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July 24, 2017
Travel-Associated Zika Virus Infections Continue to Be Reported Among Monterey County Residents
Health care providers who care for reproductive age women should advise pregnant women and women planning pregnancy to avoid travel to areas with Zika travel notices.
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. Many areas of the Caribbean and Latin America continue to experience transmission of Zika virus, including Mexico.
While there has been no local transmission of Zika virus in California to date, the California Department of Public Health (CDPH) has confirmed 575 cases of Zika virus infections among California residents. Of these, 141 infections occurred in pregnant women. Eight infants have been born with Zika virus infection-associated birth defects in California. Zika virus causes microcephaly and other serious brain abnormalities in infants. 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 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 a Zika travel notice (https://wwwnc.cdc.gov/travel/page/zika-travel-information).
- Recent unprotected sexual contact with a male who has traveled within the prior 6 months to an area with a Zika travel notice or with a female who has traveled within the prior 8 weeks to an area with a Zika travel notice.
B. Screen and report suspected Zika virus cases (symptomatic individuals) to the Health Department:
- All symptomatic 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. ·
- Collect the following and coordinate PCR testing at a public health laboratory with Communicable Disease Unit staff:
- At least 2 mL of serum or 5-10 mL of whole blood collected within 14 days of illness onset in a red top or serum separator tube, AND
- At least 2 mL of urine in a sterile container within 21 days of illness onset.
C. Screen asymptomatic pregnant women exposed to Zika virus through travel or sexual activity for Zika virus infection.
- Asymptomatic pregnant women exposed to Zika virus through travel or sexual activity no longer need to be reported to the Monterey County Health Department’s Communicable Disease Unit unless their screening tests are positive.
- Providers should refer exposed, asymptomatic pregnant women to a commercial laboratory for screening (e.g., Quest Diagnostics or Laboratory Corporation of America).
- Collect at least 2 mL of serum between 2 and 12 weeks after last possible exposure to Zika virus and order Zika virus IgM antibody serology.
- A screening guidance algorithm for pregnant women is available from the CDC at https://www.cdc.gov/zika/hc-providers/pregnant-women/testing-and-diagnosis.html.
- If providers need assistance testing asymptomatic pregnant women, please call the Communicable Disease Unit at 831-755-4521 for guidance.
D. Provide preventative education to patients:
- Pregnant women in any trimester should not travel to areas where there is Zika virus travel notice (https://wwwnc.cdc.gov/travel/page/zika-travel-information).
- Pregnant women or their sexual partners who have lived in or traveled to an area with a Zika travel notice 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 trying to conceive should avoid exposure to Zika virus during the 8 weeks prior to conception.
- 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 a Zika travel notice, 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.
- Women exposed to Zika virus who are planning to conceive should delay conception:
- If a woman is exposed, the couple should wait at least 8 weeks after her symptoms started or last possible Zika virus exposure before trying to get pregnant.
- If a man is exposed, the couple should wait at least 6 months after his symptoms started or last possible Zika virus exposure before trying to conceive.
- If a woman and man travel together and both are exposed, the couple should wait at least 6 months after their symptoms started or last possible Zika virus exposure before trying to conceive.
- During the waiting periods after their possible exposure, couples should also be counseled to correctly and consistently use condoms for vaginal, anal, oral sex, and the sharing of sex toys, in addition to their chosen method of birth control, or to not have sex.
- Antibody test results before pregnancy should not be used to determine if it is safe for a woman to become pregnant because the test results could have multiple interpretations.
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: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/ZikaInformationforHealthProfessionals.aspx.