The Zika virus is a mosquito-transmitted infection that is “spreading explosively” across Caribbean, South and Central American countries since an initial outbreak occurred last May in Brazil. As of February 24, 2016, there have been 107 travel-associated cases of Zika virus reported within the United States, plus 39 locally-acquired and one travel-associated case in U.S. territories. Most people infected with the Zika virus are asymptomatic or only have mild symptoms such as fever, chills and joint pain. There is major concern for pregnant women and their babies because Zika virus has been linked to microcephaly, a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age.
Scientists do not fully understand the connection, but early evidence suggests that Zika virus has contributed to an increase in the number of cases of microcephaly in Brazil since the outbreak began. Babies with microcephaly often have smaller brains that might not have developed properly. Other symptoms include seizures, developmental delays, intellectual disability, movement and balance problems, feeding difficulties, hearing loss and vision problems.
The public health impact of microcephaly is profound. It is a lifelong condition with no known cure or standard treatment. Children with microcephaly need routine examinations to monitor their growth and development. For severe forms of microcephaly, children often need ongoing treatment related to other symptoms stemming from the condition.
Due to the serious health consequences of Zika virus to pregnant women and their unborn babies, the Centers for Disease Control and Prevention (CDC) has issued an Alert Level 2 travel notice recommending special precautions for pregnant women and women who are trying to become pregnant. These travel notices cover over 25 countries in the Caribbean, North, South, and Central America, and Africa (with new countries frequently added). The CDC also issued a specific Level 2 travel notice in anticipation of the upcoming 2016 Summer Olympics, to be held in Rio de Janeiro, Brazil. In the notice the CDC provides important steps for travelers to take in advance of the trip and during the trip for the Olympics.
Travel notices issued by the CDC fall into three categories, with the levels varying by the risk to the traveler. A Watch Level 1 indicates individuals should “practice usual precautions” due a baseline or slightly elevated baseline risk to travelers at a specific destination. An Alert Level 2 Travel Notice provides a notice to “practice enhanced precautions.” The highest level issued by CDC is the Warning Level 3, which advises travelers to “avoid nonessential travel” to a destination due to a high risk of exposure for travelers. In July 2014, CDC issued a Level 3 travel warning for the West African nations of Guinea, Liberia, and Sierra Leone due to the worsening Ebola outbreak in the region.
The CDC derives the general authority to issue travel notices through the Secretary of the U.S. Department of Health and Human Services’ statutory responsibilities for preventing the introduction, transmission, and spread of communicable diseases in the United States. This authority has been delegated to CDC’s Division of Global Migration and Quarantine. The legal foundation for this authority is found in Title 42 of the U.S. Code and supporting regulations, including 42 CFR 70 and 42 CFR 71.
Up-to-date information related to Emergency Legal Preparedness Concerning Zika Virus can be found on the Network’s Primer.
This post was developed by Jennifer Bernstein, J.D., M.P.H., Senior Attorney, Network for Public Health Law - Mid-States Region, and Leila Barraza, J.D., M.P.H., Consultant, Network for Public Health Law – Western Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.