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Republicans’ war on science just got frighteningly real.
As many conservatives see it, environmental science is an enabler of dreaded government regulation. Two terrible bills that Obama would have vetoed are back in play, and they stand a very good chance of becoming law under Trump.
As many conservatives see it, environmental science is an enabler of dreaded government regulation. When enough studies show that there is no safe level of lead in water, then we have to regulate lead pollution. When scientists agree that mercury pollution can effect developmental health, then we have to regulate mercury. And when scientists agree that excessive carbon emissions threaten public health and welfare—well, you get the point.
An obvious solution, for those seeking to avoid such regulation, would be to prevent that science from seeing the light of day. That’s exactly what Lamar Smith, a Republican congressman from Texas, is trying to do. On Thursday, the House Science Committee passed two of Smith’s bills: The Honest and Open New EPA Science Treatment Act (HONEST Act) and the Science Advisory Board (SAB) Reform Act. Combined, they would significantly change how the Environmental Protection Agency uses science to create rules that protect human health.
The HONEST Act is essentially a re-brand of Smith’s notorious Secret Science Reform Act, a bill that would have required the EPA to only use scientific studies for which all data is publicly available and the results are easily reproducible. The SAB Reform Act would change the makeup of the board that reviews the “quality and relevance” of the science that EPA uses: Scientists who receive EPA grants would be forbidden from serving, while allowing the appointment of industry-sponsored experts who have a direct interest in being regulated—so long as they disclose that interest.
In a press release, Smith said these bills would help promote “an open and honest scientific process” at the EPA. He says past regulations have been “based on hidden science” and that the SAB needs “a more balanced group of scientists to assist EPA in fulfilling its core mission.”
But several scientists, science advocates, and former EPA officials told me this week that these bills are a solution in search of a problem. The bills, while couched in good intention, will add significant expense and delay to the scientific process, effectively preventing the EPA from using the best available science to protect the public from pollution. Worse, they said, the bills would embolden polluters and discourage good scientists from working in government.
“I’ve always had a hard time understanding why members of Congress like to tell scientists how to conduct their research,” said Democratic Representative Bill Foster, one of only two scientists in Congress. “Scientists should set the standards for research. Not politicians.”
According to The Intercept, “The small group of lawyers and PR strategists orchestrating the secret science effort are closely tied to those attacking the EPA from within. All have connections to either big tobacco, oil, or both.” And those industries would, of course, benefit financially by killing or delaying regulation. “I’m sure you’ve heard of the ‘Delay Game,’ where clearly it’s in the best interests of certain major stakeholders to delay science so they can in effect delay regulations that may have an impact on their business or industry,” said Thomas Burke, who served as the EPA’s chief science advisor under President Obama. “So one has to be a little skeptical of an intent to a bill like this that might lead to an endless loop of reanalysis of data.”
Burke and others said the HONEST Act would delay or stymie the approval of scientific data at EPA because it requires that the disclosure of private data and that study results be “reproducible,” meaning an outside source must be able to replicate the entire study on their own and get the same results. Scientists say that’s just not possible for many public health studies. Consider a 10-year study of lead exposure in pregnant women and children: How would scientists swiftly replicate the results? Or a study on the BP oil spill’s impact on public health in coastal Gulf communities: How can one reproduce that event?
“It’s really hard to reproduce long term studies because variables change, people grow up,” said Yogin Kothari, a scientific integrity advocate at the Union of Concerned Scientists. “If they can’t use these studies, the EPA’s policy decisions won’t be based on the best available science.”
The HONEST Act’s requirement that all raw data be available is also problematic, scientists say, because many public health studies use private medical data, while other studies—like oil well emission research, for instance—can contain trade secrets and industry data. The HONEST Act does say that type of information must be redacted, but then it says that it can be disclosed to anybody who signs a confidentiality agreement. Kothari said that requiring raw data also fundamentally misunderstands how the scientific process works. “You don’t need to see raw data to actually understand a scientific analysis,” he said. “When a peer reviewer at a journal is looking at a study, a paper that they’re reviewing, they don’t ask for the data. They look at the methodologies and how it connects to the research results.”
Besides, Burke said, there is no reason for reviewers to essentially re-do the entire research process when reviewing the validity of a study. That is what the peer-review process is for—a process that has served science well for nearly 300 years. “This bill really does not honor the scientific process that has been the basis for decision-making in the U.S. and around the world,” he said. “It sets up so many potential road blocks. I am very concerned about the public health implications.”
Opponents of the Scientific Advisory Board bill, which bars scientists who have received money from the EPA in the last three years from serving on the board, say it’s insulting to allege that scientists who receive EPA grants are inherently biased in favor environmental regulation. Most scientific research in the U.S. is funded by government grants. Does that mean every scientist is biased toward government regulation?
“They’re basically saying that people who are experts in environmental science, who have spent their careers working on this and may have received EPA grants to do their work, are inherently conflicted, whereas people who are working in the industry, who would be impacted by the board’s advice, are not conflicted,” Kothari said. “I mean, that’s bananas, right?”
There’s no shortage of outrageous bills in Congress that few people take seriously. Republican Representative Matt Gaetz’s bill to abolish the EPA, for instance, caused widespread internet outrage and inspired hundreds of protesters to show up at a town hall Gaetz hosted. But the bill has absolutely no chance of becoming law.
Quite the opposite is true of the HONEST and SAB Reform acts. Both bills passed the GOP-controlled House in 2014 and 2015, back when the HONEST Act was called the Secret Science Reform Act. In 2015, after Democrats lost the Senate, the secret science bill passed the chamber’s Committee on Environment and Public Works. The Obama White House issued veto threats on both bills, both years.
“I would say it’s more real now than ever before because of the current political situation,” said Kothari. “A lot of people paying attention to this always understood that President Obama would veto this legislation. We don’t have that veto promise anymore.”
President Donald Trump has not commented on these bills, but he’s expressed an extreme distrust of science in general, and the EPA specifically. He doesn’t believe in climate change, for instance, and has appointed several climate deniers to cabinet positions. Some of the very people behind these two bills are now serving on Trump’s EPA transition team.
“We now have a president who has attacked mainstream scientific views repeatedly,” Democratic Representative Eddie Bernice Johnson said at Thursday’s House Science Committee hearing. “The threats to the scientific enterprise in America right now are profound.”
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Hot days in early pregnancy: A potential risk factor for congenital heart defects.
A new study in EHP explores women’s exposure to high heat during early pregnancy as a possible risk factor for congenital heart defects in their babies.
Lindsey Konkel is a New Jersey–based journalist who reports on science, health, and the environment.
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Related EHP Article
Risk of Congenital Heart Defects after Ambient Heat Exposure Early in Pregnancy
Nathalie Auger, William D. Fraser, Reg Sauve, Marianne Bilodeau-Bertrand, and Tom Kosatsky
If the frequency and intensity of heat waves continue to increase in certain parts of the world as predicted,1 more people are likely to be exposed to prolonged periods of hot days. A new study in EHP explores women’s exposure to high heat during early pregnancy as a possible risk factor for congenital heart defects in their babies.2
The fetal heart begins to form in the earliest weeks of gestation.3 About 8 in every 1,000 infants are born with some form of congenital heart defect, making these the most common type of birth defects.4 Three-quarters of congenital heart defects are noncritical, meaning the infant likely won’t need surgery or other procedures in the first year of life. Critical congenital heart defects, although less common, are more severe, with many requiring treatment soon after birth.5
Only a few studies have investigated mothers’ exposure to hot days in the first weeks of pregnancy as a risk factor for congenital heart defects in their babies.
© Chayathorn Lertpanyaroj/Shutterstock
It is not clear what causes most congenital heart defects, although previous research has suggested that factors such as maternal smoking and diabetes may elevate risk.6 Maternal fever during the first trimester has been associated with congenital heart defects in some human studies,7,8 although earlier studies on maternal exposure to hot days did not find strong associations.9,10
In the current study, lead author Nathalie Auger, an epidemiologist at the University of Montreal Hospital Research Centre, and colleagues analyzed records for infants born in Quebec between 1988 and 2012. They calculated each baby’s conception date based on gestational age at delivery, and identified more than 700,000 babies conceived between the months of April and September.
Next, they compared the prevalence of seven critical heart defects and eight noncritical heart defects in these infants against the number of hot days to which mothers would have been exposed between weeks 2 and 8 of pregnancy. The researchers counted days in which maximum outdoor temperatures reached 30°C (86°F) or above.
Roughly 980 babies per 100,000 exposed to 10 or more hot days in weeks 2–8 were born with a congenital heart defect, compared with roughly 879 babies per 100,000 with zero days of exposure. Exposure to at least 15 hot days during weeks 2–8 was associated with a 37% higher prevalence of atrial septal defects compared with zero exposure.1
“We would expect that risk would be small, because we would not expect temperature to have a strong effect,” says Shao Lin, an epidemiologist and professor at the University at Albany, State University of New York. She explains that if maternal heat exposure were a major risk factor for heart defects the same as, say, smoking is for lung cancer, we would already know it. She says temperature is more likely just one of several risk factors, and any adverse birth effect could be due to joint or mediating effects between heat and maternal chronic diseases, use of certain medications, or activity patterns. Lin was not involved in the study.
Although the researchers based their findings on measures of outdoor temperature, they lacked information on how much time the women actually spent outside on hot days. They also didn’t know what temperatures the mothers were exposed to inside their homes or workplaces. The impact of outdoor heat could be mitigated by air conditioning or worsened in urban areas that retain high heat.2
It is still not clear how outside heat might affect heart formation, although Auger and colleagues point to studies that have suggested high temperatures could alter cell physiology.11 Previous research has also found associations between air pollution and specific congenital heart defects.12 But it is unknown how other environmental factors related to heat waves—such as an increase in levels of certain air pollutants—might interact with the effects of temperature or whether those other factors could even be responsible for the association, says Martine Vrijheid, an epidemiologist at the Barcelona Institute for Global Health. Vrijheid was not involved in the study.
Vrijheid says future studies should explore factors such as air pollution and indoor temperature in relation to hot weather, and they should be conducted in other populations. “It’s well known that the health effects of heat waves depend on the normal temperatures in a given location,” she explains—for instance, the temperatures that constitute a heat wave are lower in Quebec than in, say, Florida.
Lin adds that studies also should control for time-varying factors such as long-term trends and vacations, and separate summer months from spring and fall months. “Heat’s effects could be quite different by season,” she says.
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Two decades of enhancing children’s environmental health protection at the US Environmental Protection Agency.
At the U.S. EPA, significant efforts have been made to address the special susceptibility of children, and our work continues to address emerging environmental concerns to ensure that children’s environments are free of hazards and support healthy development.
Michael Firestone, Martha Berger, Brenda Foos, and Ruth Etzel
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Summary
About This Article
This article provides an overview of public health efforts by the U.S. Environmental Protection Agency (EPA) during the past two decades to protect children’s health from environmental hazards. It highlights examples of concrete steps and accomplishments toward improving environmental protection and health outcomes achieved through public policy, rules and regulations, increased scientific understanding, and public health messaging. Additionally, examples of future challenges for better understanding and improving children’s environmental health are discussed.
Introduction
Children do not react like adults when exposed to environmental chemicals because their organ systems and metabolic capabilities are not fully developed. Children eat, breathe, and drink more, relative to their body mass, than adults. Their exposures to environmental chemicals differ from that of adults due to child-specific behaviors, such as hand-to-mouth and object-to-mouth activities, crawling on the ground, and breastfeeding. Meanwhile, research shows that exposures to environmental chemicals in homes, schools, food, and common household products may be associated with chronic conditions such as asthma, diabetes, obesity, attention-deficit disorders, learning disabilities, and autism (OUP 2013).
The efforts of the U.S. Environmental Protection Agency (EPA) to enhance consideration of the potential for early-life susceptibility stem from the 1993 National Research Council’s “Pesticides in the Diets of Infants and Children” (NRC 1993) and the subsequent 1996 Food Quality Protection Act (FQPA 1996). Twenty years ago, this legislative change to the regulation of pesticides initiated an unprecedented drive by the U.S. EPA to explicitly consider the unique exposure pathways of children versus those of adults. This summer, President Obama signed the Frank R. Lautenberg Chemical Safety for the 21st Century Act (2016), which reforms the 1976 Toxic Substance Control Act (1976) by directing the U.S. EPA to make an affirmative finding on the safety of a new chemical or a significant new use of an existing chemical before it is allowed into the marketplace. These revisions, 40 years in the making, provide a fresh opportunity for the U.S. EPA to further protect children’s environmental health by requiring the agency to address unreasonable risks to those who may be the most susceptible including children and pregnant women.
Discussion
Early Drivers for Focusing on Children’s Environmental Health
In 1988, when the U.S. EPA attempted to ease restrictions on several pesticides that posed a de minimis cancer risk to humans, the Natural Resources Defense Council brought suit and prevailed. The court stated that only Congress could change the provision designed to protect the public from carcinogens in processed foods and animal feeds in the Food Additives Amendment of 1958, known as the Delaney Clause (Hoyle 1996). Also in 1988, the Congress responded to public concerns about pesticide safety by requesting that the National Academy of Sciences study the issue of vulnerability of children to pesticides residues in foods. The resulting 1993 report “Pesticides in the Diets of Infants and Children” (NRC 1993) made several recommendations for changes in pesticide regulations to protect children’s environmental health, including accounting for the unique exposures of children and improving risk assessment methods to estimate the magnitude of the effects of these exposures on infants and children. This NRC report was a principal driver in ultimately elevating awareness among national policy makers of children’s vulnerability to toxic hazards, thereby moving U.S. environmental policy toward enhanced protection of children’s health and catalyzing research investment (Landrigan 2016). As a compromise to address both the public’s concern with protecting children and industry’s concern with the inflexibility of the Delaney Clause, the U.S. Congress revoked the Delaney Clause (Appel 1995) and then enacted the FQPA. It was passed unanimously by Congress and then signed into law by former President Clinton in 1996.
The FQPA included a number of provisions to better protect children starting with the use of an additional 10-fold safety factor when setting or reassessing tolerances for pesticides in foods unless adequate data are available to support a different factor. Other provisions that could address potential risk included screening pesticides for endocrine disruption, assessing aggregate exposure from both food and residential uses, and accounting for cumulative exposure to pesticides that have common mechanisms of toxicity.
Building Children’s Environmental Health Protection at the U.S. EPA
Recognizing the imperative to protect the health of children, in 1995 the U.S. EPA issued its Policy on Evaluating Health Risks to Children (U.S. EPA 1995) directing the agency to explicitly and consistently take into account environmental health risks to infants and children in all risk characterizations and public health standards set for the United States (U.S. EPA 1995). In 2013, the U.S. EPA reaffirmed this policy and stressed the importance of “…encourag(ing) much-needed research to provide child-specific data required to thoroughly evaluate the health risks children in all life stages face from pollution in our air, land and water” (U.S. EPA 2013c).
Expanding the scope of federal protections, from the U.S. EPA to the myriad of agencies with responsibility for children’s health, former President Clinton issued Executive Order 13045 entitled “Protection of Children from Environmental Health Risks and Safety Risks” (The President 1997). The Executive Order required all federal agencies to assign a high priority to addressing health and safety risks to children, improve coordination of research priorities on children’s health, and ensure that federal standards take into account special risks to children.
The Executive Order required the creation of the “President’s Task Force on Environmental Health Risks and Safety Risks to Children” (https://www.epa.gov/children/presidents-task-force-environmental-health-and-safety-risks-children) to help implement the order across the federal government. To date, the task force, co-chaired by the U.S. EPA and the Department of Health and Human Services (DHHS), has focused on issues including lead, racial and ethnic asthma disparities, healthy homes, chemical exposures, and climate change.
The U.S. EPA created its Office of Children’s Health Protection (OCHP) in 1997. Although the agency’s mission has always been to protect human health and the environment, C.M. Browner and subsequent agency leaders have recognized that protecting children from environmental hazards required explicit and dedicated resources. The office promotes the protection of children by leading and/or partnering with other parts of the agency to ensure that actions by the U.S. EPA take into account any heightened risks faced by children, to help identify research gaps, and to encourage and expand health outreach efforts.
Raising Awareness of Children’s Environmental Health
Reaching parents. The U.S. EPA’s outreach and education efforts are designed to gather together the most important suite of key issues and public health messages on a given topic and share it widely. Outreach materials on topics such as asthma prevention, secondhand smoke, and impacts of climate change on children are available at the agency’s “Protecting Children’s Environmental Health” web site (https://www.epa.gov/children).
Reaching health care providers. In the field of pediatrics, concerns about environmental influences on disease were infrequently considered in the 1990s. A 1995 Institute of Medicine report identified the lack of curricula on topics in environmental medicine in the training of physicians (IOM 1995). In order to increase the knowledge of practicing medical and nursing providers, the U.S. EPA has supported the development of and promoted the use of numerous training courses, information tools, manuals, and educational opportunities such as Recognition and Management of Pesticide Poisonings now in its 6th edition (U.S. EPA 2016). In 1999, with funding from the U.S. EPA, the American Academy of Pediatrics (AAP) first published its Handbook of Pediatric Environmental Health—a seminal accomplishment for building an academic foundation for children’s environmental health—the 3rd edition was published in 2012 (AAP 2012). Additional outreach materials can be found online at the agency’s “Children’s Environmental Health: Online Resources for Healthcare Providers” (https://www.epa.gov/children/childrens-environmental-health-online-resources-healthcare-providers).
Spurred by the lack of environmental health training among pediatricians, the “Pediatric Environmental Health Specialty Units” (PEHSU; https://www.pehsu.net/)—a network of experts in reproductive and children’s environmental health—has been jointly funded by the U.S. EPA and the Agency for Toxic Substances and Disease Registry to provide medical advice, outreach, and training about prevention, diagnosis, treatment, and management of environmental health illnesses for children. From 1999 to 2014, PEHSU conducted approximately 8,000 consultations and educational activities, reaching more than 700,000 individuals (Woolf et al. 2016).
Informing safer school environments. Across the U.S. EPA, numerous efforts to address air quality, drinking water, and chemical safety in school environments represent ongoing federal assistance to local school districts in protecting America’s 53 million school children who will spend their formative years in environments potentially affected by numerous environmental threats. This effort was amplified with the Energy Independence and Security Act of 2007 (2007) that mandated “School Siting Guidelines” (U.S. EPA 2011d). These voluntary guidelines are designed to inform and improve the school siting decision-making process. Much additional information and tools to help establish, maintain, or enhance a school environmental health program can be found at U.S. EPA’s “Healthy Schools, Healthy Kids” website (https://www.epa.gov/schools).
Addressing Early Life-Stage Risks
Exposure assessment. In the early 2000s, the U.S. EPA began a process to consider how behavioral and physiological changes associated with childhood life stages could impact exposures to environmental hazards. Although environmental laws have referred to children as a subpopulation, two important risk assessment guidance documents published by the U.S. EPA in the mid-2000s emphasized the importance of distinguishing between population groups that form a relatively fixed portion of the population (e.g., groups based on ethnicity) and life stages or age groups that are inclusive of the entire population. The term “life stage” refers to a distinguishable time frame in an individual’s life characterized by unique and relatively stable behavioral and/or physiological characteristics that are associated with development and growth. Thus, the U.S. EPA is evolving to view childhood as a sequence of life stages, including infancy and adolescence through adulthood, rather than considering children as a fixed subpopulation.
In 2005, the U.S. EPA’s “Guidance on Selecting Age Groups for Monitoring and Assessing Childhood Exposures to Environmental Contaminants” (U.S. EPA 2005a) was published. This report considers unique behaviors of children such as breastfeeding, crawling, and hand-to-mouth and object-to-mouth activities. The development of a standard set of age groupings (see Table 1) is critical for developing risk assessments that adequately consider early life exposures and for focusing future research and data collection efforts toward a goal of addressing all significant variations in life stage (Firestone et. al. 2007; Firestone 2010). The U.S. EPA’s guidance helped inform the development of similar guidance by the World Health Organization (Cohen Hubal et al. 2014).
Table 1 – Children’s age groups for exposure assessment (U.S. EPA 2005a).
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To support implementation of the guidance, the U.S. EPA published the “Child-Specific Exposure Factors Handbook” (U.S. EPA 2008a). The information in this report has been incorporated in the Agency’s updated document entitled “Exposure Factors Handbook 2011 Edition” (U.S. EPA 2011a). The Handbook provides information on various physiological and behavioral factors to be used in assessing exposure, arrayed by the life stages and age groups as defined in the 2005 guidance on age groupings (U.S. EPA 2005a).
An example of the application of these exposure tools is the use of both the age-grouping guidance and exposure factors handbook data in “Perchlorate Supplemental Request for Comments” (see Table 2 in U.S. EPA 2009). This analysis informed the agency’s 2011 announcement that perchlorate meets the Safe Drinking Water Act criteria for a positive regulatory determination (U.S. EPA 2011b).
Risk assessment. An adage in the field of toxicology attributed to the Swiss scientist Paracelsus (1493–1541) is that “the dose makes the poison.” This simplification does not take into account two potentially important factors. The first involves the issue of timing of exposure or dose, as some chemicals exhibit unique and enhanced toxicity during critical windows of development that can impact the nature and severity of disease (Selevin et al. 2000). The second factor relates to endocrine-disrupting chemicals whose effects may be very different at low doses than at high doses (Vandenberg et al. 2012).
Incorporation of new information regarding early life-stage susceptibility represented a key challenge in the U.S. EPA’s almost 20-year effort to update its 1986 “Guidelines for Carcinogen Risk Assessment” (U.S. EPA 1986). The Agency ultimately developed two guidance documents in 2005—a revised “Guidelines for Carcinogen Risk Assessment” (U.S. EPA 2005b) and a companion “Supplemental Guidance for Assessing Susceptibility from Early-life Exposure to Carcinogens” (U.S. EPA 2005c). The supplemental guidance was not included as a part of the 2005 revised cancer guidelines because the field of early life-stage susceptibility was thought to be actively changing; thus, revising and updating the guidance could be performed in a more expeditious manner than would be required for a major U.S. EPA risk assessment guideline.
The supplemental guidance, based upon an analysis of data for more than 50 chemicals causing cancer through perinatal exposure, concluded that cancer risks generally are higher from early-life exposure than from similar levels of exposure later in life, especially for mutagenic carcinogens. The guidance recommends the use of age-dependent adjustment factors (ADAFs) for those cases where chemical specific data are lacking when assessing cancer risk, but only for carcinogens that act via a mutagenic mode of action:
For exposures before 2 years of age, a 10-fold adjustment.
For exposures between 2 and < 16 years of age, a 3-fold adjustment.
For exposures after turning 16 years of age, no adjustment.
The supplemental guidance states that “development of guidance for estrogenic agents and chemicals acting through other processes resulting in endocrine disruption and subsequent carcinogenesis, for example, might be a reasonable priority in light of the human experience with diethylstilbesterol and the existing early-life animal studies” (U.S. EPA 2005c). Additionally, the National Research Council (NRC) in their “Science and Decisions” report observed that “in practice, EPA treats the prenatal period as devoid of sensitivity to carcinogenicity … and that EPA needs methods for explicitly considering in cancer risk assessment in utero exposure and chemicals that do not meet the threshold of evidence that the agency is considering for judging whether a chemical has a mutagenic mode of action. Special attention should be given to hormonally active compounds and genotoxic chemicals that do not meet the threshold of evidence requirements” (NRC 2009).
To follow up on these findings, research is needed in addressing cancer risk resulting from early-life exposure to carcinogens.
Addressing Children’s Environmental Health through the Development of the U.S. EPA’s Rules and Regulatory Support
In order to implement environmental laws passed by Congress and signed by the President, the U.S. EPA develops and enforces environmental regulations. The Agency has authority under more than twenty statutes, including the Clean Air Act Amendments of 1990 (1990), the Safe Drinking Water Act (2002), and the Toxic Substances Control Act of 1976 (1976). Addressing children’s environmental health in regulatory actions is a central part of the U.S. EPA’s work to protect children. In addition to the three key statutory authorities explicitly calling for children’s health protection—FQPA, Safe Drinking Water Act, and Toxic Substances Control Act—children are generally identified as a sensitive, susceptible, or vulnerable group under the authorities granted by other statutes.
The U.S. EPA’s “Action Development Process: Guide to Considering Children’s Health When Developing EPA Actions” (U.S. EPA 2006b) provides information for considering children’s environmental health in regulatory actions, such as what type of children’s health information should be described, questions for risk assessors, and how to present children’s health considerations to decision makers. Examples in the next section are intended to provide insight into various types of regulatory approaches taken by the U.S. EPA, including updating existing regulatory standards to better protect children, expanding regulatory action that did not previously focus on children, and developing new standards in which protection of children from emerging threats is a key driver.
National Ambient Air Quality Standards for Lead—2008 Revisions
Since the time of initial publication in 1978, the goal of the National Ambient Air Quality Standards (NAAQS) for lead (Pb) has been to protect children from the neurodevelopmental effects of airborne lead exposure (U.S. EPA 1978). Under authority granted by the Clean Air Act, the 1978 standard set the level at 1.5 μg/m3 and acknowledged that young children (1–5 years old) should be regarded as a group within the general population that is particularly sensitive to lead. Based on new scientific information regarding adverse neurodevelopmental outcomes (U.S. EPA 2006a, 2013c), the Agency lowered the Pb NAAQS by an order of magnitude to 0.15 μg/m3 in 2008 (U.S. EPA 2008b). The preamble to this revision recognizes that “(t)here is no level of Pb exposure that can yet be identified, with confidence, as clearly not being associated with some risk of deleterious health effects” and further describes children to be at increased risk due to various factors that enhance their exposures such as hand-to-mouth activity.
The public health impact of the U.S. EPA’s regulatory actions, including the banning of lead in paint and automotive gasoline in the 1970s and 1980s, has resulted in a significant reduction of children’s exposure to lead. The U.S. EPA’s “America’s Children and the Environment” (https://www.epa.gov/ace) indicators report shows that the median concentration of lead in the blood of children between the ages of 1 and 5 years dropped from 15 μg/dL in 1976–1980 to 1.0 μg/dL in 2011–2012, a decrease of 93% (U.S. EPA 2015a; see Indicator B1: https://www.epa.gov/ace/biomonitoring-lead).
Several studies have reported that reducing lead exposure was associated with a reduction in criminal behavior (Carpenter and Nevin 2010; Muennig 2009; Wright et al. 2008).
Restriction in Organophosphate Pesticide Registrations Including Residential Use Cancellations in 2000
Chlorpyrifos and other organophosphate (OP) pesticides are thought to act through a common mode of action by inhibiting nerve function through inhibition of acetylcholinesterase (Mileson et al. 1998). Prior to 2000, chlorpyrifos was the most widely used household pesticide in the United States and was registered for home uses such as outdoor broadcast lawn treatment and indoor crack and crevice treatment. In an effort to protect children, all residential uses (except for roach bait stations in child resistant packaging and fire ant mound treatments) were eliminated in 2000 due to a concern about developmental neurotoxicity of chlorpyrifos (U.S. EPA 2000a).
In addition, many agricultural uses of OPs were also restricted (e.g., tomatoes) or discontinued or cancelled (e.g., apples, citrus, and tree nuts). The risk assessment supporting these actions retained the 10-fold safety factor defined by the FQPA for the protection of children (U.S. EPA 2000b). The U.S. EPA illustrates the reduction in detectable OP pesticide residues in some fruits and vegetables over a 10-year period beginning in the late 1990s (U.S. EPA 2013a; see Indicator E9: https://www.epa.gov/ace/environments-and-contaminants-chemicals-food).
Scientific information on risks associated with chlorpyrifos exposure continues to develop, further illustrating risks to children’s health. Based on a revised risk assessment identifying drinking water and occupational risks (U.S. EPA 2014), the U.S. EPA has proposed a cancellation of all remaining food tolerances for chlorpyrifos (U.S. EPA 2015c).
Control of Greenhouse Gas Emissions from Light-Duty and Medium- and Heavy-Duty Vehicles—2011–2012
In recent years, the U.S. EPA has established new regulations to address climate change under the authority granted by the Clean Air Act. The final rules controlling emissions of greenhouse gasses from light-duty (cars and light trucks) and medium- and heavy-duty vehicles are examples of such standards (U.S. EPA 2011c, 2012). In limiting greenhouse gas emissions, the U.S. EPA is addressing threats to public health, including children’s health, associated with climate change. In its continued effort to address climate change, the Agency has proposed Phase 2 of the Greenhouse Gas Emissions Standards and Fuel Efficiency Standards for medium- and heavy-duty engines and vehicles (U.S. EPA 2015d), among other actions to adapt and mitigate climate change.
Children’s Environmental Health Research
Building on the imperative of the Executive Order 13045, the U.S. EPA and the National Institute of Environmental Health Sciences (NIEHS) have jointly funded the Children’s Environmental Health and Disease Prevention Research Centers since 1998. These multidisciplinary research centers examine how environmental factors affect children’s health and promote translation of basic research findings into intervention and prevention methods to prevent adverse health outcomes [see U.S. EPA (https://www.epa.gov/research-grants/niehsepa-childrens-environmental-health-and-disease-prevention-research-centers) and NIEHS (https://www.niehs.nih.gov/research/supported/centers/prevention/)].
Examples of emerging areas of research include understanding the role of environmental factors in the public health epidemic of obesity among our nation’s children; determining how widespread are exposures to chemicals that interfere with the body’s hormones affecting children; and identifying how epigenetic modifications to DNA resulting from diet, aging, stress, and environmental exposures affect our children and our grandchildren.
Recently, the U.S. EPA published its “Children’s Environmental Health Research Roadmap” (U.S. EPA 2015b). In response to the EPA’s unique mandate to understand the role of exposure to environmental hazards during early life, this research roadmap presents a vision for providing integrated, cutting-edge science on children’s environmental health to inform agency decisions. The research described in this roadmap includes efforts by agency researchers as well as externally funded scientists such as the Centers described above.
Future Challenges
Although the U.S. EPA has taken many actions during the past two decades to improve children’s health protection, important challenges remain. Perhaps the most daunting challenge is understanding and mitigating, to the degree possible, the impacts of climate change on children. The U.S. Global Change Research Program has released a new report—“The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment” (USGCRP 2016) that includes information on those most vulnerable including children and pregnant women. The effects of climate change on children’s health include physical and psychological impacts of weather disasters, increased heat stress, decreased air quality, altered disease patterns, and impacts on the availability of food and clean water (Ahdoot et al. 2015).
Implementing the newly enacted 2016 Frank R. Lautenberg Chemical Safety for the 21st Century Act (2016), which amends the Toxic Substances Control Act, represents an opportunity to improve protection of “potentially exposed or susceptible sub-populations … such as infants, children, (and) pregnant women” from exposure to industrial chemicals. The new provisions allow for greater opportunity to take action to address potential health risks from both new and existing toxic chemicals with explicit considerations for infants, children, and pregnant women.
The U.S. EPA continues to explore incorporating new research in its risk assessment methodology. While many advancements have been made in children’s health risk assessment, there are still many research needs including the following:
Improved understanding of mechanisms leading to early-life windows of susceptibility (e.g., examining possible links between early-life exposure to endocrine disrupters and cancer).
Better characterization of child-relevant exposure pathways such as soil and dust ingestion.
Models that more accurately reflect the dynamic and variable nature of growth that can appropriately represent early-life stages, especially given the expanded use of physiologically based pharmacokinetic models in risk assessment.
Data to illuminate possible links between early-life exposure to environmental chemicals and chronic disease in adulthood (i.e., Barker Hypothesis) (Calkins and Devaskar 2011).
Improved reporting and application of epidemiology findings in risk assessment, so that the observations in children may be better used in decision-making.
There will remain emerging children’s environmental health concerns that have not yet been discovered or addressed. For example, questions about the safety of recycled tire crumb used in athletic fields and playgrounds has recently led to a new federal-wide (including U.S. EPA) effort—Federal Research on Recycled Tire Crumb Used on Playing Fields (https://www.epa.gov/chemical-research/federal-research-recycled-tire-crumb-used-playing-fields). The continued engagement of the research community in children’s environmental health is needed to help address these challenges and protect our nation’s children for generations to come.
Conclusion
Building on two decades of experience, the U.S. EPA continues to focus its efforts in three principal areas—science to better understand early-life susceptibility, consideration of children in environmental regulations, and outreach to inform health care providers and the public.
Much of the U.S. EPA’s work during the past 20 years to protect children from environmental hazards can be considered primary prevention. These are actions and measures at the population level that minimize hazards to health and that inhibit the emergence and establishment of factors known to increase the risk of disease. For example, the U.S. EPA’s regulations for Pb and OP pesticides have reduced children’s exposures and thus, the potential for neurodevelopmental disease.
The evolution and expansion of children’s environmental health protection over the past two decades has been remarkable. At the U.S. EPA, significant efforts have been made to address the special susceptibility of children, and our work continues to address emerging environmental concerns to ensure that children’s environments are free of hazards and support healthy development.
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British doctors and health professionals call for rapid coal phase-out.
Groups representing Britain’s 600,000 doctors and health professionals say it is “imperative” to phase out coal rapidly to improve health and reduce NHS costs.
Groups representing Britain’s 600,000 doctors and health professionals say it is “imperative” to phase out coal rapidly to improve health and reduce NHS costs.
The doctors and nurses say tackling outdoor air pollution from traffic and power stations would cut climate emissions, reduce air pollution, and deliver a powerful boost to the nation’s health.
“Climate change and air pollution are both major health threats,” says the UK Health Alliance on Climate Change in a report. “They share a common driver: the combustion of fossil fuels. Pollution from coal plants alone costs the UK as much as £3.1bn each year in human health impacts.”
The group of 15 health bodies includes seven royal colleges of medicine and the British Medical Association.
Pollution from coal plants causes many serious health conditions including stroke, coronary heart disease and lung cancer. It disproportionally affects children and kills more people than road accidents , says the report.
The government has said it intends to phase out coal power plants by 2025 but the doctors say they are alarmed that no consultation papers looking at how this could be achieved have been published in more than a year.
“Ending the use of coal is a simple, no-regrets public health intervention. The rapid phase-out of coal fired stations is an imperative first step. Coal is the most carbon-intensive source of power generation, and is a key focus for reducing the risks of climate change.
“In the UK, burning coal is linked to 1,600 premature deaths, 68,000 additional days of medication, 363,266 working days lost and more than 1m incidents of lower respiratory symptoms,” says the report.
It urges politicians not to tackle air pollution and climate individually, as has been done in the past. “The UK has witnessed ... policies that encouraged the use of diesel cars which inadvertently worsened air quality. Considering air pollution and climate change together can limit adverse health effects.
“Some strategies can be good for both air quality and climate change, for instance wind, solar and tidal energy. Acting on ones that are beneficial to both is advantageous to health. Indeed, joining up policies on health, air pollution and climate change can offset the costs of climate mitigation policies through the health benefits that they bring.”
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Air pollution is the second biggest public health threat in the UK after smoking and kills 40,000 people a year in Britain, said Prof John Middleton, president of the Faculty of Public Health. “Coal-fired energy is particularly damaging through its invisible particulates and because it is a driver of climate change,” he said.
“The phase-out of coal use is an essential step towards creating a sustainable energy policy for the UK,” said Dr Richard Horton, editor-in-chief of the Lancet medical journal. “It is also a vital co-benefit for health - ending coal use will deliver long-lasting health and dividends for the British population. Life expectancies will be prolonged, disease and disabilities reduced, and future risks to health diminished. This is an opportunity to be seized.”
Jonathan Griggs, professor of paediatric respiratory and environmental medicine and fellow of the Royal College of Paediatrics and Child Health said that children were particularly vulnerable to burning coal.
“Air pollution from burning coal has been linked to low birth weight and pre-term delivery as a result of maternal exposure during pregnancy,” he said. “The phase-out of coal is a double win for tackling the twin health threats of air pollution and climate change.”
“Tackling air pollution and climate change will have numerous health benefits but it requires a joined-up approach from government to ensure the health impacts are better recognised and fully realised,” said Janet Davies, the Royal College of Nursing’s chief executive and general secretary.
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CDC tells men at risk of Zika to put off procreation for 6 months.
Men who may have been exposed to the Zika virus should wait at least six months before trying to conceive a child with a partner, regardless of whether they ever had any symptoms, federal health officials are recommending.
CDC Tells Men At Risk Of Zika To Put Off Procreation For 6 Months
September 30, 20161:40 PM ET
ROB STEIN
The Zika virus has been largely spread by mosquitoes, but it can also be spread by sexual intercourse.
NIAD/Flickr
Men who may have been exposed to the Zika virus should wait at least six months before trying to conceive a child with a partner, regardless of whether they ever had any symptoms, federal health officials are recommending.
The Centers for Disease Control and Prevention had previously recommended that only men with Zika symptoms had to wait that long. Those who may have been exposed to Zika but never developed any symptoms were told to hold off on trying to conceive for just eight weeks.
But on Friday the agency published revised recommendations based on new evidence indicating the Zika virus can remain in semen longer than had been thought and can be spread by men even if they don't have symptoms.
"The updated recommendations incorporate what's been learned since the previous guidance was released," the CDC said in a statement announcing the change.
"The new time period for couples to wait to attempt conception when the man has possible Zika exposure but no symptoms [is] expected to minimize the risk of sexual transmission around the time of conception and prevent possible early fetal exposure to the Zika virus," the CDC said.
The Zika virus can cause a variety of birth defects when women get infected while pregnant. The most serious birth defect that has been linked to Zika is microcephaly, which causes babies to be born with abnormally small heads and badly damaged brains.
For couples planning to conceive who do not live in a place where the virus is actively spreading, the CDC recommends men who may have been exposed to the virus by traveling where the virus is being transmitted wait at least six months before trying to conceive.
The virus has spread through Latin America, especially Brazil, and the Caribbean, including Puerto Rico. It has also been spread by mosquitoes in Pacific islands such as Fiji.
For couples who live in a place where the virus is spreading, the CDC recommends women and men should be tested if they develop any symptoms. Men who test positive should wait at least six months to try to conceive. Women who test positive should wait at least eight weeks. Those who test negative should talk to their doctor about what to do.
The guidelines are less specific for couples who live in a place experiencing an outbreak, such as Miami, but who don't have any reason to believe they may have been infected.
The guidelines recommend that those couples talk their doctors about what they should do, weighing factors that "might influence pregnancy timing," such as their age, whether they had problems getting pregnant and their fertility.
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The agency stressed that its guidelines could continue to change as new information about Zika becomes available.
The virus has repeatedly surprised health authorities. At first they thought the virus was only transmitted by mosquitoes. Then researchers discovered men could spread Zika to women through sexual contact. The CDC was surprised again when doctors determined women could also spread the virus to men.
The Food and Drug Administration also recently recommended that all blood donations be screened for the virus to minimize the chances pregnant women could get infected from a transfusion, or sex with someone who had a transfusion.
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In Florida, pregnant women cover up and stay inside amid Zika fears .
Amanda Paradiz is 16 weeks pregnant, and she has a mission: to get through her entire pregnancy without a single mosquito bite.
MIAMI — Amanda Paradiz is 16 weeks pregnant, and she has a mission: to get through her entire pregnancy without a single mosquito bite.
It hasn’t been easy. Ever since health officials in July announced four cases of Zika transmission by local mosquitoes detected in a Miami-area neighborhood, Mrs. Paradiz and her husband, Alex, have largely secluded themselves in their Broward County home. They canceled a vacation, and stopped taking evening strolls around the lake and swimming in the neighborhood pool. To walk the dog, Mrs. Paradiz, 35, throws on long pants and a hoodie, even though it’s 90 degrees outside. She’s debating quitting her job as a sales rep, to avoid coming into contact with a mosquito that might carry the Zika virus, which can lead to devastating birth defects, including an abnormally small head, called microcephaly.
“All it takes is one mosquito bite to change the entire course of our lives,†Mrs. Paradiz said.
In the past three weeks, the number of confirmed Zika infections in the greater Miami area has increased to 36, including 25 linked to the one-square-mile neighborhood of Wynwood considered the Zika zone, as well as isolated cases outside Miami-Dade County in Broward and Palm Beach counties. Since Thursday, the number has included a small cluster in Miami Beach, suggesting that there is at least one other location where mosquitoes may be transmitting the virus locally. Federal health officials now are advising pregnant women to avoid traveling to the Miami-Dade County area.
Public health officials have emphasized they do not expect the virus to spread here as it has in other countries because many homes have screened windows and air-conditioning, which keeps mosquitoes at bay. But pregnant women still are worried.
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Some expectant mothers are choosing confinement indoors to avoid mosquitoes. Women who wouldn’t dream of drinking coffee while pregnant now are coating exposed limbs in bug spray, a tactic recommended by health officials. Some women even are considering temporary moves, leaving their homes, families and doctors to stay with relatives or friends far away from a Zika zone until they give birth.
“Patients are very anxious, and they bring up the subject of Zika with me before I even get a chance,†said Dr. Elizabeth Etkin-Kramer, an obstetrician-gynecologist who is a past president of the Dade County Medical Association. “Before, this was an ocean away. Now it’s in their backyard.â€
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Amanda Paradiz is 16 weeks pregnant and anxious about Zika. She and her husband, Alex, are wondering if Amanda should quit her job because it involves long hours outside. Credit Joshua Prezant for The New York Times
While the Zika epidemic has been sweeping across Latin and South America and the Caribbean since last year, in the United States it is still relatively new. So far, some 2,260 infections have been confirmed, including 529 pregnant women, according to the Centers for Disease Control and Prevention.
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But those cases involved people who are believed to have been infected while traveling, as well as 22 who contracted it by having sex with an infected person. Now that the virus has been transmitted through local mosquitoes, pregnant women say they feel vulnerable and frightened, and wonder how they can keep mosquitoes at bay during an entire pregnancy while living in a state that is swarming with the insects.
At a regional meeting of obstetricians and gynecologists in Orlando last week, Zika was the main topic of conversation, said Dr. Karen Harris, an obstetrician-gynecologist in Gainesville who heads the Florida arm of the American Congress of Obstetricians and Gynecologists.
“It’s hard on the patients, but it’s also hard on the staff, because we don’t have anything to offer but prevention,†she said. “We can’t answer their questions. If you get Zika a month before you’re due, does that affect the baby? We don’t know. There’s total uncertainty.â€
The black-and-white Aedes aegypti mosquito, which carries the Zika virus, doesn’t normally fly more than about 500 feet in its lifetime. Health officials assume that Miami-area mosquitoes picked up the infection from someone who had just returned from Latin America or the Caribbean with the virus in his or her blood.
The latest guidelines direct obstetricians to assess every pregnant patient for exposure to Zika at each prenatal visit, and counsel them to use condoms and insect repellent to lower their risk for exposure.
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Tyriesha Williams, 24, of Dania, Fla., is seen by her obstetrician, Dr. Aaron Elkin, as her daughter Ambrie, 4, watches. Ms. Williams is five months pregnant and is so concerned about the Zika virus that she is usually covered with long sleeves and pants even in the summer heat. Credit Joshua Prezant for The New York Times
Dr. Aaron Elkin, a Broward County obstetrician-gynecologist who treats a diverse group of patients from Miami and surrounding areas, keeps a basket of free condoms on the counter in the reception area, along with containers of Off bug spray. Dr. Elkin, a past president of the Broward County Medical Association, spent every visit last week discussing Zika precautions, assuring women that bug spray would not harm the fetus, taking blood and urine samples for tests and doing ultrasounds.
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“Every pregnant woman who comes in for prenatal care wants Zika testing,†Dr. Elkin said. “You can’t say no to them. They’re very frightened. I’m doing 15 tests a day.â€
One patient, Idit Zalouf, a 37-year-old who lives in Sunny Isles Beach just north of Miami Beach, is five months pregnant. She showed Dr. Elkin a bracelet she bought that she thinks will protect her from mosquitoes. Dr. Elkin advised her to use insect repellent with DEET.
“Do you think it would be good for me to go to New York for a while?†she asked him. “If a pregnant woman gets the Zika, what does she do?â€
Dr. Elkin tried reassuring her that preventing mosquito bites and other forms of Zika transmission should be her focus, and that it would be difficult to manage her care from afar.
Later Ms. Zalouf said she may move anyway. “I think it’s better to be away from here,†said Ms. Zalouf. “I’m stressed about it. It’s very frightening. “
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Dr. Aaron Elkin checks fetal size on the sonogram of Samantha Flax, 33, of Boca Raton, Fla. Ms. Flax and her sister, Brittany Schuman, 28, who is also pregnant, are both concerned about Zika virus. Credit Joshua Prezant for The New York Times
Another patient, Unique Robinson, a 22-year-old licensed practical nurse who is not working now and lives in Broward County, said she is terrified. She rarely ventures outside her home, except to go to the mall or the movies.
“I’ve looked it up and seen the babies, how they come out. I don’t think I could handle that,†she said, her voice breaking. She often goes online to look up information. “The internet makes it worse.â€
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Some patients are worried about Zika, but find it difficult to take precautions. Malorie Fitzgerald, a 29-year-old part-time secretary who is 33 weeks pregnant with her third child, has separated from the father and has been living in a homeless shelter in an area of Miami adjacent to Wynwood. While most patients came to the office wearing long pants and long sleeves, Mrs. Fitzgerald, who caught a bus, was wearing an ankle-length dress with a halter top.
At the shelter she shares a room with 25 people, and they are lax about leaving doors open. She hangs blankets around her bunk bed to keep flies and mosquitoes out, to no avail. “I get bit a couple of times a day,†she said. “It’s a little less since the doctor gave me a can of Off. But the mosquitoes and flies are horrible there.â€
Dr. Elkin runs an ultrasound, and reassures Ms. Fitzgerald that the measurements are normal. It’s not a perfect guarantee, however. Infections can occur at later stages of pregnancy, and the scan won’t pick up more subtle abnormalities caused by Zika that are not visible, like stiff joints and eye damage.
“That is the head of the baby, see? It’s completely normal,†Dr. Elkin said. Ms. Fitzgerald smiled with relief. But he repeated his advice about prevention. “Wear long clothes and use the Off!â€
But even the most vigilant efforts to prevent mosquito bites are not always successful. Lori Tabachnikoff, 36, who is 24 weeks pregnant with her first child and lives in South Miami, said she was fortunate because her employer, the Greater Miami Jewish Federation, located just outside Wynwood, has allowed her to work from home to minimize her time outdoors.
Even so, mosquitoes sneak in. She recently let a plumber into her home and was soon bitten by a mosquito that must have slipped in at the same time. She has been bitten five times so far this summer, and she and her husband recently went to the health department at 4 a.m. to get in line to be tested. There were already four couples ahead of them. They are waiting for the results.
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Military discloses at least 11 troops infected with Zika virus this year.
At least 11 U.S. troops have been infected with the Zika virus since January, nearly all of whom traveled to countries where the mosquito-born illness is prevalent, a Pentagon health report published Friday disclosed.
Military discloses at least 11 troops infected with Zika virus this year
Gregg Zoroya and Liz Szabo, USA TODAY 1:13 p.m. EDT June 3, 2016
(Photo: Mario Tama)
At least 11 U.S. troops have been infected with the Zika virus since January, nearly all of whom traveled to countries where the mosquito-born illness is prevalent, a Pentagon health report published Friday disclosed.
In addition, four dependents of service members — which can include spouses and children — and two military retirees contracted the illness, according to the report. It underscored the risks to military personnel of child-bearing age exposed to the virus during deployments.
A fetus infected with the Zika virus during the first three months of pregnancy has about a 1% to 13% chance of developing microcephaly, an abnormally small head usually caused by incomplete brain development, according to the Centers for Disease Control and Prevention.
Among the 17 infected are four women, though none were pregnant, said Dr. Jose Sanchez, director of the Armed Forces Health Surveillance Branch.
Troops suffering from the Zika were four soldiers, three Airmen, a Marine and three members of the Coast Guard, according to Sanchez. The first confirmed case was diagnosed in late January, the report said.
Fifteen of the 17 had traveled to South America or the Caribbean. They included four who visited Columbia, three who went to the Dominican Republic and three who visited Puerto Rico. One person had traveled to Brazil, which is dealing with a Zika epidemic.
"It is a fair assumption that the military is at higher risk for mosquito-borne infections," said Amesh Adalja, a senior associate the Center for Health Security at the University of Pittsburgh Medical Center.  "The military is stationed all over the world and often have prolonged outdoor exposure, enhancing the likelihood they will be bitten."
The military should make sure that service members and their families "are made completely aware of the risks and the measures required to protect themselves from both mosquito and sexual transmission," Adalja said. "Mosquito repellents for troops in active Zika zones will be essential, as will minimizing standing water mosquito breeding sites on military bases.
The Pentagon this year ordered heightened monitoring for certain mosquito species at military installations in 27 states and the District of Columbia in response to the Zika virus crisis, according to Military Times. The Pentagon called for monitoring, trapping, testing and eliminating water sources as breeding grounds, the newspaper reported.
The Pentagon also offered to relocate family members of active-duty personnel and civilian Defense Department employees assigned to regions at higher risk for infecting people with the virus, Military Times reported.
More than 600 people in the continental U.S. have been infected with Zika, including 195 pregnant women. All of those cases were related to travel. More than 1,100 cases of Zika, including 146 involving pregnant women, have been detected in the U.S. territories of Puerto Rico, American Samoa and the U.S. Virgin Islands, where the disease is spreading among local mosquitoes, according to the Centers for Disease Control and Prevention.
The true number of Zika cases could be much higher. Only about 20% of people infected with Zika have symptoms, which can include fever, rash, joint pain, pink eye and headache.
Zika is spread by the Aedes aegypti mosquito species, found in much of the southern U.S., as well as Latin America and the Caribbean, and possibly the Aedes albopictus, whose range stretches as far north as New England, according to the CDC.
The people at highest risk from the Zika virus are pregnant women, because the virus can cause devastating birth defects in fetuses, according to CDC director Thomas Frieden. The CDC encourages pregnant women to avoid traveling to areas with Zika outbreaks.
Infected men also can spread Zika through vaginal, oral or anal sex, according to the CDC. It’s not known if infected women can pass the virus to men.
The CDC has issued guidance to help reduce the risk of sexual transmission.
If a man has had a possible Zika exposure and has a pregnant partner, he should wear condoms or abstain from sex for the duration of the woman’s pregnancy, according to the CDC.
If a man has had symptoms of Zika, he should consider using condoms or abstaining from sex for six months, according to the CDC.
Men who have traveled to a Zika-affected area, but who have not had symptoms, should consider using condoms or abstaining from sex for eight weeks, according to the CDC.
Women who’ve traveled to Zika-affected areas should delay trying to get pregnant until eight weeks after their symptoms start; if they don’t have symptoms, they should avoid trying to conceive for eight weeks after being exposed.
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