Update on Zika Virus (2)

The Centers for Disease Control and Prevention (CDC) has issued new guidelines for evaluation of possible Zika virus infection. New recommendations include:

  1. Providers should offer Zika testing between 2 and 12 weeks after a pregnant woman returns from travel to areas with ongoing Zika virus transmission, even if asymptomatic. Full recommendations are available at http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er.htm_w . In West Virginia, testing can be arranged through the local health department.
  2. Men who have traveled to an area of active Zika virus transmission and have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy. Full recommendations are available at http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1.htm_w .

On February 10, 2016, CDC published a paper documenting Zika virus in the brains of two fetuses (miscarried at 11 and 13 weeks) and two microcephalic infants who died within 20 hours of birth. This week the New England Journal of Medicine independently reported Zika RNA in the brain of a microcephalic infant of a woman who had Zika-like symptoms during the 13th week of gestation while volunteering in Brazil.

Persons with symptoms of Zika (acute fever, rash, myalgia or arthralgia, and/or conjunctivitis) occurring within 2 weeks of travel to an area with ongoing transmission (http://wwwnc.cdc.gov/travel/page/zika-travel-information ) can be offered testing. Testing must be arranged through the local health department.

Providers should keep other mosquito-borne infections in the differential diagnosis, including malaria, dengue and chikungunya. Malaria should always be in the differential diagnosis of fever in travelers recently returned from endemic areas. Correct laboratory diagnosis and appropriate treatment of a patient with malaria improves outcomes. CDC maintains provider information and offers a consultation service to support United States providers, visit http://www.cdc.gov/malaria/diagnosis_treatment/index.html . Early recognition and appropriate management of dengue complications is critical for successful outcomes. CDC maintains information on dengue diagnosis and management, visit http://www.cdc.gov/dengue/clinicalLab/clinical.html . For information on chikungunya, please see http://www.cdc.gov/chikungunya/ .

For more information, please visit www.dide.wv.gov or call the Division of Infectious Disease Epidemiology at (304) 558-5358, extension 1 or the answering service at (304) 925-9946.

Update on Zika Virus (1)

This alert is an update on the Zika virus, a reportable arboviral disease. Nineteen states have had imported cases of the disease; West Virginia has no cases to date. Pregnant women should consider postponing travel to areas where Zika virus transmission is ongoing due to possible association between infection and poor pregnancy outcomes (e.g. microcephaly and other birth defects).

The West Virginia Bureau for Public Health would like to bring the following key points to your attention:

  • Differential diagnoses for Zika virus infection should be based on travel history and exposures.
  • Providers should report suspected cases of Zika virus to the local health department within 24 hours to facilitate diagnosis and testing, and to mitigate the risk of local transmission.
  • Testing for the Zika virus must be arranged by the local health department in conjunction with the Office of Laboratory Services (OLS). OLS will coordinate specimen shipment to CDC for testing.
  • Dengue, chikungunya, and Zika virus are all transmitted by the same mosquitoes and have similar clinical presentations. It is important to rule out dengue in order to appropriately manage the disease.
  • CDC has issued a Level 2 travel alert for people traveling to Zika virus affected countries: http://wwwnc.cdc.gov/travel/notices/alert/zika-virus-caribbean.

Zika virus cases are encouraged to avoid mosquito bites during the first week of illness as the risk of transmitting the virus to a mosquito is highest during this time period. Infected mosquitoes can bite other people, resulting in locally-acquired cases of the disease. No locally-acquired cases have been reported in the United States. Aedes albopictus, a vector of the Zika virus, is widespread in counties across West Virginia.

Symptoms of the Zika virus are mild and usually begin 2-7 days after being bitten by an infected mosquito. Symptoms include fever, joint pain, rash, and conjunctivitis, headache, and muscle pain. About 80% of infected persons are asymptomatic. Hospitalization and death are not usually associated with this disease. There is no vaccine or treatment for the Zika virus and cases are advised to get plenty of rest, keep hydrated, and relieve acute pain and fever with non-steroidal anti-inflammatory drugs (e.g. acetaminophen).

For more information, contact your local health department or the Office of Epidemiology and Prevention Services, Division of Infectious Disease Epidemiology at 1 (800) 423-1271, ext. 1 or (304) 558-5358, ext. 1.