Preconception Counseling and Prevention of Sexual Transmission of Zika Virus
Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission, or sex (vaginal, anal, or oral sex) without a condom with a person who traveled to or lived in an area of active transmission.
Women and men who live in areas of active Zika virus transmission should talk with their healthcare provider about attempting conception.
- Women who may have been exposed to Zika virus should wait to conceive until at least 8 weeks after symptom onset or the last possible Zika virus exposure.
- Men who may have been exposed to Zika should wait to try to conceive with a partner until at least 6 months after symptom onset or the last possible Zika virus exposure (if asymptomatic).
- Anyone who may have been exposed to Zika virus and wants to minimize the risk for sexual transmission should use a condom or abstain from sex for the same periods of time.
- Women of reproductive age who may have been exposed to Zika virus, or who may be in the future, and who do not want to become pregnant should use barrier contraceptive methods.
- More details are available from the CDC's updated Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure — United States, September 2016.
Zika Virus Laboratory Testing
DSHS has updated its recommendation for testing of pregnant women in Cameron, Hidalgo, Kinney, Maverick, Starr, Val Verde, Webb, Willacy, and Zapata counties to include routine testing three times during pregnancy by PCR only. This matches the CDC guidance for testing women with possible Zika exposure. In other parts of the state, testing for pregnant women with no symptoms but recent possible exposure should be tested as soon as possible up to 12 weeks after exposure using PCR only.
Inadequate testing of pregnant women might delay identification of some infants who do not have clinical findings apparent at birth, but who may still experience complications from congenital Zika virus infection. Communication about maternal exposures is critical between pediatric healthcare providers and obstetric care providers.
If you are unsure whether your patient meets the recommended testing criteria for DSHS, please contact your local health department or DSHS public health region for assistance. For more information about testing, visit the Laboratory Testing page of this website.
Prenatal Management of Pregnant Women with Laboratory Evidence of Possible Zika Virus Infection
The CDC recommends the following prenatal services for pregnant women with laboratory evidence of possible Zika virus infection:
- Serial fetal ultrasounds (every 3-4 weeks) should be considered to assess fetal anatomy, particularly fetal neuroanatomy, and to monitor growth.
- Prenatal ultrasounds should carefully evaluate the fetal anatomy, particularly the neuroanatomy, to identify brain or structural abnormalities that might occur before microcephaly.
- Decisions about performing amniocentesis should be individualized because there is a paucity of data regarding the usefulness of amniocentesis in diagnosing congenital Zika virus infection.
- More details are available from the CDC’s updated Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States (Including U.S. Territories) — July 2017.
Caring for Infants, Children of Mothers Exposed to Zika
The CDC indicates that if adequate laboratory testing is performed, there is no laboratory evidence of congenital Zika virus infection, and the clinical evaluation is normal, then congenital Zika virus infection is unlikely. Infants should continue to receive routine pediatric care, and healthcare providers should remain alert for any new findings of congenital Zika virus infection.
Further clinical evaluation for infants with laboratory evidence of congenital Zika virus infection should follow recommendations for infants with clinical findings even in the absence of clinically apparent abnormalities.
As a change from previous guidance, a diagnostic automated auditory brainstem (ABR) is no longer recommended at age 4-6 months for infants who passed the initial hearing screening with automated ABR.
Although Zika virus has been detected in breast milk, there are no reports of health problems in babies tied to breastmilk from an infected mother. Current evidence suggests the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission. All women with Zika virus infection during pregnancy should be encouraged and supported to breastfeed their infants, regardless of infant Zika virus testing results.
For additional information, see the CDC’s updated Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017.
Protecting Healthcare and Laboratory Workers
Employers and workers in healthcare settings and laboratories should follow good infection control and biosafety practices (including universal precautions) as appropriate, to prevent or minimize the risk of transmission of infectious agents, such as Zika virus. Additionally, employers should ensure that workers:
- Follow workplace standard operating procedures and use the engineering controls and work practices available in the workplace to prevent exposure to blood or other potentially infectious materials.
- Do NOT bend, recap, or remove contaminated needles or other contaminated sharps. Properly dispose of these items in closable, puncture-resistant, leakproof, and labeled or color-coded containers.
- Use sharps with engineered sharps injury protection (SESIP) to avoid sharps-related injuries.
- Report all needlesticks, lacerations, and other exposure incidents to supervisors as soon as possible.
- More details are available from the CDC's Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus (4/10/16) (PDF) .
Also, healthcare workers who travel to or reside in areas with ongoing Zika virus transmission should strictly follow measures to prevent mosquito bites during their work.
Additional CDC Resources
- Clinical evaluation and disease
- Caring for Pregnant Women
- Caring for Infants and Children
- Caring for Couples Trying to Conceive
- Zika and Sexual Transmission
- CDC Resource Guide for Clinicians: Zika Virus (PDF)