For more than seven months, U.S. agencies charged with responding to the public health threat from the Zika virus have had to borrow from other programs to fund important counter efforts — from vaccine development to local assistance. “We didn’t wait for legislation because the threat was too great,” said Sylvia Burwell, Secretary, U.S. Department of Health and Human Services (HHS), during a media conference call.

Finally, Congress appropriated $1.1 billion specifically to combat the Zika virus as part of a bipartisan temporary spending bill that continued government funding through Dec. 9. While the final appropriation is still far short of the Obama administration’s original request of $1.9 billion, here’s where some of the money will go:
• At the Centers for Disease Control and Prevention (CDC), $44 million will replenish funds that were redirected towards Zika virus prevention from existing programs, while $350 million will fund such activities as sending support teams to deal with outbreaks, assessing Zika’s impact on pregnancy and determining long-term impacts on children born from those who were infected, cited Dr. Tom Frieden. CDC’s Director. The money will also be used to research technologies to better detect Zika, develop centers of excellence, and build a more agile response to threats, he said. The biggest unknown, he added, is what disabilities will emerge later in children born without obvious health problems at birth.
• The National Institutes of Health and the Biomedical Advanced Research and Development Authority receives $397 million for research related to Zika, vaccine development and diagnostic tests for Zika virus. As many as nine Zika vaccine candidates are in the works in collaboration with other agencies and pharmaceutical companies. “It takes from five to nine starts to get one vaccine candidate across the finish line,” explained Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response, HHS.
• State, foreign operations and related programs (SFOPS) will receive $175.1 million to support response efforts and health conditions related to the Zika virus.
Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, emphasized the importance of having a fund in place for emergency health issues that arise, similar to the Federal Emergency Management Agency. “That should be seriously considered,” he said,” so we don’t have to wait for a sometimes delayed appropriations process.”

The Numbers
• In U.S. states (as of Oct. 5): 3,818 total Zika cases (30 sexually transmitted, 13 with Guillain-Barré syndrome) and 105 locally acquired mosquito-borne cases.
• In U.S. territories (as of Oct. 5): 24,118 locally acquired cases, 83 travel-associated cases, with Guillain-Barré syndrome showing in 39 of the total 24,201 cases.
• Pregnant women with laboratory evidence of possible Zika virus infection: 837 for the U.S. and District of Columbia, and 1,638 for U.S. territories (as of Oct. 5).
Update: Florida
• Florida Department of Health (FDOH), as of Oct. 14, reported 738 travel-related Zika infections, 156 non-travel-related infections, and 106 infections involving pregnant women. Pregnant women are advised to avoid non-essential travel to the impacted areas in Miami-Dade County. On Sept. 19, the Zika zone in Wynwood was lifted after 45 days with no evidence of active Zika transmission.

CDC Guidance Changes (cdc.gov/zika)
• Women and men who are planning a pregnancy in the near future should consider avoiding nonessential travel to areas with active Zika virus transmission.
• The amount of time to wait to attempt conception for couples in which the man has had possible Zika exposure but no Zika symptoms has increased from at least 8 weeks (previous guidance) to at least 6 months after last possible exposure (updated guidance).
• The amount of time to use a condom to protect against transmission of Zika virus infection or not have sex for men with possible Zika exposure but without symptoms has increased from at least 8 weeks to at least 6 months after last possible exposure.
• Pregnant women should consider postponing nonessential travel to 11 Southeast Asia countries with reports of Zika virus infection from local transmission or related to travel to those countries, and those countries with adjacent borders where limited information is available to fully evaluate risk of Zika virus infection. They include: Brunei, Burma (Myanmar), Cambodia, Indonesia, Laos, Malaysia, Maldives, Philippines, Thailand, Timor-Leste (East Timor) and Vietnam. — Maxine Golding