NEWS

Zika virus: Delaware braces for unlikely outbreak

State health officials prepare for spread of virus, with pregnant women most at risk

Jen Rini
The News Journal
Kevin Brown sprays for mosquitoes at a home in North Wilmington on Monday. State health officials have plans in place to handle the Zika virus.
  • The mosquito-borne Zika virus has spread across the Caribbean and Latin American.
  • The virus is especially dangerous for pregnant women and it is believed to cause birth defects.
  • Three Delawareans have tested positive after being bitten by infected mosquitoes abroad.

Pregnant women are wary of what's to come. Mosquito-spraying businesses have seen more interest. And state officials are renewing calls to rid backyards of standing water — prime mosquito-breeding grounds — just to be safe.

It's not likely Delaware will see a Zika outbreak this summer, but the threat isn't being ignored. Three Delawareans have tested positive after being bitten by infected mosquitoes abroad. No one was pregnant.

"It’s a little unnerving knowing that something as small as a mosquito, that is so uncontrollable, can cause such a dramatic change or effect to someone's body," said Alexis Reider, 24, of Clayton, who is 15 weeks pregnant and recently had a pest control company spray her heavily wooded property. "It's something you can't control."

The mosquito-borne Zika has spread across the Caribbean and Latin American, and isolated cases have been reported in the U.S.

The virus, which typically spreads through the Aedes aegypti mosquito, is especially dangerous for pregnant women because it can lead to miscarriages and serious birth defects. It also can be sexually transmitted by infected males.

Alexis and John Reider of Clayton are expecting their first child in the Fall. As a precaution against mosquitoes and a possible spread of the Zika virus they are having their property treated.

The CDC reported 426 cases in the U.S. in its latest report on April 27, all acquired through international travel, and the rate is expected to grow. No vaccine or antiviral medications is available to threaten the virus, which in most cases results in a mild fever, but can be more serious in the sick, elderly and expecting moms.

It's expected the Gulf Coast region will be hit hardest because of the high prevalence of the Aedes aegypti mosquito, although there's some indication the related Asian tiger mosquito — which is extremely prevalent in Delaware — could also be a carrier.

Delaware Division of Public Health Director Dr. Karyl Rattay said they're closely monitoring the situation.

"Our guidance will evolve based on how this virus evolves. Right now, local transmission in the continental U.S. is not occurring on a widespread level," she said.

If a person shows symptoms, officials assess how contagious he or she is, depending on when travel took place. Someone who recently returned from a trip would be evaluated and advised to avoid mosquitoes. Mosquito control would survey his or her home as well to check for mosquitoes.

They've also developed a plan as suggested by the CDC and sent information to every licensed medical provider in the state.

If there were cases reported in southern states where the Aedes aegypti mosquito is present, the division would have to consider additional travel precautions for pregnant women.

The CDC also is recommending that local health departments create a Zika registry to catalog infected or potentially exposed pregnant women. The idea would be follow the women and their children as they age to look for any problems.

So far the state has issued 75 Zika tests. Sixteen tests are pending and 12 are for pregnant women.

A sign saying a lawn has been treated for mosquitoes is shown on a North Wilmington lawn. Wilmington City Council is discussing mosquito mitigation measures.to prevent local transmission of mosquito-borne illnesses like the Zika virus.

Officials will hold a public Zika awareness day on May 23, before Memorial Day, to discuss how people can protect themselves against mosquitoes, prevent transmission and dispel any myths about the virus.

"The concern should be heightened," Rattay said. "The outcome of Zika virus infection on pregnant women and their fetuses is very concerning and prevention is possible. By preventing mosquito bites you can prevent the transmission of the disease."

Watching the spread

Some of the lessons are coming from the response to Ebola, although there are major differences.

When Delaware was grappling with the Ebola virus outbreak in 2014, there was a coordinated state response for hospital and emergency services personnel.

Ebola is extremely contagious and can be through contact with bodily fluids. Officials had to train staff on how to safely treat and isolate a person, which included learning how to take on and off full-body protective suits.

Planning for Zika patients is completely different.

"Ebola was so much more complicated because the fatality rates was so high and it's a fairly contagious infection," Rattay said.

If there were an influx of pregnant Delaware women infected with Zika and needing care, the neonatal intensive units throughout the state would already be prepared to address complications, Rattay said.

It is premature to think about capacity issues in the NICU, said Dr. Marci Drees, head of infection control at Christiana Care Health System. Zika doesn't have the same risks as Ebola or even Middle East Respiratory Syndrome, a severe viral respiratory illness that is new to human, Drees said, but it is still crucial for doctors to take travel histories from patients.

Local transmission of mosquito-borne illness typically hits the southernmost parts of the country initially. The climate is most similar to the Caribbean and South and Central Americas, but modern conveniences such as air conditioning and screened-in windows limit spread of infection."We are still catching up on fully understanding its impact and unfortunately you can't always predict which viruses are going to do this and which ones are never going to make much of an impact," she said.

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For instance, it took about a year before birds carried West Nile virus to New York City. Dengue fever and Chikungunya viruses have not been transmitted by many East Coast mosquitoes either, said Dr. Martin Hirsch, professor of medicine at the Harvard Medical School.

"My best guess would be Zika will follow the same pattern," Hirsch said.

Delaware just doesn't have the same level of exposure as people in Central and South America do. Testing people for the virus without any travel risks is unnecessary at this point.

"Some limited, local transmission is probably likely, but I don’t think its going to be a huge out of control outbreak in any way," Drees said. "We just need to keep a very close eye on what is happening with mosquitoes."

Though the virus isn't expected to be widespread, it's just a matter of time before it reaches Delaware's mosquitoes, said Dr. Richard Henderson, an obstetrician/gynecologist with Saint Francis Healthcare.

“I don’t think Delaware is going to be able to escape it any better than any other state has," Henderson said.

There are still so many questions about the impact of Zika, he explained, particularly around why some women have complications and others do not. The uncertainty is influencing how doctors counsel women on birth control options. Contraception is one of the ways to prevent having an infected child, he added.

"I think that’s really going to change the conversation both about the availability of contraception and the importance of having that conversation," Henderson said.

Microbiologist Ria Allman tests samples for the Zika virus at the Delaware Division of Public Health Laboratory in Smyrna on Thursday.

Controlling mosquitoes

Mosquitoes take the most human lives each year through diseases such as malaria and dengue. The numbers amount to about 725,000 lives a year; by comparison, sharks take 10 lives and lions take 100.

More than 1,700 agencies across the country are charged with managing mosquitoes, but many communities still lack adequate resources.

Lawmakers on the Delaware General Assembly Joint Finance Committee, which writes the state budget, historically have been good about allocating money to mosquito control, said Bill Meredith, environmental program administrator for the state Mosquito Control Section.

Typically the budget for spraying and treating communities tops at around $672,800 a year. Meredith said he doesn't expect there to be a pressing need for increased staff or resources this summer, but the state is pursuing federal grants to bolster their Zika campaign. Officials could not disclose how much money they might receive.

"We react to Mother Nature, so we are at her mercy or if the budget is adequate or not," he said.

Instead, resources will be put toward educating communities about ridding properties of stagnant or accumulating water, but not on spraying homes unless there's evidence of Zika.

Asian tiger mosquitoes are difficult to control with sprays, he said, so the best way to avoid them is to clean standing water. That could be the water in clogged rain gutters, down spouts, upright wheelbarrows and abandoned swimming pools.

Residents cannot be fined by the state for failing to clean a backyard, but the state has reached out to homeowners associations and municipalities to educate and enforce standing water codes.

Kevin Brown sprays for mosquitoes on a North Wilmington lawn on Tuesday. The Zika virus has prompted a state health officials to develop a response plan.

"What you really need to knock off the problem is a concerted effort [among] all the homeowners," he said. "It doesn’t do you much good if you clean up your backyard and 10 people around you are slobs. You are still going to be bit by their Asian tiger mosquitoes."

Taking action

A crew with the the company Mosquito Ranger battled light drizzle on Tuesday to spray residential properties in the North Wilmington Foulk Woods neighborhood.

Typically, people schedule 10 treatments a season. Larvicides prevent mosquitoes from actually hatching, while a solution of natural oils, synthetic products, garlic, cedar and peppermint manages adult populations.

Rick Yates, owner of Mosquito Ranger, said spraying for residential properties runs from May through September. They also treat areas for weddings, country clubs and festivals, including Firefly Music Festival.

But things are different this year.

"We’ve seen a roughly 15 percent increase in our customer base and we really haven’t done any advertising yet," Yates said.

The Asian tiger mosquito feeds during the day and needs only as much as a bottle cap of water to breed. Fives years ago it would be rare to see one, Yates said, but now they are all over and especially in urban areas.

Standing water on a property makes for an even more expedient breeding ground, as does trash piles and leaf debris.

"The most important thing about this whole Zika virus is for people to be smart. Don't panic," Yates said. "A lot of people are saying they are not going to do anything differently. It makes sense to take the small steps to protect yourself."

Mosquito Authority, the Dover-based company Reider used, went one step further, offering a free initial treatment for expectant moms.

Owner Matt Rotuno said he first got into the mosquito-control business after his uncle contracted West Nile virus. The 43-year-old went into a coma and had serious brain swelling. At the time, Rotuno had a 3-year-old and a newborn, and was terrified the infection could have happened to them.

Now onto his third season, he said his customer base has exploded.

Matt Rotuno, owner of Mosquito Authority's New Castle and Kent locations, demonstrates how to use a mosquito sprayer on Wednesday. The Asian tiger mosquito feeds during the day and need only as much as a bottle cap of water to breed.

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When Kate Eberly saw a Facebook post about Rotuno's offer for expectant moms, she called to schedule an appointment that day. "Our growth at this point has been tremendous. Normally our acquisition season isn’t until mid-May," Rotuno said.

"All the media stuff just freaked me out," said Eberly, 32, who is expecting in the fall. "And the mosquitoes at our house are horrifically bad anyway."

She said they had to take prevention measures.

"There's no chance I am not going to be outside this summer," she said. "If there's a potential for me to protect against something I'm going to do it."

Jen Rini can be reached at (302)324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.