NC Zika Guidance Update

May 25, 2016

Remember that physicians are required to report suspected or confirmed Zika virus and that approval is required for submission of specimens to the State Lab of Public Health. 
 
Please contact the Communicable Disease Branch at 919-733-3419 or your local health department (828-250-5109 for Buncombe County Disease Control; available 24/7) if Zika virus infection is suspected.
 
UPDATED INFORMATION FROM THE ATTACHMENT
Zika virus infection and pregnancy
•       Zika virus infection is associated with an increase in certain birth defects, including microcephaly.
•       NC DPH is working with the CDC to enroll all pregnant women (and their infants) with positive or indeterminate Zika virus test results in a national registry to provide more comprehensive information on the effects of infections during pregnancy.
•       Women trying to become pregnant should wait at least 8 weeks after possible exposure via recent travel or sex without a condom with a man infected with Zika.
             
Who should be tested for Zika virus infection?
 
Testing is recommended for the following individuals:
     Pregnant women presenting with signs and symptoms consistent with Zika virus disease within two weeks of travel to areas with ongoing Zika virus transmission that are < 2,000 m in elevation.
•      Pregnant women presenting with signs and symptoms consistent with Zika virus disease who have had condomless sex (i.e., vaginal intercourse, anal intercourse, or fellatio) during the current pregnancy with a male partner who has traveled to an area of ongoing Zika virus transmission and who has had symptoms of Zika virus disease during travel or within 2 weeks of return.
    Asymptomatic pregnant women who have ultrasound findings of fetal microcephaly or intracranial calcifications and who report travel to an area with ongoing transmission during the current pregnancy.
 
Testing can also be considered for the following individuals:
 
    Asymptomatic pregnant women (including those who traveled during the 8 weeks before conception) from 2–12 weeks after return from travel to areas with ongoing Zika virus transmission that are < 2000 m in elevation. 
    Asymptomatic pregnant women who have had condomless sex (i.e., vaginal intercourse, anal intercourse, or fellatio) during the current pregnancy with a male partner who has traveled to an area of ongoing Zika virus transmission and who has had symptoms of Zika virus disease during travel or within 2 weeks of return.
    Any person presenting with signs and symptoms consistent with Zika virus disease within two weeks of travel to an area with ongoing transmission.
    Symptomatic persons who have had condomless sex (i.e., vaginal intercourse, anal intercourse, or fellatio) with a male partner who has traveled to an area of ongoing Zika virus transmission and who has had symptoms of Zika virus disease during travel or within 2 weeks of return.
•     NEW! – Individuals who did not travel to a Zika affected area but have had > 3 symptoms of Zika virus infection (fever, rash, arthralgias, or conjunctivitis) in the past 13 days not explained by another etiology AND have a history of mosquito bite(s) within 2 weeks of symptom onset.
 
What tests should be done?
 
    Real-time RT-PCR is the preferred test for Zika virus infection because it can be performed rapidly and is highly specific.

      *Zika virus RNA can be detected in serum in the first week of illness in most patients and in urine           for at least 2 weeks after the onset of symptoms.

    Antibody testing may make the identification of the infecting virus difficult to discern when individuals have a past history of flavivirus (e.g., dengue and yellow fever viruses) infection or vaccination because of the high degree of cross-reactivity of those viruses.
    See the attachment for specifics about which testing method and specimen type is appropriate for specific patient situations.
 
Where can test specimens be sent?
 
•     Testing for Zika virus is now available at Quest Diagnostics, in addition to the NC State Lab of Public Health. 
•     See memo for specifics about the testing offered at both sites.
 
This is an evolving situation and recommendations are likely to change as new information becomes available. Updated information and guidance are available from CDC at http://www.cdc.gov/zika.  
 
As always, contact Buncombe County Disease Control at 828-250-5109 if you have any questions regarding this or other communicable disease matters.
 
Thanks,
 
Jennifer Mullendore, MD, MSPH
Medical Director
Buncombe County Health and Human Services
Office:  (828) 250-6308
Mobile:  (828) 989-6145