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With 10 new Zika cases in Miami, CDC advises pregnant women to avoid Wynwood

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Federal health officials on Monday advised pregnant women to avoid a Miami neighborhood — marking the first time the Centers for Disease Control and Prevention has warned against travel

to any area within the continental United States — as a Zika outbreak in South Florida has led to 10 more local cases spread by mosquitoes.

The advisory extends to all expectant mothers, and women planning on becoming pregnant who have traveled to a one-square-mile area north of downtown Miami — including Wynwood, Midtown and the Design District — on or after June 15, said CDC Director Tom Frieden.

Pregnant women and their partners who live in the area are advised to take steps to avoid mosquito bites, such as using insect repellant with DEET, wearing long sleeves and pants, and using condoms to avoid sexual transmission of Zika. Frieden also advised that all expectant mothers who have traveled to the area in recent weeks be tested for the virus.

Perhaps most troubling, Frieden said, is that extensive spraying of insecticides in the area over the past several weeks has not reduced the local population of mosquitoes capable of transmitting Zika virus.

“It’s possible that the mosquitoes there are resistant to the insecticide that’s been used,” Frieden said. “It’s possible that there may be what we call cryptic breeding places. … This is a very difficult mosquito to control, particularly in a complex urban environment.”

Friden said “there are undoubtedly more infections” in South Florida because only one in five people infected with Zika show symptoms, but he tempered his statement by noting that the Aedes aegypti species of mosquito most capable of transmitting the virus typically does not travel more than 150 meters — about 500 feet — in its lifetime.

“Nothing that we've seen indicates widespread transmission,” he said, “but it’s certainly possible there could be sustained transmission in small areas.”

The Centers for Disease Control and Prevention on Monday advised pregnant women to avoid the Wynwood neighborhood of Miami. Pregnant women and their partners living in or traveling to the area should take steps to avoid mosquito bites. Women and men who live in or traveled to the area since June 15 and who have a pregnant sex partner should use condoms or abstain from sex during pregnancy. All pregnant women in the United States should be tested for possible Zika virus exposure during each prenatal care visit.

The new cases in Miami, a major entry port for people traveling from countries and U.S. territories with active Zika transmission, triggered warnings from public health officials in England and elsewhere.

But for many people in Miami’s Wynwood neighborhood, which has burnished a reputation as an international arts destination over the past decade, news of the new local Zika cases came as a surprise.

“Now we understand why the cameras are here,” said Francisco Whilliams, 46, gesturing to the television vans down the street. It was his first time in Wynwood, strolling around with his wife, Kim, after a trip to the PaniQ Escape Room Miami, an entertainment venue in Wynwood. They live in Doral.

At Jucy Lu, a vegetarian restaurant in the heart of the affected area, employee Victoria Urrabarri said the owners told employees to wear lotion and insect repellent to work. But she felt that people in the neighborhood were not taking Zika seriously.

“I think they should be more alert,” said the 30-year-old, who lives in Doral, about 15 miles west of Wynwood. “We don’t have more info, and I think that’s really bad.”

Among the 10 new local Zika cases reported on Monday, six were asymptomatic and were identified from the door-to-door community survey that the state’s health department is conducting. In total, Florida has reported 14 local Zika cases — 12 in Miami-Dade and two in Broward — including two women and 12 men.

In response to the new Zika infections, and the four cases identified last week as the nation’s first locally transmitted episodes, Florida Gov. Rick Scott called on the CDC to dispatch an emergency response team to Miami to help with the state health department’s ongoing investigations.

“Florida has a proven track record of success when it comes to managing similar mosquito-borne viruses,” Scott said in a written statement. “We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses.”

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Combating Zika in Miami's Wynwood district

Miami-Dade County Mosquito Control inspectors work to combat Zika on Saturday, July 30, 2016, after four people in South Florida acquired the virus from local mosquitoes.

Marsha HalperThis email address is being protected from spambots. You need JavaScript enabled to view it.

The area, identified by Florida health officials, touches on the Wynwood, Midtown and Design District neighborhoods in Miami, popular with tourists. The area is bordered by Northwest Fifth Avenue to the west, U.S. 1 (Biscayne Boulevard) to the east, Northwest/Northeast 38th Street to the north, and Northwest/Northeast 20th Street to the south.

Frieden said that all of Miami-Dade’s local Zika cases were transmitted within a 150-meter area surrounding an unidentified “workplace” likely at the center of the designated zone. The neighborhood remains the only area of Florida where the health department has confirmed ongoing local transmissions of Zika.

Asymptomatic men and women who have traveled to the Miami neighborhood in that time frame should wait at least eight weeks before trying for pregnancy, said Denise J. Jamieson, a physician and expert on pregnancy and birth defects with the CDC’s Zika response team. Symptomatic men with Zika should wait six months.

And women and men who live in or traveled to the area since June 15 and who have a pregnant sex partner should use condoms or abstain from sex during pregnancy, the CDC advised.

All residents of the area were advised to repair and use screens on windows and doors, and to remove all containers with standing water that may act as mosquito breeding sites.

Florida health officials and local mosquito control workers have been inspecting and spraying the area since the first case was diagnosed several weeks ago. They also have been trapping and testing mosquitoes in Miami-Dade and Broward.

Miami-Dade’s mosquito control website notes that rotating insecticides reduces the likelihood of resistance, and that the county uses at least two types of insecticides, including BioMist 30+30, a synthetic version of Pyrethrin, and Naled, an oil-based organic phosphate used only for aerial spraying. However, it’s unclear which insecticides the county has been using in the affected area north of downtown Miami.

While some have criticized Scott for failing to ask the CDC to send an emergency response team prior to Monday, the federal agency and the White House have praised Florida’s aggressiveness in responding to mosquito borne-diseases in the past.

Frieden said on Monday that two members of the CDC’s emergency response team arrived in Florida last week, including a medical epidemiologist, Marc Fischer, and that three more would arrive on Monday and another three on Tuesday.

“We’ve had very close coordination, collaboration with Florida from the beginning of this,” Frieden said, adding that he has spoken almost daily with State Surgeon General Celeste Philip, and that experts from the CDC and Florida’s health department have been in contact, too.

“This just steps it up to the next level,” Frieden said of dispatching the eight-member team to Miami.

Florida and the CDC have long anticipated that Zika would begin to spread locally in Miami and other cities in the South, just like they saw with chikungunya and dengue fever and other mosquito-borne diseases. Despite thousands of imported cases of chikungunya virus, the CDC reported only 12 locally transmitted cases of the disease in Florida in 2014.

But Zika is different, not just because the virus can cause birth defects but because it is also sexually transmitted, and may be even more infectious from person to person than scientists know, as a mystery case currently under investigation by the CDC in Utah makes clear.

“What we know about Zika is scary,” Frieden said, noting that Zika is the first time scientists have seen a devastating birth defect like microcephaly resulting from a mosquito-borne disease, even among asymptomatic women.

“What we don't know is more unsettling,” he added, explaining that scientists have little research on the long-term effects of congenital Zika virus on children. “This may not become apparent for months or years,” he said.

CDC officials also are working to learn more about how the virus spreads, an effort that Frieden linked to Barack Obama’s February request for $1.9 billion in emergency funding for Zika preparedness, which Congress has yet to approve.

Lyle Petersen, a physician and incident manager for the CDC’s Zika response team, said that agency researchers have been investigating the Culex quinquefasciatus species or southern house mosquito and its reputed ability to carry the virus.

“We found no evidence to date that the virus can be propagated in those mosquitoes,” Petersen said.

Florida reported the state’s first baby born with Zika-related microcephaly in June. A total of 55 pregnant women statewide have been confirmed to have acquired the disease this year.

In the continental United States,1,657 Zika cases have been reported in 46 states — except Alaska, Idaho, Wyoming and South Dakota — as of July 27, according to the CDC. Florida reported two new travel-related Zika infections on Monday, including one in Manatee and one in St. Lucie counties, raising the statewide total to 388 people affected this year, not including the 14 local cases in Miami-Dade and Broward.

The Florida Department of Health has conducted testing for the Zika virus on more than 2,300 people statewide. Since the agency began its investigation into possible local transmissions of Zika on July 7, more than 200 people in Miami-Dade and Broward counties have been tested for the virus. They all live or work near the people already confirmed to have acquired Zika from local mosquitoes.

While I encourage all residents and visitors to continue to drain standing water and wear bug spray, FL remains safe and open for business.

— Rick Scott (@FLGovScott) August 1, 2016

Frieden said it is likely but not possible to establish that the first local transmission involved a mosquito biting someone who had contracted Zika while traveling abroad, and that insect then spreading the virus to others in the area.

“It’s unlikely we’ll ever know who brought it in and where they brought it in from,” he said, adding that international travel will continue to introduce new, asymptomatic people with Zika virus to South Florida and the rest of the continental United States.

“Everyone returning [from areas with ongoing Zika transmission] should use repellant for three weeks to protect their family in case a mosquito bites them and gets infected,” he said.

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3 ways to protect yourself from Zika

Zika outbreaks are currently happening in many countries and territories. The mosquitoes that can become infected with and spread Zika live in many parts of the world, including parts of the United States. Learn how you can protect yourself from Zika.

Courtesy of the U.S. Department of Health and Human Services (HHS)

For now, though, the message from public health officials has failed to persuade many locals in the only area in Florida with ongoing Zika transmission.

Outside Jucy Lu restaurant in Wynwood on Monday, art dealer Mali Parkerson, 33, was finishing up lunch with her intern, Juliette Eskinazi, 20. The two women had walked about a block from their art gallery to the restaurant, but they had no idea about the 10 new local Zika cases announced that morning.

“It’s definitely scary,” Eskinazi said. Her father had told her to wear mosquito repellent that morning, but she had only put on a little.

“I don’t really want to smell like Off in a gallery setting,” she said. “It’s such a close space.”

Now, with the number of local cases climbing, both Eskinazi and Parkerson plan to wear more repellent — despite the smell — and eat lunch inside the air-conditioned gallery more often.

But Parkerson said she’s not going to stop taking breaks outside every now and then.

“If it’s my day to get Zika, it’s my day to get Zika,” she said. “I’m not going to stop living my life.”

Zika cases reported in Florida as of Aug. 1

County

Number of Cases

Alachua

5

Brevard

8

Broward**

55

Charlotte

1

Citrus

2

Clay

3

Collier

4

Duval

6

Escambia

2

Highlands

1

Hillsborough

10

Lake

1

Lee

6

Manatee

2

Martin

1

Miami-Dade**

99

Okaloosa

2

Okeechobee

1

Orange

40

Osceola

18

Palm Beach

18

Pasco

6

Pinellas

7

Polk

12

Santa Rosa

1

Seminole

12

St. Johns

3

St. Lucie

2

Volusia

5

Total cases not involving pregnant women

333

Cases involving pregnant women regardless of symptoms*

55

* Counties of pregnant women not disclosed.

** Does not included suspected cases of local transmission.

Source: Florida Department of Health

Who To Call

People who live in the area north of downtown and want to be tested for Zika should contact the Florida Department of Health in Miami-Dade County at 305-324-2400 for more information.

CDC ADVISORY

The Centers for Disease Control and Prevention on Monday advised pregnant women to avoid the Wynwood neighborhood of Miami. Pregnant women and their partners living in or traveling to the area should take steps to avoid mosquito bites. Women and men who live in or traveled to the area since June 15 and who have a pregnant sex partner should use condoms or abstain from sex during pregnancy. All pregnant women in the United States should be tested for possible Zika virus exposure during each prenatal care visit.

Source: Centers for Disease Control and Prevention