Preconception Counseling and Prevention of Sexual Transmission of Zika Virus
- All men with possible Zika virus exposure who are considering attempting conception with their partner, regardless of symptom status, wait to conceive until at least 6 months after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
- Recommendations for women planning to conceive remain unchanged: women with possible Zika virus exposure are recommended to wait to conceive until at least 8 weeks after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
- Couples with possible Zika virus exposure, who are not pregnant and do not plan to become pregnant and want to minimize their risk for sexual transmission of Zika virus, should use a condom or abstain from sex for the same periods for men and women described above.
- Women of reproductive age who have had or anticipate future Zika virus exposure and who do not want to become pregnant should use the most effective contraceptive method that can be used correctly and consistently.
- 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 intercourse) without a condom with a person who traveled to or resided in an area of active transmission.
- Women and men who reside in areas of active Zika virus transmission should talk with their health care provider about attempting conception.
- 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
The DSHS Austin and South Texas Laboratories, and many other Texas Laboratory Response Network laboratories (LRNs) are performing the Trioplex Real-Time reverse transcriptase polymerase chain reaction (rRT-PCR) for Zika, and a Zika virus-specific IgM antibody test. Laboratory testing for Zika virus has a number of limitations. Cross-reactivity of Zika virus IgM antibodies with other, related viruses called flaviviruses can result in false-positive test results. Depending on the test results, one additional test, the plaque reduction neutralization test (PRNT), may be requested to help identify which flavivirus may be causing the infection. The CDC’s updated guidance for maternal testing and the CDC’s updated guidance for infant testing provide details about who to test and which tests to administer.
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, 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.
For more information about testing, visit the Laboratory Testing page of TexasZika.org.
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 recommends 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 health care 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 reported cases of transmission through breastfeeding. 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, visit 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 Health Care and Laboratory Workers
Employers and workers in health care 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, all travelers to or residents of areas with ongoing Zika virus transmission should strictly follow measures to prevent mosquito bites.
Additional CDC Resources
- Clinical evaluation and disease
- Caring for Pregnant Women
- Caring for Infants & Children
- Zika and Sexual Transmission
- CDC Resource Guide for Clinicians: Zika Virus (PDF)
last updated June 13, 2018