farther north.
According to the CDC, as of April 6, 2016, New York had 55 confirmed cases of Zika virus, all of them from people who had traveled to an area where the infection is ongoing. In fact, of the 346 confirmed cases in the continental US, none of them have been locally transmitted. But as the weather warms and mosquito season begins, local transmission of the Zika virus within the continental US becomes a possibility. While the Capital District is not at risk, since the mosquitoes that can carry the virus are not native to upstate New York, Puerto Rico has already had 325 locally acquired cases of Zika, and that number is expected to rise in the coming months. Southern Florida is also likely to experience an increase in Zika cases as mosquito season begins. Highly populated areas that have both Aedes mosquitoes that can transmit the virus and busy airports, like Atlanta and New York City, are also at risk of a potential Zika outbreak.
With the Summer Olympics being held in Brazil this summer, and the disease making its way north, a lot is being done to try and combat the spread of the virus. Several companies are working on a vaccine for the Zika virus and clinical trials may begin as early as Spring of 2016. In Brazil they are using GMO mosquitoes created by the company Oxitec to control the mosquito population and slow the spread of viruses like Zika.
These measures will likely take months to stop the spread of Zika and will likely have little impact on the current outbreak until late in 2016. If you are pregnant, the best way to protect yourself from the Zika virus is not to travel to areas with ongoing transmission of the disease. If you must travel to one of these areas, take preventative measures to protect yourself from mosquito bites such as wearing long sleeves and pants, using insect repellents, and using air conditioning or window and door screens when indoors. If you would like to talk to your doctor about the Zika virus, Community Care Physicians is here to help.
UPDATE: On March 30th the CDC updated the range that Aedes aegypti and Aedes albopictus mosquitoes are expected to reach in the US. The Aedes aegypti mosquito, which is known to transmit the Zika virus, was expected to only be found in the southernmost states in the continental US. Now, the CDC is predicting the mosquito could reach as far north as New York City, Long Island, and Connecticut.
The Aedes albopictus mosquito, which has the potential to transmit the Zika virus, although it is far less likely to transmit the virus than the Aedes aegypti mosquito since Aedes albopictus mosquitoes do not feed exclusively on humans, is expected to reach the Capital Region. This mosquito had previously been known to reside in Orange, Westchester, and Rockland counties as well as New York City and Long Island. The recent changes in the maps by the CDC are due to increased tracking of the mosquitoes since the outbreak of Zika virus in Brazil last year. The information on the previous maps were estimated to be twelve years old.