Should We Be Worried About Zika in North Georgia?

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Residents of southern United States’ big cities and coastal towns have a reason to worry about Zika.  Indeed, as of the first week of August, Miami already has 15 cases where people were infected with Zika locally. Now the number is 22. We can expect places like Houston, New Orleans, Savannah, Atlanta and Washington DC to follow.  But what about Jasper, Ellijay, Blue Ridge, Blairsville and Dawsonville?

Geographic spread of Aedes aegypti mosquito, the main transmitter of Zika.

Geographic spread of Aedes aegypti mosquito, the main transmitter of Zika.

 

 

There could be some isolated cases occurring in the area, but a large outbreak is unlikely for several reasons.  First, the mosquito species Aedes aegypti, which is responsible for much of Zika transmission is a relative homebody, only flying about 500 feet from where it hatched.  The mosquito loves breeding in small pools of water like unemptied pet water bowls, water-collection saucers under potted plants, bird baths, or pieces of trash crumpled up in just the right way to hold a little bit of water.  While you might have these scattered throughout your yard, in most cases, due to the low population density in north Georgia, your neighbor’s small-sized mosquito nurseries are more than 500 feet from yours.  Compare this to a place like Savannah, where the yards are only a bit bigger than the house and all the garbage bins (excellent mosquito nurseries) are sitting out in the alleys, about 200 feet from the house.

For Zika to have a foothold here, it has to come from somewhere else.  Definitely, there are north Georgia residents travelling to Atlanta and Miami all the time.  If a person acquires Zika there, the virus will travel back home.  Then, though, a mosquito here must bite the infected person, incubate the virus and come across another person to bite.  However, remembering that the Aedes ageypti is a homebody, the potential new victim has to be close.  For the virus to really spread, there needs to be an area with potential mosquito nurseries every few feet.

Also, mosquitoes need access to us.  The South’s dependence on air conditioning to make it through the summer and dependence on screens to keep the insect hordes out means that relatively few mosquitoes make it into the home.  This is unlike areas in Brazil where Zika has gained a foothold.  In these areas, the relatively poor population does not use air conditioning or have window screens.  Thirdly, north Georgia has a cold winter that, thankfully, decimates hordes of biting insects.

If, on a slight chance, Zika does show up in north Georgia, is Zika really as devastating as the amount of attention surrounding it? No.  According to Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease, “Zika is a realtively mild disease – fever, aches, pain, rash, conjunctivitis and done.”  Only 1 in 5 people who are infected with Zika will actually have the symptoms.

In comparison, malaria, another mosquito-borne virus, infected 214 million people world-wide last year and killed 438,000, mostly children under five.  The virus causes fever, fatigue, vomiting, headaches and death. Malaria is widely-present in countries between the Tropic of Cancer and the Tropic of Capricorn.  Within the last 60 years, the United States has had 63 small-scale malaria outbreaks.

Another common world-wide disease carried by the Aedes aegypti mosquito is dengue.  It causes fever, vomiting, muscle and joint pains and skin rash and in advanced cases internal bleeding and death.  Approximately 10,000 to 20,000 world-wide people die each year from it.  The virus is now becoming entrenched along the Mexico-US border and the coastal area of Gulf Coast states.

A third Aedes aegypti borne disease is chikungunya.  It is not as deadly as malaria or dengue, but its toll can be enormous body pain.  The virus lasts from two to four days and causes severe joint pains for months, sometimes years.  From 2013 to 2014, there were 1,118,763 suspected cases in the North and South America.

Not to forget, yellow fever, which was the scourge of southern port cities during the 1700 and 1800’s.  In August 1876, 1,066 people died in Savannah, GA during a month-long yellow fever outbreak.  That was approximately one out of every 25 people.  Still now, there are 200,000 yellow fever infections per year, resulting in 30,000 deaths.  90% of these are in Africa.  Yellow fever causes chills, fever, loss of appetite, nausea, muscle pain, and liver damage – which causes the yellow tint in the skin of someone who has yellow fever.

In the past, the US government has come together over public health mosquito-control programs. One of the largest mosquito eradication efforts in US history took place in the southeastern United States through the National Malaria Eradication Program.  13 southeastern states and the Centers for Disease Control (CDC) started the program in 1947.  The main components of the program was DDT application to interior surfaces of rural homes, drainage of mosquito breeding sites and some aerial spraying of insecticides.  By 1952, the Centers for Disease Control stopped the program because it had significantly reduced chances of a widespread malaria outbreak in the United States.

So, compared to malaria, yellow fever, dengue and chikungunya, Zika seems to be a relatively mild mosquito-borne virus. Only 20% of people infected even feel the symptoms and, for the most part, the discomfort is gone after a few days.

A baby with microcephaly born to a Brazilian mother infected with Zika.

A baby with microcephaly born to a Brazilian mother infected with Zika.

However, Zika has characteristic that strikes fear into women who become pregnant.  The virus eats at protein sheaths covering the developing nerve cells of the brain.  When the virus attacks an unborn child through the mother’s bloodstream, the result can be microcephaly, a condition where the brain does not fully develop.  This can cause a whole range of brain deformities from relatively mild behavior disorders to severe retardation to miscarriage.   Other effects include abnormal eye development, clubfoot and inflexible joints.  Dr. Denise Jamison of the CDC estimates that for every 100 women infected with Zika during their pregnancies, 1% to 15% of the children born will have severe birth defects.  Brain abnormalities can also occur in children and adults who contract Zika.  They can develop Guillian-Barre syndrome.  In Guillian-Barre syndrome, immune system cells start to attack myelin sheaths surrounding nerves, which prevents the nerves from transmitting signals efficiently.  It causes weakness and tingling sensations in the limbs and, in severe cases, lead to paralysis.

If the effect on pregnant women and developing fetuses was taken out of the equation, Zika would not be such a troubling virus.  However, the prospect of caring and raising children with Zika-caused brain abnormalities is heart-breaking and tremendous for the family and the community at large.  Current estimates of the cost of raising a child is $1 million; the cost for raising a child with microcephaly can be upwards of $10 million.  This includes cost of special schooling until age 21 and numerous medical interventions, with most of the costs being carried in public health and education services.  Having a large, geographically-specific population that needs this care will place an excessive financial responsibility on a community.

Area of Miami with confirmed cases of locally-spread Zika.

Area of Miami with confirmed cases of locally-spread Zika.

So, heading off the Zika public health crisis has become important for public officials, especially in states like Florida, where the climate and population density is prime for a Zika outbreak.  Puerto Rico, a US Territory, has a dire need for mosquito control efforts.   As reported in the July 30th New York Times Puerto Rico has 5,500 confirmed Zika cases with 672 of them being pregnant women.  Puerto Rican officials believe about 50 pregnant women per-day become infected.

However, the US Congress has stalled in any action to fund Zika-related mosquito-control programs.  There is a bill for $1.9 billion to fund mosquito-control programs, which has been sitting in Congress since spring.  Democrats and Republicans won’t bring it to vote because the bill contains riders which anger voting constituencies.   Republicans inserted a rider which takes money away from Planned Parenthood in Puerto Rico.   Democrats argue that taking money away from Planned Parenthood in Puerto Rico denies the contraceptive services and education that women greatly need at this time.  Republicans state that there are still enough non-Planned Parenthood community health services which can provide the same information.  The second rider Republicans added was taking money out of the Affordable Care Act fund to pay for part of the Zika mosquito eradication efforts.  Democrats did not agree with this.  As of yet, there is no word when the House or Senate will put forth a “clean” bill, meaning one with no riders, which will go to helping states like Florida begin massive mosquito control programs.

Zika information flyer from Georgia Department of Public Health

Zika information flyer from Georgia Department of Public Health

We do know from previous mosquito control public health programs like the National Malaria Eradication Program that the government can come together for a single non-partisan purpose like controlling mosquito-borne viruses.  However, at present, keeping Aedes aegypti mosquitos at bay is up to the public:  wear long-sleeved shirts and pants, use insect repellent with DEET, keep potential mosquito nurseries emptied out and rely on screens and nets to keep mosquitoes out of the house.

Recently, Good Morning From the Office  interviewed Dr. Bill Whaley of Fannin County about Zika. Watch the interview on the video below.

 

 

 

 

 

 

 

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