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Zika outbreak spurs travel advisory to part of Miami

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Federal health officials Monday issued an unprecedented travel warning for a Miami neighborhood because of a risk of transmission of the Zika virus, which can cause birth defects.

Pregnant women should avoid travel to the Zika-stricken area, and expectant mothers who have visited the neighborhood since June 15 should get tested for the virus. The number of people suspected to be locally infected through mosquito bites climbed to 14, officials with the Centers for Disease Control and Prevention said Monday.

Nearly all of the infections have been linked to a 150-meter area surrounding two workplaces in the Wynwood arts district, but the travel advisory was broadened to a buffer zone five times larger.

State health officials went door to door in the area and identified infected people through urine tests, because most did not report any symptoms. The first four cases were announced on Friday, with 10 more counted over the weekend.

In its warning Monday, the CDC also said men and women who recently have visited the area should wait at least eight weeks before trying to conceive a child. Pregnant women who live or work in the area should take precautions to avoid mosquito bites.

Dr. Tom Frieden, director of the CDC, said there is no history of a medical travel advisory in the U.S. An emergency response team of eight CDC experts was dispatched to Florida at the request of Gov. Rick Scott to help combat the spread of the virus.

“We do expect that additional individual infections will be reported,” Frieden said in a conference call with reporters.

Mosquito control efforts in the neighborhood have not been as effective as hoped, Frieden said. The mosquitoes that carry the virus, Aedes aegypti, may have developed resistance to the pesticides used, or the spraying has not reached all of the insects’ breeding areas.

The mosquito is also particularly difficult to kill off because it thrives in urban areas. The risk is highest for people living in crowded conditions without window screens or air conditioning, which is partly why the virus has flourished in Latin America and the Caribbean.

There have been no Aedes aegypti mosquitoes trapped in the St. Louis area this summer, according to a vector control supervisor with the St. Louis County health department. The mosquito most commonly found in the region, the Culex, is not believed to carry Zika.

The first-ever travel warning in the U.S. probably was issued to help contain the virus, said Dr. Alexander Garza, associate dean for public health practice at St. Louis University and former medical chief for the Department of Homeland Security.

“There are going to be pockets that pop up here and there they can react to promptly. That’s probably the strategy they’re adopting right now,” he said.

The relatively small area covered by the warning indicates the threat is limited. The risk comes from the number of Floridians who travel outside the country combined with a high concentration of Aedes aegypti mosquitoes in the state. Since the insects mainly feed on humans and have a small flight range, urban areas are more prone to outbreaks and widespread transmission is unlikely.

Fighting mosquito-borne disease outbreaks typically takes two approaches: preventing bites in people and killing off the insects and their larvae. An added challenge with Zika is its ability to be transmitted through sex.

Efforts to stop similar mosquito-borne viruses Chikungunya and Dengue have been effective in the past during small outbreaks in Texas and Florida, even without door-to-door surveillance.

“The reason they’re being much more aggressive about trying to find out how much penetration there is (with Zika) is because of the really devastating outcomes for women that are pregnant,” Garza said.

Most people who catch Zika have no symptoms or mild fevers, joint pain, pink eye and rash, but if the virus crosses the placental barrier it can cause brain damage to the fetus.

While it is unknown how the warning will affect tourism in Florida, most people should not change their travel plans, said Dr. Antonio Crespo, an infectious disease specialist at Orlando Health. There have been no cases of Zika linked to mosquitoes in Orlando or other parts of the state, Crespo said.

“It’s very, very localized,” Crespo said. “At this point, we don’t need to panic. I would recommend to stay tuned and follow the developments.”

Florida health officials said they’ve tested more than 200 people in Miami-Dade and Broward counties in the last month. Of the 14 people believed infected in the Miami neighborhood, two are women and 12 are men. Officials did not say whether the women are pregnant.

U.S. health officials do not expect widespread outbreaks as seen in Latin America and the Caribbean, mostly because the U.S. is more sparsely populated and the Aedes aegypti mosquito does not circulate nationwide. Aside from the 14 locally acquired cases in Florida, more than 1,650 cases of Zika linked to travel abroad have been reported in the U.S., including 12 cases in Missouri and 29 in Illinois.

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