Not surprisingly, partisan political wrangling has delayed congressional action on funding that states need to prepare for and fight the Zika virus. And now it's mosquito season. Texas is home to 85 different species of mosquito, including the Aedes aegypti, the primary carrier of Zika.
"It is only a matter of time before one of those mosquitoes bites an infected traveler and then passes the disease on to another Texan," TMA President Don Read, MD, wrote in a letter to the Texas congressional delegation. "Local and state public health officers in Texas are working hard to prepare for that day, but we need help. We have the experience and expertise necessary, but our public health infrastructure is not up to a task of this magnitude."
Lab testing — especially of pregnant women — monitoring travelers, and keeping Texans informed about the state of the disease all need bolstering from federal dollars. "We already have waited too long," Dr. Read wrote. "We need that action now. Several months from now will be too late."
In Washington, D.C., Congress has been dragging its feet on funding to help the United States prepare for and battle the Zika virus. President Barack Obama requested $1.9 billion in emergency funds in February. In May, the House offered a plan that includes just under $700 million. The Senate's plan includes $1.1 billion.
In May, Houston obstetrician Catherine Eppes, MD, whose high-risk pregnancy clinic has been overrun by women concerned about Zika infection, told the Senate Health and Human Services Committee Texas needs to find more ways to screen pregnant women for the Zika virus. "The combination of a relatively new but profoundly significant disease with little knowledge about the exact timing and rates of transmission, and complex, often inaccessible testing options leaves pregnant women and physicians frustrated," the member of the TMA Committee on Maternal and Perinatal Health said. "I think doctors would benefit from statewide dissemination of the options and costs for testing within our state and city health departments."
Dr. Eppes also recommended Texas Medicaid and the Women's Health Program be authorized to support the screening and testing of their eligible populations.
The Texas Department of State Health Services (DSHS) reports that as of May 25, Texas had 36 confirmed cases of Zika virus disease. Of those, 35 were in travelers infected abroad and diagnosed after they returned home; one of those travelers was a pregnant woman. One case involved a Dallas County resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Nationally, as reported by the U.S. Centers for Disease Control and Prevention (CDC), 157 pregnant women in the continental United States and another 122 in U.S. territories, primarily Puerto Rico, had tested positive for the infection as of May.
DSHS is testing for Zika virus at its public health lab in Austin. CDC encourages Texas physicians to report suspected Zika virus cases to DSHS.
According to DSHS, Aedes aegypti mosquitoes can be found in Texas, particularly in urban areas in the south and southeast portions of the state. While there is no evidence of local transmission by Texas mosquitoes yet, state health officials have implemented Zika virus prevention plans in anticipation of increased mosquito activity and the potential for local mosquito transmission.
At a recent Texas Public Health Coalition "University of Health" educational session, former and current Texas health commissioners, the chair of TMA's Council on Science and Public Health, and a public health officer in the lower Rio Grande Valley gave legislative staffers an in-depth look into how Texas is preparing for the Zika virus.
"We in public health would not be doing our job if we weren't planning for the eventuality that Zika would become locally transmitted," John Hellerstedt, MD, DSHS commissioner, told the crowd. "Large areas of Texas could be impacted." Coalition Vice Chair John Carlo, MD, stressed Texas should focus on the state's poorest communities, where decent housing and access to health care are lacking and where a Zika outbreak would have a devastating effect. Eduardo Olivarez, chief administrative officer for Hidalgo County Health and Human Services, spoke about the need for coordinating a patchwork of state and local agencies in the fight against a difficult foe. "You're not going to be able to spray this problem away," he said.
To help ensure Texas physicians have all they need to diagnose the virus, DSHS has updated its texaszika.org website with a supplemental testing information form and polymerase chain reaction (PCR) and serology specimen criteria form. The PCR test can confirm the presence of Zika virus. Serologic testing can detect Zika infection in people who may not have had symptoms, and the test can be conducted up to 12 weeks after infection. DSHS says a positive serologic test result requires confirmatory testing to pinpoint Zika because it can cross-react with other viruses, such as dengue.
DSHS is working with local officials in the Rio Grande Valley area, a potential hot spot for Zika virus transmission, to monitor mosquito activity. The agency reports spot trapping in the area in February yielded no Aedes aegypti mosquitoes. DSHS urges communities to consider expanding their surveillance in coordination with local mosquito control efforts.
The disease can cause fever, rash, muscle and joint aches, and red eyes, and also has been linked to the birth defect microcephaly and other poor birth outcomes in some women infected during their pregnancy.
To help prevent the spread of Zika virus in Texas, DSHS also developed flyers and door hangers (available in English and Spanish) you can use in your office to educate your patients on protecting themselves from the disease.
CDC issued Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016. CDC's recommendations apply to men who have traveled to or reside in areas with active Zika virus transmission and their sex partners.
TMA and the Texas Association of Obstetricians and Gynecologists have prepared guidance for physicians on the Zika virus and pregnant patients.
State health officials continue to encourage people to follow travel precautions. CDC is advising pregnant women to delay travel to foreign countries where Zika is being transmitted.
General information about Zika virus
Information for clinicians
Protection against mosquitoes
Zika virus travel notices
Action, June 1, 2016