Public health officials, regrouping after the birth last week of the first baby in New Jersey with Zika-linked birth defects, have their sights set on the smallest of creatures: the mosquitoes in the Garden State.
The question is what role will they play in the unfolding public health crisis, which has been linked to infected mosquitoes. Experts don't know if Zika will spread through New Jersey's mosquito populations, with worrisome implications for humans. The Aedes aegypti and a closely related breed common in New Jersey, the Aedes albopictus, known locally as the Asian tiger mosquito, are both carriers.
Both breeds live throughout the state.
“Will the mosquitoes here in New Jersey pick up the virus from an infected person?" asked Dr. Joseph Apuzzio, professor and vice chairman of obstetrics, gynecology and women's health at Rutgers New Jersey Medical School. "The answer is we don’t know.”
"They’re finding out so much more about it every day," said Mike Romanowski, superintendent of the Ocean County (N.J.) Mosquito Extermination Commission. "There’s a learning curve here on this whole thing."
The questions and answers took on greater urgency this week.
New Jersey has 18 documented cases of Zika, which experts said caused microcephaly — an underdeveloped brain and head — in a baby born Tuesday at Hackensack University Medical Center to a mother from Honduras. The baby was the first born in New Jersey and third born in the United States with serious Zika-link birth defects.
Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, recently recalled inspecting evidence of the "very special stains" showing the Zika virus invading the neural tissue of newborn infants, with devastating effects.
"This is a horrible thing to see. It is just the kind of thing you would never want to see," Freiden said. "And yet to understand that when a child is born with microcephaly, it's not because the skull was malformed. It's because the virus destroyed the brain cells. And the skull collapsed around the demolished or devastated brain. It's a horrible situation."
"We know it's a danger to pregnant women and women who are planning to become pregnant," said Leslie Terjesen, spokeswoman for the Ocean County Health Department.
Against that backdrop, health departments across the Jersey Shore are launching campaigns to eliminate mosquito breeding sites and are working with local mosquito control commissions, towns and residents to reduce the pests' populations.
Mosquito control experts in both Monmouth and Ocean counties are beginning to trap adult mosquitoes and sample the varieties found.
"There’s no evidence of Zika in Monmouth County right now," said Laura Kirkpatrick, a spokeswoman for Monmouth County who spoke on behalf of its Mosquito Control Division.
The division is monitoring mosquito populations here using both traps and water samples.
"We’re ready to spray, if need be," Kirkpatrick said.
So far, all of New Jersey's Zika cases were diagnosed in people who had recently traveled outside the region, according to the New Jersey Department of Health, but experts are watching the state's mosquito communities closely.
Microcephaly is extremely rare, but countries with active Zika-infections are seeing an dramatic increase in children born with the condition, said Apuzzio, from Rutgers New Jersey Medical School. If the disease spreads, New Jersey hospitals might also see more babies born with the life-altering condition.
"It’s the brain tissue that’s affected, and depending upon which areas of the brain are affected, you can get a very severely handicapped child," Apuzzio said.
Pregnant women are at risk of contracting Zika from infected mosquito bites if they are in areas with active outbreaks, such as Mexico, Central America, the Caribbean and South America.
Though other babies have been born in New Jersey to women who had contracted Zika, Tuesday's birth was the first in the state where a child had obvious Zika-related birth defects, Apuzzio said.
The Honduran mother told doctors she was bitten by a mosquito early in her pregnancy and developed a rash, but was not diagnosed in Honduras due to a lack of nearby testing resources, said Dr. Manny Alvarez, Fox News Channel's senior managing editor for health news. He helped deliver the baby.
"When we did the ultrasound it became very apparent to us that the baby had the small head, microcephaly, it was very growth-restricted, it had multiple issues that we were very concerned about," Alvarez said in an interview. "We brought her back... Tuesday and our team, all of the high risk OB, we all decided that it was best suited to have the baby delivered. She was a previous C-section so we went ahead and did that."
Alvarez said the baby's brain is "incredibly underdeveloped."
"When that occurs, basically it’s gonna have deficiencies, perhaps motor deficiencies, blindness, maybe it's not going to be able to hear – definitely cognitive dysfunctionalities might include seizures and tremors and things of this sort," he said.
As of May 19, there were 310 pregnant women in the United States – 168 in states and 142 in territories – who were infected with Zika, according to the CDC.
Yet many more may actually be infected, because 4 in 5 people who become infected show no symptoms, and those who do usually suffer from a fever, rash, red eyes and joint pain.
Health departments across the Jersey Shore are strongly urging residents to empty all standing water out of yards: old tires, children's toys, pool covers, planters and other objects that collect water.
Within seven days, mosquitoes can hatch from a container of standing water as small as a bottle cap, Kirkpatrick said.
Health departments are also urging the use of mosquito repellent.
"I even sprayed part of my yard with some pesticides actually to cut down on the amount of mosquitoes," said David Henry, health officer with the Monmouth County Regional Health Commission.
Cleaning gutters to remove standing water and making sure window screens have no holes are important steps to preventing the transmission of mosquito-borne diseases, he said.
Business is booming at Last Bite Mosquito Control in Oceanport, where owner Jason Julio had to hire additional staff to handle the swell in work.
“I would say about 40 percent of the calls might be Zika related," he said. “After all the rain that we had and the break of 80 degree weather just before Memorial Day, there’s a lot of bugs out. All of the sudden those insects start to pop up, and our phones are ringing off the hook.”
Pregnant women are not only at risk from infected mosquito bites, but can catch the disease from sexual partners who might have contracted the virus in areas with active transmissions.
The CDC recommends men who were diagnosed with the disease abstain from sex for at least six months or use condoms, and women who are returning from those areas without symptoms of infection wait eight weeks before trying to get pregnant. Apuzzio said the virus can last in semen for at least six months.
This week, the World Health Organization advised partners of pregnant women who have returned from areas of local transmission to practice safe sex or abstain from sex for the entire length of the pregnancy.
There is still much that is not known about the virus. According to the CDC:
— Scientists are unsure if infected men who show no symptoms can pass Zika to their sexual partners.
— They do not know if infected women can pass Zika to men.
— They are unsure if Zika can be passed through kissing.
Meanwhile, the disease continues to spread across central and South America. The CDC reported that there were 591 travel-related cases of Zika in the United States as of May 25, including 11 cases that were sexually transmitted.
"It seems like Zika has only been in this section of the hemisphere for 18 months, and it’s really spread very quickly," said Henry, of the Monmouth County Regional Health Commission. "Only time will tell in regards to what the future holds in regards to the spread of Zika."