Zika Virus Guidelines for HCP

ZIKA INFORMATION FOR CALIFORNIA HEALTHCARE PROVIDERS HEALTH ADVISORY

February 8, 2016

On February 5, 2016, The U.S. Centers for Disease Control and Prevention (CDC) released two new interim guidelines on Zika, one for prevention of sexual transmission (Click here) and the other for healthcare providers caring for pregnant women and women of reproductive age (Click Here). This second document is an update to guidance issued on January 22, 2016.

The California Department of Public Health (CDPH) encourages healthcare providers to review the CDC guidelines. Key elements of the documents are summarized below.

Interim Guidelines for Prevention of Sexual Transmission of Zika Virus, 2016

The interim guidelines for prevention of sexual transmission state that sexual transmission of Zika virus is possible based on reports of two cases of sexual transmission and one case of Zika virus detection in semen. In all three cases, men who traveled to areas with Zika transmission experienced symptoms of Zika infection before or shortly after transmitting the virus to their partners or testing positive for Zika virus in semen. It is not known whether infected men who never develop symptoms can transmit Zika virus to their sex partners. CDC recommends that "men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy." Men with nonpregnant sex partners "who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus might consider using condoms consistently and correctly during sex or abstaining from sexual activity." The current understanding of genitourinary shedding of Zika virus is limited to one case report. There are insufficient data on the use of laboratory testing to assess the risk of sexual transmission and the new interim guidance states that "at this time, testing of men for the purpose of assessing risk for sexual

Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure - U.S., 2016

In the updated interim guidelines, CDC now recommends that testing for Zika virus infection be offered to all pregnant women who have traveled to an area where Zika virus is circulating.

Women who experience symptoms consistent with Zika virus disease during travel to, or within 14 days after returning from, an area with Zika virus transmission should be evaluated for Zika virus infection. Testing for Zika virus RNA by polymerase chain reaction (PCR) should be done within 7 days of symptom onset if possible. Serologic testing can be done on specimens collected 4 or more days after symptom onset.

ZIKA INFORMATION FOR CALIFORNIA HEALTH CARE PROVIDERS

Women who have not experienced symptoms can be offered serologic testing between 2-12 weeks after return. Interpretation of serologic results among asymptomatic pregnant women is complex and should be done in consultation with public health The guidelines also provide detailed recommendations for the prenatal management of pregnant women residing in areas with ongoing Zika virus transmission, with or without clinical illness consistent with Zika virus disease.

Prevention recommendations for women of reproductive age now include not only mosquito bite prevention but also reproductive life planning, and preconception care to discuss the risks of Zika virus infection and prevention of unplanned pregnancy. CDC advises that there is no evidence that prior Zika virus infection poses a risk for birth defects in future pregnancies.

Thus far in California, Zika virus infections have been documented in only a few people, all of whom were infected while travelling outside the United States. There has been no local transmission of Zika virus in California to date, and the risk of Zika virus transmission in California remains low. For information on countries where Zika virus is circulating, please see the CDC website at www.cdc.gov/Zika.

Healthcare providers should report all suspect cases of Zika virus infection to their local health department. Local health departments can provide guidance on laboratory testing, which is currently only available in public health laboratories. Local health departments and CDPH are closely monitoring the Zika virus situation. Additional information is available at

www.cdph.ca.gov and http://www.cdph.ca.gov/HealthInfo/discond/Pages/Zika.aspx.