Zika

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Integrated Mosquito Management for Aedes aegypti and Aedes albopictus mosquitoes

Local governments and mosquito control programs often use an integrated mosquito management (IMM) or integrated vector management (IVM) approach to control mosquitoes. IMM uses a combination of methods to prevent and control mosquitoes that spread viruses, like Zika, dengue, and chikungunya. IMM is based on an understanding of mosquito biology, the mosquito life cycle, and the way mosquitoes spread viruses. IMM uses methods that, when followed correctly, are safe and have been scientifically proven to reduce mosquito populations.

Everyone can help control mosquitoes.

  • Professionals from local government departments or mosquito control districts develop mosquito control plans, perform tasks to control young and adult mosquitoes, and evaluate the effectiveness of actions taken.
  • You, your neighbors, and the community can also take steps to reduce mosquitoes in and around your home and in your neighborhood.

Estimated range of Aedes aegypti and Aedes albopictus

Two maps of the United States showing Aedes aegypti and Aedes albopictus mosquitoes are or have been previously found. Aedes aegypti range is the southern half of the United States. Aedes albopictus range is the eastern half of the United States as well as the southwest

Conduct mosquito surveillance

Conduct mosquito surveillance

Mosquito control plans include steps that are taken before control efforts begin and before people start getting sick with a virus spread by mosquitoes. Professionals need to understand what types and numbers of mosquitoes are in an area. In order to find out this information, mosquito control experts conduct surveillance. Surveillance activities can include:

  • Monitoring places where adult mosquitoes lay eggs and where young mosquitoes can be found
  • Tracking mosquito populations and the viruses they may be carrying
  • Determining if EPA-registered insecticides will be effective

These activities help professionals determine if, when, and where control activities are needed to manage mosquito populations before people start getting sick. If professionals discover that local mosquitoes are carrying viruses (like dengue, Zika, or others), they start implementing other activities identified in their mosquito control plans.

Remove places where mosquitoes lay eggs

Remove places where mosquitoes lay eggs

Removing places where mosquitoes lay eggs is an important step. Mosquitoes lay eggs near water because young mosquitoes need water to survive. Professionals and the public can remove standing water.

  • Professionals at local government agencies and mosquito control districts may collect and dispose of illegally dumped tires, clean up and maintain public spaces like parks and greenways, and clean up illegal dumps and roadside trash.
  • You, your neighbors, and community can remove standing water. Once a week, items that hold water like tires, buckets, planters, toys, pools birdbaths, flower pot saucers, and trash containers should be emptied and scrubbed, turned over, covered, or thrown away.
  • If needed, a community clean up event can be held to remove large items like tires that collect water.
Control young mosquitoes

Control young mosquitoes

Once mosquito eggs hatch, they become larvae and then pupae. Both larvae and pupae live in standing water. Dumping or removing standing water in and around your home is one way to control young mosquitoes. For standing water that cannot be dumped or drained, a larvicide can be used to kill larvae. Larvicides[PDF – 1 page] are products used to kill young mosquitoes before they become biting adults.

The public and professionals can use US Environmental Protection Agency (EPA)-registered larvicides according to label instructions.

  • Professionals treat water-holding structures and containers in public places, like storm drains or urns in cemeteries. They may also treat standing water on private property as part of a neighborhood cleanup campaign.
  • People can treat fountains, septic tanks, and pool covers that hold water with larvicides.

Controlling young mosquitoes before they become adults, can minimize widespread use of insecticides that kill adult mosquitoes.

Control adult mosquitoes

Control adult mosquitoes

Adult mosquitoes can spread viruses (like dengue, Zika, or others) that make you sick. When surveillance activities show that adult mosquito populations are increasing or that they are spreading viruses, professionals may decide to apply to kill adult mosquitoes. Adulticides help to reduce the number of mosquitoes in an area and reduce the risk that people will get sick. The public and professionals can use US Environmental Protection Agency (EPA)-registered adulticides according to label instructions.

  • If mosquitoes are spreading viruses over larger areas, professionals spray adulticides by using backpack sprayers.
  • People can buy adulticides and use them inside and outside their homes.

Monitor control programs

To make sure that mosquito control activities are working, professionals monitor the effectiveness of their efforts to control both young and adult mosquitoes. For example, if an insecticide didn’t work as well as predicted, then professionals may conduct additional studies on insecticide resistance or evaluate the equipment used to apply insecticides..

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Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are

  • Fever
  • Rash
  • Joint pain
  • Conjunctivitis (red eyes)

Other symptoms include:

  • Muscle pain
  • Headache

How long symptoms last

Zika is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. Symptoms of Zika are similar to other viruses spread through mosquito bites, like dengue and chikungunya.

How soon you should be tested

Zika virus usually remains in the blood of an infected person for about a week. See your doctor or other healthcare provider if you develop symptoms and you live in or have recently traveled to an area with Zika. Your doctor or other healthcare provider may order blood tests to look for Zika or other similar viruses like dengue or chikungunya. Once a person has been infected, he or she is likely to be protected from future infections.

When to see a doctor or healthcare provider

See your doctor or other healthcare provider if you have the symptoms described above and have visited an area with Zika, this is especially important if you are pregnant.  Be sure to tell your doctor or other healthcare provider where you traveled.

If you think you have Zika

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Basics of Zika Virus and Sex

  • A man with Zika virus can pass it to his female or male partners during vaginal, anal, or oral (mouth-to-penis) sex without a condom.
  • Zika can be passed from a man with symptoms to his sex partners before his symptoms start, while he has symptoms, and after his symptoms end.
  • Men with Zika who never develop symptoms may also be able to pass the virus to their sex partners.
  • Zika virus can stay in semen longer than in blood, but we don’t know exactly how long Zika stays in semen or how long it can be passed to sex partners.

Basic Prevention

  • Condoms can reduce the chance of getting Zika from sex if used correctly from start to finish, every time you have vaginal, anal, or oral (mouth-to-penis) sex.
  • Not having sex eliminates your risk of getting Zika from sex.

Fast Facts

  • A man with Zika virus can pass it to his female or male sex partners.
  • Using condoms or delaying sex can reduce the risk of getting Zika from sex.
  • The length of time to consider using condoms or delaying sex depends on your situation and concerns.

What We Do Not Know

There are some things we still do not know about Zika and sex.

  • We don’t know if a woman with Zika can pass the virus to her partners, during vaginal or oral (mouth-to-vagina) sex.
  • We don’t know if Zika can be passed through saliva during kissing.
  • We don’t know if Zika passed to a pregnant woman during sex has a different risk for birth defects than Zika transmitted by a mosquito bite.

CDC and other public health partners continue to study Zika virus and how it is spread and will share new information as it becomes available.

How to Prevent Sexual Transmission of Zika

Couples Who Are Pregnant

Pregnant couples with male partners who live in or travel to areas with Zika should take steps to protect their pregnancy. A man who has Zika can pass it to his pregnant partner during sex, even if he does not have symptoms at the time or his symptoms have gone away.

Because Zika can cause birth defects, these couples should

  • Use a condom every time they have sex or not have sex during the pregnancy. To be effective, condoms must be used correctly from start to finish, every time they have sex. This includes vaginal, anal, and oral (mouth-to-penis) sex.
  • Take steps to prevent mosquito bites[PDF – 2 pages] while in an area with Zika. This protects the couple and prevents further spread of the virus.
  • Even if they do not feel sick, travelers returning to the United States from an area with Zika should take steps to prevent mosquito bites for 3 weeks so they do not pass Zika to uninfected mosquitoes.

Not having sex can eliminate the risk of passing Zika during a pregnancy.

Pregnant couples who are concerned that the male partner may have or had Zika should tell their healthcare provider immediately about:

  • His travel history
  • How long he stayed
  • If he took steps to prevent mosquito bites
  • If they had sex without a condom

Couples Trying to Become Pregnant

Men or women who live in or travel to an area with Zika who are concerned about trying to get pregnant should talk to their healthcare provider.

Others Concerned About the Sexual Transmission of Zika

Anyone concerned about the sexual transmission of Zika and not concerned about pregnancy can consider using a condom every time they have vaginal, anal, and oral (mouth-to-penis) sex or not have sex. To be effective, condoms must be used correctly from start to finish, every time during sex.

For couples with a male partner who has traveled to an area with Zika

  • If the male partner has been diagnosed with Zika or has (or had) symptoms, the couple should consider using condoms or not having sex for at least 6 months after symptoms begin.
  • If the male partner does not develop symptoms, the couple should consider using condoms or not having sex for at least 8 weeks after the man returns.

For couples with a male partner living in an area with Zika

  • If the male partner has been diagnosed with Zika or has (or had) symptoms, the couple should consider using condoms or not having sex for at least 6 months after symptoms begin.
  • If the male partner has never developed symptoms, the couple should consider using condoms or not having sex while there is Zika in the area.

For couples with a non-pregnant female partner who lives in or has traveled to an area with Zika

  • It is not known if a woman can pass Zika to her sex partners.
  • These couples can also consider using condoms or not having sex.

Couples who are not pregnant and are considering these options should weigh the personal risks and benefits, including

  • The mild nature of the illness for many people*
  • The man’s exposure to mosquitoes while in an area with Zika
  • Plans for pregnancy (if appropriate) and access to contraception
  • Access to condoms
  • Desire for intimacy, including willingness to use condoms or not have sex
  • Ability to use condoms or not have sex

*In many cases, Zika does not cause any symptoms or causes only mild symptoms lasting several days to a week. Severe disease requiring hospitalization is uncommon.

Sexual Transmission and Testing

  • CDC recommends Zika virus testing for people who may have been exposed to Zika through sex and who have Zika symptoms.
  • A pregnant woman with possible exposure to Zika virus from sex should be tested if either she or her male partner develops symptoms of Zika.
  • Testing blood, semen, or urine is not recommended to determine how likely a man is to pass Zika virus through sex. This is because there is still a lot we don’t know about the virus and how to interpret test results. Available tests may not accurately identify the presence of Zika or a man’s risk of passing it on.
  • As we learn more and as tests improve, these tests may become more helpful for determining a man’s risk of passing Zika through sex.

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Through mosquito bites

Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). These are the same mosquitoes that spread dengue and chikungunya viruses.

  • These mosquitoes typically lay eggs in and near standing water in things like buckets, bowls, animal dishes, flower pots and vases.  They prefer to bite people, and live indoors and outdoors near people.
    • Mosquitoes that spread chikungunya, dengue, and Zika are aggressive daytime biters, but they can also bite at night.
  • Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.

From mother to child

  • A pregnant woman can pass Zika virus to her fetus during pregnancy. Zika is a cause of microcephaly and other severe fetal brain defects. We are studying the full range of other potential health problems that Zika virus infection during pregnancy may cause.
  • A pregnant woman already infected with Zika virus can pass the virus to her fetus during the pregnancy or around the time of birth.
  • To date, there are no reports of infants getting Zika virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.

Through sexual contact

  • Zika virus can be spread by a man to his sex partners.
  • In known cases of sexual transmission, the men developed Zika virus symptoms. From these cases, we know the virus can be spread when the man has symptoms, before symptoms start and after symptoms resolve.
  • In one case, the virus was spread a few days before symptoms developed.
  • The virus is present in semen longer than in blood.

Through blood transfusion

  • As of February, 1, 2016, there have not been any confirmed blood transfusion transmission cases in the United States.
  • There have been multiple reports of blood transfusion transmission cases in Brazil. These reports are currently being investigated.
  • During the French Polynesian outbreak, 2.8% of blood donors tested positive for Zika and in previous outbreaks, the virus has been found in blood donors.

Through laboratory exposure

  • Prior to the current outbreak, there were four reports of laboratory acquired Zika virus infections, although the route of transmission was not clearly established in all cases.
  • As of June 15, 2016, there has been one reported case of laboratory-acquired Zika virus disease in the United States.

Risks

  • Anyone who lives in or travels to an area where Zika virus is found and has not already been infected with Zika virus can get it from mosquito bites. Once a person has been infected, he or she is likely to be protected from future infections.

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What we know

  • No vaccine exists to prevent Zika virus disease (Zika).
  • Zika virus is mostly spread through the bite of an infected mosquito. Prevent Zika by avoiding mosquito bites (see below).
  • Mosquitoes that spread Zika virus bite mostly during the daytime.
  • Mosquitoes that spread Zika virus also spread dengue and chikungunya viruses.
  • Zika virus can be spread during sex by a man infected with Zika to his sex partners.

Steps to prevent mosquito bites

When in areas with Zika and other diseases spread by mosquitoes, take the following steps[PDF – 2 pages]:

  • Wear long-sleeved shirts and long pants.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Take steps to control mosquitoes inside and outside your home.
  • Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.
  • Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. Choosing an EPA-registered repellent ensures the EPA has evaluated the product for effectiveness. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women.
    • Always follow the product label instructions.
    • Reapply insect repellent as directed.
    • Do not spray repellent on the skin under clothing.
    • If you are also using sunscreen, apply sunscreen before applying insect repellent.
  • To protect your child from mosquito bites:
    • Do not use insect repellent on babies younger than 2 months old.
    • Do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old.
    • Dress your child in clothing that covers arms and legs.
    • Cover crib, stroller, and baby carrier with mosquito netting.
    • Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.
    • Adults: Spray insect repellent onto your hands and then apply to a child’s face.
  • Treat clothing and gear with permethrin or purchase permethrin-treated items.
    • Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.
    • If treating items yourself, follow the product instructions carefully.
    • Do NOT use permethrin products directly on skin. They are intended to treat clothing.

Even if they do not feel sick, travelers returning to the United States from an area with Zika should take steps to prevent mosquito bites for 3 weeks. These steps will prevent them from passing Zika to mosquitoes that could spread the virus to other people.

If you have Zika, protect others from getting sick

  • During the first week of infection, Zika virus can be found in the blood and passed from an infected person to another mosquito through mosquito bites. An infected mosquito can then spread the virus to other people.
  • To help prevent others from getting sick, strictly follow steps to prevent mosquito bites[PDF – 2 pages] during the first week of illness.
  • A man with Zika virus can pass it to his female or male sex partners.
    • Zika virus can stay in semen longer than in blood, but we don’t know exactly how long Zika stays in semen.
  • To help prevent spreading Zika from sex, you can use condoms, correctly from start to finish, every time you have sex. This includes vaginal, anal, and oral (mouth-to-penis) sex. Not having sex is the only way to be sure that someone does not get sexually transmitted Zika virus.

If you are a man who lives in or has traveled to an area with Zika

  • If your partner is pregnant, either use condoms correctly (warning: this link contains sexually graphic images) from start to finish, every time you have vaginal, anal, and oral (mouth-to-penis) sex, or do not have sex during the pregnancy.
    • Even if they do not feel sick, travelers returning to the United States from an area with Zika should take steps to prevent mosquito bites[PDF – 2 pages] for 3 weeks so they do not spread Zika to mosquitoes that could spread the virus to other people.

If you are concerned about getting Zika from a male sex partner

  • You can use condoms correctly from start to finish, every time you have vaginal, anal, and oral (mouth-to-penis) sex.  Condoms also prevent HIV and other STDs.  Not having sex is the only way to be sure that you do not get sexually transmitted Zika virus.
    • Pregnant women should talk to a doctor or other healthcare provider if they or their male sex partners recently traveled to an area with Zika, even if they don’t feel sick.

Information for travelers

  • Traveling? Visit CDC’s Travelers Health website to see if the country you plan to visit has any travel health notices.
    • Even if they do not feel sick, travelers returning to the United States from an area with Zika should take steps to prevent mosquito bites for 3 weeks so they do not spread Zika to mosquitoes that could spread the virus to other people.

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Zika virus spreads to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). People can also get Zika through sex with an infected man, and the virus can also be passed from a pregnant woman to her fetus. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly, as well as other severe fetal brain defects. Once a person has been infected, he or she is likely to be protected from future infections.

Zika virus was first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations. Before 2007, at least 14 cases of Zika had been documented, although other cases were likely to have occurred and were not reported. Because the symptoms of Zika are similar to those of many other diseases, many cases may not have been recognized.

In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. On February 1, 2016, the World Health Organization (WHO) declared Zika virus a Public Health Emergency of International Concern (PHEIC). Local transmission has been reported in many other countries and territories. Zika virus will likely continue to spread to new areas.

Specific areas where Zika is spreading are often difficult to determine and are likely to change over time. If traveling, please visit the CDC Travelers’ Health site for the most updated travel information.

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Symptoms

  • Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
    • See your doctor or other healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within 2 weeks after traveling to an area with Zika. Be sure to tell your doctor or other healthcare provider where you traveled.
  • The illness is usually mild with symptoms lasting for several days to a week.
  • People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected.
  • Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.
  • Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis

  • The symptoms of Zika are similar to those of dengue and chikungunya, diseases spread through the same mosquitoes that transmit Zika.
  • See your doctor or other healthcare provider if you have the symptoms described above and have visited an area with Zika.
  • If you have recently traveled, tell your doctor or other healthcare provider when and where you traveled.
    • A blood or urine test can confirm a Zika infection
  • Your doctor or other healthcare provider may order blood tests to look for Zika or other similar viruses like dengue or chikungunya.

Treatment

  • There is no vaccine to prevent or medicine to treat Zika virus.
  • Treat the symptoms:
    • Get plenty of rest.
    • Drink fluids to prevent dehydration.
    • Take medicine such as acetaminophen (Tylenol®) or paracetamol to reduce fever and pain.
    • Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) until dengue can be ruled out to reduce the risk of bleeding.
    • If you are taking medicine for another medical condition, talk to your doctor or other healthcare provider before taking additional medication.
  • If you have Zika, take steps to prevent mosquito bites for the first week of your illness.
    • During the first week of infection, Zika virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
    • An infected mosquito can then spread the virus to other people.

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Stark claim comes ahead of WHO’s emergency meeting, with notional vaccine-testing on pregnant women a ‘practical and ethical nightmare’

The Zika virus outbreak in Latin America could be a bigger threat to global health than the Ebola epidemic that killed more than 11,000 people in Africa.

That is the stark claim of several senior health experts ahead of an emergency meeting of the World Health Organisation on Monday which will decide whether the Zika threat – which is linked to an alarming rise in cases of foetal deformation called microcephaly – should be rated a global health crisis.

“In many ways the Zika outbreak is worse than the Ebola epidemic of 2014-15,” said Jeremy Farrar, head of the Wellcome Trust.

“Most virus carriers are symptomless. It is a silent infection in a group of highly vulnerable individuals – pregnant women – that is associated with a horrible outcome for their babies.”

There is no prospect of a vaccine for Zika at present, in contrast to Ebola, for which several are now under trial. “The real problem is that trying to develop a vaccine that would have to be tested on pregnant women is a practical and ethical nightmare,” added Mike Turner, head of infection and immuno-biology at the Wellcome Trust.

With at least 80 per cent of those infected showing no symptoms, tracking the disease is extremely difficult. The mosquito species that spreads Zika, Aedes aegypti, has been expanding its range over the past few decades. “It loves urban life and has spread across the entire tropical belt of the planet, and of course that belt is expanding as global warming takes effect,” added Farrar.

Only extreme measures are likely to contain the Zika threat, said Turner. These could include the use of DDT to eradicate Aedes aegypti as quickly as possible.

“We have to balance the risk posed to the environment by DDT with the terrible impact this virus is having on the unborn.”

Britain is unlikely to be affected because Aedes aegypti cannot survive the cold of UK winters. However, couples returning from south or central America have been warned not to try for a baby for at least a month in case they have become infected.

Public Health England said that the risk of sexual transmission of Zika was low, but it had been recorded in a limited number of cases.

–Science Daily