By Bara Vaida
WebMD Health News
Cases of the Zika virus have been reported in all but two states, Alaska and Wyoming, although the only locally transmitted cases have been in South Florida. Anne Schuchat, MD, principal deputy director of the CDC, talked to writer Bara Vaida about the CDC’s efforts to prevent the spread of Zika and the agency’s concern about its long-term costs.
WebMD: What does travel-associated mean when you talk about Zika?
Schuchat: Zika is usually transmitted by a mosquito bite, so most Americans who have gotten it, have gotten it outside the U.S. in places where the virus is still spreading. When a person is bitten, the virus can be in their blood, and then the mosquito gets the Zika and carries it to someone else. That is what happened in South Florida. For people who travel to a place where the outbreak is still ongoing and then return to the U.S., it’s very important that, for the next three weeks, [they] prevent the spread of Zika. Any EPA-registered repellent is recommended to prevent mosquito bites for everyone except babies 2 months or younger.
WebMD: In the spring, experts said they didn’t really expect Zika to spread explosively here because of window screens and air conditioning. After the floods in Louisiana and the multiple infection hubs in Florida, have those projections shifted at all?
Schuchat: Although there have been many surprises with Zika, the patterns we are seeing in South Florida are similar to what we were expecting. We did expect local transmission was going to be possible and would likely happen in places that already have outbreaks of mosquito-borne viruses. It is still the early days with this virus and mosquitoes. We hope the intensive intervention in Florida will bear fruit. In Louisiana, experts are on both sides about what floods will mean. Usually, with heavy rains, you wash away the larvae that grow into these problem mosquitoes. But there may be mosquitoes left, and there may be destruction of window screens and interruption of power and A/C, so things might be worse, or it might be a wash. We are working very hard to reduce mosquito burden and protect women.
WebMD: We’ve heard from NGOs (non-governmental organizations) that are trying to educate people and doctors about Zika in Puerto Rico that many people there just don’t believe in it. They say it’s U.S. propaganda. Is Zika denial making the job of controlling the outbreak more difficult?
Schuchat: There are many reasons for suspicion and skepticism in Puerto Rico, so it’s really important that we build bridges with the clinician community, the authorities, and the state officials and work together. The sad reality of Zika is you have an outbreak of mosquito-borne viral illness, but it is 6 to 7 months later before there are births or birth defects. Zika causes such mild symptoms in comparison to what Puerto Ricans are used to who have had dengue or chikungunya that it is understandable they think, what is the big deal? They haven’t yet seen or known anyone personally that delivered babies that were infected. So we hope that interventions will be taken in Puerto Rico, but the human psychology of denial and complacency and distrust can emerge. So we have a lot of work to do.
WebMD: It’s really, really hard to prevent mosquito bites. Do we need to be talking more about birth control to blunt the worst effects of the infection?
Schuchat: The issue of having a family is so personal; we don’t want to get in the middle of that. We want to make sure people have information so they can get access to care. It’s important to have access to contraception and it’s important to protect yourself from mosquito bites. We may not be 100% successful, but with personal efforts like using insect repellent, wearing long pants and sleeves, cleaning up [standing water around] the home, along with municipal efforts [focused] on mosquito control, we do believe we can reduce the intensity of mosquitoes.
WebMD: We know about 1,700 pregnant women have been infected with Zika (in the U.S. and U.S. territories). Is that number correct?
Schuchat: Every week we update the U.S. numbers for cases of Zika and pregnancy-associated cases, but we know many people don’t have symptoms and so don’t seek care. Many have mild symptoms so they don’t seek care, and not everyone who seeks care gets a test, and not all tests have been run or have given a definitive answer. So we believe that reported cases and reported Zika in pregnant women is a fraction of the total.
WebMD: Do we have enough resources to care for infants infected by Zika?
Schuchat: This may just be devastating. One individual child with a severe disability like Zika syndrome might lead to $ 1 million to $ 10 million in costs for caring for the child, not to mention the tragedy for that family. The effects are enormous.
WebMD: How much funding do you need to get the job done?
Schuchat: Congress right now is working on an emergency request for funding and that is really important. But the second thing Congress is talking about is that maybe we need a type of public health emergency response fund, or infectious disease response fund. We know that FEMA [the Federal Emergency Management Agency] has a way to move quickly when there is an emergency. We need to move quickly and to deliver something; the first reaction needs to be fast.
WebMD: What would be on your wish list if you could have as much resources as you need?
Schuchat: It is important to say in an emergency you don’t know the full extent [of it]. So your best estimate is that first request. If we had an emergency fund, we could move quite quickly. With Zika, we didn’t know that it was going to be sexually transmitted. We didn’t know the whole U.S. blood supply was going to need to be screened. The research needs just get greater and greater. We need [better] diagnostic [tests]. The goal of developing a vaccine is correct, but it will be expensive. Then we’ll need to follow these children for years. What if the child looks fine, but they did get damaged and we didn’t know?