By Michele Dargan, Special Report from the Civic Association.
Dr. Robert Jacobson, a retired hematologist/oncologist, was raised and attended medical school in South Africa, where mosquito-borne illnesses were common and protective measures had to be taken.
With the mosquito-borne Zika virus becoming a worldwide concern, Dr. Jacobson urges residents to take precautions when going outside. He emphasizes the importance of screens on all windows and any outside porches or patio areas.
Image: Mosquito larve growing in collected water of a Bromeliad.
“Firstly, be aware these mosquitoes bite during the day,” said Dr. Jacobson, a 22-year Palm Beach resident. “Avoid sitting outside without protective sprays, clothing or screening around you. Secondly, be aware that still water is breeding grounds for mosquitoes. A common breeding ground for these mosquitoes are discarded soda cans and plastic bottles that people throw on the ground. Bromeliads accumulate water and are breeding grounds for the mosquitoes.”
Florida is home to the Aedes aegypti and Aedes albopictus mosquitoes, transmitters of Zika, dengue, and chikungunya viruses.
There are no known cases where mosquitoes have transmitted Zika in the United States. The virus also can be transmitted sexually. Zika usually remains in the blood of an infected person for about a week or two, but it can be found up to two months in semen. A blood or urine test can confirm a Zika infection.
There have been more than 800 cases diagnosed in the U.S., including 220 in Florida and 12 in Palm Beach County, all originated in countries where the mosquitoes are spreading the disease, according to the CDC and the Florida Department of Health.
It’s an important enough concern that Florida Governor Rick Scott is hosting a Zika Roundtable this week in West Palm Beach.
“Our Civic Association Health Care Committee has been monitoring the situation since the early spring, consistent with the charter of our committee,” said Jeff Levitt, chairman of the committee. “We felt it was time for us to become more actively involved in the dissemination of timely and accurate information to alert all residents of Palm Beach to this situation. We've already met with Town of Palm Beach officials and have reviewed their communications and education plans. We believe the Civic Association can assist in these efforts and will be announcing special education programs to help support these initiatives."
According to the CDC, lab tests have confirmed Zika virus in travelers returning to the United States and in some non-travelers who got Zika through sex with a traveler.
Zika is most harmful to fetuses. Zika infection during pregnancy is linked to a serious birth defect of the brain called microcephaly, as well as other problems in fetuses and infants infected with Zika before birth.
There is no vaccine to prevent or medicine to treat Zika.
The CDC issued travel advisories for regions where mosquitoes are transmitting the virus. They are: Cape Verde, Mexico, Central America, South America, the Pacific Islands and the Caribbean, including U.S. territories of Puerto Rico and the U.S. Virgin Islands.
“It’s really important to test people who have traveled to those countries for Zika,” said Tim O’Connor, spokesman for the Florida Department of Health, Palm Beach County.
“Only one-in-five will show any signs or symptoms and most won’t even know they have it. Zika is causing an awareness in the medical community to be on the lookout for it. Our main focus right now is educating the community on prevention measures and to recognize any signs or symptoms.
If they’ve traveled to any of these countries and have any signs or symptoms, they should go to their physician, who will report it to us. Our epidemiologists contact those individuals to get more background. From there, mosquito control is contacted. We follow up after that to see how they’re doing until such time everything is clear. It’s all reported into a central database.”
The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. The illness is usually mild with symptoms lasting for several days to a week. The grave danger is for the fetus in pregnant women. -- Center for Disease Control (CDC)
The species of mosquitos associated with Zika only travel within 100 yards of its breeding ground and only breed in containers found around the yard, such as buckets, bird baths or stacks of tires, said Gary Goode, environmental control manager for Palm Beach County’s mosquito control.
Mr. Goode urges residents to eliminate any containers that hold standing water to prevent the breeding of these mosquitos.
“We don’t have any indication that it’s being transmitted locally,” Mr. Goode said. “This particular mosquito, if you don’t have a huge tire pile, you won’t see them in huge numbers. It’s like looking for a needle in a haystack.”
A hand-held fogger is what mosquito control uses to fight this species of mosquito, because they’re day-flying mosquitoes that are located within a small perimeter, Mr. Goode said. Mosquito control spreads granular larvicide on bromeliads and containers with larvae, because the foggers don’t kill the larvae, he said.
“Treatments only last 30 days and it’s labor intensive,” he said. “That’s why when we identify a source, we want it removed.”
Mr. Goode emphasizes that the virus is only carried by one species of mosquitoes, not by what he calls the everyday “nuisance mosquito.”
“We’re hearing from a lot of folks,” Mr. Goode said. “A lot of people are nervous about this disease being present. They’re not aware of what an imported case is versus a local case. Most people don’t know there are different types of mosquitoes.”
Palm Beach County Division of Mosquito Control is spraying Tuesday evening this week, in an effor to keep the mosquito population down for the Fourth of July weekend; but, the county says that's regular spraying for nuisnace mosquitos and isn't very effective against the type of mosquito that carries the Zika virus.
The Town of Palm Beach’s role is to keep residents educated and aware of the latest information on Zika, said Deputy Town Manager Jay Boodheshwar. The town manager’s office plans on issuing a travel update later this week in advance of the July 4th holiday, he said.
“There is no known mosquito-borne transmission in U.S., but the reality is that the type of mosquito that carries the virus is prevalent in South Florida,” he said. “It’s not a matter of if, it’s a matter of when the virus becomes mosquito-borne in the US. This is based on history. West Nile and chikungunya didn’t originate here. We learned what we can do from each of these virus outbreaks. We’re in constant communication with the county regarding actions they’re taking. We encourage residents to call the county if they see if see mosquito activity. Most importantly, find the source of the breeding and eliminate it. That’s key.”
Regular pest control companies aren’t equipped to handle these types of mosquitos. If you have concerns about mosquitos on or near your property, contact Palm Beach County Mosquito Control: 561-967-6480
Mr. Boodheshwar recommends flushing out bromeliads once a week, cleaning out gutters that are clogged with leaves and overturning kayaks and other containers that could become breeding grounds for mosquitos.
“Anywhere where water will stay for more than a day are areas that need to be addressed,” he said. “We’re asking landscapers to keep an eye out for breeding areas and advise homeowners of any issues. Our landscapers can be great eyes and ears for us.”
Florida Gov. Rick Scott announced Thursday that $26.2 million dollars of state money will be used to fight Zika.
The money will be used for mosquito control, lab equipment and to purchase "Zika prevention kits" from the Centers for Disease Control and Prevention. Those kits include a bed net, insect repellent, standing water treatment tabs and condoms.
Blood banks have to screen for the virus, since most people have no symptoms and are unaware they even have it, said Dr. Jacobson, who retired from the Florida Cancer Specialists & Research Institute at Good Samaritan Medical Center in January and is teaching at Florida Atlantic University’s medical school.
“The CDC is advising blood banks that people coming from areas where the Zika virus is present should not be blood donors,” Jacobson said. “The concern is people can unknowingly spread the virus coming from those areas.”
The CDC also is investigating the link between Zika and Guillain-Barré syndrome. Zika likely triggers Guillain-Barré in a small proportion of infections, according to the CDC.
Guillain-Barré syndrome is a disease of the nervous system, causing muscle weakness, and sometimes, paralysis. The Brazil Ministry of Health has reported an increased number of people who have been infected with Zika virus who also have Guillain-Barré, according to the CDC.
Dr. Hyeryun Choe, of The Scripps Research Institute in Jupiter – a Civic Association partner, is one of a dozen researchers working on inhibitors, antibodies, and basic research pertaining to the Zika virus.
Although Scripps is not specifically designing a Zika vaccine, the ongoing research will help improve the vaccines, she said.
“Antibodies can be made in the lab and injected into people who need the antibodies,” she said. “That’s one way of treating some viral diseases. But there are so many things we do not know about Zika. Vaccines can be designed, and tested, taking time, but it may turn out the vaccine doesn’t work.”
Dr. Choe describes Zika as a “close cousin” to the dengue and West Nile viruses.
“They’re cousins, but dengue and West Nile do not cause microcephaly and Zika does and we don’t know why,” she said. “That will determine what we will use and what we should not use to treat infected people.”
Dr. Choe said that her laboratory has identified the molecule Zika uses to infect the cells in the placenta. “Instead of the placenta being a barrier, Zika infects the placenta and is transmitted to the fetus,” she said. “Usually, an inhibitor or antibodies would be developed to block that molecule. In this case, we cannot do it. This molecule is essential for fetus development. You cannot touch anything involved in placenta development. If a placenta does not develop normally, that will affect the development of the fetus. You have to consider, when you design an inhibitor or vaccine, that it won’t affect fetal development. So our goal, with respect to vaccine improvement, is to modify a vaccine that won’t infect the placenta, but will work in the rest of the body to induce a proper immune reaction.”
Zika was first discovered in 1947 in Africa and for more than 50 years outbreaks have been detected in Asia and the Pacific Islands.
In May 2015, the Pan American Health Organization issued an alert regarding the first confirmed Zika virus infection in Brazil. On February 1, the World Health Organization declared Zika virus a public health emergency of international concern.
Dr. Choe said researchers are struggling to pinpoint why Zika is coming to the forefront now.
“It was relatively easy to pinpoint why the SARS virus became so virulent, because there were not many genetic mutations that contributed to its enhanced infectivity,” she said. “In the case of Zika, there are many genetic mutations and thus it is hard to pinpoint the changes that have made it easier to infect the placenta.”
For now in Palm Beach, mosquito breeding and bite prevention is the key to controlling Zika.