MIAMI — Every time she wants to go outside, 2-year-old Emmaline Smith stops at the door and holds out her arms, waiting for a head-to-toe spraying with insect repellent.
“She knows it. It’s become routine,” mom Jennifer Smith, a 40-year-old Hollywood, Florida resident, said. “We’re probably buying a can of OFF a week. We’re going through it very quickly.”
Applying insect repellant is a ritual adopted by many South Florida residents since the Miami area became the only place in the U.S. with reports of locally acquired cases of the mosquito-borne Zika virus. The Florida Health Department announced Thursday it had found a new zone of Zika transmission in the Miami region.
The federal government is taking precautions to try to prevent locally transmitted Zika cases from occurring elsewhere. Congress passed a measure Sept. 29 that included $1.1 billion to fight Zika. The money will be used to continue work on a vaccine, study the virus in different populations and help states control and contain the spread of Zika, health officials say.
The Centers for Disease Control and Prevention said it is unable to predict how far the virus could spread in the United States. The estimated range concluded by the CDC, of the breed of mosquito that carries the Zika virus, Aedes aegypti, encompasses 29 states, mostly on the lower half of the map. The mosquitoes could survive as far north as lower New York State, according to the CDC.
About 4,000 people have contracted Zika in the U.S., mainly people who traveled to countries where the virus is rampant.
But the danger of a travel-related Zika case causing locally transmitted Zika is not far-fetched.
Experts note that someone who contracted Zika in Latin America could visit the U.S., be bitten by a mosquito and that mosquito could then infect another victim, which is how the outbreak began in Florida.
The first case of locally transmitted Zika was reported in July in the Wynwood neighborhood of Miami; since then the number of local, mosquito-related cases has risen to 153 (the virus can also be transmitted through sexual contact). The total number of travel-related and local Zika cases reported in Florida so far exceeds 1,000, according to the Florida Department of Health.
Containing the outbreak in Miami may be impossible, especially with tourists streaming in and out, but city officials are hoping they can succeed in doing so. Workers roam the city to remove standing water – which are breeding grounds for mosquitos — from public areas, and homeowners with stagnant water can be fined $1,000. Infrastructure Director Roy Coley said that while standing water might seem like a small component, it can help stop the virus from spreading nationwide.
Following the CDC guidelines, mosquito control officials in Dade County sprayed insecticides to kill the bugs over a span of several weeks. Now, the county’s efforts have been focused on larvicide application on the beach and larvicide and adulticide (which combats adult mosquitoes) treatment by inspectors.
“Zika is becoming everywhere in the United States and in many parts of the world. It’s not unique to Miami or Miami Beach,” Coley said. “However, the responsible thing for us to do is to eliminate as many possibilities as we can to prevent it from spreading from here.”
The University of Miami Hospital created a Zika response team that has been working on rapid diagnosis and treatment of existing symptoms. Dr. Ivan Gonzalez, head of the pediatric division of the team, said more attention and funds are needed to actively track children born with Zika or exposed to it in utero. The team wants to follow these infants for up to three years because doctors are unsure of the repercussions of Zika exposure.
Health departments in states like Utah and Texas have reached out to the University of Miami in recent months to learn how they could best prepare for a possible local Zika outbreak. Shortly after the locally transmitted outbreak began in Florida, an elderly man in Utah died from travel-related Zika, making his the first Zika-caused death in the United States. The caregiver for the man who died soon after tested positive for the virus — their first case where the virus wasn’t travel-related or transmitted by sex.
“All states are in high alert but response is based on their conditions,” Angela Dunn, medical officer of the Utah Department of Health, said. “With increased funding, states have been able to increase surveillance of mosquitoes. We’re also following every baby that was born to Zika infected mothers for two years because we don’t know what effects Zika has beyond birth defects.”
A national database of Zika-positive pregnant women has been created by the CDC for health departments across the country to keep tabs on the status of babies that are born. So far, health officials have reported 106 Zika infections among pregnant women in Florida.
Everyone plays a role in curbing the Zika virus, according to Gonzalez. People coming to the U.S. from an endemic area should wear mosquito repellent to make sure they don’t start an outbreak in their own town, he said.
A key misunderstanding, Gonzalez said, is that only pregnant women should be concerned about this virus. Everyone has a role in prevention.
“If mosquitoes have no one else to feed on then you can stop the cycle,” he said.
Published in conjunction with 
