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Blog | May 2017

May 31, 2017: A Look Back. Miami's Zika Outbreak Began Months Before It Was First Detected.

Last year’s Zika outbreak in Miami likely started in the spring of 2016, with the virus introduced multiple times before it was detected, researchers say. And most of those cases originated in the Caribbean.

The study, published Wednesday in Nature, examined more than 250 cases of local Zika transmission in three Miami neighborhoods. Researchers analyzed 39 Zika virus genomes isolated from 32 people who had been infected and seven Aedes aegypti mosquitoes, the species that carries Zika.

Comparison of differences in those genomes finds the virus was introduced by travelers at least four and perhaps as many as 40 different times as early as March 2016. Local transmission of Zika wasn’t confirmed in Miami until late July.

The study concludes that Miami’s Zika outbreak was caused mostly by infected travelers arriving from the Caribbean, the region with the highest incidence of the disease.

“Miami and South Florida particularly had this correspondence of lots of travelers from the Caribbean as well as high densities of Aedes aegypti that could support local transmission,” says Derek Cummings, a professor of biology at the University of Florida and one of the study authors. “Both the genetics and the travel data supported that the majority of locally acquired Zika cases were coming from Caribbean origin.”

Some 3 million travelers from the Caribbean arrived in Miami between January and June last year. The majority, 2.4 million, arrived aboard cruise ships. The researchers caution that doesn’t mean cruise ships are risk factors for Zika transmission, only that they are a major mode of transportation from areas where the disease was active.

According to the study, Miami is one of the few places in the continental U.S. with enough foreign travelers and a high enough density of Aedes aegypti mosquitoes to be at risk for Zika. The study authors say they think Florida is unlikely to see another Zika outbreak unless it’s sparked by one elsewhere in the Americas.

While Zika remains active and continues to be spread in areas with high numbers of Aedes aegypti, outbreaks appear to have peaked in many areas.

Brazil is reporting that Zika cases are down by 95 percent from last year and has declared an end of its public health emergency. Cummings says: “Cases in the Americas are on the decline compared to last year. So we might see fewer cases just because there are fewer cases happening in the rest of the hemisphere.”

The Miami study is one of three featured this week in Nature using genomic analysis to trace the spread of the Zika virus through the Americas.

In a commentary, Michael Worobey, a professor of ecology and evolutionary biology at the University of Arizona, says this kind of analysis needs to become part of the first-line response to future infectious disease outbreaks. “We should be detecting such outbreaks within days or weeks through routine, massive, sequence-based approaches,” he writes, “not months or years later, when clinical symptoms have accumulated.”

Source: NPR

May 29, 2017: Baltimore Unveils Zika Preparedness Plan

Baltimore City officials announced they are taking a citywide approach to combat the spread of Zika virus and other mosquito-borne illnesses.

The Zika virus is spread by mosquito bites or unprotected sex and is linked to serious birth defects.

“Ensuring that our city is safe from mosquitos and the diseases that they carry is dependent upon the collaboration of residents, community organizations, businesses, and city agencies,” Mayor Catherine Pugh said in a statement. “I encourage everyone to do their part to help keep our loved ones healthy.”

Health officials said there have been 5,274 confirmed cases of Zika in the U.S., including 224 locally-transmitted cases in Florida and Texas, through April. There have been 15 cases reported in Baltimore, all of which included individuals who traveled to an area with active Zika transmission and contracted the virus there.

“There are two mosquitoes that carry Zika, and both types of mosquitoes can be found in this area,” Baltimore City Health Commissioner Leana Wen said. “For that reason, we need to be prepared in case Zika comes to Maryland as a locally-transmitted infection.”

Zika cannot be transmitted via casual contact, but can be transmitted through sexual contact. It can also be transmitted from a pregnant mother to her baby, health officials said.

Health officials said that most people who are infected with Zika do not show symptoms, which can include red eyes, joint pain, rash and fever, but can still pass the virus on to others.

One of the biggest dangers surrounding Zika is to pregnant women, who can spread the virus to their unborn child. The virus then can cause microcephaly, a serious birth defect that causes abnormally small heads and severe brain damage.

“Zika requires an all-hands-on-deck response. Every resident can help keep Zika and other diseases out of Baltimore by eliminating mosquito breeding grounds in their communities and taking precautions to prevent mosquito bites,” Wen said in a statement. “Prevention and education are critical because there is no vaccine or cure for Zika. The effects of this virus could devastate generations to come, so we must be vigilant and act now.”

Vector control is the No. 1 weapon.

“If there’s one thing you think about doing today, encourage everyone to eliminate standing water in your communities,” said Terry Hickey, with the Mayor’s Office of Human Services.

“And then to actually go out and use the approved materials and products at our sites to spray to keep mosquito proliferation at a minimum,” said Michael Braverman, with Baltimore City Housing.

City officials offered the following tips to help stop the spread of Zika and other diseases transmitted by mosquitoes:

Eliminate mosquito breeding areas: The type of mosquito that carries Zika only needs a bottle cap full of water to breed. Residents should eliminate all standing water around their homes and in their communities by removing any standing water in buckets, coolers or old tires; covering trash cans and keep recycling bins flipped over; clearing roof gutters; and treating birdbaths, ponds, or any outdoor still water with larvicide tablets.

Take extra caution while pregnant and before conceiving: Those planning to visit areas where Zika transmission is active should make sure to use insect repellent, wear light-weight long sleeves and pants, and treat their clothes with permethrin. Pregnant women should postpone trips to areas with active Zika transmission until after their pregnancy.
Protect homes from mosquitoes: Whenever possible, keep screens on all windows, shut doors and windows without screens, use air conditioning and repair damaged or torn holes in screens. When outside, use an EPA-registered insect repellent. Residents can also call 311 if they see standing water in their neighborhood for four days or more and cannot find a way to remove it themselves.

Protect homes from mosquitoes: Whenever possible, keep screens on all windows, shut doors and windows without screens, use air conditioning and repair damaged or torn holes in screens. When outside, use an EPA-registered insect repellent. Residents can also call 311 if they see standing water in their neighborhood for four days or more and cannot find a way to remove it themselves.

Take steps to prevent the spread of diseases after travel: After traveling to an area with Zika, use insect repellent for three weeks. To prevent sexual transmission, women who travel to an area with Zika should use condoms for eight weeks after they return, and all men should use condoms for six months after they return, regardless of whether they show symptoms.

Source: WBAL NBC TV

May 25, 2017: Mosquito Season In Full Swing In Ohio

Mosquito and tick season is officially off and running in Ohio. Mosquitoes will be at their blood-sucking worst from May through October, while ticks have been active since April and will stay active until September.

The mosquito species that is most active in Ohio has been known to carry the West Nile virus. Last year, there were 17 confirmed cases of West Nile among Ohio residents. About 80 percent of people who are infected with West Nile will not show symptoms, the Ohio Department of Health (ODH) says. Only one in 150 people infected with West Nile will develop serious symptoms, like high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent, the ODH says.

On the bright side, there is less reason to fear the Zika virus which has spread through parts of Central America and the Southeast U.S. The mosquito species that is known to transmit Zika has not been established in Ohio. However, a “cousin” of the mosquito has been found in different regions throughout Ohio and that speces has been known to transmit Zika.

The ODH says there were 95 travel-associated Zika cases in Ohio last year, all from travelers returning to the Buckeye State from Zika-impacted areas. There have been three travel-associated cases of Zika in 2017.

“You can take some simple precautions at home and when traveling to prevent potentially serious mosquito-borne diseases,” said Sietske de Fijter, ODH State Epidemiologist and Bureau Chief of Infectious Diseases, in a statement.

Source: Cleveland Patch

May 24, 2017: Health Officials Say More Cases Are Coming This Summer to Philadelphia

This from Mark Dent at BillyPenn.

The signs are already up. At the airport and on SEPTA buses and Regional Rail trains, the city’s Department of Public Health has posted ads zoomed in on a mosquito with the warning, “Keep These Suckers Out.” Underneath, a slogan reads, “Fight the bite. Prevent Zika.” In another ad, the Department of Health warns, “Mosquitoes aren’t the only ones that spread Zika. Wear a condom.”

The department’s goal is to get the word out quickly in hopes of curbing a Zika problem. While Philadelphians need not worry as much as residents of southern states, the disease is expected to be a bigger issue than last summer. Of the approximately 200 cases Pennsylvania has experienced since late 2015, about 25 percent were in Philadelphia. Steve Alles, bioterrorism and public health preparedness manager for the Department of Public Health, said he expects that number of infections to rise this summer compared to last year.

“The biggest concern we have,” he said, “is not letting Zika get into our own mosquito pools.”

“The way we could get a Zika outbreak here,” said Dr. Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at Penn, “is through our airport.”

The CDC expects the Aedes aegypti to carry the virus into parts of the southern United States, like Florida, Texas and other Gulf states. This breed of mosquito has been found farther north in rare cases, including once in Bucks County.

Philadelphia does have the Asian Tiger mosquito, known as the Aedes albopictus. It’s the same genus as the aegypti but a different species. It can carry Zika but would have to get it from a host.

So when Alles speaks of the concern, he’s referring to the possibility of Philadelphia’s Asian Tiger mosquitoes contracting Zika by biting somebody who returns from a southern state or foreign country with the virus. For every case last year, Zika patients were successfully prevented from spreading the virus in that fashion.

To reduce the possibility of Zika-carrying mosquitoes, which again are highly unlikely in Philadelphia, Jamieson recommends being mindful of standing water and making sure screens in houses are repaired. Another concern regarding Zika here — and elsewhere — is the spread of the disease through sexual contact. Both men and women can spread it sexually.

About 80 percent of people who contract Zika show no symptoms, but they can still pass on the virus. Those with symptoms experiencing a sickness similar to the flu.

Pregnant women or women about to become pregnant face the greatest risk. They can give birth to children with microcephaly or other development conditions. Last year, the CDC tracked 442 pregnant women in the US who had Zika and six percent had a child with Zika-related birth defects.

“Though it will have low impact on our city,” Alles said, “it will have high impact on people that get the disease.”

Jamieson said the Health Department’s warnings about practicing safe sex after visits to infected areas and controlling the mosquito population are important to make people aware of these risks. She recommends making sure screens on windows are prepared and preventing mosquitos from breeding in watery areas.

“I pass West Philly and see tires on the side of the street,” she said. “If I’m in that community I should tip those tires or they’re going to gather water. These mosquitoes can breed in a bottle cap.

“We don’t know the extent to which we are vulnerable. We do know the preventive actions to take are good things to do anyway because we don’t want to breed mosquitoes.”

Source: BillyPenn

May 23, 2017: Double Trouble? Zika Mosquito May Transmit Dengue, Chikungunya with One Bite.

Aedes aegypti, the primary mosquito that carries Zika virus, may also transmit chikungunya and dengue viruses with one bite, a new study has found.

The findings shed new light on what is known as a co- infection, which scientists say is not yet fully understood and may be fairly common in areas experiencing outbreaks.
“A mosquito, in theory, could give you multiple viruses at once,” said Claudia Ruckert, post-doctoral researcher at Colorado State University (CSU) in the US.

The team infected mosquitoes in the lab with multiple kinds of viruses to learn more about the transmission of more than one infection from a single mosquito bite.
The researchers found that mosquitoes in the lab can transmit all three viruses simultaneously, although this is likely to be extremely rare in nature.

While they described the lab results as surprising, researchers said there is no reason to believe that these co- infections are more severe than being infected with one virus at a time.
“Dual infections in humans, however, are fairly common, or more common than we would have thought,” Ruckert said.

The researchers had expected to find that one virus would prove to be dominant and outcompete the others in the midgut of the mosquito where the infections establish and replicate before being transmitted to humans.

“It is interesting that all three replicate in a really small area in the mosquito’s body,” Ruckert said.

“When these mosquitoes get infected with two or three different viruses, there is almost no effect that the viruses have on each other in the same mosquito,” she said.

The first report of chikungunya and dengue virus co- infection occurred in 1967, researchers said. More recently, co-infections of Zika and dengue viruses, Zika and chikungunya, and all three viruses have been reported during various outbreaks, including the recent outbreak of Zika virus in North and South America.

Source: Daily Excelsior

May 22, 2017: Zika Babies Negatively Impacted by Trump

Although one of Donald Trump’s first acts as president was reinstating the Global Gag Rule, on Monday his administration announced it had expanded the policy targeting non-governmental organizations (NGOs) that provide family planning services.

The Global Gag Rule, also known as the Mexico City Policy, blocks any U.S. Agency for International Development funding from going not only to organizations and clinics that perform abortions, but even agencies that merely give patients information about abortions. In spite of the fact that no U.S. funding goes toward paying abortion, Trump decided to reinstate the Global Gag Rule while framing it as a pro-life venture with the title Protecting Life in Global Health Assistance.

The Global Gag Rule has been rearing its head since 1984, when Ronald Reagan instated it. Republican presidents have maintained and reinstated it, while Democratic president have rescinded it. However, critics argue that Trump’s version of the Global Gag Rule is even more far-reaching than any previous president’s.

With Trump’s plan, roughly $8.8 billion of global health funds coming from the Department of Defense, the State Department, and USAID will be blocked from clinics abroad that provide family planning services, such as offering birth control and HIV/AIDS prevention as well as maternal health, primary care, and Zika treatment. The effects of this span even wider than the rule under George W. Bush, which prohibited $600 million in family planning funds.

While the effects of the Global Gag Rule on maternal death rates and increased abortion rates is of top concern, it could also greatly affect Zika response efforts.

“By targeting not only family planning programs but all global health programs including those that address Zika response efforts and other health and disease areas, this policy threatens to gut funding for many of the most effective and well-positioned health organizations in more than 60 low and middle income countries,” Lori Adelman, the global communications director for the U.S. sector of the International Planned Parenthood Federation (IPFF), tells Bustle in an email.

May 20, 2017: Scientists to Test Whether Zika Can Kill Brain Cancer Cells

Scientists in Britain plan to harness the Zika virus to try to kill brain tumor cells in experiments that they say could lead to new ways to fight an aggressive type of cancer.

The research will focus on glioblastoma, the most common form of brain cancer, which has a five-year survival rate of barely 5 percent.

Zika causes severe disability in babies by attacking developing stem cells in the brain – but in adults, whose brains are fully formed, it often causes no more than mild flu-like symptoms.

In glioblastoma, the cancer cells are similar to those in the developing brain, suggesting that the virus could be used to target them while sparing normal adult brain tissue.

Experts say existing treatments have to be given at low doses to avoid damaging healthy tissue.

Researchers led by Harry Bulstrode at Cambridge University will use tumor cells in the lab and in mice to assess Zika’s potential.

The mosquito-borne virus has spread to more than 60 countries and territories in a global outbreak that was first identified in Brazil in 2015.

“Zika virus infection in babies and children is a major global health concern, and the focus has been to discover more about the virus to find new possible treatments,” Bulstrode said in a statement.

“We hope to show that the Zika virus can slow down brain tumor growth in tests in the lab,” Bulstrode added. “If we can learn lessons from Zika’s ability to cross the blood-brain barrier and target brain stem cells selectively, we could be holding the key to future treatments.”

Source: Reuters

May 5, 2017: A Speedy, Sensitive, and Low-Cost Detection Test for Zika Virus

A fast, highly sensitive, and inexpensive new test not only detects Zika virus in mosquitoes and human bodily fluids, but can also distinguish between African and Asian strains — a result that could improve efforts to more effectively track the virus’ spread.

The Asian-lineage strain of Zika virus, which has been implicated in causing severe birth defects such as microcephaly, rapidly infiltrated the Americas after its introduction in 2015, transmitted by mosquito species in the genus Aedes.

According to recent Centers for Disease Control estimates, 5,238 cases of Zika virus infection have been reported in the United States, 223 of which were presumed to have been acquired locally.

Nunya Chotiwan et al. devised an assay to directly detect Zika virus from mosquitoes and several different types of unprocessed clinical samples (including human blood, saliva, and semen). They amplified Zika virus genomes using a specialized technique called LAMP, an approach that proved comparably sensitive to the current gold-standard detection method, qRT-PCR.

Unlike qRT-PCR, however, LAMP does not require costly reagents. Importantly, LAMP did not yield false-positives for closely-related pathogens such as Dengue virus and Chikungunya virus. The researchers validated the LAMP test using virus artificially spiked into materials obtained from healthy individuals, and also in clinical specimens collected from confirmed cases of Zika virus infection. LAMP was also sufficiently sensitive to identify one single infected mosquito from a collection pool of 50 uninfected insects.

The authors say that LAMP’s minimal processing requirements and accelerated turnaround time will be valuable for Zika virus surveillance and control.

Source: Outbreak News Today

May 3, 2017: Zika Epidemic in U.S. Could Be a Costly Scenario

An outbreak of the mosquito-borne Zika virus in the United States could be very costly, a new study warns.

“This is a threat that has not gone away. Zika is still spreading silently and we are just now approaching mosquito season in the United States, which has the potential of significantly increasing the spread,” said study leader Dr. Bruce Lee. He is an associate professor in the department of international health at Johns Hopkins University’s Bloomberg School of Public Health.

“There’s still a lot we don’t know about the virus, but it is becoming clear that more resources will be needed to protect public health. Understanding what a Zika epidemic might look like, however, can really help us with planning and policy making as we prepare,” Lee said in a Hopkins news release.

In the study, computer models of outbreaks in Florida, Georgia, Alabama, Mississippi, Louisiana and Texas suggest that even a mild Zika outbreak, with an infection rate of only 0.01 percent, could lead to more than 7,000 infections and $183 million in medical costs and lost productivity.

More severe outbreaks could strain the bank, the study findings suggest.

The impact of a 1 percent infection rate could reach $1.2 billion, while a 10 percent infection rate could cost more than $10.3 billion, the researchers found.

The states included in the analysis have the highest populations of Aedes aegypti, the mosquito most likely to carry and spread the Zika virus, the study authors noted.

Last year, Congress approved just over $1 billion for mosquito-control efforts and Zika vaccine development, as well as for emergency health care for Puerto Rico, where more than 35,000 people have been affected by the virus, the researchers said.

“Without details regarding the Zika-prevention measures that would be implemented and how effective these may be, it is unclear what percentage of these costs may be averted,” Lee said.

“But our model shows it is very likely that preventing an epidemic — or at least finding ways to slow one down — would save money, especially since epidemics like Zika have hidden costs that aren’t always considered,” he added.

There is no treatment or vaccine for Zika. Most infected people have only mild symptoms, but the virus can cause severe, neurological birth defects that include microcephaly, where a baby is born with a smaller-than-normal head and an underdeveloped brain. The virus can also trigger a nervous system disease called Guillain-Barre syndrome.

In the United States, 5,264 people had been infected with Zika as of April 26, according to the U.S. Centers for Disease Control and Prevention. Meanwhile, 1,762 pregnant women had tested positive for the virus, while 58 babies have been born with Zika-related birth defects as of April 11, the agency reported.

Source: Tucson.com

May 2, 2017: Senate Committee Unanimously Approves King-Authored Bill to Combat Spread of Zika Virus

On April 26, 2017, the Senate Health, Education, Labor and Pensions (HELP) Committee unanimously approved the Strengthening Mosquito Abatement for Safety and Health (SMASH) Act, bipartisan legislation introduced by Senator Angus King (I-Maine) that would help give states and localities the tools they need to fight back against mosquitos and the viruses they carry. The bill will now be sent to the full Senate for its consideration.

The HELP Committee’s unanimously approval of the legislation, which is also cosponsored by Senators Richard Burr (R-N.C.), Bill Nelson (D-Fla.) and Marco Rubio (R-Fla.), comes in the wake of a recent report from the Centers for Disease Control and Prevention that said one in 10 pregnant women confirmed with the Zika virus gave birth to a child with virus-related birth defects. It also comes ahead of the warm summer months when mosquitos carrying the virus are expected to transfer

In considering the legislation today, HELP Committee Chairwoman Patty Murray (D-Wash.) said the bill “will be very critical in our efforts to combat the Zika virus.”

“This is a positive step forward in the ongoing work to prepare for the fight against the Zika virus as we move into the warmer summer months,” Senator King said. “And states and localities are where the battle can most effectively be fought. As we know, Maine has been fighting insect-borne diseases like Lyme for decades. Now, with the CDC outlining the serious and growing dangers of this virus, it’s critical that Congress move in an expedited manner to provide states with the funding they need for mosquito abatement efforts. I hope the Senate can quickly pass this common-sense bill.”

More specifically, the Strengthening Mosquito Abatement for Safety and Health (SMASH) Act would reauthorize critical public health tools that support states and localities in their mosquito surveillance and control efforts, especially those linked to mosquitos that carry the Zika virus, and improve the nation’s preparedness for Zika and other mosquito-borne threats.

Zika is a mosquito-borne infectious disease that is primarily transmitted to humans by the female yellow fever (A. aegypti) and Asian tiger (A. albopictus) mosquitos. The U.S. Centers for Disease Control and Prevention, which recently said that 44 states reported cases of pregnant women with evidence of Zika in 2016, has linked the Zika virus to serious health condition, including birth defects in infants such as microcephaly as well as neurological disorders.

Despite the very real and imminent threat posed by Zika, the United States remains woefully unprepared to prevent and address the spread of the virus. To help change that, the SMASH Act takes the following three immediate steps to combat the threat of Zika and other mosquito-borne diseases:

Strengthens our ability to respond to Zika by reauthorizing and improving mosquito control: The legislation reauthorizes and makes targeted improvements to the lapsed Mosquito Abatement Safety and Health (MASH) Act, which was enacted in 2003 in response to the West Nile virus. It also authorizes increased support for state and local mosquito control work – efforts that are critical for controlling and reducing the mosquitos that spread infectious diseases. Under the bill, up to $100 million in grants will be authorized each year in addition to matching funds to state and local governments.

Improves public health preparedness through laboratory research: The legislation reauthorizes the epidemiology laboratory capacity grants under the Public Health Service Act, which support state and local health departments in surveillance for, and response to, infectious diseases, including Zika. Laboratory capacity plays a pivotal role in preparation for and response to public health threats.
Inform how we can refine and improve mosquito control: Requires timely study, report, and recommendations by the Government Accountability Office regarding existing mosquito and other vector-borne surveillance and control programs. This analysis will help Congress to identify opportunities to strengthen our public health preparedness programs in partnerships with states and local communities. Ultimately, such analysis will better protect Americans from emerging mosquito-borne infectious diseases. Applying the lessons learned from responses to public health threats is critical for continuing to optimize our nation’s medical and public health preparedness and response.

The legislation has been endorsed by the National Pest Management Association, the American Mosquito Control Association, the Entomological Society of America, the Infectious Diseases Society of America, and the American Academy of Pediatrics.

Source: https://www.king.senate.gov/newsroom/press-releases/senate-committee-unanimously-approves-king-authored-bill-to-combat-spread-of-zika-virus

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