*** Missouri healthcare providers and public health practitioners: Please contact the Missouri Department of Health and Senior Services' (DHSS') Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7) with questions regarding Zika testing of patients. For all other questions, contact DHSS' Office of Veterinary Public Health at 573-526-4780 or 800-392-0272 (24/7). Links to previous Health Advisories/Updates on Zika sent by DHSS are available at http://health.mo.bov/emergencies/ert/alertsadvisories/index.php ***
The Florida Department of Health (FL DOH) has identified an area with local mosquito-borne Zika virus transmission (active Zika virus transmission) in Miami (http://www.cdc.gov/zika/intheus/florida- update.html). Based on the earliest time of symptom onset and a maximal two-week incubation period for Zika virus, this guidance applies to women of reproductive age and their partners who live in or traveled to this area after June 15, 2016.
This is an ongoing investigation, and CDC is rapidly learning more about the extent of active Zika virus transmission in the area identified by the FL DOH. With the recommendations below, CDC is applying existing guidance to the occurrence of Zika virus transmission in this area of Florida. As more information becomes available, we will update these recommendations.
Zika is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). Zika virus can also be sexually transmitted. Zika virus infection during pregnancy can cause microcephaly and severe fetal brain defects, and has been associated with other adverse pregnancy outcomes. Most persons infected with Zika virus will not have symptoms; infants with microcephaly and other birth defects have been born to women with Zika virus infection who do not report symptoms.
CDC’s testing recommendations for pregnant women with ongoing or limited risk for possible Zika virus exposure who report clinical illness consistent with Zika virus disease (symptomatic pregnant women) are the same. Symptomatic pregnant women who are evaluated less than two weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated two to 12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal (unclear), serum and urine rRT-PCR testing should be performed.
Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women with ongoing risk for possible exposure and who are evaluated less than two weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed two to 12 weeks after the exposure. Asymptomatic pregnant with limited risk for possible exposure who are first evaluated 2–12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for possible exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the firstand second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal.
Further information on the interpretation of testing results and clinical management of pregnant women with laboratory evidence of possible Zika virus infection are available below.
The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.