The number of known cases of Zika in Israel has reached nine, the Health Ministry told Haaretz on Monday, a few days after the World Health Organization warned that Israel faces "moderate" likelihood of an outbreak.
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That does not mean the viral disease has become endemic in Israel yet. It hasn't.
It also doesn't mean that there aren't more cases. Zika is notorious for having little effect on most adults, which means there could be more cases that weren't recognized. (Common Zika symptoms include rash, fever, joint pain, or conjunctivitis (an eye infection), and sometimes muscle pain and headache, which characterize quite a few conditions).
All the nine known cases in Israel were contracted abroad – five in Colombia, and one each in Mexico (or possibly Guatemala), the Dominican Republic, in Cuba – and one in Vietnam, according to Health Ministry data. (See map below for Zika danger areas.)
Israel is at risk, the Health Ministry explains, chiefly because it has mosquitoes that can carry and propagate the virus, and because the country is among the most crowded in the world – a carrying mosquito can easily bite a lot more people than in a sparsely populated place and because the climate is extremely amiable for mosquitoes.
Another vulnerability is that Israel is profoundly exposed to the world. Israelis famously travel a lot, including to the South American hotspots for Zika, and is also a popular world tourism destination. At least some Israelis are catching the disease overseas and bringing it home. Incoming tourism with the condition has not been identified, but that is probably a matter of time.
The mosquito is here
Zika is a viral condition that had gone unremarked by the medical community until Brazilian medical authorities suddenly noticed a correlation with severe birth defects, including microcephaly, in April 2015. The disease itself had been known for around 60 years and is believed to have originated in Uganda, but it had not been thought to have any serious effects. Indeed it doesn't for most adults, though it can cause a condition called Guillain-Barré syndrome, which can be fatal.
Like malaria, Zika spreads through specific species of mosquito and may spread in any country infested by the insects that can carry it. As global warming proceeds, the mosquito's range in both north and south hemispheres is likely to expand. (Unlike malaria, Zika can also be spread by sexual transmission.)
Most commonly, Zika is spread by the Aedes aegypti mosquito but the tiger mosquito, which has become prevalent in Israel over the last 10 years, can also carry and spread the germ.
In other words, the mosquito is here and once the virus arrives, assuming it does, the disease is likely to be here to stay.
Only advice? Don't get bitten
The WHO risk assessment is based on two main factors: the probability of an initial outbreak in each country, and the ability of each country to stop the outbreak in its early stages.
Health authorities, including the Israeli ministry, publish advice for people heading for areas known to harbor Zika, which boil down to "don't let mosquitoes bite you."
Pregnant women, at any stage of gestation, should avoid Zika-infested areas entirely, if possible, and if they must visit, be very sure to wear long clothing that covers bare skin, sleep under mosquito nets imbued with repellent, use mosquito repellent outside the net too, and so on.
The Health Ministry points out that this travel advisory only applies to sites below 2,000 meters in altitude: mosquitoes don't exist above that level.
After a visit to any Zika-infected region, women planning to get pregnant should wait for eight weeks, the Health Ministry advises.
But note well, ladies, that mosquitoes bite men too. They can't get pregnant but they can get and carry Zika.
The WHO itself urges that a man who visited a Zika-prone area forgo sex, or use a condom for eight weeks after their visit, especially if the coitus is with a woman who could get pregnant.
If a man visited a Zika-stricken area and exhibited symptoms of the disease, let alone got a lab diagnosis that he contracted it – the WHO urges that he abstain from sex, or use condoms, for six months as of his last exposure to the insect; and if his life mate is pregnant, the safe sex practice should continue until the baby is born, the Israeli Health Ministry urges. If his life mate is a man, that need not apply.