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March 2, 2016
Travel-Associated Zika Virus Infections Continue to Be Reported Among Monterey County Residents
Providers are urged to identify patients potentially exposed to Zika virus and offer screening to symptomatic individuals and pregnant women.
Monterey County Health Department continues to receive reports of travel-associated Zika virus infections among Monterey County residents, as well as reports of pregnant women exposed to Zika virus during travel. Certain regions of Latin America and the Caribbean experienced a significant increase in Zika infections in 2015 to 2017. Many areas of Mexico continue to experience transmission of Zika virus, including Mexican states with popular tourist destinations. In addition to Baja California, the states of Baja California Sur, where Cabo San Lucas is located, and Sonora, which borders Arizona, have also reported local Zika virus transmission. The Centers for Disease Control and Prevention (CDC) considers any travel to Mexico to be a potential risk for Zika virus infection.
While there has been no local transmission of Zika virus in California to date, the California Department of Public Health (CDPH) has confirmed 505 cases of Zika virus infections among California residents as of February 24, 2017. Of these, 88 infections occurred in pregnant women. Florida and Texas have experienced locally transmitted cases of Zika.
Zika virus causes microcephaly and other serious brain abnormalities in infants. Risk of microcephaly is in the range from 1-13% for first trimester exposures. First trimester exposures appear to be at higher risk than later exposures. Among infants with prenatal exposure to Zika virus, absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities.
Recommendations for Healthcare Providers
A. Identify Patients at Risk for Exposure to Zika Virus:
- All pregnant women (with or without symptoms) and patients who have symptoms consistent with Zika virus disease (ZVD) should be assessed for potential Zika virus exposures.
- Symptoms compatible with ZVD include maculopapular rash, fever over 100.4 F, arthralgia, and conjunctivitis.
- Criteria for possible exposure to Zika virus include:
- Recent travel to an area with active Zika virus transmission. A map of areas affected by Zika virus is available at https://www.cdc.gov/zika/geo/active-countries.html.
- Recent unprotected sexual contact with a male who has traveled within the prior 6 months to an area with active Zika virus transmission or with a female who has traveled within the prior 8 weeks to an area with active Zika virus transmission.
B. Screen Symptomatic Patients and Exposed Pregnant Women:
- A Zika screening algorithm is available from CDPH at http://www.cdph.ca.gov/HealthInfo/discond/Documents/ZikaScreeningAlgorithm.pdf.
- Zika virus testing is indicated for individuals who have been exposed to Zika (through travel or sexual contact) and who have symptoms of Zika infection within 2 weeks of last exposure.
- Pregnant patients with possible exposure to Zika virus, whether they are symptomatic or asymptomatic, should also be tested for Zika virus. A screening guidance algorithm for pregnant women is available from the CDC at https://www.cdc.gov/zika/pdfs/testing_algorithm.pdf.
C. Report Suspected Cases and Exposed Pregnant Women to the Health Department:
- All suspected Zika virus infections must be reported to the Monterey County Health Department’s Communicable Disease Unit on a Confidential Morbidity Report (CMR) form faxed to 831-754-6682 or by telephone to 831-755-4521.
- All pregnant women exposed to Zika virus through travel or sexual activity should be reported to the Monterey County Health Department’s Communicable Disease Unit on a Confidential Morbidity Report (CMR) form faxed to 831-754-6682 or by telephone to 831-755-4521.
- If providers need assistance testing pregnant women, fax a completed Request for Zika Virus Screening form to the Communicable Disease Unit at 831-754-6682 in addition to a completed CMR form.
- Both forms are available on the Health Department Zika website for medical providers at http://www.mtyhd.org/index.php/for-providers/communicable-disease-reporting__trashed/zika-virus-information-for-medical-providers/.
D. Provide Preventative Education to Patients:
- Pregnant women in any trimester should not travel to areas where there is Zika virus transmission.
- Pregnant women or their sexual partners who have lived in or traveled to an area with Zika should use condoms from start to finish every time they have sex (oral, vaginal, or anal) or not have sex during the pregnancy. This includes same sex couples and applies even if the pregnant woman’s partner does not have symptoms of Zika or feel sick. Pregnant women should not share sex toys throughout the entire pregnancy. Women should avoid exposure to Zika virus within 8 weeks prior to conception (6 weeks prior to last menstrual period).
- If patients are planning travel to areas where Zika is present, they should be advised to protect themselves from mosquito bites and sexual transmission.
- Apply EPA-registered mosquito repellents; wear long-sleeved shirts and long pants; and use air conditioning or window/door screens to keep mosquitoes outside or use a mosquito bed net.
- After returning from an area with active Zika transmission, use mosquito repellent for 3 weeks to prevent spreading Zika to California mosquitoes and the community.
- People who have Zika infection or have been potentially exposed to Zika infection (through travel or sexual contact) should abstain from sex or use condoms/barriers to prevent transmitting the virus to their sexual partner, as follows:
- Pregnant women should abstain from sexual contact or use barrier protection for the duration of the pregnancy.
- Non-pregnant women should abstain from sexual contact or use barrier protection for 8 weeks after last exposure or symptom onset.
- Males should abstain from sexual contact or use barrier protection for 6 months after last exposure or symptom onset.
For additional information about Zika virus, please contact the Communicable Disease Unit at 831‑755‑4521 or visit the California Department of Public Health’s provider website: http://www.cdph.ca.gov/HealthInfo/discond/Pages/ZikaInformationforHealthProfessionals.aspx
Health Alert: Warrants immediate action or attention. Health Advisory: Provides information for a specific incident or situation; may not require immediate action. Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.