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Everything You Need to Know About Zika, in the U.S. and Abroad

All your Zika questions, answered.

If you’ve been following the advancement of the Zika virus—the mosquito-borne disease that’s been spreading throughout Latin America, the Caribbean, and most recently, into southern Florida—it may feel as though the virus is unstoppable.

Since the World Health Organization declared Zika a global public health emergency in February, the number of people infected with the pathogen has grown exponentially, the documented modes of disease transmission have increased, and researchers have linked the virus to both congenital birth defects and neurological disorders in adults.

But there is reason to be hopeful: Congress finally approved $1.1 billion to fight against Zika, which means prevention efforts (such as mosquito control and vaccine research) may soon move into a higher gear. What’s more, even though infectious disease specialists continue to learn about Zika and the complications it can cause, there is plenty of information they already know about what you can do to protect yourself while traveling. Get the facts straight, your fears squelched, and Zika questions answered here.

How much of the world is affected by Zika right now?

Though it may seem as though Zika is everywhere, it’s not. According to the Centers for Disease Control and Prevention (CDC), locally acquired Zika infections, which occur when infected Aedes aegypti mosquitoes bite humans and infect their bloodstream, have been reported in much of Latin America, the Caribbean, the Pacific Islands, Africa’s Cape Verde, Singapore, and southern Florida. At this point there are more than 60 countries and territories that have reported local transmission. To find out the areas where reported Zika cases have risen to the level of an outbreak, visit the CDC’s site.

Aren’t there a lot of Zika cases in the continental United States too?

It’s true that Zika-infected mosquitoes have infiltrated Florida’s Miami-Dade county and have led to 105 locally acquired Zika infections. The other cases you may have heard about in the country, however, were associated with travel, meaning that people got infected with Zika in another country and then returned to the U.S. with the illness. As of October 5, 2016, the CDC reports that there have been 3,712 confirmed cases of travel-associated Zika in the U.S., 30 cases in the U.S. in which Zika was transmitted through sexual contact, and one documented case in which Zika was acquired through physical contact with the bodily fluids of an infected person with an extremely high viral load.

“It was a real surprise when a researcher reported that case of transmission through physical contact. Fortunately that seems to be exceptional,” says Marten Edwards, professor of biology at Muhlenberg College in Allentown, Pennsylvania. Researchers were also surprised when they learned that Zika could be transmitted sexually through an infected man or woman. “Mosquito-borne illnesses aren’t generally transmitted sexually; that doesn’t happen with other arboviruses like chikungunya or dengue,” Edwards adds. Still, he notes that currently, mosquitoes are the principal mode of Zika transmission.

We need to stay on top of prevention even when there are no known important viruses being transmitted, because viral diseases are one airplane ride away.

If I Visit Northern part of the U.S. Should I be worried about mosquitoes carrying Zika here?

Not at this point. Last spring, researchers had predicted that Aedes aegyptimosquitoes (which populate warmer areas) could possibly make their way to northern parts of the U.S. over the summer, but that did not happen. Also reassuring: Researchers had speculated that the Aedes aegypti mosquito’s cousin, theAedes albopictus—which does live in the north and can survive colder climes—could become infected with Zika and transmit it locally, but that has not happened either. There hasn’t been any evidence yet of the Aedes albopictustransmitting Zika in this outbreak, and as we head into the winter months, those adult mosquitoes will die off.

But that doesn’t mean you should throw all caution to the wind and hang out near stagnant water without mosquito repellent.

Continued mosquito prevention—on an individual and state level—is crucial in keeping the threat of Zika and other mosquito-borne pathogens at bay. Mosquitoes are invasive pests that are almost impossible to get rid of, and there weren’t enough preventive efforts over a long period of time when the Zika virus wasn’t an immediate threat, which lead to the situation we are in now.

Mosquitoes can’t be considered on a crisis-to-crisis basis. We need to be ready for the next virus to come. Nobody is wondering if—we’re wondering when the next virus will come.

That’s why states continue to need funding to develop and maintain an infrastructure of mosquito control, which includes traps, monitoring, testing, and sprays. Though there are always limits of manpower, cooperation, and budget, there is always more that could be done by way of prevention. In other words, if you visit the northern part of the U.S, you should not be panicking, but you should be vigilant.

There is so much international travel and so many viruses waiting in the wings. We need to stay on top of prevention even when there are no known important viruses being transmitted, because viral diseases are one airplane ride away.

Should I avoid traveling to areas with outbreaks of Zika?

Yes, if you’re pregnant or considering becoming pregnant, you should not travel to areas where Zika is endemic because the virus has been tied to devastating birth defects (such as microcephaly, which causes unusually small heads and brain damage) in babies born to women who were pregnant while infected with Zika. This is a dynamic situation and what we say today may change tomorrow but the conservative recommendation from the CDC now is that pregnant women or those who want to be pregnant soon should avoid areas where there is active Zika transmission.

What if I have to travel to an area where Zika is present?

Again, pregnant women should try to avoid traveling to a Zika infected area at all costs. If you must go—pregnant or not—it’s key to take precautions to avoid mosquito bites. These precautions include staying inside as much as possible with the doors closed and screens shut tight. When outside, wear long sleeves and pants, and invest in clothes that have been treated with the built-in mosquito repellent Permethrin. Avoid standing water (which is where mosquitoes breed), wooded areas, and of course, spray yourself with mosquito repellent that has been approved by the Environmental Protection Agency.

The CDC also recommends that upon returning to the U.S., all travellers should practice safe sex. An estimated 80 percent of people do not show symptoms of Zika, so it’s very possible to have the infection and not realise it. To avoid infecting your partner or conceiving a baby while infected, women should avoid unprotected sex for at least eight weeks after returning from a Zika infected area. Men should avoid unprotected sex for six months after travelling to an area where Zika is active because the virus has been identified in semen for up to that length of time.

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Can I get a Zika blood test to find out if I have it?

If you are showing symptoms of Zika (such as rash, fever, and conjunctivitis) and have reason to think that you may have the virus, then, yes, you are eligible for Zika blood testing according to the Department of Health. Talk with your doctor to get a referral for a testing site.

Also, all pregnant women who have travelled to an area where Zika is active, or had unprotected sex with someone who has recently travelled to an area where Zika is active should seek out testing. “But a 30-year-old male, for example, who traveled to a Zika endemic area, has no symptoms, and simply wants to know if he has Zika will have trouble getting tested because he does not meet the testing criteria from the Department of Health. If, however, that man is showing signs of Guillain-Barré syndrome (GBS), a neurological autoimmune disorder that causes temporary paralysis and has been associated with Zika, he should seek out testing and treatment immediately.

When it comes to testing for Zika, though, there is no perfect test. There is an RNA blood test that can confirm the Zika virus in cells within the first two weeks of the disease, but a negative RNA test does not confirm that you are Zika-free. There is also a test that screens for antibodies of Zika in the blood, but a positive antibody test doesn’t necessarily tell us that you’re infectious.

The antibodies may be present from an infection from a while ago or may be potentially cross reacting with another arbovirus such as dengue. Testing is often a multi-step process and should involve counseling from a healthcare expert.

Is it true that Zika is linked to Alzheimer’s?

Not in humans as far as we know. Because Zika has been linked with neurological disorders, such as microcephaly and GBS, researchers decided to study whether or not Zika could cause long-term brain damage in adults. So, scientists conducted a very small studyin which they injected Zika into mice that were bred with immune deficits. What they found was that the virus attacked portions of the mice’s brains where new brain cells are made, causing memory loss similar to that caused by Alzheimer’s.

The thinking being that if Zika can destroy brain tissue in adult mice, maybe it can cause brain destruction in adult humans. But it’s crucial to note that this study is not directly applicable to humans. This was a very small study on one type of mouse with immune deficiencies, so it’s a real stretch to say Zika causes brain damage long term in adult humans. There is definitively no connection between Zika and Alzheimer’s now but this study says that we need to do more research on Zika’s long term effect on humans.

When will the Zika vaccine be ready?

Right now there are many groups working on vaccine strategies. From the time of the identification of Zika until a couple of vaccines were developed, it was less than 6 months, which is amazing. But there is still a long way to go. Currently, there are a few groups (a mix of academics, government agencies, and private companies) that are leading in the race to develop a safe and effective vaccine, including one from the National Institutes of Allergy and Infectious Disease and another from Beth Israel Deaconess. Two vaccines are in phase 1 trials, which means they are being tested for safety in humans. Researchers are hoping that the vaccines will be ready for larger randomized controlled trials in early 2017.

How can I cancel my trip to a place with Zika?

Fortunately, many airlines have instituted Zika-related refund policies. If, for instance, you’re pregnant and booked to travel to an area where Zika is active (check the CDC website for updated travel advisories) some airlines, such as American Airlines, will give you a refund or change your itinerary without a fee as long as you provide a doctor’s note.

Other airlines, such as Southwest, United, and Delta, may allow you to change or cancel your trip without incurring fees regardless of whether you are pregnant or have a doctor’s note.

Bottom line: Call the airline or travel agent to see what you can do to either get a refund or book an alternate trip. Several cruise lines have also relaxed their change and refund policies, particularly for pregnant travelers headed to Zika affected areas. And most hotels tend to have 24- or 48-hour cancellation policies that allow you to get a full refund for any reason.

If you’re booked to stay at a private vacation rental, the owner of the property generally sets cancellation policies, so do your best to plead your case if you need to cancel due to Zika concerns.

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