The poorest parts of Houston remind Dr. Peter Hotez of some
of the neighborhoods in Latin America hardest hit by Zika. Broken window screens. Limited air conditioning. Trash piles
that seem to re-appear even after they're cleaned up. On a hot, humid day this month, Hotez pointed at one pile
that included old tires and a smashed-in television with water pooling inside.
It was a textbook habitat for the mosquitoes that carry and transmit the Zika
virus, and one example of the challenge facing public health officials. "I'm showing you Zika heaven," said Hotez, the
tropical medicine dean at Baylor College of Medicine.
Hotez and other tropical disease specialists are most
concerned about impoverished urban areas and along the Gulf Coast, where the
numbers of the mosquito that spreads Zika are expected to spike. Texas already
has dealt with dengue fever, transmitted by the same mosquito.
Zika causes only a mild and brief illness, at worst, in most
people. But it can cause fetal death and severe brain defects in the children
of women infected during pregnancy.
So far, Texas officials have reported 48 people infected
with Zika, all associated with travel. In one case, the virus was sexually
transmitted by someone who had been infected abroad.
Public health officials have spent months preparing for what
they are certain will be at least some locally transmitted cases. "It's
not a matter of if, it's a matter of when," said Dr. Umair Shah, the
executive director of the Harris County public health department. Florida and other states in the South where the Aedes
aegypti mosquito is present also are taking steps to prepare. In Florida, for
example, Gov. Rick Scott used his emergency powers last week to authorize
spending up to $26.2 million for Zika.
His action comes as Congress remains stalemated on President
Barack Obama's $1.9 billion proposal to fight the virus. A scaled-back $1.1
billion Republican-drafted measure was blocked in the Senate on Tuesday by
Democrats opposed to its denial of new funding for Planned Parenthood clinics
in Puerto Rico, where there already are more than 1,800 locally acquired cases,
and to easing rules on pesticide spraying. In Texas, major cities have sophisticated mosquito screening
programs and years of dealing with other mosquito-borne illnesses like dengue
and West Nile virus. But local authorities in most of the state have limited or
no mosquito surveillance. The mosquitoes they do capture are typically sent to
outside labs, and getting results can take weeks.
The smallest counties often have a single person driving
around conducting surveillance — "Chuck in a truck," Hotez calls it. The state health department has spent more than $400,000
since the start of the year to expand its lab capacity and to buy mosquito
traps. It also launched a $2 million Zika awareness campaign. Shah said there are cuts that can be made, "but there
comes a point where you stretch people too much." In Harris County, which encompasses Houston and is the
third-most populous county in the U.S., officials aren't waiting for the
federal government. They purchased their own testing machines and have
retrofitted two labs to run tests only for Zika to get results faster.
Mosquito traps are set out on lawns and inside sewers in
more than 250 designated areas. Thus far, no mosquitoes have tested positive
for Zika.
If one does, the county will send out three-person
investigative teams and use staff from other agencies and volunteers to clear
any containers with water and other possible mosquito breeding grounds. Other counties don't have the same capacity. Hidalgo County, which covers McAllen and poor areas along
the border with Mexico, is using 12 traps to collect mosquitoes for testing,
county health director Eduardo Olivarez said. Officials are also trying to get
residents to clean up trash and install window and door screens. He is stymied by the problem of old tires collecting across
the county, apparently on their way to and from Mexico.
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