Health officials work to contain Zika virus in Miami-Dade
At least two people acquired Zika from mosquitoes that bit them within a one-square-mile area north of downtown Miami sometime in early July, state and federal health officials said Friday, confirming the first cluster of the virus spread locally in the continental United States.
Four people in South Florida — two in Miami-Dade County and two in Broward — have been infected by local mosquitoes, according to Florida Gov. Rick Scott, whose announcement triggered a wave of response from public health agencies and elected officials.
“Florida has become the first state in the nation to have local transmission of the Zika virus,” Scott said.
Zika’s arrival in the continental United States has been anticipated since last fall, following the virus’ rapid spread through the Caribbean and Latin America. But confirmation that local mosquitoes have transmitted Zika in Florida set off alarm bells in Congress, with Republicans and Democrats blaming each other for failing to approve emergency funding to respond to the public health threat.
The disease also might have major impacts on travel and tourism. Miami is a major port of entry for people traveling from countries and U.S. territories with active Zika transmission, and millions of people are expected to flow through South Florida on their way to and from the veritable epicenter of the outbreak, Brazil, which is hosting the Summer Olympics.
But while the Centers for Disease Control and Prevention has advised expectant mothers and women considering becoming pregnant to avoid travel to areas with ongoing Zika virus transmission, CDC Director Tom Frieden said Friday that the agency is not advising the same for Miami — even for pregnant women, who are at greatest risk from the disease because it can cause microcephaly and other neurological disorders in their newborns.
The CDC has advised pregnant women to avoid travel to Puerto Rico and other places with ongoing Zika transmission, he said, because the agency had anticipated an explosive outbreak of the disease on the island due to environmental and other factors.
“There are likely to be isolated cases in the United States, and there may be occasional clusters in the United States,” Frieden said. “We don’t expect widespread transmission.”
He said women in the area who are pregnant should consider getting tested for Zika and that they take steps to avoid mosquito bites. However, he warned, if new Zika infections continue to occur in the same Miami neighborhood even after extensive spraying, inspections and other efforts to reduce mosquitoes, “this would be a concern and warrant further advice and action.”
Among the four Zika cases confirmed in South Florida, Frieden said at least two of the people acquired the virus within the same few blocks north of downtown Miami. He said the two people are not related, and they are not co-workers but that their presence in that small area was “their only association.”
“The investigations there identified significant numbers of mosquitoes that can spread Zika,” he said.
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.
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.
Investigators have gone door-to-door in the affected neighborhoods, interviewing residents and collecting urine samples for testing, State Surgeon General Celeste Philip said. Earlier this week, the CDC dispatched a medical epidemiologist to Florida to help with the investigation.
Frieden said that no local mosquitoes have tested positive for Zika virus to date — “It’s like finding a needle in a haystack,” he said — but that epidemiologists ruled out other modes of transmission, such as sex.
“Everything we’ve seen so far indicates to us this is mosquito-borne transmission,” he said. “There isn’t a test to confirm that unless we get lucky enough to find Zika in a mosquito.”
The local cases were identified by private physicians who reported symptoms in their patients and had them tested. Frieden said that given Zika’s relatively mild effects on most people, there may be more locally acquired cases that have gone undetected.
“We would not be surprised if additional individual cases are reported,” he said. “In fact, there may well be more cases that we’re not aware of right now because most people infected with Zika don’t have symptoms.”
On Friday, Florida’s health department reported three new Zika infections in Miami-Dade, but all of the cases were classified as travel related. At least 99 people in Miami-Dade and 55 in Broward have tested positive for Zika this year, not including the four locally transmitted cases and pregnant women.
Elizabeth Etkin-Kramer, a Miami Beach gynecologist and former president of the Dade County Medical Association, said the local cluster of Zika is not alarming because it’s contained in a small area — a characteristic of Aedes aegypti, the mosquito species most likely to transmit the virus.
“Mosquitoes that carry Zika tend to live and die in the same area. They are homebodies,” she said. “If it was diffusely in South Florida, there would be much more concern.”
But even a small cluster of cases near downtown Miami and South Beach has raised alarm among local hoteliers concerned about the impact on tourism.
The Greater Miami Convention & Visitors Bureau and the Greater Miami and the Beaches Hotel Association held a joint Zika preparedness meeting last week with the general managers of major hotels, Miami-Dade officials and the health department.
Hotels were prepped on preventive measures, such as draining and covering containers that collect standing water, and advising travelers to wear mosquito repellent and long sleeves and pants, said William D. Talbert III, president of the tourism bureau.
“There’s no reason not to travel here,” Talbert said.
With the news that Zika is now spreading in Miami, the White House praised the state’s leaders for their response efforts.
“Governor Scott has been preparing for this circumstance for quite some time,” White House Deputy Press Secretary Eric Schultz said during a press conference. “They’ve had aggressive vector control in place to limit transmission with mosquitoes.”
In confirming local transmission of Zika, Scott said he directed the health department to immediately begin contracting with commercial pest control companies to increase spraying and mosquito reduction efforts in the Miami area.
He also ordered that Florida provide $620,000 to OneBlood, the primary blood bank in the area, to establish blood screening, which began on Friday. And he said Miami-Dade and Broward mosquito control would receive $1.28 million in state funding through December to combat Zika.
Florida’s congressional delegation called for a more robust federal response, with each party blaming the opposing one for failing to pass an emergency spending bill to fight the spread of the virus.
Sen. Bill Nelson, a Florida Democrat, called on Congress to immediately return to Washington and approve President Barack Obama’s February request for $1.9 billion in emergency funding for Zika preparedness.
Nelson made the call in a letter he sent Friday to Senate Majority Leader Mitch McConnell, a Kentucky Republican. “If there was ever a time for Congress to act, it is now,” Nelson said in the letter.
U.S. Sen. Marco Rubio, a Miami Republican, addressed the outbreak at an event originally planned to showcase his opposition to recent events in Venezuela. Speaking at the Venezuelan restaurant, Arepazo #2, in Doral, Rubio was joined by fellow Republicans, including U.S. Reps. Carlos Curbelo and Illeana Ros-Lehtinen, state Rep. Carlos Trujillo and state Sen. Rene Garcia.
“Zika doesn’t just bite Republicans or Democrats or independents. It bites everyone,” Rubio said, adding that earlier this week he wrote to the president and asked him to spend about $300 million in federal funds available now.
Curbelo blamed Democrats for refusing to support a House Republican proposal that would have designated $1.1 billion for Zika but also reduced funding for Planned Parenthood, defunded parts of the Affordable Care Act and reversed a ban on flying Confederate flags in military cemeteries.
“I’ve been very fair in terms of criticizing both parties for failing to act,” Curbelo said. “Now, it’s Senate Democrats who are regrettably blocking this funding from moving forward. It’s not the $1.9 billion that we would have all wanted, but $1.1 billion dollars is still significant funding to fight this disease.”
Anthony Fauci, a physician and director of the National Institute of Allergy and Infectious Diseases, said the agency is running out of money to pay for research and trials for a Zika vaccine.
“If we don’t get money soon, it’s going to have a ripple effect down the pipe,” Fauci said.
As researchers work to develop a vaccine for Zika and learn more about its long-term effects, the CDC’s Frieden sounded confident that Zika may follow the pattern of past local and federal efforts to control other mosquito-borne viruses, such as West Nile, dengue fever and chikungunya.
He said epidemiological investigations into mosquito-borne transmission of those viruses did not find more than a small number of people affected, including cases in Key West and Texas. “Generally,” he said, “when the cases come in, they kind of dead-end after infecting one person.”
Still, Frieden cautioned that while widespread transmission of Zika is unlikely in the continental United States, “it’s not impossible,” he said.
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.
Miami Herald reporters Alex Daugherty and Chabeli Herrera contributed to this article.
Zika cases reported in Florida as of July 28
Number of Cases
Total cases not involving pregnant women
Cases involving pregnant women regardless of symptoms*
* Counties of pregnant women not disclosed.
** Does not included suspected cases of local transmission.
Source: Florida Department of Health