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CDC 'surprised' by Zika virus transmission not associated with travel
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The CDC, along with state and local public health agencies, is investigating a "unique" case of Zika virus in Utah in which an individual acquired the virus after caring for an elderly patient infected with Zika.
The caregiver had not recently traveled to an area with Zika or had sex with someone infected with the virus, according to Satish Pillai, MD, Incident Manager, CDC Zika Response. This patient developed mild symptoms and recovered quickly in a time course "typical" for Zika.
Erin Staples
"The new case in Utah is a surprise, showing that we still have more to learn about Zika," Erin Staples, MD, PhD, CDC's medical epidemiologist in Utah, said in a release from the agency. "Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, non-sexual spread from one person to another does not appear to be common."
The elderly patient, who was the first Zika-related death reported in the continental U.S., had traveled to an area with Zika. As detailed in a release from the CDC, lab tests showed that the patient had a high viral load in his blood — "more than 100,000 times higher than seen in other samples of infected people." The agency noted that the patient also had an underlying illness.
At the request of the Utah Department of Health, a CDC Emergency Response Team (CERT) is in the state to conduct an investigation which includes interviews, lab testing and mosquito trapping "to cover all the bases."
Part of the investigation will focus on if contact played a role in how the individual acquired Zika and transmission in general.
"The primary mode for transmission of Zika is through the bite of the Aedes mosquito," Pillai said in a media briefing. "That has, thus far, been the most common mode of transmission. There have been other modes of transmission, such as through sex and through pregnant women passing the virus through a fetus during pregnancy or at the time of birth — that is what we know. We don't have evidence right now that Zika can be passed from one person to another by sneezing or coughing, routine touching, kissing, hugging or sharing utensils."
He continued: "The person with the new case of Zika that is being reported today was a family contact of an elderly Utah patient who had been infected with Zika and, as we heard earlier, had a very high viral load. While we still don't know exactly how this family contact became sick and we're actively investigating it, what we do know is that the primary mechanisms of transmission are mosquito-borne, so we feel that should provide reassurance to the public."
Officials with the CDC urged health care providers to stick to standard precautions in preventing contact with blood or other bodily fluids in general and did not issue any Zika-related prevention updates. – by Chelsea Frajerman Pardes
Perspective
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Amesh Adalja, MD, FACP
Understanding the events in Utah are vitally important for the control of Zika. That the secondary case patient cared for a fatal case of Zika leads to the hypothesis that some body fluid transmission may have been the vehicle for transmission. More details regarding the fatal case and the types of exposures the secondary case had will be required to know definitively how transmission occurred. The implications of this transmission event could impact infection control guidance. Overall, this event highlights how much more we need to know about Zika.
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