Updated Guidelines For Zika Virus Exposure Prevention And Management

 

Indiana Health Alert Network Advisory — February 9, 2016 

UPDATED GUIDELINES FOR ZIKA VIRUS EXPOSURE PREVENTION AND MANAGEMENT 

The Indiana State Department of Health has identified the first confirmed case of Zika virus infection in an Indiana resident. The patient, who had a mild illness that did not require hospitalization, had a recent history of travel to Haiti. The patient is not a pregnant woman. The local health department has been notified and will be conducting a public health investigation. 

Zika virus infection is transmitted primarily through the bite of an infected Aedes species mosquito. Most people infected with Zika virus will be asymptomatic; about 20% will have a mild, self-limiting illness characterized by fever, maculopapular rash, arthralgia, and/or conjunctivitis. There have been rare reported cases of Guillain-Barre syndrome following Zika virus infection. There have also been rare reported cases of sexual transmission of Zika virus infection. 

The ISDH expects that more Zika virus cases will be identified in travelers returning from countries affected by the epidemic currently occurring in Latin America and the Caribbean. Zika virus infection should be considered any patient with compatible illness and history of travel to areas with ongoing transmission (http://www.cdc.gov/zika/geo/index.html) in the two weeks prior to illness onset. Local transmission of Zika virus has not been documented in the United States, and the risk of a Zika virus outbreak occurring in Indiana is currently thought to be low. 

There is mounting evidence in the present outbreak of an association between Zika virus infection in pregnant women and microcephaly in their infants. The Centers for Disease Control and Prevention (CDC) currently recommends the following for the protection of pregnant women and their babies: 

  • Pregnant women should postpone travel to countries where Zika virus transmission is occurring. 
  • If travel is unavoidable, then pregnant women should take rigorous precautions to avoid mosquito bites. 
  • Health care providers who have patients who are pregnant should ask about travel history to areas where Zika virus infection is occurring and pursue testing for pregnant patients who report a compatible travel history. The optimal time for testing is within 7 days of symptom onset (if symptomatic) or within 2–12 weeks after travel (if asymptomatic). 
  • Men who have traveled to countries where Zika virus transmission is occurring should abstain or use condoms during sex (oral, anal, or vaginal) if they have a pregnant partner for the duration of that partner’s pregnancy. 

Testing Patients for Zika Virus Infection 

  • Please contact Jen Brown, State Public Health Veterinarian, at 317-233-7272 (M-F, 8:15 a.m. -4:45 p.m) or the ISDH duty officer at 317-233-1325 (outside of business hours) to arrange testing. 
  • Specimens will not be accepted without prior authorization from the Indiana State Department of Health. A screening algorithm to select patients for testing is located at http://in.gov/isdh/26910.htm. 
  • Zika virus testing for Indiana residents is currently only available at CDC via the ISDH Laboratories. Guidelines for specimen collection and submission are located at http://in.gov/isdh/26910.htm. 
  • Dengue and chikungunya should be considered as differential diagnoses for patients with illnesses compatible with Zika virus infection. Clinicians are encouraged to submit specimens to commercial laboratories for dengue testing while awaiting Zika testing results. Chikungunya testing will be performed at the CDC. 
  • Suspected Zika patients should be advised to avoid mosquito exposure for one week by remaining indoors in an air conditioned or screened environment or by wearing EPA-registered insect repellents when outdoors. Male suspected Zika patients should also be advised to abstain or use condoms during sex (oral, vaginal, or anal) until test results are available. 

Resources for Health Care Providers and Local Health Departments 

ISDH’s Zika virus web page: http://in.gov/isdh/26910.htm 

CDC’s travel notices web page: http://wwwnc.cdc.gov/travel/page/zika-travel-information 

CDC Health Advisory: Recognizing, Managing, and Reporting Zika Virus Infections in Travelers Returning from Central America, South America, the Caribbean, and Mexico 
http://emergency.cdc.gov/han/han00385.asp 

UPDATED Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age With Possible Zika Virus Exposure—United States, 2016 
http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_e 

Interim Guidelines for Prevention of Sexual Transmission of Zika Virus—United States, 2016 
http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1.htm_w 

Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection—United States, 2016 
http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e3.htm?s_cid=mm6503e3.htm_w