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Fla. Gov. declares state free of local Zika transmission; Texas reports new cases; CDC cites increase in microcephaly cases in Colombia

Florida Gov. Rick Scott (R) on Friday announced that the state is free of local Zika virus transmission, the New York Times reports (Alvarez, New York Times, 12/9).

Background

The Zika virus is not easily diagnosed, and it does not have a cure or vaccine. The virus is most commonly transmitted by a bite from an infected mosquito, but it can also be spread through sexual activity (Women's Health Policy Report, 11/23).

Researchers have linked Zika infection during pregnancy to congenital Zika syndrome, which includes microcephaly, a sometimes fatal anomaly in which a fetus develops an abnormally small head and brain; decreased brain tissue with a distinct pattern of calcium deposits that suggest brain damage; damage to the back of the eye; limited range of motion in the joints; and excessive muscle tone that restricts movement shortly after delivery (Women's Health Policy Report, 11/21).

As of Thursday, Florida had reported 1,244 cases of Zika. That represents over one-quarter of cases of Zika reported in the United States. Of the cases reported in Florida, 249 were locally acquired and 185 involved pregnant women (New York Times, 12/9).

Latest developments

According to the AP/Sacramento Bee, Florida officials had identified four zones in the Miami area where local mosquitos were transmitting Zika. Over time, the areas were deemed clear of local Zika transmission. The last zone, a 1.5-square-mile portion of South Beach, was declared Zika free on Friday (Kay, AP/Sacramento Bee, 12/9).

Following the announcement clearing the South Beach zone of active Zika transmission, CDC updated its travel guidelines for the area. Previously, the agency urged pregnant women to avoid the area. It now directs pregnant women to exercise caution when travelling to the area.

According to the Times, the drop in local Zika transmission is the result of aggressive mosquito control efforts as well as changing weather. In South Florida, winter marks the end of the rainy season as well as slightly cooler temperatures, which make it harder for the Zika-carrying Aedes aegypti mosquito to survive.

However, the state is still expected to continue experiencing isolated cases of Zika, according to the Times (New York Times, 12/9). In addition, officials warned travelers visiting Florida from out of state or the country could continue to carry the virus (AP/Sacramento Bee, 12/9).

Meanwhile, Miami-Dade County is preparing for the next cycle of Zika, which is expected to begin when rain comes in early summer, the Times reports. Chalmers Vasquez, Miami-Dade County's mosquito control manager, said, "The virus is endemic; it's here now." He continued, "But we have a good picture of what we are dealing with the next mosquito outbreak."

According to Paul Mauriello, deputy director for solid waste management for Miami-Dade County, the county's efforts to prepare for the next cycle include applying larvicide through the winter, inspecting properties and checking traps to tally the mosquito population. The county wants to double the number of traps in coming weeks (New York Times, 12/9).

Texas reports new local Zika cases

In related news, the Texas Department of State Health Services (DSHS) and the Cameron County Health Department on Friday announced they have identified four new cases of locally acquired Zika in Cameron County, the Texas Tribune reports (Silver, Texas Tribune, 12/9).

Texas officials in late November reported the first probable case of locally acquired Zika in the state. The patient, a non-pregnant woman, resides in Brownsville, which is on the Gulf Coast, near the Mexican border. The woman told investigators that she had not recently traveled to an area where the virus had been spreading, had sex with a person who had visited such an area or experienced any other risk factors (Women's Health Policy Report, 11/29).

According to state health officials, the new patients "live in very close proximity to the first case." The officials stated, "Though the investigation is ongoing, the infections were likely acquired in that immediate area. They reported getting sick with Zika-like symptoms between Nov. 29 and Dec. 1 and were likely infected several days earlier before mosquito control efforts intensified in that part of Brownsville."

Health officials said none of the identified patients are pregnant (Texas Tribune, 12/9).

Report finds spike in microcephaly cases in Colombia

In other related news, Colombia in 2016 reported four times as many cases of microcephaly as it did in 2015, which corresponds with a widespread Zika outbreak, according to a report released by the Centers for Disease Control and Prevention (CDC) Friday, the Washington Post's "To Your Health" reports (Sun, "To Your Health," Washington Post, 12/9).

Zika has been found in 60 counties since the outbreak was identified last year in Brazil (Women's Health Policy Report, 11/21). Colombia had the second-largest Zika outbreak of any country, following Brazil (Women's Health Policy Report, 11/1).

Key findings

The latest report marks the first month-by-month analysis of reported microcephaly cases in Columbia. In the report, CDC said there were 476 cases of microcephaly identified between February and mid-November 2016, of which 44 ended in miscarriage or abortion. In comparison, there were 110 cases of microcephaly identified in the same time period in 2015.

CDC found the number of reported cases of microcephaly in 2016 peaked in July, about 24 weeks after the height of the Zika outbreak. Officials counted 94 cases in July 2016, a nine-fold increase over July 2015 ("To Your Health," Washington Post, 12/9).

Overall, there were 9.6 cases of microcephaly per 10,000 live births in Colombia in 2016. Up to 20,000 pregnant women have contracted Zika virus since the outbreak began in October 2015. Meanwhile, the number of live births recorded in Colombia dropped by about 18,000 between 2015 and 2016 (Steenhuysen, Reuters, 12/9).

According to "To Your Health," the latest report confirms earlier findings that the risk of Zika-related fetal anomalies is greatest during the first and early-second trimester of pregnancy. However, the report acknowledged a limitation in that there was not laboratory confirmation of maternal Zika infection for the majority of reported microcephaly cases.

Experts expect increased microcephaly rates in Zika-affected countries

The findings dispel earlier projections that Colombia might have only a relatively small number of microcephaly cases, despite the high rate of Zika infection, "To Your Health" reports. Experts had cautioned against making predictions prematurely about microcephaly in Colombia, explaining that if a woman is infected with Zika early in pregnancy, it can take several months before a fetus displays symptoms. In addition, "To Your Health" reports that data collection in the country is a laborious process that can slow the promulgation of data.

CDC's Margaret Honein said, "The evidence was compelling." She continued, "We expect that every country with a major Zika outbreak will see an increase in microcephaly and severe brain abnormalities" ("To Your Health," Washington Post, 12/9).

Nonetheless, according to Reuters, the overall number of microcephaly cases in Columbia is still substantially lower than Brazil, which has confirmed 2,228 microcephaly cases linked with Zika and is investigating another 3,173 cases. Experts have suggested several possible reasons for the disparity, including greater abortion access in Colombia (Reuters, 12/9).