In a span of 13 months, a relatively unknown virus morphed into a global health emergency thanks to a pest less than four millimeters wide.
The Pan American Health Organization reports more than 50,000 people in the Western Hemisphere are infected with the Zika virus. The primary mode of transmission is by mosquitoes — the Aedes aegypti, to be precise — and its relative the Aedes albopictus. But the virus can also be transmitted sexually.
For most, the illness causes flu-like symptoms. It has also been connected to Guillain–Barré Syndrome, which is marked by muscle weakness in the arms and legs, and sometimes severe nerve damage and even paralysis.
Pregnant women are considered especially at risk of the threat, because Zika can cause severe birth defects, such as microcephaly.
So far, no cases of locally transmitted Zika infection have been reported in the U.S. But, with summer vacations on many people’s minds, here is a breakdown of what travelers should know about where the virus is most likely to circulate and how the risks could affect travel plans.
What is the normal season for these mosquitoes?
The Aedes aegypti mosquito thrives in hot, humid, tropical climates. This is why, in the U.S., states such as Texas and Florida are expected to be among the hardest hit. Meanwhile, one study found more than 22 million people live in areas of the country where the Aedes mosquito can thrive all year.This KHN story also ran in the Miami Herald. It can be republished for free (details).
But these pests are also not immune to changing weather patterns.
Dr. Jean-Paul Mutebi, a Centers for Disease Control and Prevention entomologist and researcher, said the bug seldom survives in temperatures below 55 degrees Fahrenheit and elevations above 6,500 feet. Temperatures above 95 degrees Fahrenheit also keep the pests at bay.
Experts note, though, that mosquitoes generally follow the seasons’ temperature fluctuations. Their numbers rise in the spring and reach their peak in the summer, then dwindle in autumn until they die in the winter. In tropical conditions, the mosquitoes can live all year round.
This means travelers need to be conscious of the weather patterns in their destinations to determine the Zika risk they could face.
Where have the outbreaks occurred so far this season and what areas are expected to be hard hit?
Forty countries and territories in the Western Hemisphere have locally transmitted Zika, according to the latest report from the Pan American Health Organization. The CDC also is tracking Zika virus activity.
The Zika HealthMap, an online disease tracker created by Boston Children’s Hospital and Harvard School of Medicine, shows the number of Zika cases in South America are concentrated in areas along the equator and near a coast, like western Colombia and eastern Brazil.
Countries such as Brazil, Bolivia and Paraguay that have areas with consistently warm weather and are beginning their dry seasons will likely see fewer mosquitoes, said Mauricio Santillana, faculty member at Boston Children’s Hospital and HealthMap lead researcher. In some such locations, the number of cases are already declining, based on WHO data.
Meanwhile, some countries entering their wet, rainy season, such as Panama and Dominica, are reporting lower case numbers than expected. However, Santillana said some Caribbean countries, such as Martinique and Jamaica, are experiencing erratic rates of infection.
Though no cases have yet been locally transmitted in the continental U.S., New York, Florida and Texas have reported the highest tallies of travel-associated cases, according to the CDC. Meanwhile, Puerto Rico has reported nearly 2,000 locally acquired cases.
Am I safe to travel?
The CDC implemented a three-level warning system to categorize the danger associated with traveling to each country affected by the virus. As of July 5, all countries affected by the epidemic are categorized as Level 2, which means Zika poses a threat to the general public and a danger to pregnant women.
The notice advises travelers to take “enhanced precautions” such as treating skin with Environmental Protection Agency-registered insect repellents and clothing with the insecticide permethrin to reduce the risk of infection.
Destinations located above an elevation of 6,500 feet are considered safe for all travelers.
Take seasons into consideration when traveling. Destinations south of the equator are now beginning their winter season, which means the Zika threat may be ebbing.
The CDC strongly discourages women who are pregnant from visiting any area of Brazil below an elevation of 6,500 feet. In addition, women who are trying to become pregnant should talk to their doctors about their risk of infection before departing.
A full list of travel notices can be found on the CDC website.
Why are these mosquitoes so good at spreading disease like Zika?
The Aedes aegypti mosquito’s ability to spread disease lies in its behavior.
These Zika carriers can often live inside, lurking in closets and under beds. They also tend to move from person to person rather than being satisfied with one target, biting with speed and aggression. In addition, they feed throughout the day, but their most active times are at sunrise and sunset. They also deliver a relatively painless bite, targeting ankles and elbows, according to the CDC.
“If you wanted to design the ideal vector to spread disease in humans, you couldn’t get much better than Aedes aegypti,” said Scott Weaver, director of the Institute for Human Infection and Immunity at the University of Texas Medical Branch.
How can I protect myself from the mosquitoes?
The CDC recommends taking the following steps to prevent contracting the Zika virus:
- Apply EPA-registered repellents to the skin that contain DEET, picaridin or oil of lemon eucalyptus, or other specific treatments listed by the agency.
- Treat clothing with permethrin, a potent insect repellent safe for humans when used properly.
- Pack enough of these repellents to last the entire trip. It might be difficult to find them at your destination.
- Empty standing water from containers near your home and hotel room.
- Use air conditioning or window screens to keep mosquitoes outside.
- Wear pants and long-sleeved shirts when possible.
This is the second in a series of videos about health care promises from presidential candidates that “sound like a good idea.” Julie Rovner of Kaiser Health News explores why proposals to regulate drug prices may not be such a good idea after all.
For more information, see:Use Our Content This KHN story can be republished for free (details).
— Earlier KHN coverage: Candidates’ Drug-Price Plans May Miss The Mark
— Kaiser Family Foundation/Peterson Center on Healthcare survey: Recent Trends In Prescription Drug Spending, And What To Look Out For In Coming Years.
The first video in KHN’s “Sounds Like A Good Idea” series examined selling insurance across state lines.
When Annie Powell, 35, was in the midst of a 72-hour manic episode in February 2013, she felt like Superwoman: productive and energetic. “I went to the gym for a 5:30 a.m. class, worked all day, came home and went to the gym again with my family. Then, I stayed up all night and organized my office, worked more, cleaned the house and did laundry,” says Annie.
But once the 72 hours ended, she crashed and fell into a deep depression. “I sat in the basement and stared at the wall for hours,” says Annie.
In the morning, her husband, Kevin, came downstairs to get ready for work — and was startled by the blank, distant look on Annie’s face. Their three children, now ages 6 to 8, followed, hugging Annie and jumping on her the way they did every day. But Annie wasn’t responding.
Kevin quickly took the kids upstairs and got them ready for school. He called Annie’s mom to come over and, once she arrived, they called her psychiatrist (Annie was still being treated for postpartum depression three years after the birth of her twin boys in 2010).This KHN story also ran in Woman’s Day. It can be republished for free (details).
After hearing what had happened, the doctor suggested bipolar II, a type of bipolar disorder in which the person experiences both manic highs and depressive lows. What some might consider a frightening response, Annie found to be a huge relief. “I thought, Finally, an answer. I was glad that we had a new direction that was possibly the right one.”
She went on Lamictal, a medication used off-label for bipolar disorder, and felt like a new person. “It may sound weird, but my diagnosis has been a blessing,” she says. “My chemical imbalances are leveled out and I’ve come up with my own self-care tools like healthy eating, exercise and quiet time. It’s been three years since my episode and life just keeps getting better.”
Annie’s story is proof that it’s very possible to survive and thrive after a diagnosis. Nearly 20 percent of American adults will suffer from a mental illness at some point in a given year, according to the National Institute of Mental Health. The condition can range from a mild, short-lived bout of depression to severe schizophrenia that may require hospitalization or lifelong medication.
As common as mental illness is, though, certain myths are surprisingly persistent and prejudice continues to be widespread. Here are four common beliefs debunked.
You can “snap out of” mental health problems.
The facts: You can’t just magically think your way out of a mental illness, whether it’s mild or severe. This idea is pervasive — and damaging, because it creates unreasonable expectations for the person who is suffering from the illness, says Nelson Freimer, MD, psychiatry professor at the University of California, Los Angeles.
Annie experienced this firsthand. “My faith is important to me, so when I first started taking medication, I said, ‘Why do I need this if I’m a Christian?’ My psychiatrist at the time — who also happens to be Christian — said, ‘You need the medicine to get everything in balance so you can see clearly enough to deal with life. You can’t just pray it off. You need some sort of medical intervention.’”
Amy Marlow, 33, of Reston, VA, heard similar “snap out of it” sentiments over and over again as she struggled to cope with her severe depression and anxiety. “People would say I didn’t look depressed — why would I be depressed if I had a job and friends, and things were going well? For a long time, I tried to work a little harder hoping it would go away. But I couldn’t outrun it.”
Some may regard mental illness as a personality or character flaw, but that simply isn’t the case. Researchers have found many factors that contribute to and influence whether someone will develop mental illness, including genetics, biochemical imbalances in the brain, childhood abuse and the hormonal changes that come with pregnancy.
If you have a mental illness, you can’t hold down a job.
The facts: While it’s true that those with a serious mental illness are less likely to be working, many people are able to successfully manage their conditions and find success at work.
Liz Norton, a senior systems manager at a mental health advocacy organization, was diagnosed with obsessive-compulsive disorder at 20. Now in her 30s, her condition is well-controlled with medication and cognitive therapy, and she is open with her employer about it.
On the other hand, Amy Marlow worked as a public relations professional and never disclosed her illness. But when she cut back on her medications while trying to get pregnant, she found herself spiraling downward and needed to take a medical leave of absence. Her manager was supportive, but she chose to leave for a part-time job as a church bookkeeper and office manager, allowing her more flexibility. “Having a mental illness makes me a more compassionate employee,” says Amy.
Annie Powell feels her diagnosis works to her advantage as well. Last year, she launched a personal training and public speaking company called Own It Daily, and she says that her openness is a big reason that clients are drawn to her. “My transparency makes them more comfortable,” she says.
Yet, even though federal law prohibits employers from discriminating against workers because of mental disability, studies show that workers who are open about their illness may still face discrimination, so it’s important to assess your situation carefully.
The National Alliance on Mental Illness offers a useful fact sheet to your legal rights in the workplace at nami.org.
Mental health problems breed violence.
The facts: There’s a big disconnect between our perceptions and the evidence, says Jeffrey Swanson, PhD, a psychiatry and behavioral sciences professor at Duke University School of Medicine. It is hard to escape the headlines about mass shootings committed by someone with a history of mental illness, and polls show that a majority of people believe that the mentally ill are more likely to be violent.
But the truth is, the vast majority of people with mental illness are not violent, says Dr. Swanson. Although people with severe mental illness are up to three times more likely to be violent than those who are mentally healthy, they contribute to just a small part of violence in society, he says. And only about 3 percent to 5 percent of violent acts can be attributed to mental illness. In fact, researchers have found that people with mental illness are about 10 times more likely to be victimized by violence than the general population.
Violent behavior is caused by many factors other than mental illness, says Dr. Swanson. Being young and male increases the risk of committing a violent act, as does being exposed as a child to violence in the community.
You can’t recover from mental illness.
The facts: Many people do make it through mild or moderate episodes of mental illness and never experience them again. Others with more serious conditions are able to successfully control them and live the life they want, just like people with such chronic diseases as diabetes.
Recovery often depends on the type of mental illness, how old you are when diagnosed and other health conditions. The good news is that recovery rates are generally high: up to 50 percent for schizophrenia, 70 percent for panic disorder and 80 percent for bipolar disorder.
Recovery can feel different to different people, but it’s helpful to think of it as an ongoing process of regaining control over your life after a diagnosis, says 63-year-old Susan Noonan, MD, a Boston physician and author who suffers from depression herself. Recovery doesn’t necessarily mean being the person you were before you got sick — that’s likely not realistic. “But it doesn’t mean you can’t enjoy your life,” says Dr. Noonan. “Living in recovery means being able to handle tough days, and it looks different for everyone.” The challenge lies in setting realistic expectations for what recovery means to you. “Mental illness changes how my life goes, but it doesn’t dictate. It’s not the decider,” says Dr. Noonan.
This article is part of an editorial partnership between Woman’s Day and Kaiser Health News.