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 recently traveled to or lived in an area of current or prior Zika virus transmission.  

Women and men who live in areas of Zika virus transmission risk 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 exposed to Zika should wait to try to conceive until at least 3 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.  

Find more details from the CDC guidance documents:  

• Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika VIrus for Men with Possible Zika VIrus Exposure - United States, August 2018  
• Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure — United States, September 2016  

We updated our statewide testing guidance for asymptomatic and symptomatic persons based on local and national trends. There is now increased scientific knowledge of the disease and the limitations of available tests. Zika virus testing is no longer recommended for asymptomatic persons, regardless of travel history or pregnancy status. Providers should consider appropriate testing for other possible etiologies such as dengue and chikungunya viruses when the patient has had relevant exposure by travel. 

Test symptomatic pregnant women with possible Zika exposure using PCR only, including symptomatic pregnant women living in Cameron, Hidalgo, Kinney, Maverick, Starr, Val Verde, Webb, Willacy, and Zapata counties.  

Zika IgM testing is not recommended except for pregnant women with ultrasound evidence of fetal abnormalities consistent with Zika after possible Zika exposure (alongside PCR). Zika testing is no longer recommended for symptomatic non-pregnant persons with exposure to a Zika risk area.  

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 or refer to the referenc document below from CDC:  

• Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses | MMWR 

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.  

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.  

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 available from the CDC’s Protecting Workers from Zika page.  

• 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.  

Zika virus testing is not recommended for asymptomatic persons, regardless of travel history or pregnancy status. 

Test symptomatic pregnant women with possible Zika exposure using PCR only. Zika IgM testing is not recommended.* 

• Possible exposure to Zika includes: 
• Recent travel to or residence in a Zika virus risk area, or sexual exposure to a traveler to a risk area, or 
• Residence in Cameron, Hidalgo, Kinney, Maverick, Starr, Val Verde, Webb, Willacy, and Zapata counties. 
• Zika virus symptoms may include: 
• Rash 
• Fever 
• Conjunctivitis (red eyes) 
• Joint pain 

*Zika IgM testing is still recommended alongside PCR for pregnant women with ultrasound evidence of fetal abnormalities consistent with Zika after possible Zika exposure. 

The DSHS Austin Laboratory and many other Texas Laboratory Response Networks (LRNs) are performing the Trioplex Real-Time reverse transcriptase polymerase chain reaction (rRT-PCR) for Zika and the Zika virus-specific IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (Zika MAC-ELISA). Please review the Chikungunya, Dengue, and Zika PCR and Serology Specimen Criteria guidance document (updated Dec. 16, 2016)  to facilitate laboratory testing of individuals meeting the testing criteria. Specimens submitted to the DSHS Austin Laboratory must be accompanied by a G2-V form and a completed Chikungunya, Dengue, and Zika Testing Supplemental Information Form (updated Sept. 12, 2016) . The plaque-reduction neutralization test (PRNT), used to confirm Zika virus infection in certain situations, is available at the U.S. Centers for Disease Control and Prevention (CDC) and some state laboratories. 

On June 14, 2019, the Centers for Disease Control and Prevention provided detailed, updated guidance on appropriate testing and test result interpretation for individuals with Zika-compatible symptoms and exposure – refer to Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses. 

On May 31, 2017, the CDC released interim guidance on Zika virus antibody testing and interpretation of results. Because of the differences in recommended clinical management of Zika and dengue virus infections, and the risk of adverse pregnancy outcomes in women infected with Zika virus during pregnancy, a conservative approach to the interpretation of antibody test results is necessary to reduce the possibility of a missed diagnosis of either infection. The timing of IgM antibody testing and the thresholds of plaque reduction neutralization test (PRNT) have changed. 

• Based on earlier flavivirus research and limited preliminary data specific to Zika virus, the historical use of a 4-fold higher titer by PRNT might not discriminate between anti-Zika virus antibodies and cross-reacting antibodies in persons who have been previously infected with or vaccinated against a related flavivirus (i.e., secondary flavivirus infection). 
• Together with a positive or equivocal IgM to Zika or dengue virus: 
• A PRNT titer >10 will be interpreted as evidence of infection with that specific flavivirus infection when the PRNT to the other flavivirus(es) tested is <10. 
• A PRNT titer <10 to a specific flavivirus will be interpreted as no evidence of infection with that virus. 
• If PRNTs are positive i.e., >10 to multiple flaviviruses, this will be interpreted as evidence of recent infection with a flavivirus. 

CDC will continue to update this guidance as additional data becomes available. For more information about this guidance, visit Interim Guidance for Interpretation of Zika Virus Antibody Test Results.

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.