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\nDistributed via the CDC Health Alert Network
October 19, 2016, 1700 ET (5:00 PM ET)
CDCHAN-00398
Summary
\nThe U.S. Centers for Disease Control and Prevention (CDC) previously issued travel, testing, and other guidance related to areas of active Zika virus transmission in Florida. Because local transmission of Zika virus continues to be reported in Miami-Dade County, CDC is strengthening travel recommendations for pregnant women to Miami-Dade County and also reinforcing recommendations for use of protective measures to prevent exposure to Zika. CDC is updating recommendations to emphasize testing for pregnant women with an epidemiologic link to Miami-Dade County. An epidemiologic link means that they lived in, traveled to, or had unprotected sex with someone who lived in or traveled to, the designated area. In addition, CDC has made specific recommendations for areas of identified active transmission.
\nThe Florida Department of Health (FL DOH) has identified a new area where local, state, and CDC officials have determined that the intensity of Zika virus transmission presents a significant risk to pregnant women in a designated one-square-mile area located in Miami-Dade County (NW 79th St. to the north, NW 63rd St. to the south, NW 10th Ave. to the west and N. Miami Ave. to the east).
\nBecause the incubation period for Zika virus infection is up to two weeks and many people infected with Zika virus will not have symptoms or will only have mild symptoms, investigating cases may take several weeks. Data collected during the ongoing investigation indicate the period of time since August 1 represents the timeframe with the highest transmission in Miami-Dade County.
\nFL DOH and CDC continue to work together on this ongoing investigation to learn more about active Zika virus transmission in Miami-Dade County. CDC will update these recommendations as more information becomes available. Healthcare providers should visit CDC\u2019s Zika website (https://www.cdc.gov/zika/) frequently for the most up-to-date recommendations.
\nRecommendations
\nRed and Yellow Area Designation
\nCDC has defined two types of geographic areas within the continental United States and Hawaii to implement measures to prevent Zika virus transmission: Zika active transmission areas (designated as red) and Zika cautionary areas (designated as yellow).
\nCurrently, a 4.5-square-mile area of Miami Beach and one-square-mile area in Little River located in Miami-Dade County (http//www.cdc.gov/zika/intheus/florida-update.html) are red areas and the rest of Miami-Dade County is a yellow area. Because this investigation is ongoing and the designation of areas is likely to change over time, please frequently check the website (http//www.cdc.gov/zika/intheus/florida-update.html) for the most up-to-date designation of red and yellow areas.
\nRecommendations for Miami-Dade County
\nTravel Recommendations for Pregnant Women
\nTesting Recommendations for Pregnant Women
\nProtective Measures Recommendations for Pregnant Women
\nWomen and Men Who are Planning to Conceive
\nAdditional Recommendations
\nFor the yellow area, additional Zika-related interventions (e.g., testing of symptomatic non-pregnant persons) may be implemented depending on local circumstances.
\nBackground
\nZika virus is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). Zika virus can also be sexually transmitted. Zika virus infection during pregnancy is a cause of microcephaly and severe fetal brain defects and has been associated with other adverse pregnancy outcomes. Most people infected with Zika virus will not have symptoms; infants with microcephaly and other birth defects have been born to women with Zika virus infection who did not report symptoms.
\nFor pregnant women who report clinical illness consistent with Zika virus disease (symptomatic pregnant women), CDC\u2019s testing recommendations are the same for those with ongoing risk and those with limited risk for possible Zika virus exposure. Symptomatic pregnant women who are evaluated less than two weeks after symptom onset should receive serum and urine Zika virus RNA nucleic acid test (NAT) testing. Symptomatic pregnant women who are evaluated 2 to 12 weeks after symptom onset should first receive a Zika virus immunoglobulin (Ig) M antibody test; if the IgM antibody test result is positive or equivocal (unclear), serum and urine RNA NAT testing should be performed. If the RNA NAT result is negative, a positive or equivocal (unclear) Zika virus IgM antibody test result should be followed by plaque reduction neutralization testing (PRNT). Interpretation of serologic results has been described (https://www.cdc.gov/mmwr/volumes/65/wr/mm6521e1.htm).
\nTesting recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women with ongoing risk for possible exposure who are evaluated less than two weeks after last possible exposure, RNA NAT testing should be performed. If the RNA NAT result is negative, a Zika virus IgM antibody test should be performed 2 to 12 weeks after the exposure. Asymptomatic pregnant women with limited risk for possible exposure who are first evaluated 2 to 12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal (unclear), serum and urine RNA NAT should be performed. Asymptomatic pregnant women with ongoing risk for possible exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate RNA NAT testing should be performed when IgM antibody test results are positive or equivocal (unclear).
\nFurther information on the interpretation of laboratory test results and clinical management of pregnant women with laboratory evidence of possible Zika virus infection are available below.
\nFor More Information
\nThe Centers for Disease Control and Prevention (CDC) protects people\u2019s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.
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This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
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