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CDC issues Fla. travel warning for pregnant women over Zika concerns

August 2, 2016 — CDC on Monday issued an advisory directing pregnant women to avoid a Miami neighborhood where officials believe mosquitoes might be transmitting the Zika virus, the New York Times reports.

According to the Times, the warning marks the first time the agency has cautioned against visiting a region of the continental United States (Belluck, New York Times, 8/1).

Background on Zika virus

The Zika virus is not easily diagnosed, and it does not have a cure or vaccine. It is linked to the birth defect microcephaly, a condition in which an infant is born with an abnormally small head and brain. The condition is fatal for some infants, while others experience permanent disabilities.

The virus is most commonly transmitted by a bite from an infected mosquito, but it can also spread through sexual activity.

Congress last month left for a seven-week recess without sending President Obama legislation to fund a response to Zika. Existing funding for Zika response efforts is expected to run out in late July or early August, according to HHS Secretary Sylvia Mathews Burwell.

As of July 27, CDC reports that there have been 1,658 cases of Zika in the continental United States and 4,750 cases in U.S. territories (Women's Health Policy Report, 7/29). U.S. health officials do not anticipate an outbreak in this country similar to outbreaks seen in Latin America and the Caribbean (AP/Los Angeles Times, 8/1).

Zika in the United States

Last week, Florida Gov. Rick Scott (R) announced that four cases of Zika reported in Miami-Dade and Broward counties were likely transmitted by local mosquitoes (Women's Health Policy Report, 7/29). On Monday, Florida officials said they had identified 10 additional cases, bringing the total to 14. Twelve of the 14 cases are tied to a 150-meter area where the first two Florida cases were identified, and all of the cases were identified in the Wynwood neighborhood of Miami (New York Times, 8/1).

CDC Director Thomas Frieden said health officials are focusing efforts on the 150-meter radius around that area. The Aedes aegypti mosquito, which carries Zika, flies about 150 meters over the course of its life. As a result, an outbreak would have a relatively limited impact if only a few mosquitoes are infected, the Wall Street Journal reports (McKay/Evans, Wall Street Journal, 8/1). So far, no mosquito caught in the Wynwood area has been found to carry the virus (New York Times, 8/1).

Florida officials said two of the 14 people infected with Zika are women, but officials did not disclose the pregnancy status of either woman. According to officials, the 10 individuals most recently diagnosed with Zika likely contracted the infection several weeks ago. Of those 10 people, six had no symptoms of Zika and learned they were infected as a result of door-to-door testing (New York Times, 8/1).

In Florida, more than 2,300 individuals have been tested for Zika and more than 200 people have been tested in Miami-Dade and Broward counties since July 7 (Ross Johnson, AP/Modern Healthcare, 8/1).

CDC has sent an eight-member team, consisting of experts in birth defects, mosquito control, Zika and other fields, to help with the investigation (Wall Street Journal, 8/1).

Advisories for pregnant women

CDC's travel warning encompasses about one square mile in Wynwood (AP/Los Angeles Times, 8/1).

Frieden stated, "We advise pregnant women to avoid travel to [the Wynwood] area." Further, according to Frieden, the agency says pregnant women and their partners who live in the area should "make every effort to avoid mosquito bites and practice safe sex." CDC also is directing pregnant women who have been in the neighborhood since June 15 to discuss the possibility of Zika testing with their doctor.

Denise Jamieson, a leader of CDC's pregnancy and birth defects team, added that CDC recommends a woman considering pregnancy who has visited the Wynwood area "not get pregnant for up to eight weeks after returning from that area" (New York Times, 8/1).

Frieden noted that while CDC expects additional cases of infection, health officials do not expect a widespread outbreak. "Nothing we've seen indicates widespread transmission, but it's certainly possible there could be sustained transmission in small areas," he said (Wall Street Journal, 8/1).

Separately, health officials in Britain have said the affected area poses a moderate risk to tourists and advised pregnant women from the United Kingdom to "consider postponing nonessential travel to affected areas until after the pregnancy" (New York Times, 8/1).

Comments

Peter Hotez, a tropical medicine expert at the Baylor College of Medicine, said CDC should expand its travel advisory to encompass all of Miami-Dade County. "If you're pregnant or think you might be pregnant, avoid travel to Miami, and possibly elsewhere in South Florida," he said, adding, "I'm guessing most women who are pregnant are doing that" (AP/Modern Healthcare, 8/1).

Separately, Ellen Schwartzbard, a Miami-based OB-GYN, said many patients had called her office on Monday with questions about Zika. Noting that it could be impractical for pregnant women in the area not to leave their homes for the duration of their pregnancies, Schwartzbard advised women to wear long-sleeved clothing, use mosquito repellant and avoid having standing water near their places of residence (Wall Street Journal, 8/1).