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  • July 29, 2016 8:52 AM | Deleted user

    Dutch case finds woman's infection in South America may have spurred her pregnancy loss

    En Español

    WEDNESDAY, July 27, 2016 (HealthDay News) -- Dutch researchers are reporting a case of miscarriage tied to maternal infection with the mosquito-borne Zika virus.

    The virus is best known for its links to a devastating fetal birth defect known as microcephaly, where babies are born with smaller-than-expected heads and brains. But Zika's links to miscarriage haven't been clear.

    "Data linking Zika virus infection to fetal death have been reported in only a handful of cases," wrote a team led by Dr. Annemiek van der Eijk, of Erasmus Medical Center in Rotterdam, the Netherlands.

    The researchers said a 31-year-old Dutch woman lost her baby at 11 weeks' gestation, after contracting Zika on a trip to the South American country of Suriname. Suriname borders Brazil, which has been hit hard by thousands of cases of Zika-linked microcephaly.

    The report was published online July 27 in the New England Journal of Medicine. In it, the researchers described how the pregnant woman became ill with headache, joint pain and rash the day after she returned to the Netherlands after more than three weeks in Suriname.

    She recovered after six days. But, about two weeks after her symptoms first emerged, doctors found no fetal heartbeat -- indicating a miscarriage -- when the woman went in for a routine ultrasound. She received a D&C (dilation and curettage) a week later.

    Traces of Zika virus were found in amniotic fluid, placental tissue, and in the mother's urine and blood, van der Eijk's team noted. The virus was also found in fetal stem cells, suggesting that Zika "replicates in [these cells] involved in early stage embryo development," the researchers explained.

    The study can't prove that maternal Zika infection caused the miscarriage, only that there was an association. However, the Dutch team pointed out that traces of Zika virus in blood and fetal tissue were found for at least 21 days, suggesting that the "window" for testing a pregnant woman for the virus may need to be expanded. The current testing window set by the U.S. Centers for Disease Control and Prevention is 14 days.

    In the United States, the CDC has been keeping a close eye on Zika, and revising its recommendation for pregnant women accordingly.

    On Monday, the CDC updated its guidelines to say that pregnant women could contract Zika from a sex partner of either gender. While mosquitoes remain the biggest source of infection, cases of sexually transmitted Zika do occur.

    Based on that, the CDC now "recommends that all pregnant women with sex partners (male or female), who live in or traveled to an area with Zika, use condoms during sex or abstain from sex for the remainder of their pregnancy," the agency said.

    "Sex includes vaginal, anal and oral sex, and may also include the sharing of sex toys," the CDC said.

    Any pregnant woman who suspects that she may have been exposed to Zika -- either through a mosquito bite or sexual contact with an infected person -- should be tested for the virus, the agency stressed.

    The CDC also pointed out that "new information has indicated that some infected pregnant women can have evidence of Zika virus in their blood for longer than the previously recommended seven-day window."

    Because of that new data, the agency updated its recommendation to lengthen the time frame for blood testing for Zika to 14 days.

    The vast majority of cases of Zika-linked illness and birth defects are occurring in Latin America. However, Zika may be making inroads into the United States. Late last week, Florida health officials said they were investigating a second possible case of locally transmitted Zika infection.

    The first possible case of local infection in the continental United States was reported early last week by the Florida health department. That case involved a woman in Miami-Dade County, while the newer, second case involved a resident of Broward County, north of Miami.

    Florida health officials said they were capturing and testing mosquitoes in the neighborhoods where the two unidentified patients live. Meanwhile, Gov. Rick Scott has asked for assistance from the CDC, The Miami Herald reported.

    The CDC said it has provided $2 million for Zika preparedness and another $5.6 million was just allotted, the newspaper reported.

    There have been more than 1,400 confirmed Zika cases in the United States, but so far all of them have been contracted through travel abroad -- either by a mosquito bite or by sexual intercourse with someone who had traveled to a Zika-infected area.

    CDC officials have said repeatedly they expect to see cases of local transmission of the Zika virus this summer in southern states with warm, humid climates such as Florida, Louisiana and Texas. The virus is typically transmitted through the bite of Aedesmosquitoes.

    The CDC has also reported 14 cases of sexually transmitted infections. These infections are thought to have occurred because the patients' partners had traveled to countries where Zika is circulating, the CDC said.

    Typically, the Zika virus doesn't cause serious illness. Only about 20 percent of patients notice symptoms.

    But the virus also has been linked to a rare paralyzing condition called Guillain-Barre syndrome.

    The CDC advises pregnant women not to travel to an area where Zika transmission is ongoing, and to use insect repellent and wear long pants and long-sleeved shirts if they are in those areas.

    More information

    The U.S. Centers for Disease Control and Prevention provides more information onmosquito-borne diseases.

    This Q&A will tell you what you need to know about Zika.

    To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

    SOURCES: July 27, 2016, New England Journal of Medicine, online; July 25, 2016, news release, U.S. Centers for Disease Control and Prevention; July 19, 2016, news release, Florida Department of Health; July 18, 2016, media briefing with Satish Pillai, M.D., incident manager, U.S. Centers for Disease Control and Prevention Zika Response; July 18, 2016, news release, U.S. Centers for Disease Control and Prevention; Miami Herald

    -- HealthDay staff

    Last Updated: Jul 27, 2016

    Copyright © 2016 HealthDay. All rights reserved.

  • July 29, 2016 8:52 AM | Deleted user

    Pink Book Webinar Series
    This online series of 15 webinars provides an overview of the principles of vaccination, general recommendations, immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them.

  • July 29, 2016 8:48 AM | Deleted user
    The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions.

    Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–104. DOI:

  • July 29, 2016 8:47 AM | Deleted user

    CDC has updated interim guidance for the prevention of sexual transmission of Zika virus. The recommendations apply to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners.

    Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, July 2016

  • July 29, 2016 8:46 AM | Deleted user

    U.S. Zika Pregnancy Registry
    To understand more about Zika virus infection, CDC established the U.S. Zika Pregnancy Registry and is collaborating with state, tribal, local, and territorial health departments to collect information about pregnancy and infant outcomes following laboratory evidence of Zika virus infection during pregnancy

  • July 26, 2016 6:41 PM | Deleted user

    The Centers for Disease Control and Prevention is calling on doctors to more aggressively screen pregnant women for the Zika virus and to take advantage of new testing technology to improve the diagnosis, follow-up and monitoring of those who have been infected.

    The guidance, published Monday, comes amid growing concerns about Zika, which is spread by mosquito bite and sexually transmitted. If contracted by pregnant women, it can result in severe birth defects — including microcephaly, which stunts children’s brain development. It has also been implicated in miscarriages and diseases like Guillain-Barre, a neurological disorder that causes temporary paralysis.

    By urging testing for more pregnant women, the recommendations “will improve our ability to give definitive diagnoses of the Zika infection to those women who are at the highest risk,” said Margaret Honein, who chairs the CDC’s birth defects branch. She was also a co-author on the guidance.

    Previously, Zika testing was only recommended for pregnant women if they or their sexual partner had traveled to an area where the virus was actively spreading, and if they showed symptoms. That’s changed — even if a pregnant woman or her partner doesn’t show symptoms, the CDC now says she needs to be tested.

    “They’re incorporating the fact that we know transmission can occur, even in the absence of symptoms,” said Neil Silverman, a clinical professor of obstetrics and gynecology at UCLA’s medical school, and an expert in obstetric infectious diseases.

    Zika has been spreading in many Latin American and South American countries, along with Puerto Rico. Public health experts warn it could reach the continental United States by summer’s end. In Florida, epidemiologists are investigating two cases in which local mosquitoes may have transmitted the virus. About one-fifth of those infected show symptoms, which can resemble the flu.

    Another key part of the guidelines emphasizes the need for physicians to use various testing methods.

    For instance, both symptomatic and asymptomatic pregnant women should be screened within two weeks of the date of possible Zika exposure through a DNA-based test known as PCR. PCR has been in use already, but until recently, was believed to only work within one week of exposure.

     “Dominicans, Puerto Ricans and Guyanese do not have a higher risk of transmission for Zika infection,” the department said in a statement. “The data we have released simply reflects New York City’s demographics and travel patterns.”

    If the PCR test turns up negative or an at-risk pregnant woman missed that initial two-week window, the CDC calls for screening with a test that searches for antibodies the virus produces. That test, which is effective for as long as 12 weeks after exposure, is considered a less reliable indicator and has drawn some criticism because it can generate false positives.

    That’s part of the reason, Honein said, the CDC has emphasized the PCR approach. “We’re trying to increase the number of women who know for sure it’s a Zika virus infection,” she said.

    And that could make a difference.

    “The expansion of the time frame for testing of pregnant women to 14 days is quite significant — it means we can offer testing to more women and I suspect we will find more cases that would have otherwise been missed,” said Ranit Mishori, director of global health initiatives and a professor in the family medicine department at the Georgetown University Medical Center.

    But these testing guidelines are complicated. For instance, not all physicians understand the absolute nature of two-week window. If physicians test too late, Silverman said, and the test comes up negative, patients can be lulled into a false sense of security. “This is a fast-moving target,” he said.

    The CDC has been working with a number of physicians groups to help educate doctors about when and how to use different tests, Honein said.

    Beyond testing, the guidance says all pregnant women in the United States and its territories should be “assessed for possible Zika virus exposure” whenever they get a prenatal care visit. That doesn’t necessarily mean testing, especially if a patient hasn’t been exposed to the virus. But it’s a firmer line than the government’s previously taken.

    “This is the first time [screening] has been this strongly emphasized,” Silverman said.

    There’s no known cure for Zika. If pregnant women test positive for the virus, the CDC recommends regular ultrasounds to gauge the fetus’ health and the level of risk the individual patient might face. Those recommendations are similar to the agency earlier directions.

    Meanwhile, the Zika threat isn’t a new one. Lawmakers and public health advocates have been articulating concern since spring — experts argue that the summer weather is prime time mosquitoes carrying the virus to emerge in the U.S.

    And figuring out the best strategy will take time. New research highlights where public health interventions need to be stronger. But these guidelines, Silverman said, track well with what’s currently known about the disease.

    “The gaps become apparent as we learn more,” he said. “These are very appropriate guidelines based on our current level of knowledge … [but] that may change as we learn more.” | @Shefalil

  • July 25, 2016 9:05 AM | Deleted user

    This question originally appeared on QuoraAnswer by Tirumalai Kamala, Immunologist, Ph.D., Mycobacteriology.

    Primarily because its intended target is the healthy population, the economics of vaccines are unlike those for other medicines.

    • Most governments already factor in this difference and have specific policy guidelines and even laws to help fund mass immunizations campaigns.
    • An international two-tier pricing structure ensures that vaccine costs in poorer countries are far lower than those in their wealthier counterparts.
    • Vaccine cost is also fundamentally different between countries with a publicly funded national health care system. [For example, in Canada it's lower versus other countries like the United States, where it's higher.]
    • [The] difference between childhood and adult vaccination programs is another element that influences vaccine cost: While the former are the intense focus of governments and therefore have robust public-private partnerships to defray costs, adult vaccinations can be fee for service. [This is to say a] healthcare provider [will purchase] vaccines upfront and get reimbursed after administering them.

    Whether a future Zika vaccine will be available for free, or free to everyone, depends on whether Zika presents an epidemic or pandemic threat (circumstance one) or not (circumstance two), if and when such a vaccine becomes available

    Zika virusAedes aegypti mosquitoes are seen at the Laboratory of Entomology and Ecology of the Dengue Branch of the U.S. Centers for Disease Control and Prevention in San Juan, March 6, 2016.Reuters/Alvin Baez/Files


    When a vaccine becomes finally available, if Zika presented an epidemic or pandemic threat, affected governments would likely support mass immunizations campaigns, meaning vaccine cost would be heavily subsidized or even free. Though the particulars of how vaccines are funded differ in different countries, by and large most governments heavily subsidize costs of vaccination. For example, in the U.S., vaccine costs were brought under a common umbrella through the 1962 Vaccination Assistance Act (Section 317 of the Public Health Service Act). Section 317 has been continuously reauthorized since 1962. Thus, it's now a mainstay of immunization support in the U.S.

    The US Vaccine Assistance Act ended up doing several things,

    One, it allowed the Centers for Disease Control and Prevention (CDC) to support mass immunizations through the National Immunization Program.

    Two, it provided financial assistance 'in lieu of cash' to state and local health departments to in turn support mass immunization programs. Specifically, Section 317 allows the U.S. federal government to provide vaccines and personnel, such as CDC Public Health Advisors and epidemiologists to assist local and state health departments in managing these programs.

    Three, through Section 317, the U.S. federal government is able to negotiate down vaccine prices with manufacturers. Factors relevant to cost reduction include sales volume, limited distribution points, no-return policy, to name a few.

    Four, in addition, the U.S. 1993 Vaccines for Children (VFC) Act ensures free vaccines to uninsured children, those on Medicaid or American Indian or Alaska Natives. Thus, in the U.S., most recommended vaccines are covered by either private health insurance plans or government subsidies.


    If, on the other hand, Zika threat in a particular country is so low that it would not be cost-effective for its government to subsidize it, then an individual may have to pay for it out of pocket, similar to the way they do now for travel-related vaccines not covered by health insurance. Intended to protect against a mosquito-borne viral disease like Zika, the yellow fever vaccine is a helpful guide for the cost of a travel-related vaccine in the U.S. See below.

    Yellow feverYellow fever vaccine costs in the United States.Quora

  • July 25, 2016 8:58 AM | Deleted user

    Research has shown no evidence that replacing fat with carbohydrates reduces cardiovascular disease. In fact, the opposite is true: researchers now know that dietary cholesterol is not a cause of clinical cardiovascular disease.3 With both dietary fat and dietary cholesterol exonerated as causes of cardiovascular disease and type 2 diabetes, much recent research has focused on the role of fructose as a cause of these modern-day epidemics.4


    The first US dietary guidelines were issued in 1977 by a commission chaired by Sen. George McGovern (D-S.D.).5 The commission recommended that Americans receive no more than 30% of their energy requirements from fat and no more than 10% of their calories as saturated fat.

    At the time, Robert Olson, MD, PhD, professor of medicine and chairman of the biochemistry department at St. Louis University and an expert on nutrition science, argued that the recommendations were not supported by the available science, and asked for “more research on the problem before we make announcements to the American public.”5 Sen. McGovern, speaking for the commission, stated that “senators don't have the luxury the research scientist does of waiting until every last shred of evidence is in.”5

    Sen. McGovern's comment concerning “every last shred of evidence” was widely off the mark. It was never a question of having supportive but incomplete evidence. There simply was no convincing scientific evidence in support of the commission's recommendations.

    At the time the commission issued its dietary guidelines, only 2,500 people had been studied in randomized control trials that compared different macronutrient content. No study included women. No study showed that a low-fat diet was superior to a diet higher in fat content in any measure of health outcome. In fact, in the one study that compared a 10% saturated fat intake with a diet with unrestricted saturated fat, the patients in the low-fat group had a greater risk of glucose intolerance, insulin resistance, and inflammation. The patients on the low-fat diet also developed atherogenic dyslipidemia with an increase in small dense low-density lipoprotein (LDL) particles and a decrease in protective high-density lipoprotein (HDL) cholesterol.4 Yet, without any study recommending the dietary guidelines, and without any science to back up the guidelines, and with some evidence that the contrary was in fact true, 220 million Americans were advised to lower their saturated fat intake. And Americans have been following that advice for the last 40 years.

    Unfortunately these recommendations were not only wrong, they were dangerously wrong. They have helped lead the way to the present epidemics in coronary heart disease and type 2 diabetes.


    When the food manufacturers started removing the fat from food, the taste went with the fat. The solution: Add sugar and lots of it. This worked well economically, as the introduction of high-fructose corn syrup made cheap sugar plentiful.6

    It didn't work so well metabolically. The huge increases in sugar intake have exceeded patients' physiologic limits.7,8 The result is the pathophysiology that healthcare providers see all around us. Although added sugar seems to be the worst culprit, refined grains appear to share the blame. The 2015 DGAC report explains that more than 70% of the US population eats too much processed grain.

    The medical community is beginning to acknowledge that the old paradigm is crumbling.

    A recent review article titled “Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences” states that Americans on average consume 30 times more added sugar than they did when the Declaration of Independence was written.8 This added sugar, according to the article, is a major cause of today's diabetes epidemic.

    Another article, with the provocative title “Carbohydrate Intake and Nonalcoholic Fatty Liver Disease: Fructose as a Weapon of Mass Destruction,” states that excessive fructose intake leads to fatty liver disease.9 This initiates a cascade of events resulting in metabolic syndrome and its related illnesses: coronary heart disease, type 2 diabetes, hypertension, and obesity.9


    The liver is the only organ in the human body capable of metabolizing fructose. When the liver is presented with a large fructose load, it converts some to energy through the Kreb cycle, and some to glycogen. The remaining fructose is shunted to the de novo lipogenesis pathway for conversion to fat. The greater the fructose load, the more fat produced. This fat is stored throughout the body, leading to obesity. Fat also is stored in the liver, causing nonalcoholic fatty liver disease.

    A fatty liver is unable to perform normal hepatic functions and loses the ability to respond to insulin. This insulin resistance, in turn, provokes pancreatic beta-cell overactivity, as the pancreas attempts to meet the increased insulin requirements. Eventually the pancreatic beta cells wear out from the overwork, and type 2 diabetes results.

    The fats produced by the liver in response to a high fructose load include triglycerides and small, dense LDL particles. A fatty liver also decreases production of protective HDL cholesterol. This combination of triglyceride and small, dense LDL particle elevation coupled with HDL reduction predisposes patients to coronary heart disease.10-12

    One of the leaders in this field of nutrition science, James J. DiNicolantonio, PharmD, put it this way: “The global epidemic of atherosclerosis, heart disease, diabetes, obesity, and the metabolic syndrome is being driven by a diet high in carbohydrate/sugar as opposed to fat, a revelation that we are just starting to accept.”4

    Now, the so-called French paradox makes sense. Frenchmen and women with their high intake of fatty foods do not have a correspondingly high incidence of coronary artery disease. Now we know why: Dietary fat isn't the cause of coronary artery disease.13,14

    We also now understand how the Inuit could exist on caribou and seal meat, each with high saturated fat content, without developing coronary artery disease. They ate no sugar.15,16 Old paradigms die hard. Galileo spent the last 6 years of his life under house arrest for the heresy of believing that the earth was not the center of the universe. During Galileo's time, the Catholic Church was all powerful. The church found Galileo's ideas heretical.17

    Today, we take for granted that the planets revolve around the sun and find it hard to imagine that this was once viewed as heretical. There will come a time when people will be surprised that we ever doubted that added sugars and refined carbohydrates were driving the coronary heart disease and type 2 diabetes epidemics. In order to reverse these epidemics, a new paradigm will need to be accepted by both the medical community and the lay public.

    This will not be an easy task. A 2014 Gallup Poll shows that the erroneous dietary advice we have been giving has taken hold.18Nearly twice as many Americans try to avoid fat in their diet as opposed to avoiding carbohydrates. Fewer Americans now avoid fat compared with our intake a decade ago. Removing the harmful sugars and refined carbohydrates from our diets is a major challenge for the healthcare industry. PAs are in a unique position to help facilitate this necessary shift.


    Most physicians are undereducated on matters of nutrition. The paradigm implicating dietary fat as the cause of coronary heart disease has reigned supreme for so long that physicians are not aware that their scant dietary knowledge is out of date. PAs can disseminate the correct dietary information to the physicians with whom they are working.

    Research shows that PAs are in an excellent position to provide health education to patients.19 Some physicians may find that they lack the skills, time, and interest to be effective health educators. These physicians may prefer to empower PAs on their teams to provide health education directly.

    PAs are trained in general medical practice. Many PA programs train primary care providers who will work in underserved regions. These are the very same areas that suffer a high prevalence of metabolic syndrome and its tragic sequelae: coronary heart disease and type 2 diabetes. This appears to be due, at least in part, to food industry advertising campaigns, which preferentially target Hispanic and black youth.20 PAs can deliver a different message.

    The desire and ability to educate and guide patients toward healthy lifestyle choices, coupled with an emphasis on providing primary care in underserved areas, place PAs in an ideal position. Training programs must prepare future PAs to understand the biochemistry, pathophysiology, and nutrition science related to excess fructose ingestion.

    With this knowledge, PAs can lead the charge in reversing the devastating epidemics of coronary artery disease and type 2 diabetes.

    See full list of resources here.

    Journal of the American Academy of Physician Assistants:
    July 2016 - Volume 29 - Issue 7 - p 1–3
    doi: 10.1097/01.JAA.0000484299.50943.55

    Ritterman, Jeffrey MD

    Free Access

    Article Outline

    Author Information

    Jeffrey Ritterman is an associate professor and assistant clinical coordinator of the joint master of physician assistant studies/master of public health program at Touro University in Vallejo, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise.

    Every 5 years, following an expert panel's systematic review of the literature on diet, the US Department of Agriculture and the Department of Health and Human Services issue dietary guidelines. The 2015 Dietary Guidelines Advisory Committee (DGAC) report has two startling changes: The 30% upper limit on fat consumption has been eliminated and dietary cholesterol is no longer listed as a nutrient of concern.1 Lifting these restrictions on fat and cholesterol intake reverses 4 decades of dietary advice. This is nothing short of a scientific revolution.2

    Figure. No caption a...

    Image Tools

  • July 25, 2016 8:21 AM | Deleted user

    The health risks that come with smoking cigarettes has been well documented over the decades, with lungs being especially susceptible to smoke inhalation. But a new study has found another key part of the human anatomy could lopsidedly affect women who smoke: The brain. 

    In particular, women who smoke are more likely to experience bleeding on the brain, a condition that is medically known as a stroke called subarachnoid hemorrhaging. In fact, researchers from Finland found, women who smoke at least one pack of cigarettes a day are eight times more likely than their male counterparts to suffer from subarachnoid hemorrhages. 

    The study's lead researcher wanted to make it known that there are a host of adverse health effects that come with smoking cigarettes regardless of gender, but subarachnoid hemorrhages account for 3 percent of all strokes, Health24 reported. 

    "The message for policymakers is that by implementing effective strategies against smoking, they can considerably reduce the burden of subarachnoid hemorrhage," said Dr. Joni Lindbohm, who works at the University of Helsinki with a specialties in neurosurgery and public health. 

    Studies have shown that most strokes are preventable, with an obvious first step for smokers being to quit the habit to reduce chances of suffering from brain bleeding. 

    Most recently, researchers found this week that a risk of having a stroke would be reduced by 12 percent by quitting smoking alone, science news outlet EurekAlert reported. DNA: Smoking dips 10% in 2 yrs, but women smokers up sharply in India.

    "Our findings will inform the development of global population­level interventions to reduce stroke, and how such programs may be tailored to individual regions," said Dr. Salim Yusuf, a professor of medicine of McMaster's Michael G. DeGroote School of Medicine in Ontario, Canada, who co­authored the report. 

    "This includes better health education, more affordable healthy food, avoidance of tobacco and more affordable medication for hypertension and dyslipidaemia." 

    Compounding the new study is the fact that an increasing number of women are apparently smoking cigarettes while they're pregnant, according to research findings released this month and reported on by CBS News. 

    "We have long suspected that smoking status during pregnancy is under­reported," said Dr. Jim Greenberg, director of the Perinatal Institute at Cincinnati Children's Hospital and author of the report. 

    "But now we know just how many women struggle to quit smoking when they are pregnant."

  • July 25, 2016 8:18 AM | Deleted user

     by MAGGIE FOX 

    Florida health officials said Thursday they were investigating a second possible case of Zika spread locally, and Brazilian scientists said they feared they may have found a second species of mosquito can transmit the virus. The two Florida cases — one in Miami­Dade county and another in Broward county — both appear to have no connections to travel to Zika­affected areas, and neither appears to have had sexual contact with a Zika­infected patient, but Florida officials are still checking both possibilities. They're also looking for mosquitoes infected with Zika near both homes, and testing people in both areas to see if anyone else may have been infected with Zika and not known it. 

    "Residents and visitors are urged to participate in requests for blood and urine samples by the department in the areas of investigation. These results will help the department determine the number of people affected," the Florida Department of Health said in a statement. 


    The Centers for Disease Control and Prevention says it has official reports of 1,404 cases of Zika in the continental United States — all travel related. But the CDC says it's very likely that some travelers will be bitten by mosquitoes while still actively infected and that this could cause local Zika outbreaks. That's what Florida officials are checking for now. But it takes two factors for a local outbreak: An infected patient, and an Aedes mosquito that bites the person and then lives long enough for the virus to build up in its body before it bites someone else. 

    Finding infected mosquitoes isn't necessarily easy, said Dr. Peter Hotez, dean of tropical medicine at the Baylor College of Medicine in Houston. "It's a needle in a haystack," Hotez said. 

    Mosquitoes don't transmit the virus to one another, so to find Zika­affected mosquitoes, workers must catch a mosquito that actually bit someone who was infected. "Just because they don't find Zike in an Aedes mosquito doesn't mean there is no transmission," he said. Florida is one of 26 U.S. states where Aedes aegypti mosquitoes have been found. "Now if they get lucky and find it, that's entirely confirmatory," Hotez added. 

    At the same time, officials are making sure that there's no other possible way the two Florida patients could have been infected. 

    "WE CONTINUE TO INVESTIGATE AND HAVE NOT RULED OUT TRAVEL OR SEXUAL TRANSMISSION AT THIS TIME." "We continue to investigate and have not ruled out travel or sexual transmission at this time," a department spokesperson told NBC News. 

    Separately, Brazilian researchers said they'd found that a much more common mosquito, a species called Culex quinquefasciatus, has been infected with Zika. The same team of researchers, at Brazil's Oswaldo Cruz Foundation, reported in March that they had infected Culex mosquitoes with Zika in the lab. 

    If Culex can spread Zika, that would be more troubling. Culex mosquitoes are far more common in temperate zones, such as in the United States. But just this week another team, led by Scott Weaver at the University of Texas Medical Branch, said they had tried and been unable to infect Culex mosquitoes with Zika. 

    "Without access to the methods and data (it is not published in a peer­reviewed journal yet) there is not much that I can say about this Brazilian study," Weaver told NBC News by email. 

    "An effective vector requires not only susceptibility to infection and ability to transmit (virus replication in salivary glands) but a high rate of biting humans in the case of Zika virus." 


    Hotez also says he doubts Culex mosquitoes play a big role in spreading Zika. 

    "If they found Zika in the Culex mosquitoes, it could be they had taken a blood meal from someone with Zika and then you would find the virus. It doesn't mean they transmit the virus," Hotez said. 

    And everywhere so far that Zika has spread have been areas where Aedes aegypti mosquitoes abound. Different mosquito species spread different diseases. Culex mosquitoes can spread West Nile virus, but so far are not known to spread Zika. Aedes aegypti mosquitoes spread yellow fever, dengue, chikungunya and Zika viruses, which are all closely related and biologically adapted to these mosquitoes. 

    And malaria, caused by a parasite called Plasmodium, is spread by entirely different species of mosquito, mostly Anopheles. The big danger from Zika is to pregnant women. It causes severe birth defects in babies if the mother is infected while pregnant. 

    The CDC says it knows of 400 pregnancies affected by Zika in the continental U.S. and another 378 in territories such as Puerto Rico. Of these, 12 babies have been born with birth defects caused by Zika and another six have died, miscarried or been aborted because of severe defects.

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