C.D.C. and States Ponder Plans to Keep Ahead of Zika

C.D.C. and States Ponder Plans to Keep Ahead of Zika

Daniel Markowski, a bug scientist in a cowboy hat, has a phone that won’t stop ringing. Now that summer has arrived, and with it the mosquitoes that carry the Zika virus, the services of the Arkansas-based mosquito control contractor he works for, Vector Disease Control International, are in great demand.

Its workers, the special forces of mosquito control, wield sprayers loaded with pesticide, mostly on behalf of local governments.

“I’ve had people from literally all over the country calling,” he said. “‘What should we do?’”

The federal government is trying to provide some answers. The Centers for Disease Control and Prevention last week released a 58-page blueprint for what to do if a homegrown case of Zika surfaces.

The mosquito that carries the virus, the Aedes aegypti, is found mostly in the South and Southwest, and the C.D.C. says it is focusing much of its mosquito control effort on six states at one county most at risk: California, Texas, Florida, Hawaii, Arizona and Louisiana and Los Angeles county. As far as anyone knows, the mosquito in this country has neither picked Zika up nor started to spread it. But that could happen anytime, experts warn, especially now that hundreds of Americans have been infected with the virus while abroad. (The virus can also be sexually transmitted; the C.D.C. is planning for that, too.)

Zika infection can cause debilitating birth defects, including a condition called microcephaly that results in babies with abnormally small heads. And while scientists do not expect the epidemic to take off in the continental United States as it has in Brazil, officials are warning that even a small cluster of cases could have outsize effects if it includes anyone who is pregnant.

“Even though the percentages and the likelihoods are incredibly low, the outcome is awful,” said Dr. Tim F. Jones, epidemiologist for the state of Tennessee.

Dr. Anne Schuchat, principal deputy director at the C.D.C., said the agency’s plan “sketches out what we’re expecting states and cities to need.”

That turns out to be a lot.

Mosquito control, central to containing the spread, is spotty at best, particularly in impoverished areas with weak tax bases, common in parts of the South. In Tennessee, the overwhelming majority of counties and cities do not have mosquito control programs. In North Carolina, only about a quarter of counties have them.

Dr. Thomas R. Frieden, who heads the C.D.C., said in an interview that although the disease is also transmitted sexually, “mosquitoes are how this is spread,” and the agency is putting significant effort into helping states control the insects. (Mosquito control is a local responsibility, so the C.D.C. will not do the fighting directly.)

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What would actually happen, should there be a local case?

The C.D.C. plans to help the local government investigate it and warn residents. The agency detailed how to define the area of transmission — important for warning pregnant women what places to avoid — and underscored the urgency of alerting blood banks. If asked, the agency will dispatch a team of experts to help with everything from logistics to lab testing.

Earlier this year, many areas did not even know if they had the mosquito. The C.D.C. updated old maps, but these were pieced together using references from scientific literature and were not meant to be a real-time representation of mosquito range.

With that, states went to work. Mississippi, well within the mosquito zone on the C.D.C. map, started a statewide study of the Aedes aegypti population, testing five areas in every county each month. The result was a surprise: No aegypti.

Dr. Thomas E. Dobbs III, Mississippi’s state epidemiologist, said in an interview that while most counties did not have mosquito control programs, the state had a tiny number of imported cases — three to date, all from Haiti — and considering the fact that the state is so sparsely populated, the risk of transmission was relatively low. (The mosquito flies only about 500 feet in its lifetime, roughly a city block.)

The C.D.C. plan stated that the risk of “prolonged widespread local transmission is not expected,” based on the history of two similar viruses. Of 12 homegrown cases of chikungunya reported in Florida in 2014, for instance, only two appeared to be linked, it said. The other virus, dengue fever, has not spread beyond South Florida and southernmost Texas in the continental United States. Both are mosquito-borne diseases.

And even though most people with Zika have no symptoms, posing the risk of undetected spread, most experts do not believe there will be more than a handful of local cases, mainly because of the conditions of life in the United States — namely, widespread use of air-conditioning and window screens, and relatively little crowding.

A study comparing Laredo, Tex., with its twin just across the border in Mexico — essentially the same city separated by a river — found the incidence of dengue fever was eight times higher on the Mexico side, even though the mosquitoes that carry it were more abundant in Texas. Researchers attributed the Texan advantage to air-conditioning, windows that shut and less crowding within houses.

“Everything we’ve seen from dengue and chikungunya suggests that it will not be a severe problem” in the continental United States, Dr. Frieden said. “Our best guess” is that “we’ll see a singleton case that we won’t be able to identify the source for, and possibly some clusters — maybe in the Florida Keys or Brownsville” in Texas.

Still, he noted that Puerto Rico, an American territory, is facing a public health crisis because of the virus, with potentially “dozens to hundreds of infected infants with microcephaly.”

One of the obstacles for zika preparedness is money. Congress is still arguing over President Obama’s $1.9 billion request, which was submitted in February.

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Dr. Markowski, who spoke by telephone from St. Croix, where he was working on a C.D.C. contract to control mosquitoes in the United States Virgin Islands, said his company has submitted contingency plans to about half a dozen states, including Mississippi, but so far none have been carried out, possibly because states are waiting for funding — or an outbreak.

Dr. Frieden said longer-term projects are suffering as well, such as “coming up with better diagnostics, coming up with better ways of controlling mosquitoes.” He said the funding holdup has likewise hampered efforts to follow infected pregnant women through their births for multiple years.

Despite the gridlock on funding from Washington, some states, and even cities, are preparing their own plans. Tennessee is doing drills, giving staff members in local health departments surprise scenarios.

“Instead of just letting people tell us theoretically what they think they’d do, we make them prove it,” Dr. Jones said.

He said Tennessee has set up a Zika response center, but tight funding has meant that the state has had to poach workers from other programs — including H.I.V. and immunizations — to staff it.

“People are enthusiastic about doing it, and it’s the right thing, but it means we’re diverting resources from something else,” he said. “Our surge capacity is not unlimited.”

Dr. Markowski said that he is glad that people are paying attention, but that life should not grind to a halt.

“We shouldn’t live our summer in fear and hide inside,” he said. “We should approach it with the appropriate level of respect that any mosquito-borne disease deserves. But we should also be going outside and enjoying the Fourth of July.”

Correction: June 21, 2016

An earlier version of this article, using information from the C.D.C., erroneously included New Mexico on the list of states where the agency is focusing much of its mosquito control effort. (In addition to the six other states, the C.D.C. is also focusing efforts in Los Angeles County.)

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