MIAMI _ Federal health officials Monday advised pregnant women to avoid a Miami neighborhood _ marking the first time the Centers for Disease Control and Prevention has warned against travel to any area within the continental United States _ as a Zika outbreak in South Florida has led to 10 more local cases spread by mosquitoes.
The advisory extends to all expectant mothers, and women planning on becoming pregnant who have traveled to a one-square-mile area north of downtown Miami _ including Wynwood, Midtown and the Design District _ on or after June 15, said CDC Director Tom Frieden.
Pregnant women and their partners who live in the area are advised to take steps to avoid mosquito bites, such as using insect repellant with DEET, wearing long sleeves and pants, and using condoms to avoid sexual transmission of Zika. Frieden also advised that all expectant mothers who have traveled to the area in recent weeks be tested for the virus.
Perhaps most troubling, Frieden said, is that extensive spraying of insecticides in the area over the past several weeks has not reduced the local population of mosquitoes capable of transmitting Zika virus.
"It's possible that the mosquitoes there are resistant to the insecticide that's been used," Frieden said. "It's possible that there may be what we call cryptic breeding places. ... This is a very difficult mosquito to control, particularly in a complex urban environment."
Friden said "there are undoubtedly more infections" in South Florida because only one in five people infected with Zika shows symptoms, but he tempered his statement by noting that the Aedes aegypti species of mosquito most capable of transmitting the virus typically does not travel more than 150 meters _ about 500 feet _ in its lifetime.
"Nothing that we've seen indicates widespread transmission," he said, "but it's certainly possible there could be sustained transmission in small areas."
The new cases in Miami, a major entry port for people traveling from countries and U.S. territories with active Zika transmission, triggered warnings from public health officials in England and elsewhere.
But for many people in Miami's Wynwood neighborhood, which has burnished a reputation as an international arts destination over the past decade, news of the new local Zika cases came as a surprise.
"Now we understand why the cameras are here," said Francisco Whilliams, 46, gesturing to the television vans down the street. It was his first time in Wynwood, strolling around with his wife, Kim, after a trip to the PaniQ Escape Room Miami, an entertainment venue in Wynwood. They live in Doral, Fla.
At Jucy Lu, a vegetarian restaurant in the heart of the affected area, employee Victoria Urrabarri said the owners told employees to wear lotion and insect repellent to work. But she felt that people in the neighborhood were not taking Zika seriously.
"I think they should be more alert," said the 30-year-old, who lives in Doral, about 15 miles west of Wynwood. "We don't have more info, and I think that's really bad."
Among the 10 new local Zika cases reported Monday, six were asymptomatic and were identified from the door-to-door community survey that the state's health department is conducting. In total, Florida has reported 14 local Zika cases _ 12 in Miami-Dade County and two in Broward County _ including two women and 12 men.
In response to the new Zika infections, and the four cases identified last week as the nation's first locally transmitted episodes, Florida Gov. Rick Scott called on the CDC to dispatch an emergency response team to Miami to help with the state health department's ongoing investigations.
"Florida has a proven track record of success when it comes to managing similar mosquito-borne viruses," Scott said in a written statement. "We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses."
Frieden said that all of Miami-Dade's local Zika cases were transmitted within a 150-meter area surrounding an unidentified "workplace" likely at the center of the designated zone. The neighborhood remains the only area of Florida where the health department has confirmed ongoing local transmissions of Zika.
Asymptomatic men and women who have traveled to the Miami neighborhood in that time frame should wait at least eight weeks before trying for pregnancy, said Denise J. Jamieson, a physician and expert on pregnancy and birth defects with the CDC's Zika response team. Symptomatic men with Zika should wait six months.
And women and men who live in or traveled to the area since June 15 and who have a pregnant sex partner should use condoms or abstain from sex during pregnancy, the CDC advised.
All residents of the area were advised to repair and use screens on windows and doors, and to remove all containers with standing water that may act as mosquito breeding sites.
Florida health officials and local mosquito control workers have been inspecting and spraying the area since the first case was diagnosed several weeks ago. They also have been trapping and testing mosquitoes in Miami-Dade and Broward.
While some have criticized Scott for failing to ask the CDC to send an emergency response team prior to Monday, the federal agency and the White House have praised Florida's aggressiveness in responding to mosquito borne-diseases in the past.
Frieden said Monday that two members of the CDC's emergency response team arrived in Florida last week, including a medical epidemiologist, Marc Fischer, and that three more would arrive Monday and another three on Tuesday.
"We've had very close coordination, collaboration with Florida from the beginning of this," Frieden said, adding that he has spoken almost daily with state Surgeon General Celeste Philip, and that experts from the CDC and Florida's health department have been in contact, too.
"This just steps it up to the next level," Frieden said of dispatching the eight-member team to Miami.
Florida and the CDC have long anticipated that Zika would begin to spread locally in Miami and other cities in the South, just like they saw with chikungunya and dengue fever and other mosquito-borne diseases. Despite thousands of imported cases of chikungunya virus, the CDC reported only 12 locally transmitted cases of the disease in Florida in 2014.
But Zika is different, not just because the virus can cause birth defects but because it is also sexually transmitted, and may be even more infectious from person to person than scientists know, as a mystery case currently under investigation by the CDC in Utah makes clear.
"What we know about Zika is scary," Frieden said, noting that Zika is the first time scientists have seen a devastating birth defect like microcephaly resulting from a mosquito-borne disease, even among asymptomatic women.
"What we don't know is more unsettling," he added, explaining that scientists have little research on the long-term effects of congenital Zika virus on children. "This may not become apparent for months or years," he said.
CDC officials also are working to learn more about how the virus spreads, an effort Frieden linked to Barack Obama's February request for $1.9 billion in emergency funding for Zika preparedness, which Congress has yet to approve.
Lyle Petersen, a physician and incident manager for the CDC's Zika response team, said that agency researchers have been investigating the Culex quinquefasciatus species or southern house mosquito and its reputed ability to carry the virus.
"We found no evidence to date that the virus can be propagated in those mosquitoes," Petersen said.
Florida reported the state's first baby born with Zika-related microcephaly in June. A total of 55 pregnant women statewide have been confirmed to have acquired the disease this year. In the continental United States,1,657 Zika cases have been reported in 46 states _ except Alaska, Idaho, Wyoming and South Dakota _ as of July 27, according to the CDC.
Outside Jucy Lu restaurant in Wynwood on Monday, art dealer Mali Parkerson, 33, was finishing up lunch with her intern, Juliette Eskinazi, 20. The two women had walked about a block from their art gallery to the restaurant, but they had no idea about the 10 new local Zika cases announced that morning.
"It's definitely scary," Eskinazi said. Her father had told her to wear mosquito repellent that morning, but she had only put on a little.
"I don't really want to smell like Off in a gallery setting," she said. "It's such a close space."
Now, with the number of local cases climbing, both Eskinazi and Parkerson plan to wear more repellent _ despite the smell _ and eat lunch inside the air-conditioned gallery more often.
But Parkerson said she's not going to stop taking breaks outside every now and then.
"If it's my day to get Zika, it's my day to get Zika," she said. "I'm not going to stop living my life."
