Local health officials weigh in on Zika in Texas

Local health officials weigh in on Zika in Texas

As the Texas Department of State Health Services (DSHS) continues to report cases of Zika virus disease in the state — the number of cases was at 10 as of Tuesday, Feb. 9 — and World Health Organization (WHO) Director-General Margaret Chan calls the virus a public health emergency of international concern, more and more question arise, and many remain unanswered.

At first, the Zika virus seemed like just another mosquito-borne virus like dengue or chikungunya, even with similar symptoms such as fever, muscle pain, and joint pain. But in contrast to these other arboviruses, Zika affects the eyes differently, causing pain behind the eyes and eye redness. 

According to the Centers for Disease Control, Zika is usually mild, with symptoms only lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika, according to the CDC, and like mild cases of dengue and chikungunya, most patients feel better within a week.

The virus, according to local health officials, is currently only a concern if people have traveled to countries where Zika virus is ongoing — countries in Central and South America. 

Kevin Nix, director of communications for Legacy Community Health, confirmed in an e-mail that Legacy’s Beaumont facility has begun screening certain patients for Zika as a precautionary measure. In Harris County, Legacy Community Health, began offering its pregnant patients clinical screening for the mosquito-borne virus Feb. 2, due to possible complications during pregnancy that can result from infection.

“Given the patient population we serve and the confirmed cases in Houston, we are taking the precautionary measure of screening our pregnant patients by asking their travel history and if they are experiencing possible symptoms of Zika virus,” said Dr. Ann Barnes, chief medical officer at Legacy Community Health. “In addition, we are ramping up our patient communications through individual letters and a radio ad to reiterate our guidance that pregnant women not travel to Central and South American countries where the virus is an epidemic as outlined by the Centers for Disease Control.”

Sherry Ulmer, director of the City of Beaumont Public Health Department, says so far, screening in Southeast Texas has “consisted of asking whether patients have traveled to any of the infected areas.”

“We do not have mosquitoes carrying the Zika virus in the United States. Most of the concerns have been from people who have traveled to these infected areas,” she said.

“The mosquito being identified as the vector of the virus is not prevalent in this area,” added Jefferson County Mosquito Control Director Kevin Sexton. “This mosquito was displaced by the Asian Tiger mosquito when it came to this area in the mid-1980s via the port of Houston.”

In the United States, mosquito pools are being monitored to see if Zika virus will occur here, coming up the coast from Mexico, said Cindy Powers, director of Infection Prevention and Control for Christus Southeast Texas Health System.

There are no confirmed cases in Jefferson County, Ulmer said. But with seven confirmed cases in Harris County, one in Bexar County and two in Dallas County, the virus doesn’t seem so far out of reach.

Dallas County health officials have even raised questions as to whether the virus can affect people who haven’t even traveled to areas where the Zika virus is present, reporting Tuesday, Feb. 2, that an individual acquired the virus while in Venezuela and came back and transmitted the disease to a second person via sex.

“Now that we know Zika virus can be transmitted through sex, this increases our awareness campaign in educating the public about protecting themselves and others,” Zachary Thompson, DCHHS director told Dallas media.

Local health officials, however, aren’t so quick to acknowledge that sexual transmission of the Zika virus is even a concern.

“It has happened in the past that when someone has a viremia or virus widespread in their body, they can transmit that disease through sexual transmission, but it is very uncommon,” Powers said. “What we don’t know is more about this virus. We don’t know if (sexual transmission) is happening in South America and Central America. I think the virus is so widespread that it’s a little difficult to say. … When it is so widespread in the mosquito pool it is difficult to make that discernment.”

Ulmer said there is not enough information about whether the virus can be sexually transmitted to raise the alarm just yet, but at the same time suggests precaution.

“I can’t say that we’re going to start testing for the Zika virus as part of regular STD testing,” Ulmer said. “You are going to have to have traveled and you are going to have to be experiencing these symptoms for any blood work to be done. But at this point, I don’t believe that (sexual transmission) has been confirmed. A decision has not been made about that.”

Even though the virus has even milder symptoms than dengue or chikungunya, sexual transmission is a particular concern because the affect the virus has when pregnant women contract it and the complications that may arise in their pregnancies.

“It’s apparently causing macrocephaly,” Ulmer said.

According to the CDC, microcephaly is a condition where a baby’s head is much smaller than expected. During pregnancy, a baby’s head grows because the baby’s brain grows. Microcephaly can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size.

“Typically (Zika) is not a fatal disease, but it does cause that serious birth defect,” Ulmer said.

In early 2015, an outbreak of Zika virus transmitted by Aedes mosquitoes was identified in northeast Brazil, according to a report from the CDC. By September, reports of an increase in the number of infants born with microcephaly in Zika virus-affected areas began to emerge. Among the first 35 cases of microcephaly reported, 74 percent of mothers reported a rash illness during pregnancy, 71 percent of infants had severe microcephaly, approximately half had at least one neurologic abnormality, and among 27 who had neuroimaging studies, all were abnormal.

In an interview with Dallas media, DCHHS director Zachary Thompson said, for men who believe they might be infected with Zika or traveled to Zika affected areas, “Next to abstinence, condoms are the best prevention method against any sexually-transmitted infections.”

Ulmer suggests letting your sexual partner know if you’ve been traveling to Zika-active areas, especially if she’s pregnant.

“Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States” even suggests that men with nonpregnant sex partners who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus consider abstaining from sexual activity or using condoms consistently and correctly during sex.

Regardless, patients will have to meet certain criteria to be tested for Zika, Ulmer said.

“Just because you’re pregnant doesn’t mean you can get tested for it. … If a women is pregnant, she will have to have traveled to one of the affected areas and … she has to be exhibiting symptoms,” she said. “Then the doctor or health care provider should call the Health Department, and we would work through our state laboratory to get the specimen to the CDC. Right now, we don’t know of any testing that is occurring in local laboratories. That would have to be sent off to the CDC. Our state lab, hopefully, will be able to test for it in about two to three weeks.”

There is no specific medicine to treat Zika virus, according to the CDC, and no vaccine to prevent it, and suggestions from health officials on how to keep a mosquito from giving it to you seem all too familiar and somewhat impractical.

“It’s the same information we put out every year,” Ulmer said. “Stay indoors from dusk to dawn, dress in long-sleeved pants and shirts, loose and light colored clothing when outdoors, defend yourself by using a mosquito spray with DEET and drain any standing water around your homes and areas where you work.”

“These mosquitoes are container breeders such as old tires, bird baths, dog dishes, gutters, etc.,” added Sexton. “The public can help themselves by eliminating these sources of breeding.”