Florida currently has two suspected cases of non travel related Zika (I.e., mosquito vectored). We have known this for a little over a week and are still "officially" confirming it. Both cases are in the Miami area, one in Miami-Dade and the other in Broward. It is in the mosquito population and there is no way to stop the spread regardless of the control efforts. Mosquito control is just that, control not eradication.
Perhaps a bigger problem is that in Florida we have a second vector in the Culex sp. of mosquito. We assumed Aedes would be the primary vector in West Nile but it never came to be, Culex was. Culex and Aedes both have an affinity for flavivirus (West Nile, Dengue, St. Louis Encephalitis, Yellow Fever...) and Culex are found across the US unlike Aedes that are primarily found in the south.
Another question that has not been fully answered is if Zika is zoonotic, do other animals become infected with it. During the WNV outbreak the rapid spread across the country was exasperated by the fact that birds and small mammals were infected with WNV giving the mosquito vectors a huge number of sources to become infected. The virus replicates in the mosquito gut and is past to offspring. There is no reason to think Zika will not follow the same progression as WNV.
Zika is pretty much a non worry to most of the population, but is a huge factor for those of child bearing years and will have a huge impact on how we all look at reproduction.
The biggest threat to us all is our blood supply. When Puerto Rico became endemic with it the FDA stopped all blood and tissue donations. That is huge because blood and tissue are in short supply and difficult to make up for a loss in collection. Because of this the FDA finally authorized an "emergency usage authorization" for a rRT-PCR platform to be used in screening blood donors (FDA does not specifically mention that this can also be used to screen tissue donors, only blood) in areas with active Zika transmission. Basically it is only approved for use in PR, but I suspect they will begin letting blood and tissue banks in Florida use it in the coming weeks once the infected mosquitoes become official. The FDA still advises that this test be used in a limited fashion and that banks continue to defer donors who have traveled to affected areas, women who have had sex with a man who has traveled to an affected area in the past 6 months, or has been diagnosed with Zika in the past six months. Currently it is easy to defer travelers, but once it is here you will have to defer everyone because they life in an endemic area.
As you can see the guidelines for deferral, issued in March, are already out dated. Since March we know that it can be sexually transmitted from woman to man, and that care givers can be infected (likely through body fluids) and that we have areas of the continental US with an active vector.
I suspect (I am in daily meetings with the state health department, CDC, FDA, and other public health officials) that the FDA will issue new guidance for blood late next week or the following and new tissue directives a few weeks later (normal progression). We are all waiting with baited breath because it could involve a temporary shut down of blood and tissue donations in Florida. I believe the blood industry will be granted an emergency solution such as allowing the EUA PCR testing. So far they have not extended that option to the rest of the tissue industry (hearts, skin, livers, egg, sperm, stem cells...). Hopefully this forces the FDA to fast track test approval. For those who don't know there are two kinds of testing. The first and most common is diagnostic testing that is used to determine if someone is infected with a disease and what your doctor orders. These are designed so that they are very specific for the disease they are diagnosing, means there is little cross reaction or interfering substances that hinder results. They also often have cutoff levels for detection meaning there is a set level you must have to be positive (I.e., drug testing for THC has a cutoff level of 50ng/mL, 49 ng/ml is negative and 50 ng/ml is positive). Donor screening test are required for donor products and are generally less specific and more sensitive meaning they are more likely to give a positive from substances other than what you are trying to detect and they detect at lower levels. This is done to err on the side of caution. The FDA's job is to protect the consumer and they would rather have a donor not accepted due to a false positive that have a contaminated product due to a false negative.
It is going to be a busy and interesting next few weeks.
Corey Burke
Tissue Bank and Laboratory Director
Cryos International
The Worlds Largest Egg and Sperm Bank.