U.S. health officials plan to send a rapid-response team to any community on the mainland and in Hawaii where the mosquito-borne Zika virus begins to be transmitted locally — even if only a single case of infection is confirmed.
The Centers for Disease Control and Prevention is prepared to deploy experts to help state and local authorities in monitoring cases, performing laboratory tests and increasing mosquito control as part of a multi-level response plan.
Last week, Health and Human Services Secretary Sylvia M. Burwell, CDC Director Tom Frieden and Deputy Homeland Security Adviser Amy Pope hosted a video-conference with governors and local officials from the states with the highest risk for local transmission — Alabama, Arizona, Florida, Louisiana, Mississippi and Texas — along with officials from Georgia, Hawaii and California.
“We’re thinking through with them all the things that may happen when there is that first suspected case,” Frieden said in an interview afterward.
The response includes case monitoring to minimize the spread of infection, appropriate testing, prompt investigation and communication with the public, according to a summary of the plan.
U.S. officials are anticipating local cases of Zika infection because the mosquito that is the primary vector is found throughout the South, as well as parts of the Southwest and even Midwest. But they do not expect an explosion of cases, as has been seen in Puerto Rico and countries in the Caribbean and South America.
Americans generally have more air-conditioning and window screens and live in less densely crowded conditions in those other Zika-affected regions, Frieden said. And the Aedes aegypti mosquito’s range is only about 150 meters in its lifetime.
“We don’t think this is going to be a very common problem, but we do think it’s going to be a very high-profile problem,” Frieden said. Based on past experience with chikungunya and dengue, which are related viruses transmitted by the same type of mosquito, he said communities are more likely to see a scattering of single cases, not clusters of them or widespread outbreaks.
But managing expectations around those single cases actually may trigger more anxiety because it may take 10 days to determine their origin. “It’s not always the easiest of dynamics,” Frieden said.
Among the issues raised by the Republican governors was the adequacy of mosquito-control programs, which are locally funded, and the capacity of state labs to do Zika testing, he said.
“One of the things they’re concerned about, if they had local transmission, is they might have huge demand for testing that isn’t really clinically indicated,” Frieden said. “That could overwhelm lab capacity.”
Despite dire warnings from public health officials and experts about the spread of the virus this summer, Congress has balked on approving the Obama administration’s $1.9 billion request for Zika funding. The Senate approved $1.1 billion in funding in May. The House passed legislation that would provide $622 million, which would be drawn from money already set aside for Ebola programs.
In April, the administration redirected more than $500 million from Ebola funds to get geared up for Zika, but Frieden and other experts say Congress needs to act immediately so expanded measures can be put into place and be most effective when cases surface.
The administration also redirected about $44 million in general emergency-preparedness grants that state and local public health departments expected to receive starting in July.
Administration officials say Congress needs to replenish both the Ebola and emergency-preparedness funding. Otherwise, Frieden has said, the government will have fewer resources for critical studies of what happens to Zika-infected mothers and their children or for research on new mosquito-control technologies.
Federal health officials say the first priority is to protect pregnant women and their developing babies. They recommend that any woman who’s had possible exposure to Zika be closely monitored and tested during her pregnancy. But that goal could fall short; only 20 percent of people who are infected even show symptoms.
Zika usually remains in the blood of an infected person for about a week; after that, making a diagnosis can be more difficult. Other tests can look for the presence of antibodies that humans produce in response to the virus. But people who have been previously infected with dengue or other viruses related to Zika also produce antibodies. Tests to differentiate between those antibodies take longer and are more complicated.
Another major challenge could be identifying the location of transmission. Frieden said health officials would likely draw a map around an area and provide public advisories about traveling there.
“No one wants to be that place,” he said. “But if you had a cluster, then the public has a right to know about ongoing transmission.” Pregnant women may want to consider avoiding the area, he said.
In places in Latin America where Zika has spread widely, about 2 percent of the adult population is getting infected every month. That may be even higher during peak months, he said.