The trucks drive through New Jersey towns at night, fogging neighborhoods with pesticide to kill a minuscule, and potentially deadly, insect.
This summer, health departments and mosquito control commissions worked with renewed zest to kill, capture and test the flying insect responsible for carrying diseases like West Nile virus in New Jersey. But the threat of Zika, a virus capable of causing devastating birth defects, is bringing the mosquito new attention.
Earlier this year the New Jersey Department of Health began testing insects for Zika along with the other mosquito-borne viruses, like West Nile Virus and eastern equine encephalitis.
So far, none of the mosquitoes in the state has tested positive for Zika, but the human population has not been so lucky. As of Tuesday, New Jersey had 122 cases of travel-related Zika infections, according to the state Department of Health.
Five are in Burlington County, and four are in Camden County. Gloucester and Cumberland counties each have one case.
New Jersey was fifth-highest in the nation for Zika infections as of Aug. 31, according to the Centers for Disease Control and Prevention.
Stephanie Brown, 31, of Lacey does not want to take any chances of exposing her family to the virus.
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"I got my yard treated for the first time because we normally get a lot of mosquitoes, but the threat of Zika put me over the edge," Brown said in a Facebook message to a reporter.
Experts are still unsure whether Zika will take hold in New Jersey's mosquito population. Though the Aedes aegypti mosquito is the primary carrier of Zika, and that breed of mosquito is not common in New Jersey, the state's prevalent Aedes albopictus mosquito, or Asian tiger mosquito, is also capable of carrying the disease.
But whether the tiger mosquito will transmit the disease here is still unclear, according to a report from Rutgers University's Center for Vector Biology.
The fact that Zika can also be sexually transmitted will "greatly complicate efforts to contain outbreaks," wrote Randy Gaugler and Ary Faraji, the report's authors. Both were not immediately available to discuss the Zika.
On Tuesday, the World Health Organization advised all men who have traveled to areas with active Zika, even if they have no symptoms, to use condoms during sex for six months, instead of the original recommendation of eight weeks.
When contracted during or before pregnancy, the virus can cause life-threatening birth defects such as microcephaly, a condition where babies are born with undersized skulls and underdeveloped brains. Babies born infected with Zika also face a risk of eye problems, hearing loss and impaired growth, according to the Centers for Disease Control.
Most adults infected with Zika have mild or no symptoms, the most common being fever, rash, red eyes and joint pain. Yet, in rare instances, Zika can lead to Guillain-Barré syndrome, in which the infected person's immune system damages the body's nerve cells, causing muscle weakness and sometimes paralysis, according to the CDC.
There were 2,722 cases of Zika in the United States as of Aug. 31, and seven of those who were infected also had Guillain-Barré, according to the CDC. An overwhelming majority of Zika infections are connected to travel to areas were the virus is circulating among mosquitoes.
Avoiding such places is becoming increasingly difficult. Zika is active within the mosquito populations of much of North and South America, including sections of Florida, as well as Pacific islands and portions of Africa and Asia.
To prepare for this expanding pandemic, hospitals throughout New Jersey are developing Zika-specific plans.
Infectious disease Dr. Edward Liu asks questions about travel history and mosquito exposure to people who enter Jersey Shore University Medical Center in Neptune with symptoms that match Zika. The disease is diagnosed through blood tests because its symptoms so closely resemble that of two other mosquito-borne viruses, chikungunya and dengue fever.
Yet Zika's risks are particularly concerning to doctors, Liu said.
"Almost none of them cause the concern about birth defects and microcephaly," he said. "They (doctors) have seen more cases of Guillain-Barré. It has to be considered when you've had someone with that neurologic disease."
Liu said he is aware of no other disease that is transmitted through both through sex and mosquitoes.
"It's really one of those new things where everyone's trying to learn more about it, because it's acting differently than other viruses," he said.
Hospitals across the state are preparing staff to see more cases in the future.
In the 11 hospitals in the RWJBarnabas Health network— which includes Monmouth Medical Center in Long Branch, Community Medical Center in Toms River and the Monmouth Medical Center Southern Campus in Lakewood —a team of experts are joining their efforts against Zika.
Each Wednesday, the hospital network's Zika Preparedness Committee meets to discuss the latest information on the virus and make sure that information reaches each department in each hospital, said Louis Sasso, chairman of the committee and RWJBarnebas' director of emergency management.
"We wanted to make sure we had a consistent preparedness level," Sasso said.
That is not an easy task when new information is released on the virus almost daily.
Across the nation, the federal government is also devoting resources to the fight against Zika. Last week, the U.S. Department of Health and Human Services awarded $19.8 million to an Illinois subsidiary of the Takeda Group, based in Japan, to develop a Zika vaccine.
On Sept. 2, the CDC also awarded $2.4 million to five cities— New York, Philadelphia, Chicago, Houston and Los Angeles —to establish and enhance systems to detect microcephaly.
But many are worried the U.S. effort is under-resourced and late. A $1.1 billion bill to combat Zika failed Tuesday in the Senate on a 52-46 vote. It needed 60 votes to advance. Democrats objected to a provision that would have barred funding to Planned Parenthood.
In Ocean and Monmouth counties, mosquito control commissions are sampling the flying insects looking for the disease.
"We have traps that catch mosquitoes live," said Michael Romanski, superintendent of the Ocean County New Jersey Mosquito Extermination Commission.
The traps are baited with carbon-dioxide, a chemical exhaled by people and given off through the skin.
"The traps will collect the mosquitoes live, and we collect them and keep them on dry ice, so they stay nice and cold," Romanski said. "We sort them out, identify them... and then we'll actually prepare vials and each vial is called a pool, because you're pooling together mosquitoes from a couple of different days."
The pools are sent for testing to state labs and results are returned usually within the week, he said.
So far, no New Jersey counties have found Zika in their mosquitoes, but other mosquito-borne viruses are circulating.
West Nile Virus has been detected in all but four counties— Ocean, Cumberland, Cape May and Warren counties have no positive tests so far. Most people who are infected with West Nile have no symptoms, but about 20 percent develop a fever, headache, body aches, vomiting, diarrhea or rash, according to the CDC.
Less than 1 percent of people who catch the virus will develop more serious complications, like inflammation of the brain or surrounding tissue.
Mosquito experts are also searching for eastern equine encephalitis, which has been detected in six of 12 New Jersey counties tested for the virus. Eastern equine encephalitis can sicken and kill horses, and in rare cases, humans. Though rare, the disease causes death in 33 percent of infected people and severe brain damage in most survivors, according to the CDC.
One mosquito pool each in Camden and Gloucester counties tested positive for eastern equine encephalitis, according to the state Department of Health.
Ridding yards of mosquito breeding habitats, avoiding travel to places where mosquitoes carry Zika, and using mosquito repellent are the best prevention to infection, according to experts. Across the state, they continue to watch and wait to see if the virus will gain a foothold here.
"Is the chance there? I can't say it isn't," Romanski said. "You never know. But I would say that it's very slim. ... The thing is to be aware of all of this and to take the proper precautions."
